Correlation and Bivariate Regression in Practice

For this Assignment:Write a 2- to 3-page critique of the article you found. In your critique, include responses to the following:Why did the authors use correlation or bivariate regression?Do you think it’s the most appropriate choice? Why or why not?Did the authors display the data?Does the results table stand-alone (i.e., are you able to interpret the study from it?) Why or why not?Use proper APA format, citations, and referencing.

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Original Article
Rev. Latino-Am. Enfermagem
2015 July-Aug.;23(4):595-602
DOI: 10.1590/0104-1169.0024.2593
Factors associated with knowledge of the nursing staff at a teaching
hospital on blood transfusion1
Jordânia Lumênia Tavares2
Elizabeth Barichello3
Ana Lúcia De Mattia4
Maria Helena Barbosa3
Objective: to determine whether there is an association between knowledge of the nursing
professionals about blood transfusion and the variables related to the professional aspects.
Method: this is an observational, cross-sectional and quantitative study, carried out at a large
general teaching hospital. The sample consisted of 209 nursing professionals, obtained by
simple random sampling. For data collection, a checklist was used. In the univariate analysis,
descriptive statistics and central trend and dispersion measures were used. In the bivariate
analysis, Student’s t-Test, analysis of variance and Pearson’s correlation were used. To determine
the predictors, multiple linear regression was applied. The Institutional Review Board (Opinion
number 2434) approved the study. Results: the overall average knowledge score was 52.66%; in
the Pre-transfusion Step, it corresponded to 53.38%; in the Transfusion Step 51.25% and, in the
Post-transfusion Step, 62.68%. The factors related to knowledge were professional category and
received training and/or guidance to accomplish the transfusion process (p<0.01). Conclusion: this study showed the influence of training and guidance on the knowledge and provided a diagnosis to identify the professionals’ difficulties regarding the transfusion process. Descriptors: Knowledge; Nursing; Blood Component Transfusion. 1 Paper extracted from master’s thesis “Knowledge of professional nursing staff of a teaching hospital in Minas Gerais on blood transfusion” presented to Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil. Supported by Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG), Brazil, process # APQ-01963-13. 2 MSc. 3 PhD, Adjunct Professor, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil. 4 PhD, Adjunct Professor, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. Corresponding Author: Maria Helena Barbosa Universidade Federal do Triângulo Mineiro Av. Getúlio Guaritá, 107 Bairro: Abadia CEP: 38025-440, Uberaba, MG, Brasil E-mail: Copyright © 2015 Revista Latino-Americana de Enfermagem This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC). This license lets others distribute, remix, tweak, and build upon your work non-commercially, and although their new works must also acknowledge you and be non-commercial, they don’t have to license their derivative works on the same terms. 596 Rev. Latino-Am. Enfermagem 2015 July-Aug.;23(4):595-602. Introduction are few studies, however, that point out the factors that may be related to the knowledge deficits in this area. Blood therapy plays an important therapeutic role, Based on the above, the objective of this research being used to treat various health problems. Countless was to determine whether there is an association efforts have been made to guarantee the quality of the between the knowledge of the nursing team professionals transfusion process and the security of receivers . about blood transfusion and the variables related to (1) The blood, its components and its derivatives are professional aspects. used as the base to treat many diseases and transplants, chemotherapy and surgery, turning them into essential Method and irreplaceable products. Despite presenting risks by involving biological products of human origin, blood This is an observational study with a cross-sectional transfusion is an essential part of health care, promotion design and quantitative data analysis. This study was and recovery(2-3). conducted in all care units of a large, general public transfusion teaching hospital, which offers high complexity care and procedures is determined by Resolution number 57 of In Brazil, the standardization of is located in the region known as Triangulo Mineiro, in the Board of Directors (RBD), issued on December 16 the city of Uberaba, State of Minas Gerais, Brazil. th 2010, which determines the Health Regulations(4), and The target population (N) consisted of 617 nursing by Ordinance number 1353, published by the Ministry of professionals (88 nurses, 390 nursing technicians and Health (MH) on June 13th, 2011. The latter determines 134 assistant nurses) who provided direct care to the Technical Regulations for services related to the patients on all shifts and sectors, in the institution of cyclical production of human blood and its components study. The sample size (n) was calculated assuming a and transfusion procedures. These regulations establish determination coefficient of R2=0.10, in a multiple linear rules that blood transfusion professionals need to know regression model with five predictors, with significance and follow . level or type I error (5) a=0.01, and type II error ß=0.1, Nursing has an important role in ensuring transfusion resulting in an a priori statistical power of 90%. The safety, because the nursing team is responsible for statistical software Power Analysis and Sample Size knowing the indications for transfusions, checking data (PASS), version 2002, was used. The values mentioned to prevent errors, guiding patients on blood transfusion, above were entered and a minimum sample size of detecting and acting in compliance with transfusion 206 interviews (n=206) was obtained. To obtain the reactions and documenting the procedure . Due sample, a simple random drawing was performed, using to the complexity of the transfusion process and the the Statistical Package for Social Sciences (SPSS), need for expertise during its development, this process version 20. The sample consisted of 209 nursing team requires skilled and trained professionals to achieve professionals (nurses, nursing technicians and assistant transfusion safety. Nursing professionals are directly nurses) who provided direct assistance to customers, in involved in the care of patients submitted to blood all shifts and sectors of the study institution, and the transfusion. Therefore, the correct storage of blood and sample was proportional to each professional category. (2,6-7) its identification without failures depends largely on The following inclusion criteria were considered: the performance of the nursing team, which highlights being employed by the Federal University of Triangulo the importance of the scientific knowledge on blood Mineiro (UFTM) or Foundation for Teaching and Research transfusion and the technical skills of the nursing staff, of Uberaba (FUNEPU); working in units where the survey in order to prevent the occurrence of complications and was carried out; providing direct care to patient and, be patient injury . working during the months in which the data collection (8) Knowledge is essential for humans, because was performed. It was excluded from the study it permits attributing meaning to the multiplicity professionals who were absent on the day of interview, of phenomena that surround them, whether those due to vacation, sick leave, time off, or those not found relating to physical objects, people, events or abstract after three attempts. ideas(9). For the data collection, it was used a research A number of studies in this area show deficient instrument checklist type developed by the authors knowledge of the nursing staff and the inappropriateness from the MH Ordinance number 1353/2011, the RBD of the approaches used during the transfusion. There number 57/2010 of the National Health Surveillance 597 Tavares JL, Barichello E, De Mattia AL, Barbosa MH. Agency (ANVISA), and the Conduct Manual for Clinical dichotomous variables, the analysis of variance (ANOVA) and The for variables with more than two categories and the instrument contained questions related to personal Hematological Practices of Hemominas. Pearson correlation for quantitative variables. The data, professional aspects and 35 questions about criterion for inclusion of predictors in the multiple linear blood transfusion, classified into Pre-transfusion Step regression was to consider a=0.05 as significance level. (PTS), Transfusion Step (TS) and Post-transfusion Step The bivariate analysis revealed five predictors: (POTS). Each question had only one correct answer, and received training and guidance; participate in training; it was assigned 1 (one) point to each question correctly professional category; number of blood transfusions/ marked. month; Before instruments, they professional experience. The were professional category was dichotomized, since it was realized that, from a practical perspective, nursing performed by experts in hemotherapy of the University. technicians and nursing assistants are not different. The Participated in the validation two professionals with nature of the other predictor variables was maintained, Masters degree and four with Ph.D degree. The internal but the variables “received training or guidance” and consistency analysis of the instrument was evaluated “participate in training” were classified as of dichotomous a the of submitted to content validation by means of assessment using the applying length Cronbach coefficient that, for dichotomous nature, and the variables “number of blood transfusions/ items, true or false, is equivalent to the Kuder-Richardson month” and “length of professional experience” as of (KR20) coefficient. quantitative nature. The statistical significance level After validation, a pilot test with 10 members of the was p=0.01 in the regression analysis. It is worth to nursing team was conducted in order to verify the clarity highligh that the prerequisites of the bivariate analysis and applicability of the instrument, without the need of were observed (normality and homocedasticity), as making adaptations. well as the behavior of residues in the multiple linear Data were collected from April to June 2013. The professionals received an Informed Consent and, after regression analysis such as linearity, normality and homocedasticity. signing it, they received the data collection instrument This study was developed as established by and its respective filling instructions. Subsequently, data Resolution 196/96 of the National Ethics Committee, were entered into a spreadsheet of the Microsoft Office with the approval of the institution researched and Excel program. Typing was performed the Research Committee of the Federal University of by two people, with double entry, with subsequent Triangulo Mineiro (CEP-UFTM), under protocol number verification 2434. The anonymity of all participants was guaranteed ® for Windows of ® the consistency, consolidation and validation. The data entered in Excel identifying them by numbers. ® spreadsheet were imported from SPSS statistic software version 20, for Results data processing and analysis. Initially, univariate analysis was performed, in which the qualitative variables The sample consisted of 29 nurses, 146 nursing were analyzed using descriptive statistics through the technicians and 34 nursing assistants, who provided distribution of absolute and percentage frequency, while direct care to patients of the hospital where study was for the quantitative variables it was used centrality of carried out. descriptive measures (mean) and dispersion (standard The average age of professionals was 38.2 years, deviation , minimum and maximum value). To calculate with minimum of 22 and maximum of 61 years, 29.66% the knowledge score, it was used a formula in which of the professionals were between 22 and 31 years, the number of items correctly answered was divided by 24.40% between 42 and 51 years, 10.53 % between 52 the total number of items and then multiplied by one and 61, and there was a higher concentration in the age hundred. group between 32 and 41 years (35.41%). Most were The steps used to calculate the subscore were: Pretransfusion Step (PTS); transfusion Step (TS); and Posttransfusion Step (POTS). female (81.8%). Regarding the professional aspects, the most prevalent category was the nursing technicians (69.9%), followed Although not shown in the results, the multiple by nursing assistants (16.3%) and nurses (13.9%). Most linear regression analysis was preceeded by a bivariate received training or graduated from public institutions analysis using the Student’s t-Test for categorical (51.7%), and the other ones (48.3%) graduated from 598 Rev. Latino-Am. Enfermagem 2015 July-Aug.;23(4):595-602. private institutions. The prevailing institutional bond was answers to their questions about blood transfusion. As FUNEPU (52.6%), and 47.4% were affiliated with UFTM. regards the rule/guideline followed in the transfusion It was observed that the professionals had an practice, most participants (73.2%) reported adopting average of 144.25 months of training, 147.07 months of the Standard Operating Procedure Manual (SOP) and professional experience, 117.73 months of work in the the Nursing Intervention Plan (NIP) of the institution, institution where the study was carried out, and average and 13.4% reported not following or knowing any rule of 80.74 months of work in the unit. or guideline, as shown in Table 2. Regarding to the work shift, 46.4% worked at night, 27.8%, in the morning, 23.4%, in the afternoon Table 2 - Frequency distribution of rule/guideline follwed and 2.4% worked in a system of 8 hours per day. in the transfusion practice. Uberaba, MG, Brazil, 2013 Table 1 shows the frequency distribution, according to the unit (Critical and semi-critical areas). N % RBD number 57* 5 2.4 Ordinance number 1353† Table 1 - Frequency distribution according to the professional’s unit. Uberaba, MG, Brazil, 2013 Unit Rule/Guideline N % Critical areas 8 3.8 153 73.2 RBD number 57* and SOP‡/PIE§ 3 1.4 RBD number 153|| and Ordinance number 1353† 1 5 RBD number 153|| and SOP‡/PIE§ 3 1.4 Ordinance number 1353† and SOP‡/PIE§ 6 2.9 RBD number 153||, Ordinance number 1352† and SOP‡/PIE§ 1 5 1 5 SOP‡/NIP§ Oncology units 5 2.4 Emergency Room Units 32 15.3 Intensive Care Units 54 25.8 Surgical Unit 17 8.1 RBD number 153||, RBD number 57*, Ordinance number 1353† and SOP‡/PIE§ Hemodynamics 7 3.3 Does not follow or know any rule/guideline 28 13.4 Unit infectious and parasitic diseases 8 3.8 Total 209 100 Renal Therapy Unit 5 2.4 Hospitalization Unit - Adult 56 26.8 Hospitalization Unit – Children 22 10.5 Day hospital 3 1.4 209 100 *Resolution of the Board of Directors number 57 of December 16th, 2010 †Ministry of Health Ordinance number 1353 of June 13th, 2011 ‡Standard Operating Procedure of the institution § Nursing Intervention Plan of the institution ||Resolution of the Board of Directors number 153 of June 14th, 2004 Semi-critical areas Total It is noteworthy that 92.8% of professionals feel Concerning the administration of blood confident to carry out the transfusion process. transfusions, the average number of blood transfusions The average overall knowledge score was of reported by the professional was of 4.30 times/month, 52.66%, with minimum of 17.14% and maximum of with minimum of zero and maximum of 43.33 times/ 74.29%. In pre-transfusion step, the average was month. With regard to receiving training or guidance of 53.38%. In transfusion step, the average was of the institution for this purpose, 88% of professionals 51.25%. In the post-transfusional step, the average was reported having been trained, 60.3% participated in of 62.68%, as shown in Table 3. some specific training program for blood transfusion, The value of Cronbach coefficient was a=0.57. It averaging once, minimum of zero and a maximum is noteworthy that, considering the diverse conceptual of 20 times. As for specific training courses for blood nature of the knowledge items measured by the transfusion, 35.4% reported having participated, and instrument, this is an appropriated value. 10.5% said they had participated in specific scientific events for blood transfusion and hemotherapy. Regarding to postgraduate level courses, According to the bivariate analysis, professionals who received training or guidance to carry out the 58 transfusion process attended specific training for blood (27.8%) professionals reported having postgraduation, transfusion, were postgraduated, knew or followed of which 58 (27.8%) had specialization and one (0.5%) some rule and/or guideline and had higher knowledge had Masters degree. The most prevalent postgraduate scores than the other professionals. The variables “type programs were Teaching (7.18%), Intensive Care of educational institution” and “participation in training (4.30%), Occupational Health (4.30%) and Emergency courses specific for blood transfusion” were marginally Services (2.39%). When asked about searching for significant, p= 0.016 and p= 0.015, respectively. information in the literature, 73.7% of participants reported that they often seek information and get In the correlation between the variables “professional category” and “shift” and the scores, it was 599 Tavares JL, Barichello E, De Mattia AL, Barbosa MH. observed that professional category was statistically For the linear regression analysis, five predictor significant (p<0.001 in the overall knowledge score, variables p=0.017 in the Pre-transfusion Step, p<0.001 in the guidance to perform blood transfusion; participate were considered: received training or Transfusion step), ie, the nurses had greater knowledge in specific training on blood transfusion; professional than other professional groups. Professionals working category; number of blood transfusions/month; and 8 hours per day had higher knowledge scores at all length of professional practice. Table 4 shows the stages, however it was considered significant only in the correlations. Transfusion Step, and yet, it was considered marginally In the linear regression analysis, it is noticed significant (p= 0.018). In the correlation among statistical significance associating the overall score numerical variables, it was significant only regarding the and the Transfusion Step with the predictor variables number of blood transfusions performed in the month, “Professional category” (p = 0.001) and “received which showed that the more the professionals administer training blood transfusions, the greater is their experience and transfusion process” (p <0.001). The other predictors the greater is their knowledge on the procedure (p = showed no significant influence on the knowledge 0.007 in Overall Score, p = 0.008 and Transfusion Step). score. and/or guidance for carrying out the Table 3 - Knowledge scores on blood transfusion – Uberaba, MG, Brazil, 2013 Frequency distribution Average (%) Median SD Min. (%) Max. (%) Overall score 52.7 54.3 10.2 17.1 74.3 Pre-transfusion Step Score 53.4 57.1 17.1 0 100 Transfusional Step Score 51.2 52 10.9 16 72 Post-transfusional Step Score 62.7 66.7 26.8 0 100 Table 4 - Association among Overall scores and the Transfusion Steps (TS) and the predictor variables - Uberaba, MG, Brazil, 2013 Score Overall Score Variable Pre-transfusional Step ... Purchase answer to see full attachment

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