References
A randomized control trial to compare Quiet Eye training efficacy to traditional technical training with undergraduate student nurses' peripheral intravenous cannulation performance: a protocol
Abstract
Introduction:
Peripheral intravenous cannulation (PIVC) is a common and complex procedure with low first-attempt success rates, causing patient suffering and increased healthcare costs. Quiet Eye (QE) training, a gaze-focused approach, has shown promise in improving procedural PIVC skills. We will examine the effectiveness of traditional technical training (TT) and QE training (QET) on student nurse PIVC performance.
Methods:
Forty-four participants will be randomly assigned to either the TT or QET groups using a blocked randomization method to ensure balanced group sizes. Blinded outcome assessments will minimize bias. Data will be collected using a structured questionnaire and a mobile eye tracker to simultaneously record gaze and hand movements. Participants will complete pre-intervention, post-intervention, and one-week retention tests using a light-skinned manikin arm. A transfer task, utilizing a dark-skinned manikin arm, will assess participants' skills post-trials. The TT group will receive traditional instruction on hand movement improvement; the QET group will receive feedback on their gaze behaviours. The primary outcome measure will be PIVC first attempt success defined as being able to flush the inserted catheter with 10 mL (maximum) normal saline into the vessel. A trial will be considered unsuccessful if more than gentle pressure on the syringe plunger is needed to flush the catheter or if the participant abandoned the attempt before attempting the flush. Other dependent variables will be QE duration (%), number of fixations, total movement time(s), and movement phase time(s). We will analyze data with descriptive and inferential statistics, including mixed model ANOVA and Chi-Square tests.
Discussion:
This study examines the significance of improving PIVC first attempt success rates and highlights QET potential as an intervention. Emphasis is placed on critical implications for health care, particularly the importance of integrating QET into nursing education programs. Future research utilizing large-scale trials and longitudinal designs is recommended.
Most hospitalized people (70%–80%) require vascular access device placement (Alexandrou et al, 2012; Zingg and Pittet, 2009). These peripherally inserted thin plastic tubes allow venous system access for infusing essential fluids, blood, blood products, and medications. Although this common and complex skill is routinely taught in undergraduate nursing programs, peripheral intravenous cannulation (PIVC) first attempt success rates (FASRs) differ considerably between novice (23%) and expert (98%) nurses (Carr et al, 2016; Frey, 1998). When significant complications such as infection occur, increased hospital length of stay and patient's pain and suffering often result (Catarino et al, 2022; Marsh et al, 2020; Millington et al, 2020).
Several factors contribute to inexperienced registered nurses' (RNs') and student nurses' low FASRs, including the lack of appropriate evidence-based education and PIVC skill development opportunities (Gorski et al, 2021; Rodriguez-Calero et al, 2020; Yalçınlı et al, 2019). Traditionally, nurses learn PIVC utilizing the cognitive apprenticeship model and simulation (Wooley and Jarvis, 2007). However, despite widespread PIVC teaching in nursing education and calls for close examination of individual clinical differences, there has not been a significant FASR improvement (Arslan et al, 2022; Frey, 1998; Parker et al, 2017). To increase FASRs more quickly and effectively, students and RNs urgently need improved training and support (Rivaz et al, 2017).
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