Authors: Aldea, R., R.N.,M.A.N.;Borromeo,R.,R.N.,M.A.N.,Ph Ed.; Manalastas, E.G., R.N.
Nurses did what they did because that’s how it’s always been done. INS Journal Jun/Au 2010. When it comes to taping practices, hand-me-down practice can be observed. Variation of taping practice has been long evident in nursing which calls the need for standardization, a Taping Protocol in terms of securing five major contraptions that nurses secure such as the Peripheral IV, Nasogastric Tube, Endotracheal tube, dressings and drains. S.T.E.P. (Survey,Training, Evaluation and Protocol) was the methodology used in the formulation of the Taping Protocol, which is the output of this evidence-based study.
The study was birthed after a series of observation of the variations of taping practices seen in different areas of nursing practice. Even if they belong to one hospital the ER nurse tapes differently compared to the ward nurse, ICU nurse and in all other areas. It was then realized that the root cause of this is the lack of standards and training in this aspect. We often underestimate the use and importance of medical tapes. We perceive it as “just tapes” but if we scratch beyond the surface, these can either cause a great advantage or disadvantage to our patients and to us nurses. From securement of contraptions, dressings, immobilization, and strapping just to name a few of its usage. But if not utilized, handled and applied properly it can cause malfunction and worse, skin complication such as stripping, tension blister, maceration, folliculitis, chemical injury and adhesive residue.
A total of 12 tertiary hospitals in the Metro Manila decided to join the project. These comprise of 6 government and private institutions. There was a pilot study conducted at the Philippine Heart Center which resulted into refining materials used for this study such as the questionnaires and structure implementation of the study.
Eight hospitals were able to achieve and complete the study within the given time frame. Categories balanced having 4 private and 4 government hospitals. A total of 50 wards participated and were able to experience the transformation of their taping practices.
Authors aim to produce a protocol as an output of this study. A recommendation that would serve as a guide for nurses on how to secure different patient contraptions effectively. From proper selection of tape type and size, application and removal. An endeavor that would elevate and further improve the nursing practice.
This study focuses on the 5 major adult patient contraptions being secured by the nurses such as peripheral IV, nasogastric tube, endotracheal tube, foleycatheter and dressing with drains. We aspire that these taping practices on target applications will be uniform and standardized at the end of the study.
The study’s methodology has the acronym STEP. It captures from getting and having baseline data through Survey which S stands for. Wherein the researchers conducted surveys to identify common tapes used, and current taping practices. Through this we were able to identify variations according to the institution’s policy and individual preferences. After which Training would be conducted. This addresses the need to establish a guide that would equip nurses to improve their taping application that would spare their patients from skin taping complications. Training was divided in to 2 parts: 1. Lecture-tackling principles on taping applications and techniques showed through demonstration. 2. Return Demonstration wherein participants were asked to demonstrate taping applications to be checked by respective preceptors. It was emphasized on the training module that blisters and stripping are caused by wrong application and removal of the tape and not caused by the tape per se. Recommendation on what type of tape, size together with techniques were communicated. Having these new learning from training the respondents are expected to carry out and perform these techniques in their respective areas. Thus Evaluation is done to validate if series of learning from the training were carried out or being practiced. Protocol in the end will be formulated.
Before the practices were measured and looked at. Tape preferences were also considered. Questions posted were about the tape preferences of the nurses. Paper and cloth showed to be the most preferred tapes.
Results showed consistent variation in taping techniques of these patients. It transcends from wards to hospitals. It was evident that there is no standard being followed by the respondents in terms of their practice in taping. It is evident that even if it’s the same procedure (e.g. Figure 2, peripheral IV), contraption being secured with the same tape, taping manner varies. Figure 2
This further strengthened the need for a protocol and recommendation on this specific aspect of nursing. As the study was carried out patient’s safety and confidentiality were secured. Skin assessment was done on every patient who was included to be a part of the study. Right tape for the right application. This was the core message of the training. When data was collated the variation encompassed all the observed contraptions. Different taping techniques were done. When nurses are asked regarding such practice they would say that these techniques were just done out of observation and “that’s how it’s always been done” thinking. There is no such basis and standard followed. The training done and the techniques shared were much appreciated. Apart from the value of the efficiency and ease of the taping techniques taught, no skin damage was observed when right tape was chosen and was applied with the right technique from application to removal.
This study is yet another brick laid as a foundation to bring nursing practice on to a higher ground. We have addressed a problem that might seem very basic and yet can affect patients and nurses in an impactful way. A step by step protocol was utilized and easily appreciated by the respondents. It covers recommendation from tape type, size, technique and for what specific type of contraption it should be used. This protocol was approved by nursing administrators and the respondents. It was appreciated to fill the gap that was long time present but unnoticed.