REFERENCES FOR THE TWO ARTICLESQUANTITATIVEARTICLE 1McIe, S.docx

REFERENCES FOR THE TWO ARTICLES
QUANTITATIVE
ARTICLE 1
McIe, S., Petitte, T., Pride, L., Leeper, D., & Ostrow, C. L.
(2009). Transparent film dressing vs. pressure dressing after
percutaneous transluminal coronary angiography. American
Journal of Critical Care, 18(1), 14–20.
QUALITATIVE
ARTICLE 2
Osterman, P. L., Asselin, M. R., & Cullen, H. A. (2009).
Returning for a baccalaureate: A descriptive, exploratory
study of nurses’ perceptions. Journal for Nurses in Staff
Development, 25(3), 109–117.
J O U R N A L F O R N U R S E S I N S T A F F D E V E L O
P M E N T � Volume 25, Number 3, 109–117 � Copyright A
2009 Wolters Kluwer Health l Lippincott Williams & Wilkins
One critical role of the staff development spe-cialist is to
facilitate competence and contin-
ued professional development of staff (American
Nurses Association, 2000). One approach to this is to
foster an environment which encourages staff to
advance academically, be it from the diploma or
associate’s degree to the baccalaureate level or
beyond. This is especially timely given the push for
Magnet recognition in many hospitals and given the
spotlight that has been placed on quality outcomes
and a culture of safety. Furthermore, although hos-
pitals struggle with fiscal challenges, the financial
benefit of supporting nurses who pursue advanced

education may not be immediately visible to admin-
istrators, but staff development specialists realize the
value of such a move, especially about improving
patient outcomes and enhancing patient safety.
When examining the impact of nurses’ educational
preparation on patient outcomes, Aiken, Clarke, Cheung,
Sloane, and Silber (2003) recognized
a statistically significant relationship between the propor-
tion of nurses in a hospital with bachelor’s and master’s
degrees and the risks of both mortality and failure to
rescue. . .Each 10% increase in the proportion of nurses
with [bachelor’s or master’s] degrees decreased the risk of
mortality and of failure to rescue. . .by 5%. (p. 1620).
Although this study has been the subject of some
controversy within the nursing profession, most
scholars agree that ‘‘[e]ducation makes a difference
in nursing practice. . .education broadens one’s knowl-
edge base, enriches understanding, and sharpens
expertise’’ (Long, Bernier, & Aiken, 2004, p. 48). The
value of these educational benefits, when applied to
patient care, is further clarified by the observation that
[n]urses constitute the surveillance system for early de-
tection of complications and problems in care, and they
are in the best position to initiate actions that minimize
negative outcomes for patients. That the exercise of clinical
judgment by nurses. . .is key to effective surveillance may
explain the link between higher nursing skill mix. . .and
better patient outcomes (Aiken et al., 2003, p. 1617).
The need for increasing numbers of baccalaureate-
prepared registered nurses (RNs) becomes more ob-
vious when viewed through the lens of the current

emphasis on evidence-based practice. The critical-
thinking skills that accompany bachelor of science in
nursing (BSN) education are paramount to developing
a nursing workforce that is able not only to review
Returning for a
Baccalaureate
A Descriptive Exploratory Study of
Nurses’ Perceptions
Paulette LaCava Osterman, PhD, RN
Marilyn E. Asselin, PhD, RN-BC
H. Allethaire Cullen, MSN, RN
................................................
This qualitative study examines the
experience of the RN who pursues a bachelor
of science to determine the meaning found
by pursuit of a baccalaureate, the extent to
which the pursuit of the degree influences
one’s perception of oneself as a professional,
and the impact of the degree on one’s
practice. The participants found personal
satisfaction in pursuing their degrees and

developed a broader approach to nursing
practice. Implications for staff development
specialists are discussed.
.................................................
..........................................
Paulette LaCava Osterman, PhD, RN, at the time this research
was con-
ducted, was Professor of Nursing, Community College of Rhode
Island, Warwick, Rhode Island.
Marilyn E. Asselin, PhD, RN-BC, is Assistant Professor, Adult
and
Child Nursing Department, College of Nursing, University of
Massachusetts, North Dartmouth, Massachusetts.
H. Allethaire Cullen, MSN, RN, is Assistant Professor of
Nursing,
Community College of Rhode Island, Warwick, Rhode Island.
JOURNAL FOR NURSES IN STAFF DEVELOPMENT 109
9Copyright @ 200 Lippincott Williams & Wilkins.
Unauthorized reproduction of this article is prohibited.
literature competently but also to apply true evidence-
based practice changes at the bedside.
REVIEW OF THE LITERATURE
The current nursing workforce is composed of RNs

with a variety of entry-level credentials—whether hos-
pital diplomas, associate degrees, or baccalaureates—
and 57.3% of nurses practicing in 2000 were doing
so at the subbaccalaureate level (Spratley, Johnson,
Sochalski, Fritz, & Spencer, 2000). These nurses often
express a desire to ‘‘return for my BSN’’ and appear
highly motivated to do so but find that full-time em-
ployment and family responsibilities place too high
a burden on their time to allow them to pursue a
baccalaureate. Delaney and Piscopo (2004) found that
‘‘competing priorities. . .multiple role demands, com-
bined with limited resources, as the greatest barriers
to their enrolling in a BSN program’’ (p. 158).
There has been little published research done
within the last 10 years on the topic of RNs return-
ing for their baccalaureates. What recent literature
is available has centered on teaching and learning
methods (Cangelosi, 2004; Cox, 1996; Hegge, 1995;
Stringfield, 1993), variables of empowerment and au-
tonomy (Horne, 1998; Malizia, 2000), and the meaning
of having baccalaureate-prepared nurses in the practice
setting (McCray, 1995). Much of the literature over the
past 5 years has focused on nontraditional education,
such as accelerated RN-to-BSN programs (Boylston,
Peters, & Lacey, 2004), case study analysis in lieu of
clinical requirements for experienced RNs (Hall, 2003),
and online or distance learning programs (Huston,
Shovein, Damazo, & Fox, 2001). Several doctoral dis-
sertations have addressed the RN-to-BSN student,
looking at such subjects as the motivation for return-
ing to school (Corbett, 1997) or students’ perceptions
of curriculum content as related to their already-
significant nursing experience (Clark, 2004).
It is critical to understand how the pursuit of a

baccalaureate impacts one’s self-perception as a pro-
fessional and how it influences an individual’s nursing
practice to provide a work environment that fosters
professional development, knowledge acquisition, and
transfer of new knowledge to practice such that patient
care is enhanced.
PURPOSE AND RESEARCH QUESTIONS
The purpose of this study was to describe the meaning
of personal and professional growth for experienced
RNs who return for a baccalaureate in nursing. An
additional aim of the study was to identify ways in
which the baccalaureate influences one’s approach to
nursing practice.
The following research questions served to guide
the researchers in the choice of method and analysis
of data:
1. What meaning does the RN find in the pursuit of a
baccalaureate in nursing?
2. To what extent does the pursuit of a baccalaureate
in nursing influence one’s perception of being a
professional nurse?
3. To what extent does the pursuit of a baccalaureate
in nursing influence one’s nursing practice?
RESEARCH DESIGN AND METHODS
A qualitative research design using in-depth interview
as the principle method was chosen to elicit data in
this research study. With this methodology, research
questions focus on the perception and the experience

of the RN returning for baccalaureate education.
Because the focus of the research was to explore the
meaning of pursuit of a BSN, a qualitative design was
appropriate. Qualitative research seeks to understand
phenomena from the participant’s perspective and
view of reality. In-depth interviews allow time and
space for participants to share their perceptions, be-
liefs, and experience, thus allowing the researcher to
gain an understanding of a particular phenomenon
from the perspective of those who experienced it. The
interview approach is based on the assumption that
‘‘understanding is achieved by encouraging people to
describe their worlds in their own terms’’ (Rubin &
Rubin, 1995, p. 2).
Participants
A purposive sample of 11 RNs volunteered to par-
ticipate in this study. In purposive sampling, research
participants are chosen based on their knowledge of
the phenomenon under study. The 11 participants,
who ranged from age 40 to mid-50 years, were all
women and worked in an acute care hospital on a wide
variety of patient care units including the emergency
department, medical–surgical units, operating room,
postanesthesia care unit, endoscopy unit, dialysis unit,
and critical care unit. Participants’ nursing experience
ranged from 14 to 34 years, with a mean of 24 years of
nursing experience. Most had as their basic nursing
education an associate degree in nursing; 1 participant
had a hospital diploma, and another participant be-
gan as a practical nurse. Two of the participants had
bachelor’s degrees in nonnursing fields: 1 in journal-
ism and 1 in liberal arts. Seven participants attended
the on-site baccalaureate program at the hospital (see
the Setting section), and the other 4 participants at-

tended other baccalaureate programs within the state.
110 May/June 2009
All participants were interviewed in their last semester
of study or within 1 year of graduation from the bac-
calaureate in nursing program.
Setting
The study took place in a 275-bed community hospital
in the northeast. The hospital has traditionally had a
low RN turnover rate and a significant number of long-
term RN employees; 25% of the RNs are older than the
age of 55 years. There is a high percentage of associate
degree nurses (54%) compared with that of baccalau-
reate-prepared nurses (26%). Nursing leadership has
set a goal of increasing the number of baccalaureate-
prepared nurses. The hospital has recently imple-
mented structures to promote a professional practice
model which has included a shared leadership model,
RN professional advancement ladder, and a change
from team to a modified primary model of care. To
promote nurses’ return to college for the baccalaure-
ate, the hospital expanded its tuition reimbursement
program to offer additional assistance for nurses who
chose to return to school. In addition, the education
department collaborated with a local university to cre-
ate a hospital-based dedicated on-site satellite program
for baccalaureate education in nursing.

Procedures and Data Analysis
Approval for the study was obtained through the
institutional review board process. Participants were
assigned code numbers to assure anonymity and con-
fidentiality. Each participant was asked to share her
thoughts regarding the research questions. Following
the flexible interview design of Rubin and Rubin
(1995), questions were added or probed to gain a bet-
ter understanding of responses. Interviews were ap-
proximately 1 hour in length, conducted in a private
conference room, audiotaped, and transcribed verba-
tim by a professional transcriptionist who was not
employed by either the hospital or the participating
academic institutions. The same researchers were pres-
ent at all interviews.
With each interview, significant statements were
identified. Significant statements were then grouped
into themes based on the research questions. The re-
searchers agreed on the analysis of each interview.
Data across interviews were then analyzed for similar
and contrasting themes based on the research ques-
tions. Saturation of data was reached at 11 participants.
Trustworthiness of data was determined by comparing
audiotapes of interviews against transcripts. In addi-
tion, researcher-corroborated data analysis and mem-
ber checks were used. Also, data were examined for
coherence and consistency within and across interviews.
FINDINGS
Overarching Observations
As data were analyzed, several factors emerged which

reflected common perspectives of the participants. The
participants all related examples of attending continu-
ing education programs and inservice classes at the
hospital. Primarily, these were attended on a voluntary
basis—the nurses sought out education based on their
assessed needs at that particular time. In a sense, this
group could be viewed as ‘‘knowledge seekers.’’ For
these individuals, moving from inservice classes to
classes leading to a degree was a natural progression
of their lifelong learning philosophy.
Participants generally identified ‘‘support’’ as a key
factor contributing to their success in achieving the
degree. Various sources of support were identified
including peers, family, and hospital-based sources.
Participants tended to search out peers who had simi-
lar thinking. This tactic was useful as the program
progressed because it formed a basis for peer support
throughout the program. It was especially helpful to
those participants who progressed through the bacca-
laureate program as a cohort and who worked to-
gether on either the same floor or the same shift.
The support groups also served as vehicles for criti-
cal discussion of class content, for expansion of one’s
view of other units, and for the development of new
professional networks within the organization. One
nurse stated,
I found that I met people that I’ve never had a relationship
with before, and we developed [relationships]. I really
enjoyed speaking with other nurses who were in the course
with me because. . .you find out what they’re doing in their
department. So, we shared a lot of that stuff, about what
everyone else does, and that was great.

Participants also spoke of support received from
family members who picked up extra household re-
sponsibilities. The majority also identified support
from their managers. One participant stated of the
manager,
[She] always did whatever she had to with the schedule to
make it easier for me to go to school. Unbelievable
support.
Other participants spoke of the librarian’s assis-
tance in literature searches and the preparation of class
presentations.
Participants considered several factors when choos-
ing a baccalaureate program. Factors included
1. a fit between the student’s work and class schedules,
2. issues at home,
3. anecdotal information about the program,
4. travel time to school,
5. perceived willingness of the program coordinator to
‘‘personalize’’ a course of study,
6. how many credits would be accepted,
7. length of time until degree completion, and
8. the degree of tuition assistance/personal financial

status.
Research Question 1: The Meaning of Returning
for the Bachelor of Science Degree
An interesting finding was that, on entering the pro-
gram, participants gave little thought to what getting
a baccalaureate would mean to the patients or the
care they would deliver. However, the impact on prac-
tice and professionalism did emerge as they pro-
gressed through the program; this will be discussed
later in this article.
Data related to meaning were grouped into two
categories—meaning on entering the program and
meaning on preparing to graduate or graduating.
Participants, reflecting on their experiences when
entering the baccalaureate program, presented themes
related to meaning. These included waiting for the
right time, being a means to a higher goal, address-
ing issues of aging and physical demands, role mod-
eling for others, and testing one’s ability to succeed.
For most of the participants, waiting for the right
time was a central theme that described their deci-
sion to return to school. Some described waiting for
the right time from a personal perspective. One par-
ticipant stated,
I had been single and had three children and just couldn’t
do it all, so I put that [the degree] on hold at that point.
Now, the children are older.
For several participants, the impetus to seek the
degree was spurred by other changes in their lives. For
example, one participant stated,

. . .at that point I was getting older. . .I was going to be
55. . .I felt like I deserved it [the baccalaureate] at this time
in my life. . .I felt I had a lot more to offer.
Others spoke of waiting until the right time from a
professional perspective. Several nurses spoke of
having worked on a particular unit for many years
and having acquired an expert level of knowledge but
knowing there was more to learn.
I felt that the associate degree program was excellent but
basically focused a lot on clinical aspects, so I just felt
there was more—just a little bit that I had been
missing. . .Basically just seeing people [who] started as
staff nurses, then assistant nurse manager, seeing other
people go on. . .It was just the way that the other nurses
who had the bachelor’s degree behaved.
The decision of the hospital for which they worked
to create an on-site degree program also played a role
in ‘‘right timing.’’
When the program came along to me, it was an absolute
no-brainer. The hospital is paying for the vast majority of
it. . .[The hospital is] bringing the professors to us. How
could you turn down something like that?
For others, the meaning of returning for a degree
was seen as a means to achieving a higher goal.
A CNS program is where I’m really heading, so of course I
had to get the bachelor’s degree first.
Other participants needed the degree to progress
within the organization—for example, to work in a
surgical unit or on an IV team.

Because most participants were older, several ex-
pressed concerns about the physical demands on the
older staff nurses, and some saw the degree as a means
of staying in nursing while doing less physical work.
I decided that, first of all to do anything in nursing,
the minimum standard is going to be a bachelor’s
degree. . .looking to the future, I probably have another
15 years to work, and because we work physically hard on
the floors, I want to have other options available to me. . .I
know that in order to do that I need to have at least a
bachelor’s degree to be able to open more doors so that I
don’t have to work physically hard on the nursing units.
I need to start thinking about the future. . .prepare myself
for physical changes.
By returning to school, several participants also saw
themselves as role models for family members and
other staff members. One participant who shares an
attention-deficit disorder diagnosis with her son spoke
of being a role model:
. . .when I went back to school, I did that to show my son
that the ADD diagnosis doesn’t mean anything. You can
do whatever you set your mind to. It showed my son that
you can do anything that you need to do. . .
Some nurses recognized that by returning for a
degree, they were setting a good example for other
nurses, whereas still others saw returning as a test of
their ability to succeed.
Two other themes related to meaning emerged as
the nurses graduated: an enhanced self-esteem and

confidence.
It did a lot for [me] personally with self-esteem. . .thinking
that I was [not] ‘smart enough’ to go to college was gone.
It has made me very proud of myself. I’m much more
confident. If you can instill confidence in anyone, then
you have accomplished everything because once you have
made someone confident and proud of themselves [sic],
112 May/June 2009
they can do everything. I would never have applied for a
management job. . .but now I would. . .
Research Question 2: How the Bachelor of
Science Influences One’s Perception of Being a
Professional Nurse
In some cases, the participants identified a basic
broadening of their own knowledge about the scope
of professionalism. One participant, displaying admi-
rable honesty, said,
I didn’t know what professionalism was. I didn’t know
anything about theory. I didn’t know there were nursing
theories!
Learning how to use a computer for research—
indeed, learning how to use a computer at all—was
identified by some as an epiphany. Others identified an

appreciation for the history of nursing, the value of
research, and an understanding of an ethical code for
nursing as areas that they believe increased their
perceptions of themselves as professionals.
On a somewhat more sophisticated scale, research
was identified as an element of their education that
played a major role in the participants’ perceptions
of themselves as professionals. Not all ‘‘research’’
was scholarly inquiry; some was just grassroots in-
vestigation that would be used for public policy
purposes. Even so, the desire to inquire, to find out,
was recognized by the participants as a vital part
of their educational growth. Some observations in-
clude the following:
It’s research; some of it’s knowing what the resources are
out there. The associate degree program prepares you
well for bedside care, but it doesn’t show you the
resources at a larger level and understanding that there
may be legislation that bears on what you’re doing. . .
I never really gave much thought to how the policies and
procedures that we have now came about. . .[It’s] made
me a little bit more aware of why we are doing what we’re
doing. . .You know, [it] comes down to patient care. You
use evidence-based practice and [get] the best patient
outcomes. . .Somebody studies it, there were better
patient outcomes. . .
I was not familiar with the research process; just the
concept of evidence-based practice was a fairly new
concept to me. . .
In addition, the participants believed that baccalau-
reate education helped them answer long-standing

questions concerning their professional practice and its
scope. One of the areas where insight was most evi-
dent was in the roles of management and leadership:
I found there were several things in those [leadership and
management] courses that gave me a better understand-
ing of what some of the women I have worked for were
doing and why they were doing things a certain way—I
had a better understanding of what management does. . .
As a result of my education, I think that I would manage
things a little differently. . .I would have more interaction
with my staff. . .I would understand their concerns and try
to help them work through. . .and find an answer. . .If you
treat them with respect. . .they know what you have to
accomplish. . .[and] they are going to work harder and
more diligently to help you accomplish what it is that
you’re doing.
I think that I’m more comfortable with leadership. I’ve
always had a difficult time delegating to other people,
and it [leadership education in the baccalaureate pro-
gram] helped me understand a bit more why I can’t be
the one to do everything. So, it’s helped me to share
responsibilities.
One participant related an eye-opening experience
watching two nurses interact with staff members.
These insights were a direct result of the leadership
component of baccalaureate education. She noted,
In observing two nurses. . .prior [to my return to school], I
would have said, ‘What a [expletive]. What a [expletive]
that woman in the ER was,’ but not think further to say,
‘She just doesn’t have natural leadership ability,’ where

this young nurse on the unit, in contrast, wasn’t
threatened, she wasn’t intimidated. She just made it like
a team effort, a teaching experience.
Another insight of participants was the value of
challenging assumptions and, by doing so, broadening
their perspectives:
I found a difference in speaking with each other. If there’s
something not quite right, I wouldn’t hesitate to try to
talk about it or try to resolve things. . .I feel I have a few
more resources to be able to try to change something if
something could be done better or in a different way that
would be beneficial to patients.
Nobody likes change. I remember over the past year,
having gone through change and we were all up in arms.
But, you know, now, there’s been research into it, and
this is proven to be a better way to do it. Well, I have
changed how I view change because now I can’t
say. . .‘What a pain this is, adopting a whole new way.’
Now, I know that there is probably a good reason that I
never would have thought of before.
Many of the participants tied their beliefs of how the
baccalaureate influenced their perceptions of them-
selves as professional nurses with their newfound
ability to influence others:
You’re trying to be proactive, and I think that by having
that degree behind you [you have] that sense that you
can be proactive without being a complaining individual
. . .The way I approach things is different.

The participants in this study also identified an
expanded awareness of others and a more mature
type of empathy in their dealings with patients, peers,
and members of the interdisciplinary team. A long-
time preceptor, having returned for her bachelor of
science (BS), made this observation about precepting
new graduates:
Being a student myself has kind of made me step back
and look more at why I’m doing that and think a little bit
less of myself and my schedule.
The participants also noted that having nurses from
other units in their classes helped them better un-
derstand the challenges faced by all nurses—that
knowing one another’s experiences increased empathy
for each other.
. . .you kind of get to know what really their concerns are,
what’s going on on those different units that I would
normally have no knowledge of, really. . .I think that
definitely knowing and hearing what they’re going
through and how they’re feeling about it definitely helps
to say, ‘Wow, they had to deal with this!’ So, I think that
it does kind of make me more empathetic to what’s
going on. . .
Finally, and perhaps most important, a common
theme throughout the interviews was that of partici-
pants learning to reframe their thinking, seeing a big
picture as a sign of their increased professionalism.

Consider this observation from a preceptor, a seasoned
RN who had returned for her baccalaureate:
I think that my approach to precepting is different this
year than it was 3 years ago because 3 years ago, I was
focused on the physical—the actual activity which is what
you’re doing for this patient. Now, [I] see things more as
a whole picture. It’s constantly saying to her or working
with her to not just focus on all of the little things but to
bring it all together. As graduates, they bring things in
separately. Now, it’s not just task oriented.
Research Question 3: How the BS Influences
One’s Nursing Practice
One of the findings in this section was that the
curriculum focus specific to the school of nursing
seemed to influence the participants’ approaches to
practice. One program appears to focus on disease and
the physiological aspects of patient care, with a strong
emphasis on peer and patient education. Another
program seems to focus on more global issues and an
evidence-based approach, where nursing theory and
leadership are of paramount importance.
There were, however, some consistencies across the
programs. All of the 11 participants, for example, in-
dicated in some way that their studies enabled them
to view patient care as the sum of many parts.
Some refer to a ‘‘broader picture’’ or seeing ‘‘broader
strokes;’’ others refer to ‘‘taking all things into ac-
count’’ or having a ‘‘wider perspective,’’ but all men-
tioned that the baccalaureate has given them a greater
awareness that enables them to focus on the entire
patient.

I think my nursing role now is. . .not as task oriented as
much as it was before. It’s more education, it’s more
prevention. It’s more not just taking care of that patient
in the bed but the whole patient—everything about
the patient.
You tend to see more sides. . .because of the things
that I’ve learned though research, through community,
through just learning about the history of nursing and
transition. . .you start thinking about more than one
avenue. . .
There was also a shift in thinking, from the tech-
nical to the professional, from practice that was
automatic—almost by rote—to creative, intuitive prob-
lem solving.
I think that before, if a situation arose—any situation—
you would almost take the avenue that you already knew;
but now that I’ve been exposed to research and other
venues of care and holistic nursing, community nursing,
other things that I really hadn’t even been exposed to
before, I kind of view things from a different viewpoint
now. I kind of take all things into perspective before I
make an opinion of one certain situation.
[My education] enhanced the skills that I had so that
instead of just listening to somebody’s lung sounds, now,
I’m listening to where they are and how do they
change. . .If I make them cough, does it clear? Is it one
particular spot?. . .I became more aware of why I was
listening to certain things. . .
One of most prevalent concepts that filtered
through each of the interviews is the participants’

enhanced focus on education.
Perhaps by educating myself more, [it] helps me educate
[patients] better and helps my coworkers by educating
them also. I think that it all comes down to education.
I think I’m more in tune to educating my coworkers,
patients, families—promoting maybe a better atmo-
sphere because they are now more educated and
understand better.
. . .even though I have contacts with patients, I feel that
I’m doing my fellow nurses more good, and I almost feel
I’m helping my colleagues and coworkers. . .I like it when
people ask me [my] opinion or ask questions and I find
that people come to me first—a resource, and I like that!
. . .in informal ways when there is an opportunity to tell
somebody, ‘This is what I’m doing and I think it would be
good if you do this.’
114 May/June 2009
For some of the participants, particularly those
from one college’s program, there was a realization
of the importance of applying the sciences to pa-
tient care:
I have a deeper understanding of the physiological aspects
of some disease processes, and I am more apt to go after
what I don’t know as far as the disease process. . .I feel
that I have a deeper knowledge than just the human body,

and now I’m also more apt, if I don’t understand it, I’m
going to ask until I do understand it.
Whether through the fine-tuning of skills or the
application of research to practice, participants fre-
quently verbalized a new appreciation of research and
scholarly thought.
I think that you need to pay attention to the research,
which is not something that I ever did previously. You
know, I think you do need to be current. . .and I just
didn’t pay attention to that very much before I went back
to school.
Of course, not every attempt to implement research
goes smoothly because such implementation involves
change—change that is not always welcomed by those
who have not had the exposure to the concept or value
of evidence-based practice. One participant relates a
story of how she tried to convince her peers on the
postanesthesia care unit that the environment should
be kept quieter for the well-being of the recovering
surgical patients. At the time, it had not been unusual
for a rock-and-roll radio station to be blaring loudly
and for staff members to be holding noisy conversa-
tions. Having found research to support the value of
a quieter environment, this nurse wanted to see a
change in the unit’s practice. She was not totally
successful, but she changed her own practice and
influenced a colleague as well:
[My peers] basically just disregarded it. One nurse actually
said, ‘Well, I don’t believe in any of that stuff,’ so now that
I did that research project, I keep my little two units nice
and quiet and slightly darkened. . .Well, there is one nurse
who I work with. . .and she does that now, too. . .She puts

the lights off.
DISCUSSION AND IMPLICATIONS
The study of Lillibridge and Fox (2005), which ex-
amined the perceptions of six RNs who returned for
their BSN degrees, has some congruencies with this
study, including the participants’ desire for career
mobility and the belief that the degree was instrumen-
tal in making this possible, significant peer resistance
to the participants’ pursuit of a degree, the improved
ability to see the entire patient, interest in applying
newfound appreciation for research and evidence-
based practice in the clinical setting, and feelings of
personal accomplishment.
However, participants in this study did not ex-
press the perception of not fitting in with inexperi-
enced undergraduate students, as the participants of
Lillibridge and Fox’(2005) did. Neither did partici-
pants of this study express the cynicism shown by
the participants of Lillibridge and Fox, which is thus
best described by the question, ‘‘What do you think
you can teach me that I don’t already know?’’ Instead,
most participants in this study began the baccalaure-
ate course knowing that they had much to learn and
looking forward to challenging themselves. Unlike
the participants of Lillibridge and Fox, this group
also felt that being role models and better patient
and peer teachers were positive outcomes of the bac-
calaureate education.
One difference between the study of Lillibridge and
Fox (2005) and this study may well explain these
discrepancies. More than half of the participants in the

current study participated in an on-site RN-to-BS pro-
gram, so issues of travel and intermingling with in-
experienced undergraduates were not concerns. An
interesting finding was that those four participants
who attended on-campus classes still did not mention
the campus-related issues of the other study.
The reasons an experienced nurse returns for a bac-
calaureate are personal and varied, but in this study,
each of the participants found a sense of betterment
and enhanced professionalism as she progressed
through the program. Staff development specialists
are in a unique position to support both the organi-
zation and the nurse student in the education process.
Although it is not always possible for the hospital
or agency to have a dedicated relationship with a
school of nursing, doing so can provide advantages for
all involved: For example, integration of the organi-
zation’s mission, vision, and goals into the curriculum
can further their realization while helping the nurse
student to understand their value, and assistance with
the transfer of knowledge from the classroom to the
bedside brings applicability to the curriculum while
enhancing patient care. Seven of the 11 participants
in this study benefited from such an arrangement
between a university and the hospital where they
worked: The school provided faculty for classes on the
hospital campus, and the hospital provided a gener-
ous tuition reimbursement that essentially made the
program free for participating employees. In return,
those employees promised to work for a minimum
of two additional years at the hospital. The hospital
found this to be a valuable retention strategy; the
school was able to expand its nursing program at
minimal cost; and the participants believed that the

decision to become a nurse student was, in the
words of one of them, ‘‘a no-brainer.’’ Open commu-
nications between schools and agencies are, obviously,
the foundation for such an arrangement, but if all
parties are willing, they can establish an arrangement
that benefits everyone.
Whether or not there is a dedicated relationship
between school and agency, there must be support
structures within the practice environment to en-
sure optimal outcomes. In addition to the aforemen-
tioned sharing of the organization’s mission, vision,
and goals so that these might be integrated into
the curriculum; the provision of tuition assistance;
and the accessibility of classes (e.g., on the hospital
campus), there are other ways an agency can support
the nurse student. An encouraging nurse manager
can make a tremendous impact on the success of the
nurse student, particularly if that manager is reason-
able regarding the need for flexible work hours. The
staff development specialist can work with both the
manager and the student to determine the best ways
to provide staffing coverage for the unit while allow-
ing the student to attend classes or have time off to
write papers or study.
Staff development specialists can especially provide
structures to support the transfer of new knowledge

and skills. Some of these include:
1. providing the nurse manager with information
about the curriculum to encourage a parallel be-
tween what is being learned and what is being
practiced in daily assignments;
2. advocating for administration, management, and
physician support;
3. promoting a shared decision-making model and
ensuring that nurse students participate;
4. using baccalaureate-prepared nurses as preceptors
and resource nurses, giving them an opportunity to
use and share their knowledge;
5. advocating for the inclusion of degree attainment
in the performance evaluation and career develop-
ment plan;
6. encouraging nurse students and recent baccalaure-
ate graduates to participate on appropriate com-
mittees; and
7. planning organization-wide recognition programs
for staff members who attain their baccalaureates.
Staff development specialists are ideally positioned
to take the lead in promoting a ‘‘return for your
baccalaureate’’ movement, of course, but there is so
much more that they can do. Providing discussion/
support groups for nurse students is of tremendous
value, especially if run collaboratively with the schools
of nursing. After graduation, it is the staff develop-
ment specialist who can help new graduates synthe-

size and transfer what they have learned into the
work setting. In addition, the staff development spe-
cialist can support, advocate for, or run interference
for the new BS graduate who attempts to institute
change but runs into barriers by providing evidence-
based practice research, for example, or helping the
graduate determine the best ways to approach change
on his or her unit. With such occurrences fairly com-
mon, it might be wise for an agency to dedicate one
staff development specialist as a ‘‘baccalaureate tran-
sition partner.’’
SUMMARY
Regardless of the impetus that drove these participants
back to school, each one reported tremendous satis-
faction with degree attainment. One of those inter-
viewed summed up the experience with these words:
The rewards are so great. I’m not even sure that you can
enumerate properly all of the rewards. You can make a
great salary, but there are things that are so much
more. . .Did you ever think what it would be like without
you? I can honestly go home at night and realize that it
would be different without me—that I made a big
difference. I’m really lucky to be able to say that.
ACKNOWLEDGMENT
The authors wish to thank the Delta Upsilon Chapter-
at-Large of Sigma Theta Tau International for providing
funding for this research.
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ADDRESS FOR CORRESPONDENCE: Marilyn E. Asselin,
PhD,
RN-BC, Adult and Child Nursing Department, College of
Nursing, University of Massachusetts, 285 Old Westport
Road, North Dartmouth, MA 02747-2300
(e-mail: [email protected]; [email protected]).
By Stacie McIe, RN, BSN, Trisha Petitte, RN, BSN, Lori Pride,
RN, BSN, Donna Leeper,
RN, BSN, and C. Lynne Ostrow, RN, EdD
Background Pressure dressings have been used as the standard
following sheath removal after percutaneous transluminal
angioplasty in many institutions. Patients complain about dis-
comfort while the dressing is in place, pain when the dressing
is removed after discharge, and skin complications afterward.
Many patients have experienced skin irritation where tape has
been applied. Nurses have also described difficulty assessing
the sheath insertion site in the groin when a pressure dressing
is in place.
Objectives To compare 3 different dressings with respect to
effect on bleeding, discomfort voiced by patients, and ease of
groin assessment in patients after percutaneous transluminal

coronary angiography.
Methods A total of 100 patients were randomly assigned to
1 of 3 groups: pressure dressing, transparent film dressing, or
adhesive bandage. Outcome variables were bleeding, patient
discomfort, and nurse-reported ease of observation of the
groin site.
Results No bleeding occurred in patients with transparent film
dressings or adhesive bandages. Patients rated these dressings
significantly higher than they rated the pressure dressing.
Because two-thirds of the sample had previously undergone
percutaneous transluminal coronary angiography, they could
compare their experience with the new dressing with previous
experiences with pressure dressings. Nurses rated the ease of
assessing the groin significantly higher for the transparent film
and adhesive bandage dressings than for pressure dressings.
Conclusions As a result of this study, a practice change was
made hospital-wide: rather than a standard opaque pressure
dressing, a transparent film dressing is used for all patients
after removal of a femoral sheath. (American Journal of Critical
Care. 2009;18:14-20)
14 AJCC AMERICAN JOURNAL OF CRITICAL CARE,
January 2009, Volume 18, No. 1 www.ajcconline.org
TRANSPARENT FILM
DRESSING VS PRESSURE
DRESSING AFTER PERCU-
TANEOUS TRANSLUMINAL
CORONARY ANGIOGRAPHY
C E 1.5 Hours
Notice to CE enrollees:
A closed-book, multiple-choice examination
following this article tests your under standing
of the following objectives:

1. Examine how the researchers determined
the best practice for dressing comfort and
ease of percutaneous transluminal coronary
angiography site assessment.
2. Describe how changes in practice were insti-
tuted through research.
3. Determine how this research process is
important to your practice.
To read this article and take the CE test online,
visit www.ajcconline.org and click “CE Articles in
This Issue.” No CE test fee for AACN members.
Evidence-Based Practice in Critical Care
©2009 American Association of Critical-Care Nurses
doi: 10.4037/ajcc2009949
Many patients have memories of discomfort
and skin irritation during and after dressing
removal. Specifically, patients’ complaints include
skin irritation, pain, pulling, rash, blisters, and skin
burns after the dressing is removed (see Figure).
The adult cardiac care units, the cardiac
catheterization laboratory, and the interventional
radiology department at West Virginia University
Hospital all used pressure dressings as the standard
after sheath removals. Nurses were concerned about
their inability to visualize the sheath removal site to
check for hematoma, bleeding, or groin complica-

tions at an early stage when the pressure dressing
was in place. They also were concerned for patients
who experienced discomfort, especially during and
after dressing removal.
Review of the Literature
A literature search of PubMed and CINAHL was
done by using the search terms dressings, bandages,
and catheterization and/or angioplasty. We found only
2 studies3,4 that addressed the issue of dressing type
after cardiac catheterization. In the first study,3
researchers compared traditional pressure dressing
by means of an elastic adhesive bandage (Tensoplast)
with use of a light transparent tape (Tegaderm). No
significant differences in bleeding were found between
the 2 groups, but the group that used the light trans-
parent tape reported significantly less pain and dis-
comfort. In the second study,4 a total of 739 patients
undergoing diagnostic catheterization or interven-
tional procedures were randomly assigned to receive
either a pressure dressing or an adhesive bandage.
The groups did not differ significantly in either inci-
dence or size of bruising or hematoma, or in the
frequency of complications such as pseudoa-
neurysm, embolism, or bleeding.
The authors4 concluded that the rou-
tine use of a pressure dressing was
unnecessary, and, as a result, the
institution where that study origi-
nated (in Edinburgh, Scotland) dis-
continued the use of pressure
dressings for all cardiac catheteriza-
tion patients.

The goal of our study was to
determine whether a change in the
type of dressing used after PTCA
reduced patients’ complaints and improved nurses’
abilities to assess the sheath insertion site after the
procedure while maintaining patients’ safety. Three
different types of dressings—transparent film,
A
ngioplasty, which was first performed in 1997 for treatment of
occluded coronary
arteries, is now used in more than 1 million patients a year in
the United States
alone.1 In 2005, a total of 1265000 percutaneous transluminal
coronary angio-
plasties (PTCAs) were performed.2 Nurses at West Virginia
University Hospitals,
Ruby Memorial, Morgantown, West Virginia, noted that the
type of dressing
used after PTCA sheath removal was a cause for concern,
especially for patients who had pre-
viously undergone PTCA and anticipated pain and discomfort
with the dressing because of
that experience.
About the Authors
Stacie McIe, Trisha Petitte, Lori Pride, and Donna Leeper
are nurses at West Virginia University Hospitals, Ruby
Memorial Hospital, Morgantown, West Virginia. C. Lynne
Ostrow is an associate professor at West Virginia Uni-
versity School of Nursing in Morgantown.
Corresponding author: C. Lynne Ostrow, RN, EdD, PO Box
9260, West Virginia University School of Nursing, Mor-

gantown, WV 26506 (e-mail: [email protected]).
www.ajcconline.org AJCC AMERICAN JOURNAL OF
CRITICAL CARE, January 2009, Volume 18, No. 1 15
Patients have
discomfort and
skin irritation
during and after
pressure dressing
removal.
Figure Skin breakdown across the posterior part of the thigh
where tape had been placed.
time was less than 150 seconds (eptifibatide) or less
than 200 seconds (bivalirudin). Mechanical pressure
was maintained with the FemoStop device for 60
minutes or manually for 30 minutes in each
patient. The sheath removal site was then dressed
with 1 of the 3 dressings as described earlier.
All 60 nurses employed on the unit where
patients were admitted after PTCA were trained to par-
ticipate in the study. The nurses assessed the patients
every 4 hours for complaints of discomfort in addition
to the routine checking of vital signs and assessment
of the groin site after sheath removal. The first assess-
ment of the groin site was made when the dressing
was applied, and additional assessments were done at
4-hour intervals after that. This frequency yielded a
mean of 4.7 (SD, 0.06) assessments per patient. The
nurses also recorded whether they were able to
observe the groin site directly and rated the ease of

assessment of the site for bleeding or hematoma for-
mation on a scale of 1 (difficult to assess) to 5 (easy to
assess). Patients’ complaints about the groin site were
noted during these assessments.
Patients were discharged 24 hours after admis-
sion and removed the dressing at home. A follow-
up telephone call was made within 48 to 72 hours
after discharge by a nurse investigator (T.P.). Patients
were asked to rate how comfortable it was to remove
the dressing and to rate the condition of the groin
site when the dressing was removed. In order to rate
the pain, patients were asked, “On a scale of 1 (very
comfortable) to 10 (painful), how comfortable was
it for you to remove the dressing?” The scale used
was based on the Numeric Pain Scale5 rating of 1
through 10 used in clinical nursing practice. Patients
also were asked if they had ever had a catheterization
with a pressure dressing before and, if so, how this
experience compared with the previous one. Patients
were given the opportunity to provide additional
comments about the experience. The nurse surveyor
recorded the comments verbatim.
Data Analysis
A power analysis was conducted on the basis
of previous work3 that showed a 40% difference
between the 2 groups (pressure dressing vs light
transparent tape) on the variable of discomfort.
Thus, in order to test for that same difference among
3 groups, 26 patients per group would yield 80%
power. The actual sample sizes of 32, 33, and 35
patients in each group yielded approximately 90%
power. Descriptive statistics, χ2 tests, and Kruskal-
Wallis tests were used to analyze the data from the

patients and nurses.
adhesive bandage, and pressure dressings—were
compared with respect to 3 outcomes: bleeding
after PTCA, satisfaction of patients, and ease of
nursing assessment of the sheath insertion site in
the groin. The study was conducted at
a tertiary care center (West Virginia
University Hospital, a level I trauma
center) that provides care for patients
undergoing elective and emergent per-
cutaneous coronary interventional pro-
cedures. The hypotheses for this study
were as follows:
• Bleeding complications will not
differ among the 3 dressing groups.
• Satisfaction will be higher
among patients with a transparent film dressing
and/or an adhesive bandage than in patients with a
pressure dressing.
• Nurses will rate ease of assessment of the groin
site higher in patients with a transparent film dress-
ing and/or an adhesive bandage than in patients with
a pressure dressing.
The study was approved by the institutional
review board at West Virginia University.
Methods
In this 3-arm experimental design, participants
were randomly assigned to 1 of 3 dressing conditions:

1. Pressure dressing: 4-in (10-cm) Elastikon
(Johnson & Johnson, New Brunswick, New Jersey)
elastic tape (3 pieces, each about 10-12 in [25-30 cm]
long) secured over 1 box of 4 x 4-in
(10 x 10-cm) gauze sponges
2. Transparent film dressing:
Opsite IV3000 Standard (Smith &
Nephew, London, England), a 4 x 5½-
in (10 x 14-cm) transparent dressing
applied over one 2 x 2-in (5 x 5-cm)
gauze sponge
3. Adhesive bandage: Flexible
adhesive bandage (Kendall, Covidien,
Mansville, Massachusetts), 4 x 2-in
(10 x 5-cm) opaque dressing applied
directly to the puncture site
Patients who underwent PTCA
with eptifibatide or bivalirudin and
sheath sizes ranging from 6F to 8F
were included in this study. Depending on the med-
ication used, patients’ sheaths were removed by
using either the manual technique or the FemoStop
device (RADI Medical Systems, Uppsala, Sweden).
Activated clotting times were measured hourly, and
sheaths were removed when the activated clotting
No bleeding was

noted when
either transpar-
ent film dressings
or adhesive band-
ages were used.
Ease of groin
assessment was
greater with both
the transparent
film dressing and
adhesive band-
age compared
with the pressure
dressing.
Results
A total of 213 patients gave consent to be in the
study. Of these, 100 had catheterizations that showed
stenosis and underwent angioplasty and stent place-
ment. The study sample was 68% men and 32%
women, with a mean age of 62 years (SD, 13.3).
The majority (67%) of the sample had previously
undergone catheterization. The mean number of
previous catheterizations per patient was 2.06 (SD,
2.83). The type of drugs received during catheteriza-
tions, type of pressure applied after sheath removal,
and activated clotting times are described in Table 1.
None of the demographic variables differed signifi-

cantly among the 3 dressing groups.
Patient Data
The 100 patients were each hospitalized for a
mean of approximately 24 hours if they had no
complications. After sheath removal, the mean num-
ber of hours until discharge was 14.8 (SD, 2.3).
Only 2 of the 100 patients, both in the pressure
dressing group, had bleeding after sheath removal.
One of these patients had a pseudoaneurysm. None
of the patients in the transparent film dressing or
adhesive bandage groups had any bleeding.
All but 4 patients were contacted via phone 48
to 72 hours after discharge. One patient had no
memory of the event, so the final telephone sample
was 95. A Kruskal-Wallis test was done to analyze
for any differences in scores on the pain rating scale
among the 3 dressing groups. Patients in the pressure
dressing group rated the experience of removing the
dressing as significantly more painful than did
patients in either of the other 2 groups (Table 2).
Patients in the transparent film group and patients
in the adhesive bandage group did not differ signifi-
cantly on this variable.
At each assessment from when the sheath was
removed to when the patient was discharged from
the hospital, the nurses recorded what complaints
(if any) the patients had about the groin site. A total
of 26 patients (79%) with a pressure dressing had 1
or several complaints about the groin site (Table 3).
Only 1 patient (3%) in the transparent dressing group
had a complaint (skin irritation), and 3 patients

(9%) in the adhesive bandage group had complaints.
Patients were also asked how this experience
compared with their last catheterization (67% of
the sample had experienced at least 1 catheteriza-
tion before this study, some at other institutions).
Table 4 shows patients’ assessments of the transpar-
ent film dressing and adhesive bandage compared
with prior pressure dressings.
The patients’ qualitative comments were coded
as either positive or negative depending on the words
they used to describe removal of the dressing. Almost
half (48%) of the patients in the pressure dressing
group had negative comments about the dressing.
Conversely, 71% of the transparent film dressing
group and 58% of the adhesive bandage group had
positive comments. Many negative comments about
previous pressure dressings were contained within
Table 1
Demographic data about the sample (N = 100)
Age, mean (SD), y
No. of previous catheterizations, mean (SD)
Activated clotting time, mean (SD), s
Sex, % of patients
Male
Female

First catheterization, % of patients
Yes
No
Drug during angioplasty, % of patients
Bivalirudin
Eptifibatide
Abciximab
Clopidogrel, % of patients
Yes
No
Aspirin, % of patients
Yes
No
Abciximab, % of patients
Yes
No
Tirofiban, % of patients
Yes
No
Eptifibatide, % of patients
Yes
No
Type of pressure applied, % of patients
Manual
FemStop device
62 (13.3)

2.06 (2.83)
163 (20.5)
68
32
30
67
51
31
11
78
18
74
24
13
81
1
95
30
66
60
40
a Percentages for some characteristics do not total 100 because
of missing data.
Characteristic Valuea

Table 2
Discomfort score by dressing
Pressure (n = 33)
Transparent film (n = 35)
Adhesive bandage (n = 32)
6.0 (0.67)a
2.5 (0.44)
2.0 (0.43)
a Kruskal-Wallis test, χ2 = 22.7, P < .001.
Type of dressing Mean score (SD)
the praise for the transparent film dressing or adhe-
sive bandage. Examples of actual statements by the
patients are presented in Table 5.
Nurse Data
Each patient had a minimum of 2 nurses (range,
2-4 nurses) who made the assessments every 4 hours.
The nurses were asked to respond to 2 questions at
each of these assessments. The first question was,
“Were you able to directly observe the groin site?”
Percentages of yes and no responses were averaged
for all nurses over all observation points. For the
transparent film dressing, 97% of the nurses answered

yes, as did 59% for the adhesive bandage group
(Table 6). Only 15% of the nurses in the pressure
dressing group said that they were able to observe the
groin site directly. These percentages are significantly
different from one another (χ2 = 47.2, P < .001).
The nurses also were asked to rate the ease of
assessment of the groin for bleeding or hematoma
once the dressing was in place. The scores were again
averaged for all nurses across all observation points
to determine a mean score for ease of observation.
Because the data were ordinal, a Kruskal-Wallis test
was done to assess for any differences in ease of
observation among the 3 types of dressings. A sig-
nificant χ2 of 67.1 (P < .001) was found (Table 7).
Mann-Whitney tests were used to determine which
pairs differed; differences were significant (P < .001)
between the pressure dressing and the transparent
film and between the pressure dressing and the
adhesive bandage, but not between the transparent
film and the adhesive bandage. Ease of observation
of the groin was rated significantly lower for the
pressure dressing group than for either the transpar-
ent film or adhesive bandage groups.
Discussion
No bleeding complications occurred in patients
in the transparent film or adhesive bandage dress-
ing groups, but 2 complications occurred in the
pressure dressing group. Patients rated the transpar-
ent film and adhesive bandage dressings as more
comfortable while the dressings were in place, easier
to remove at home, and better than their last expe-
rience with cardiac catheterization when they had
had a pressure dressing. Patients gave graphic com-

ments about the discomfort felt while the pressure
dressing was in place and after it was removed. In
contrast, patients in the transparent film and adhe-
sive bandage groups had positive comments about
the dressings and viewed them much more favor-
ably than pressure dressings. Although ratings for
the transparent film dressing were slightly higher
Table 4
Comparison of present dressing with pressure
dressing used in prior catheterization (n = 63)a,b
Pressure (n = 17)
2 (12)
24 (96)
18 (86)
7 (41)
1 (4)
1 (5)
6 (35) 2 (12)
2 (9)

Type of dressing Better Same Worse No memory
No. (%) of responses
Table 5
Examples of statements by patients
Pressure
Transparent
film
Adhesive
bandage
Rated as an 8 (10 being most painful) because of pain
associated with pulling hair off back of leg when
removing dressing.
Red welts all over his leg when tape came off.
Adhesive turned to glue in shower and became part
of my body.
Liked transparent dressing much better than pressure
dressing in past.
Dressing came off so easily.
Dressing this time was much better than pressure dressing.
Pressure dressing pulled skin off with last catheterization.
Lots better than when they used all tape in the hospital!
Much better than pressure dressing by far.

Dressing was a godsend. This dressing so much better.
It was much easier to walk around. Would recommend
to anyone having a catheterization.
More than better. “Fantastic.” Comes off easily.
You don’t have to pull, tug, scream, and yell.
Recommend the adhesive bandage to anyone. If he
has another catheterization, will not have that “big”
dressing again.
Type of dressing Statement
Table 3
Complaints about groin site while dressing in place
Pressure (n = 33)
a Includes itching, skin irritation, burning, tightness, and
pulling.
Type of dressing Complaints
No. (%) of
patients
Pulling
Discomfort
Anticipating pain on
removal of dressing

Several complaintsa
Skin irritation
Discomfort
Anticipating pain
Skin irritation/itching
5 (15)
3 (9)
4 (12)
14 (42)
1 (3)
1 (3)
1 (3)
1 (3)
a Percentages may not total 100 because of rounding.
b χ2 = 42.15, P < .001.
REFERENCES
1. National Heart, Lung, and Blood Institute. Diseases and
conditions index: what is coronary angioplasty? http://www

.nhlbi.nih.gov/health/dci/Diseases/Angioplasty/Angioplasty_
WhatIs.html. Published July 2007. Accessed October 2,
2008.
2. American Heart Association. Angioplasty and cardiac
revascularization statistics. http://www.americanheart.org/
presenter.jhtml?identifier=4439. Accessed October 5, 2008.
3. Boonbaichaiyapruck S, Hutayanon P, Chanthanamatta P, et
al. Groin dressing after cardiac catheterization. Comparison
among light dressing with thin transparent tape (Tega-
derm) and conventional tight/pressure dressing and elastic
adhesive bandage (Tensoplast). J Med Assoc Thai.
2001;84(12):1721-1728.
4. Robb C, McLean S. Using pressure dressings after femoral
artery sheath removal. Prof Nurse. 2000;15(6):371-374.
5. McCaffery M, Pasero C. Pain: Clinical Manual. St Louis,
MO: Elsevier Saunders; 1999.
6. American Association of Critical-Care Nurses. Procedure
Manual for Critical Care. 5th ed. St Louis, MO: Elsevier
Saunders; 2005.
To purchase electronic or print reprints, contact The
InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656.
Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax,
(949) 362-2049; e-mail, [email protected]
than ratings for the adhesive bandage, those differ-
ences were not statistically significant.
Nurses reported that they could directly observe
the groin for bleeding in patients with transparent
film or adhesive bandage dressings. Nurses also
reported greater ease in assessing the groin site with

both the transparent film dressing and the adhesive
bandage as opposed to the pressure dressing. Our
findings in relation to bleeding and increased com-
fort of patients are similar to results reported for
both earlier studies3,4 in which different types of
dressings were examined.
As a result of this research study, a practice
change has been instituted at West Virginia Univer-
sity Hospital. We discussed the study results with all
persons in the institution who had an interest in
the issue, including interventional radiologists, car-
diology physicians, and vascular surgeons, and
changes in policy and procedure were reviewed and
agreed on. Nursing staff were oriented to the policy
change via posters and staff meetings. The new pol-
icy was developed after review of the latest proce-
dure guidelines from the American Association of
Critical-Care Nurses6 and incorporates the changes
as a result of our research.
The results of our study, which had a 3-arm
experimental design, revealed significantly greater
satisfaction among patients after cardiac catheteriza-
tion when the sheath insertion site in the groin was
dressed with either a transparent dressing or a sim-
ple adhesive bandage rather than the standard pres-
sure dressing. Nurses also reported improved ease
of assessment of the groin site in patients with the
transparent film or adhesive bandage dressings.
Our report illustrates the process of making a
practice change based on research evidence. The
clinical problem of dissatisfaction among patients
was identified by the nurses caring for patients after
PTCA and spurred a review of literature on the topic.

Consultation with a faculty member in the school
of nursing enabled us to plan and implement this
study. The result has been an institution-wide change
in practice. Not only have patients benefited from
this change, but members of the nursing staff have
increased their knowledge, skills, and commitment
to evidence-based nursing practice.
FINANCIAL DISCLOSURES
None reported.
Table 6
Ability to directly observe the groin site
Pressure (n = 33)
(15)
(97)
(59)
(85)
(3)
(41)
28

1
13
5
34
19
a χ2 = 47.2, P < .001.
Type of dressing
No. (%) of dressings
Yesa No
Table 7
Ease of assessment of groin for bleeding or hematoma
Pressure
Transparent film
Adhesive bandage
2.12
4.04
3.73
0.63

0.28
0.99
a χ2 = 67.1, P < .001. Significant difference between pressure
dressing and the
other 2 types of dressings.
Type of dressing Mean scorea SD
eLetters
Now that you’ve read the article, create or contribute to an
online discussion on this topic. Visit www.ajcconline.org
and click “Respond to This Article” in either the full-text or
PDF view of the article.
Running head: TITLE OF PAPER 1
TITLE OF PAPER 5
This is the format for the title page used for every assignment at
Walden. Refer to APA resource materials for additional
information on title pages. For all other pages check APA
resources for information on page headers, page numbers, level
one headings and the reference page.

Title of Paper
Student’s Full Name
Course Number, Section number, and Title
Month, Day, Year
Title of Paper
Below is some information related to the article review
(Week 3 Assignment). Be certain that your paper has all of the
components of a paper written in APA format: title page,
introduction, purpose statement, headings, summary and
reference list.
Always add a title page. Your title can be anything that
you feel is appropriate. Then, on page 2, write a brief
introduction and purpose statement. Use Level 2 headings for
each section of the research article. Remember to use in text
citations just as you would for any other scholarly writing.
For this assignment, select two research studies from the
list of articles provided in Doc Sharing. One of the studies
selected needs to be a qualitative. Write a three to four -page
summary of each of the articles (total of 5-6 pages), and after
summarizing each, explain why you think each is a strong or
weak study. Use the following guidelines and evaluation criteria
to guide your paper. Use the headings below for each section.
Include the reference for each of the articles.
Overview of Quantitative Article--45 points
Level 1 heading
Level 2 heading
Research Question
In this section of the paper, identify the research question

and discuss briefly according to information found in Chapter 3
(Adams, 2012) of the Schmidt and Brown (2012) text
book.Provide the name of the article with an in text citation so
that the instructor knows which article is being reviewed. The in
text citation for the article must be included in each
section/paragraph below.
Study Design
In this section identify whether the study is quantitative or
qualitative. Then discuss the specific design. Information is
found in Chapters 6, 7 and 8.
Sample Size and Representativeness
Identify the size of the sample and whether is it
representative of the population.
Results of Data Analysis
Present the results of the data analysis and discuss the
analysis procedures. Be specific about the procedures used and
actual findings. Identify the statistical test used in the research
study.List the statistical results of the test used in the research
study. This will include all of the statistical results, not just the
p value.Identify whether the results of the statistical analysis
were significant. Include the p value for the tests that are
statistically significant.
Summary of Strengths and Weaknesses--45 points
Identify the strengths and weaknesses of the study.
Remember to use the textbook for supporting citation and
referencewhen making this evaluation so that quantitative
studies are evaluated for reliability and validity.
Overview of Qualitative Article --45 points
Research Question In this section of the paper, identify
the research question and discuss briefly according to
information found in Chapter 3 of the Schmidt and Brown
(2012) text book. Provide the name of the article with an in text
citation so that the instructor knows which article is being
reviewed. The in text citation for the article must be included in
each section/paragraph below.
Study Design

In this section identify whether the study is quantitative or
qualitative. Then discuss the specific design. Information is
found in Chapters 6, 7 and 8.
Sample Size and Representativeness
Identify the size of the sample and whether is it
representative of the population. Remember that the criteria for
evaluating a qualitative sample aredifferent from evaluating a
quantitative sample.
Results of Data Analysis Procedures
Present the results of the data analysis and the themes
identified. Be certain to describe the data analysis procedures
used.
Summary of Strengths and Weaknesses--45 points
Identify the strengths and weaknesses of the study.
Remember to use the textbook for supporting citation and
reference when making this evaluation. Qualitative studies are
evaluated for trustworthiness (credibility, transferability,
dependability and confirmability).
Summary of the Main Points of the Paper
Always summarize the main points of a paper. A brief summary
of the articles reviewed is sufficient. On a separate page add
the references which are the citations for each of the articles
reviewed and any other sources that you used for the paper.
References
Adams, S. (2012). Identifying research questions.In N.A.
Schmidt & J.M. Brown. (Eds.). Evidence-based practice for
nurses: Appraisal and application of research. (2nd ed., pp. 66-
87). Sudbury, MA: Jones & Bartlett Learning.
The correct citation of each article is worth 15 points so the
citation of the two articles reviewed is worth 30 points.
NOTE: Format/style
Proofread the paper as described in the tips for success in this
course and correct any typos, grammar, spelling, punctuation,

syntax, or APA format errors before submitting your paper to
Turnitin. Up to 40 points can be deducted from the grade for
this assignment for these types of errors, or for not using at
least the minimum number of required references.
Total possible points for assignment = 210 points
Application
Analyzing the Research
For the Week 3 Application, you will select two articles from a
list, identify the components of a research project and evaluate
the strengths and weaknesses of the articles.
· Select two studies from the list of articles provided in Doc
Sharing. The articles are accessed through the Course Readings
in the Library. Look for the Week 3 Articles tab.
· Choose one quantitative article and one qualitative article.
· Review each selected article based on what you have learned
about study design, identifying information from each
component of the study.
· Evaluate the strengths and weaknesses of each study.
· Based on your review, write a 6-7-page summary of the two
articles using the NURS 4000 Week 3 Assignment Rubric.
· Identify each component of the research article as outlined in
the rubric.
Explain why each is a strong or weak study based upon criteria
for reliability and validity for quantitative studies. Use criteria
for trustworthiness for qualitative studies. Refer to your
textbook for information related to evaluation of research.
· Readings
· Course Text: Evidence-Based Practice for Nurses: Appraisal
and Application of Research

·
2. Chapter 5, "Linking Theory, Research, and Practice"
This chapter begins by exploring the relationship between
theory, research, and nursing practice. It then covers the
language of research, including specific terminology. The
chapter illustrates how scientific research supports nursing
practice and how nursing practice informs scientific research.
2. Chapter 7, "Quantitative Designs: Using Numbers to Provide
Evidence"
Quantitative research designs seek to explain a phenomenon
through numerical findings. This chapter discusses key concepts
related to quantitative design, different types of quantitative
studies, and strategies nurses can use to appraise quantitative
research study designs presented in the literature.
2. Chapter 8, "Qualitative Designs: Using Words to Provide
Evidence"
Chapter 8 defines qualitative research as the focus on words
instead of numbers to give meaning to phenomena. This chapter
discusses four major types of qualitative research as well as
different sources of data. Strategies for evaluating qualitative
study designs are also presented.
2. Chapter 9, "Collecting Evidence"
This chapter describes the process of planning data collection.
The authors cover methods of collecting quantitative and
qualitative data while stressing the importance of recognizing
validity and measurement error.

2. Review this completed Journal Club Template for one
example of how this document is used to support the evaluation
of a research article. The article reviewed for this template is:
5. Hurlbut, J.M., Robbins, L.K. & Hoke, M.M. (2011).
Correlations between spirituality and health-promoting
behaviors among sheltered homeless women. Journal of
Community Health Nursing, 28(2), 81-91.
DOI:10.1080/07370016.2011.564064
2. This PDF version of a PowerPoint presentation presents
another example of how an article evaluation can be presented
to a journal club:
6. Mulligan, E. (2001). Healthsouth Orthopedic Extremity/Foot-
Ankle Journal Club. Retrieved from http://www.continuing-
ed.cc/newsletter/Thessaly%20Test%20Journal%20Club%20hand
out.pdf
. Articles
3. Schmelzer, M. (2004). Understanding statistics: What is
alpha (á)? Gastroenterology Nursing, 27(6), 292–293.
Use the Ovid Nursing Journals Full Text database, and search
using the article's author, title, or journal title.
This article, written by a nurse, explains the alpha statistic.
Using common examples, such as tossing a coin, the author
describes what the alpha statistic represents and suggests
strategies for evaluating the statistical analysis of a research
study.
.
4. Schmelzer, M. (2000). Understanding the research
methodology: Should we trust the researchers' conclusions?
Gastroenterology Nursing, 23(6), 269–274.

Use the Ovid Nursing Journals Full Text database, and search
using the article's author, title, or journal title.
In this article, Dr. Schmelzer discusses strategies for evaluating
the methodology of a research study. She also examines the
statistics presented in the methodology section and explains
common statistical terms.

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