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222 Advances in Neonatal Care • Vol. 7, No. 5 • pp. 222-229

Imagine, as you read this, your heel being piercedand sliced open with a sharp lance, and the pres-sure of a hand squeezing around your foot. Our

thoughts of discomfort have been a lived reality fornewborn babies undergoing blood testing. Tradi-tionally, heel stick has been the only blood collectionmethod used in the well infant. It has been perceivedas a relatively benign procedure requiring only oneindividual to perform the test, whether in the home,office, clinic, or hospital. However, the process is notalways straightforward. The frustrations and potentialhazards include: insufficient blood sampling, multipleskin punctures to obtain the required amount, bruisingand heel scarring, and distressed infants.1 In addition,heel sticks do elicit painful responses in newborns,specifically crying and increased heart rate.2 Yet criti-

Implementation and Evaluation of a Best Practice InitiativeVenipuncture in the Well Baby

Susan Jewell, RN, MSc, IBCLC,1 Jennifer Medves, RN, PhD,2 Lenora Duhn, RN, MSc,1

Kathy Boomhower, RN,1 Julie-Ann Barrett, RN, BScN,1 Eleanor Rivoire, RN, MSc1,3

cal, mandatory genetic screening on every baby andoccasional sampling for hemoglobin, glucose, and bili-rubin require nurses to obtain blood frequently inwell infants. As a result of these issues, a number ofstudies have investigated methods to increase the rateof success in obtaining samples,3,4 infant pain per-ception,5,6 and comfort measures to minimize theexperience of pain during this noxious episode.7–9

Researchers and clinicians recognize that if the methodof blood sampling changes, then the safety and effi-ciency of the new practice must be evidence-based andan evaluation completed.

In 2001, the nursing staff at the Kingston GeneralHospital in Ontario, Canada, was notified that thelancets they were using for capillary blood samplingwould no longer be available as they could be inserteddeeper into the heel than recommended standards.To avoid lancet penetration of the calcaneus bone, theliterature indicates the puncture should be no deeperthan 2.4mm.10 A comprehensive review of the lancetsavailable in Canada was completed. These lancets didnot provide results acceptable to the nurses as infantsended up having multiple heel sticks to obtain a suffi-cient sample for testing.

In collaboration, the nurses, managers, educators,and researchers in the hospital and local universitydecided to explore this issue. This resulted in thedevelopment of a procedure for venipuncture in the

Address correspondence to Susan Jewell, RN, MSc, IBCLC,Clinical Education, Obstetrics/Gynecology Program, KingstonGeneral Hospital, Kidd 5 76 Stuart Street, Kingston, Ontario, Canada K7L 2V7.E-mail: [email protected] 1Kingston General Hospital; 2Queen’s University, Schoolof Nursing; and 3Quinte Health Care, all in southeasternOntario, Canada.Copyright © 2007 by the National Association of Neonatal Nurses.

ABSTRACTVenipuncture is now the standard method of phlebotomy for well newborn infants at Kingston General Hospital (KGH),Canada. Newborn infants require at least one blood sample for mandatory genetic screening. Some will require additionalsamples for monitoring of hyperbilirubinemia or other laboratory tests. A change from capillary heel sticks to venipunc-ture was implemented when the lancets in use were discontinued and a suitable replacement could not be found at thetime. A review of the literature discovered a Cochrane Neonatal Review that supported newborn venipuncture as a safe,pain-reducing practice when performed by trained phlebotomists. As a result, a quality improvement project was devel-oped to implement the practice of venipuncture for the well newborn. The implementation and evaluation included lec-tures, demonstrations, return demonstrations, and eventual integration into clinical practice. Process and summativeevaluation demonstrated a willingness of staff to learn a new procedure, particularly when they had identified the needfor change. In addition, infants were not subjected to multiple, ineffective blood draws.KEY WORDS: clinical practice, evidence-based practice, implementation of best practice, newborn venipuncture

MARY A. SHORT, RN, MSN • Section Editor

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Implementation and Evaluation of a Best Practice Initiative 223

well baby. The group decided to implement and eval-uate this procedure to determine what gains, if any,would result with this process of blood collection. Itwas believed that with improved blood collectionseveral goals would be achieved. Firstly, staff frustra-tion would decrease given the use of a more efficient,timely, and effective method of blood collection.Secondly, a decreased frequency of blood draws woulddiminish infant pain. Thirdly, the actual technique ofthis particular blood collection process would alsoreduce infant pain.

A literature review was conducted accessing severaldatabases (CINAHL, MEDLINE, and the CochraneNeonatal Review) using the keywords: newborn meta-bolic screening, phlebotomy, blood sampling, andneonatal pain response. One systematic review ofvenipuncture was located in the Cochrane NeonatalReview database. The authors concluded that whena trained phlebotomist performs venipuncture, themethod is preferable to heel stick. The analysis demon-strated that for each of two venipunctures, the need forone additional skin puncture was avoided.11

The Cochrane neonatal review at the time of inves-tigation included two studies that met the criteria ofrandomized trial, with control groups.11 The metaanalysis of data from the two studies was difficultbecause the researchers used different scales for assess-ing newborn pain. However, both studies concludedthat venipuncture was less painful for the babies. Onestudy, randomly assigned 27 healthy full-term babiesto one of two groups.12 One group (n = 14) experiencedheel sticks, while the second group (n = 13) had a veni-puncture performed for blood sampling. Four babiesin the first group and one in the second group requireda second stick to obtain a sample. The Neonatal InfantPain Scale (NIPS) score was similar in both groupsprior to and after the procedure, but there were signif-icant differences in the scores assessed during the pro-cedure (P < .001). Anecdotally, mothers perceivedthat their infants experienced less pain in the veni-puncture group.

The second study randomly allocated 120 full-termbabies to one of three groups.13 Group One (n = 50) hadvenipuncture, Group Two (n = 50) had a heel stick witha small lancet, and Group Three had a heel stick witha large lancet (n = 20). Perceived pain was assessedusing the Neonatal Facial Coding System (NFCS)developed by Grunau and Craig.14 The observers whoanalyzed the data were blind to group assignment. Thetime to completion of sampling was shorter in the veni-puncture group compared to the short lancet group(191 seconds compared to 419 seconds), requiredonly one skin puncture (43/50 versus 9/47), andthe total duration of cry was shorter (P <.001). Theauthors concluded that venipuncture is more effectiveand less painful for obtaining blood samples inneonates. In summary, limited studies have reportedthat venipuncture reduces infant pain, reduces the

number of attempts required to obtain blood, and effi-ciency increases once practitioners feel competent.The implications for practice include venipuncture isa viable option that could be viewed as the method ofchoice for blood sampling in term infants.

THE SETTING

Kingston General Hospital is an academic health sci-ences centre based in south eastern Ontario, Canada.At the time, the maternity unit had 24 combined carebeds for obstetrics, 15 gynecology beds, and 2 pedi-atric beds. Traditionally, nurses working in the obstet-rical unit are certified in adult venipuncture and new-born capillary blood sampling. During this time theinstitution incorporated pain as the 5th vital sign intoall documentation in order to help reduce the burdenof pain experienced by inpatients. This initiative wasa conscious effort by all healthcare professionals toensure pain assessments, treatments, and evaluationswere carried out as part of the normal care for all inpa-tients. While a formal newborn pain assessment scalehas not been adopted on the postpartum unit, nursesare acutely aware of pain indicators, particularly facialactions.14

PROCESS AND RESULTS

In September 2001, following completion of the liter-ature review, the Clinical Nurse Specialist, and theClinical Educator in consultation with the staff nursesof the postpartum unit developed a step-by-step pro-cedure for taking blood in well babies (Appendix A).The procedure was to access a vein in the back ofeither hand using a 25 gauge butterfly needle. Eachnurse received a printed copy of the procedure.Physicians and other healthcare professionals werenotified through existing channels which includedprogram meetings, and electronic communications.Education sessions provided opportunities to reviewthe literature, discuss the implications, and adopt theprocedure. Educators and managers identified expe-rienced nurses as the expert practitioners to facilitatelearning.15 A train-the-trainer process was imple-mented with the Clinical Nurse Specialist and Cli-nical Educator demonstrating the process and eachpostpartum nurse giving return demonstrations. Asuccessful return demonstration of a newborn veni-puncture was the criterion for certification within theinstitution, given staff were already certified in adultvenipuncture.

The change in procedure was perceived positivelyby staff nurses because they quickly learned the newprocedure and recognized the benefits to both theirpractice and the baby. To make the change, it wasimportant that it occur in a timely manner, thereforeintensive training occurred over one month for allnursing staff. A survey completed by staff nurses in the


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224 Jewell et al

TABLE 1. Years of Maternal-Child Nursing Experience versus Total Nursing ExperienceYears of Experience Number of RNs With Maternal-Child Experience Number of RNs & Total Nursing Experience

<1 year 4 3

1–4 years 6 4

4–5 years 3 2

5–10 years 2 4

>10 years 11 13

TABLE 2. RNs Self-Rating of Competency in Capillary Blood Sampling Versus VenipuncturePre-Change Post-Change

Capillary Blood Adult Venipuncture Newborn Venipuncture Sampling Sampling Sampling

Competency Rating according to Benner’s Model

Novice* 4 1 1

Competent† 2 0 3

Proficient‡ 6 7 22

Expert§ 14 18 0

*Performs basic-level skills in a step-by-step fashion. Requires help and guidance.†Makes considerable progress acquiring skills within the domains of nursing practice. Demonstrates improved skills.‡Has achieved skills to consistently provide care, which meets the unit’s standards of practice.§Has mastered skills in all domains of nursing, strives to adopt evidence-based practice and mentors others.

spring of 2002 assessed the implementation of veni-puncture into the unit. The survey (Appendix B) wasbased on the Novice to Expert Model.15 Staff com-pleted a self-evaluation of their skills in capillary bloodsampling (pre-change in practice) and their skills in newborn venipuncture (post-change in practice).Thirty-two surveys were distributed with a return rateof 62.5%. An additional 6 surveys were completedby the nurses in the perinatal float pool. There was arange of nursing experience with 50% having greaterthan 10 years of total nursing experience, and 42%having more than 10 years maternal-child experience(Table 1). The majority of nurses rated themselves asproficient to expert in performing heel sticks (77%)and adult venipuncture (96%). Six months after imple-mentation of newborn venipuncture, the majority ofstaff (85%) rated themselves as proficient in the skill ofnewborn venipuncture (Table 2).

Staff (92%) indicated that they were trying veni-puncture first, and only proceeding to capillary bloodsampling if they were unable to obtain a sample.Indicators of a successful change included the reasons

provided by staff such as the ease of obtaining samples,saved time, decreased trauma for the newborn, andfewer incidences of clotted samples which resultedin fewer occurrences of repeat sampling. Even thoughthe procedure requires two nurses, the process isviewed as less time consuming, less painful to theinfant, and an easier technique for blood collection.The reasons cited for not performing venipunctureincluded if the infants had very fat hands and the veinswere not visible. Since that time, this same issue hasbeen reported in the literature.16

Two random clinical audits were conducted a yearapart to determine the frequency of venipunctureversus heel stick. The audit specifically involved asses-sing the infant’s skin to determine if blood samplingwas performed by venipuncture or heel stick. In add-ition, the venipuncture site was examined to ascer-tain if more than one attempt had been made toobtain a sample. Each well baby’s chart was reviewedto confirm these findings. In the first audit (con-ducted 6 months after implementation of the newpractice change), 70% of the babies audited had one



site on the back of their hand. In the second audit allinfants had only one site. That is, all babies hadblood obtained through venipuncture, and no infanthad a heel stick.

DISCUSSION

Implementation of evidence-based practice can bechallenging. However, evaluation of current practice,and change as required, ensures care is evidence-based. Implementation of change is often simplerwhen there is a perception that the change will providean immediate improvement to patient care. Nursesseek guidance from research findings when practice isperceived as unsatisfactory for the patient.

Nursing shortages influence the level of expertise onclinical units. In our unit, over the past five years, therehas been a significant shift in competency, as 50% ofstaff are new graduates in their first nursing position.The model of Novice to Expert developed by Benner15

was the conceptual framework that guided this imple-mentation and evaluation, as this particular change wasrecognized as challenging the nurses’ self-concept ofexpertise. The novice nurse accepts evidence-basedpractice as it is taught and modelled by the expertnurses. The novice nurses were initially taught the the-ory in orientation and practised in the clinical settingwith their preceptor. For the novice nurse, well babyvenipuncture is the standard of care.

The expert nurses were the first to identify the tech-nical problems associated with capillary blood sam-pling. In addition, the need for evidence-based prac-tice allowed for change. The expert nurses were opento a new approach as it presented a practical, safe andacceptable alternative in our setting. Initially, as theylearned the skill, expert staff rated their competencyin venipuncture at a lower level as compared to theircompetency in capillary blood sampling. Two yearslater, all nursing staff, novices and experts, usedvenipuncture as the first route for blood sampling.New staff nurses are now less familiar with the tech-nique of capillary blood sampling, though they arestill required to be certified in the skill as an alterna-tive approach.

Anecdotally, the nurses described their experienceswith this change in practice. Overall, they noted thatthe new procedure appeared to be less distressing forthe well baby, as demonstrated in their facial expres-sions and patterns of reduced crying. It was believedthat this was related to a number of variables whichincluded: reduced procedure time, fewer attemptsneeded to obtain a sample, and a heightened techni-cal proficiency. Although a formal cost-benefit analy-sis was not completed, inclusion of a second nurse forprocedural assistance could be argued as less costeffective. However, given the reduced duration of theintervention, and the comfort measures provided by

the second nurse, the gains for the baby outweigh thisargument.

Additional benefits of venipuncture included greatercontrol over the blood collection process. Specifically,with newborn genetic screening, it allowed the nurse tocorrectly and completely fill each circle on the filterpaper, ensuring complete penetration and saturation.The technique permitted precise volumes of blood tobe withdrawn, which is particularly important to avoidnon-sufficient testing quantities.

IMPLICATIONS FOR CLINICAL PRACTICE

Evidence-based practice is the goal of all nursing prac-tice. Best practice guidelines are based on the bestavailable evidence, patient preference, educationand expertise of providers, and resources.17 Theprocess and development of these particular practiceguidelines can serve as a model for change, drivenby clinical nurses. The nursing staff identified the issue,sought supporting resources, and was keen to trial anew initiative that was believed to be of benefit forboth staff and babies. This change process requiredstaff to learn a new skill, and in the process, challengetheir own self-concept of expertise in the care of thewell baby. Difficulties were identified but the com-mitment to innovation, with the goal of improvedcare, overcame the obstacles. The train-the-trainermethod worked very well because of the inclusion ofall staff as change agents, and the backing of the bestavailable evidence.

Today, there is increasing advocacy for the useof venipuncture. Consensus and policy statementsfrom national and international groups promote theuse of venipuncture instead of heel lance.18,19 TheCochrane Database of Systematic Reviews20 alsoincludes updated information in support of venipunc-ture with the inclusion of two more eligible studies onfull-term newborns. Despite the fact that the painassessment measures were again different in eachstudy, outcomes were similar.16,21 Interestingly, onegroup of investigators challenges our thinking onwhether the practice of heel lancing is ‘ethically justi-fiable’ if studies continue to produce such results.16 Arandomised, double blind, placebo controlled trialinvolving 100 healthy full-term newborn infants thatwas not reported in the Cochrane Reviews, publishedsimilar results, noting that venipuncture is less painfuland more effective than heel lance.22

As such, this practice change has implications inother clinical areas. Emergency departments, paedi-atric units, and clinic settings where capillary bloodsampling is still the dominant method of blood collec-tion, instead, could consider venipuncture given itspotential benefits. In addition, ongoing review andevaluation of this process at a unit level will allow forassurance of its continued success, and insight into pos-sible additional comfort measures to complement the




226 Jewell et al

pain-reducing aspect of this technique such as theinclusion of a topical anaesthetic.

IMPLICATIONS FOR FUTURE RESEARCH

Future research studies can and must consider addi-tional approaches to address the issue of neonatal pro-cedural pain. These must focus on clinical utility andfeasibility, so that the ever-changing practice environ-ment is indeed supported and enhanced in a mean-ingful way.

In considering this particular practice issue, furtherinvestigation into accompanying comfort measureswould be significant. For example, there appears to beonly one study examining the analgesic effect ofbreastfeeding specifically on venipuncture in the termnewborn infant,23 and while it appears to effectivelyreduce pain response, it begs the question of whetherwe know enough about promoting breastfeedingduring venipuncture. There is also limited existingresearch on the use of breast milk as an analgesic, withone study investigating breast milk versus distilledwater on full-term infants undergoing venipuncture,24

and another study examining the analgesic effect of25% sucrose, breast milk and sterile water in full-terminfants undergoing heel lance.25 The findings fromthese two studies in regard to breast milk had conflict-ing results, suggesting the need for further research inthis area, targeting venipuncture as the blood collec-tion method. Consideration of environmental stimu-lants, such as sound and lighting, as well as explorationinto combining a number of therapies (breastfeeding;sucrose; skin-to-skin care; topical anaesthetic) whilebabies undergo venipuncture would generate newknowledge regarding this clinical issue that affectsevery newborn baby.

CONCLUSION

The richness of research begins and ends in theclinical setting. This experience clearly demonstratedthe value of research to our staff. They identified theresearch question, targeted their resources for prob-lem-solving, and participated in an evaluation process.The findings then supported the clinical decision tocontinue the practice of venipuncture in the well new-born. There is now a heightened expectation that therewill continue to be innovative best practice initiativesimplemented in the unit to benefit staff and patientsalike. While we now know that venipuncture mayreduce pain response in babies, it is not a pain-free pro-cedure.26 Ever mindful of this fact, we continue to seeknew innovations and approaches to care.

AcknowledgmentsThe clinical nurses on the postpartum unit at theKingston General Hospital are gratefully acknowl-edged for their spirit of inquiry and dedication regard-ing this initiative. Their contributions to each step inthis journey were invaluable.

References1. Logan P. Venipuncture versus heel prick for the collection of the newborn

screening test. Aust J Adv Nurs. 1999;17:30-36.2. Owens ME, Todt EH. Pain in infancy: neonatal reaction to a heel lance. Pain.

1984;20:77-86.3. Barker D, Willetts B, Cappendijk V, Rutter N. Capillary blood sampling: should

the heel be warmed? Arch Dis Child Fetal Neonatal Ed. 1996;74:F139-F140.4. Moxley S. Neonatal heel puncture. Can Nurse. 1989;85:25-27.5. Hadjistavropoulos H, Craig K, Grunau R, Whitfield M. Judging pain in

infants: behavioural, contextual, and developmental determinants. Pain.1997;73:319-324.

6. Jain A, Rutter N, Ratnayaka M. Topical amethocaine gel for pain relief ofheel prick blood sampling: a randomised double blind controlled trial. ArchDis Child Fetal Neonatal Ed. 2001;84:F56-F59.

7. Carbajal R, Chauvet X, Couderc S, Olivier-Martin M. Randomised trial ofanalgesic effects of sucrose, glucose and pacifiers in term neonates. BMJ.1999;319(7222):1393-1397.

8. Haouari N, Wood C, Griffiths G, Levene M. The analgesic effect of sucrosein full term infants: a randomised controlled trial. BMJ. 1995;310(6993):1498-1500.

9. Ramenghi LA, Griffiths GC, Wood CM, Levene MI. Effect of non-sucrosesweet tasting solution on neonatal heel prick responses. Arch Dis Child FetalNeonatal Ed. 1996;74:F129-F131.

10. Wong DL. Whaley & Wong’s Nursing Care of Infants and Children. 6th ed.St. Louis, MO: Mosby; 1999.

11. Shah V, Ohlsson A. Venipuncture versus heel lance for blood sampling interm neonates (Cochrane Review). In: The Cochrane Library, Issue 1, 2000.Oxford: Update Software.

12. Shah V, Taddio A, Bennett S, Speidel B. Neonatal pain response to heel stick vsvenepuncture for routine blood sampling. Arch Dis Child. 1997;77:F143-F144.

13. Larsson BA, Tannfeldt G, Lagercrantz H, Olsson G. Venipuncture is moreeffective and less painful than heel lancing for blood tests in neonates.Pediatrics. 1998;101:882-886.

14. Grunau RV, Craig KD. Pain expression in neonates: facial action and cry.Pain. 1987;28:395-410.

15. Benner P. From novice to expert. Am J Nurs. 1982;82:402-407.16. Kvist LJ, Jonsson K, Tornestrand BM, Mansson ME. Can venepuncture reduce

the pain of neonatal PKU-sampling? A randomised study. Vard i Norden.2002;22:27-30.

17. DiCenso A, Cullum N, Ciliska D. Implementing evidence-based nursing:some misconceptions. Evid Based Nurs. 1998;1(2):38-40.

18. American Academy of Pediatrics/Canadian Paediatric Society. Prevention andmanagement of pain in the neonate: an update. Pediatrics. 2006;118(5):2231-2241.

19. Anand KJS, the International Evidence-Based Group for Neonatal Pain.Consensus statement for the prevention and management of pain in thenewborn. Arch Pediatr Adolesc Med. 2001;155:173-180.

20. Shah V, Ohlsson A. Venepuncture versus heel lance for blood sampling interm neonates. Cochrane Database Syst Rev. 2007;1.

21. Eriksson M, Gradin M, Schollin J. Oral glucose and venepuncture reduceblood sampling pain in newborns. Early Hum Dev. 1999;55:211-218.

22. Ogawa S, Ogihara T, Fujiwara E, et al. Venepuncture is preferable to heellance for blood sampling in term neonates. Arch Dis Child Fetal NeonatalEd. 2005;90:F432-F436.

23. Carbajal R, Veerapen S, Couderc S, Jugie M, Ville Y. Analgesic effect ofbreast feeding in term neonates: randomised controlled trial. BMJ. 2003;326(7379):13-15.

24. Upadhyay A, Aggarwal R, Narayan S, Joshi M, Paul VK, Deorari AK. Analgesiceffect of expressed breast milk in procedural pain in term neonates: a ran-domized, placebo-controlled, double-blind trial. Acta Paediatr. 2004;93:518-522.

25. Ors R, Ozek E, Baysoy G, et al. Comparison of sucrose and human milk on painresponse in newborns. Eur J Pediatr. 1999;158:63-66.

26. Taksande AM, Vilhekar KY, Jain M, Chitre D. Pain response of neonates tovenipuncture. Indian J Pediatr. 2005;72:751-753.



APPENDIX A

KINGSTON GENERAL HOSPITAL NEWBORN VENIPUNCTURE PROCEDURE

The procedure is similar to that for the adult, as follows:

Equipment required:• Gloves• 25-Gauge butterfly needle• 1-mL syringe• Alcohol swab• Newborn Screening form• Rubber band to act as tourniquet• Infant warm pack

Procedure:• Wrap the baby so that only the limb to be used for blood work is exposed. The venipuncture should be

completed at the bedside with the mother present. If the mother does not wish to be present, the proce-dure can be completed in a procedure room.

• Place the baby in mother’s or father’s arms or on a firm, secure surface.• Apply gloves.• Identify the most suitable vein, either in the hand or the brachial vein.• Warm the area using the infant warm pack.• You may require the assistance of a second nurse to draw back on the syringe when venous access is

achieved. The second nurse can also glove one hand to offer, as a pacifier, if the procedure is being com-pleted without the presence of the mother and the baby is upset.

• Apply the elastic band as a tourniquet above the site and stabilize the site.• Visualize the vein, cleanse the site with the alcohol swab, allow to air dry, then access with the butterfly

needle with the bevel of the needle upward.• Once flashback of blood is obtained, let the blood travel down the butterfly as far as it would go based

on gravity. When blood flow ceases, attach the TB syringe and aspirate gently. Forceful pulling on theplunger may collapse the vein. As blood slows, you may need to release the tourniquet.

• Withdraw approximately 0.4 mL for a newborn screening test. If additional blood work is required (biliru-bin, CBC), more blood will be required.

• Once blood is obtained, withdraw the butterfly and apply pressure to the site.• Fill the filter paper circles on the newborn screening form in order from 1 to 5.• Ensure that the form is completed correctly.• Occasionally, sufficient blood may not be aspirated into the syringe. Use whatever amount was collected

to complete the first circle on the newborn screening form. If blood is flowing freely from the venipunc-ture site after the butterfly is removed, you may be able to obtain a sufficient amount for the remainingcircles. Do not pump the hand or aggressively squeeze around the puncture site because this will lead toa hematoma. If unsuccessful, use an alternate site/method or have a colleague attempt the procedure.




228 Jewell et al

APPENDIX B

Evaluation of Implementation of Venipuncture for Obtaining Blood Samples in the Newborn (ie. GeneticScreening, Bilirubin)

Would all staff please complete the following evaluation form and return your completed form to theClinical Educator. Thank you for your assistance in this process.

Please indicate the following:Kidd/Davies 5 staff__________Perinatal Float Pool staff_________

Years of Maternal-Child experience:

<1 year____ 1–4 years____ 4–5 years____ 5–10 years____ >10 years_____

Years of Total Nursing Experience:

<1 year____ 1–4 years____ 4–5 years____ 5–10 years____ >10 years_____

Definitions:1. Performs basic-level skills in a step-by-step fashion. Requires help and guidance.2. Makes considerable progress acquiring skills within the domains of nursing practice. Demonstrates

improved skills.3. Has achieved skills to consistently provide care, which meets the unit’s standards of practice.4. Has mastered skills in all domains of nursing, strives to adopt evidence-based practice and mentors others.

Benner P. From novice to expert. Am J Nurs. 1982;82(3):402-407.Logan J, Boss M. Nurses’ learning patterns. Can Nurse. 1993;89(3):18-22.

Questions:

1. Prior to the initiation of venipuncture for newborn blood work, where would you have rated your com-petency level in the completion of capillary blood sampling (heel prick).

1.______ 2.______ 3.______ 4.______ (see definitions at the beginning)

2. Prior to the initiation of venipuncture for newborn blood work, where would you have rated your com-petency level in adult venipuncture.

1.______ 2.______ 3.______ 4.______ (see definitions at the beginning)

3. Indicate the reasons that helped motivate you to change from capillary blood sampling to venipuncturein the newborn (More than one reason can be indicated.)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Are you consistently trying venipuncture first to obtain newborn blood work?YES__________ NO_________

5. Please indicate reasons as to why you are using venipuncture.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6. Please indicate reasons as to why you are not using venipuncture.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

7. Please indicate an approximate number of newborn venipunctures that you have completed.____________



8. Where would you rate your competency level in the completion of newborn venipuncture blood sam-pling presently?

1._______ 2.______ 3.______ 4.______ (see definitions at the beginning)

9. Please indicate any other comments that you wish to include:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

THANK YOU FOR COMPLETING THIS EVALUATION. PLEASE RETURN TO THE CLINICALEDUCATOR.



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