IV Line Insertion 1

Running head: TEACHING METHODS

Intravenous (IV) Line Insertion: Teaching Methods

Aaron A. Almassy

Ferris State University

 Abstract

This document illustrates teaching methods to be used for class sessions regarding Intravenous

(IV) line insertion. Key topics include examination of the lecture-discussion method, and the

cooperative or group learning method. Rationale for the instructor’s choices of these methods

will be provided throughout. Means to assure a positive and productive learning experience will

be outlined and addressed. Additionally, evaluation tools and their importance will be examined.
 IV Line Insertion 3

Intravenous (IV) Line Insertion: Teaching Methods

Two teaching methods or instructional strategies will be used for imparting knowledge

and skill regarding IV line insertion. These methods are: lecture-discussion, and hands-on

practice/cooperative-group learning. Teaching IV insertion is an active-learning process, students

will benefit from these varied instructional methods. Instruction will be rooted in the three

domains of learning (cognitive, psychomotor, and affective domains). Students will be expected

to meet the expectation of the objectives set forth for the learning module. We will explore the

teaching methods that have been identified above, as well examining the resources needed to

bring these methods to fruition. Approaches for a positive learning experience will be discussed.

The evaluation process of students and instructor will be presented finally.

Teaching Methods (Instructional Strategies)

Lecture-Discussion

A lecture-discussion session will be conducted first, a few days prior to the hands-on

learning session, which will be presented. Lecture-Discussion is only one tip of a

three pronged approach, here. As Bradshaw & Lowenstein (2007) state, the lecture is most

effective when combined with other teaching strategies. Literature review assignments in the

form of textbook reading along with student generated additional research will be provided. As

with any instructional strategy, the lecture-discussion has advantages and disadvantages. The

lecture-discussion will be necessarily utilized as a component of the overall teaching process

here, to better, more fully reach the majority of students. The instructor would utilize the lecture-

discussion method in order to enhance and clarify the reading material and clarify questions that

arise as students conduct their own research. Resources that are needed for the lecture are few.

First, the main component of the lecture is the lecturer with his or her strategies to effectively

communicate with students (Bradshaw & Lowenstein, 2007). Another needful resource is the

personal computer (PC) with Microsoft Power Point software. Power Point allows the instructor

to engage his or her students visually, while lecturing. “Research reported in educational

literature suggests that using visuals in teaching results in a greater degree of learning” (Stokes,
n.d.). Another needed resource is a supply of any literature to be handed out to students.

Bradshaw & Lowenstein (2007) indicate that a skeletal outline should be given to students only

if helpful for students’ identification of key points. They go on to state that if handouts are to be

used, they should be clear and contain only a limited amount of information, also if they are

printed on colored paper, they are more likely to be utilized by students (Bradshaw &

Lowenstein, 2007). In this class, per Bradshaw & Lowenstein (2007) only a skeletal outline of

the presentation will be provided to the students. The skeletal outline provides a nice way for

students to follow along and make notations appropriately throughout the lecture. It also provides

a means for students to note questions they have for the discussion portion of the lecture.

Hands-on Practice/Cooperative-Group Learning

First, in this session, a demonstration of an IV insertion will be provided by the instructor

as an initial point of reference for the student. One purpose of the hands-on practice session is to

develop fine motor skills as a component of the student’s psychomotor skills development

(Billings & Hallstead, 2005). Fine motor skills are those required to perform procedures where

accuracy and exactness are necessary (Billings & Hallstead, 2005). Cooperative or group

learning will follow the demonstration, so that students can begin to practice what they have

seen.

As DeYoung (2003) states, cooperative learning is based on the idea that students work

together and are responsible for one-another’s learning. Therefore, the class will be broken up

into small groups of four students each. Each student will demonstrate for the group an IV

insertion from beginning to end. The rest of the group will observe the demonstration, provide

feedback and constructive criticism. The process then repeats for each subsequent group

member. DeYoung (2003) refers to Infante (1985) when noting that “observation is an essential

element of clinical learning” (p.238). Repetition is an important concept here; repeated rehearsal

of the information/demonstration is a key to knowledge retention in the short term memory.

Additionally, repetition helps the new short term memories continue long enough to transition to

long term memories (Billings & Hallstead, 2005). There are numerous advantages to structuring
 IV Line Insertion 5

a class session in this fashion. First, for nurses, group structuring represents an invaluable lesson

because we need to be able to work collaboratively and effectively within the interdisciplinary

team. Group work helps to achieve this (DeYoung, 2003). Second, group work enhances each

member’s social skills (DeYoung, 2003). Another advantage to cooperative-group work is that it

promotes the use and development of critical thinking skills, also very important for nurses to

possess (DeYoung, 2003). DeYoung (2003) presents no disadvantages to cooperative learning.

Additionally, Students learn best when they are actively engaged in the learning process.

Analysts report that, students working in small groups are more likely to learn more of what is

presented and retain it longer than when the same content is presented in other instructional

formats (Gross-Davis, 1993).

The only resources needed for effective group work are multiple students, with an

assignment to complete or a new skill to learn. However, additional resources are needed for the

actual practice environment. First, we will need access to the nursing skills laboratory. Next, we

will require all necessary supplies for IV saline lock (SL) insertion, and mannequins or artificial

upper extremities appropriate for IV insertion.

Assuring a Positive and Productive Experience

Lecture-Discussion

In order to assure a positive and productive learning experience, students will be

encouraged to ask questions and converse openly during the discussion period of the lecture-

discussion. The utilization of questioning by the instructor is helpful in actively engaging

students in the lecture (Daniel, 1999). Dissemination of content by the lecturer will be limited to

approximately ten minutes, with following discussion. This is done partly because of appropriate

time frames needed to explain the process in addition to attempting to control the students’

attention. The instructor as well as the other students will listen attentively to the questions and

offer clarification and feedback as necessary. Utilization of this lecture method with discussion

will increase student participation and likewise student experience (Billings & Hallstead, 2005).
The instructor will speak clearly and provide examples from his or her own current and past

practice experiences. This recounting of personal experiences would fall under the strategy of

modeling. As Billings & Hallstead (2005) state, “One way to help students learn…is through

modeling” (p. 260). Faculty should consistently model desired performance and views that are

integral components of nursing practice (Billings & Hallstead, 2005).

Hands-on/Cooperative-group Learning

During the initial presentation by the instructor, the students would be instructed to

assume a position where each individual can clearly see and hear the presentation. This

presentation will be especially useful for the visual learner, as these individuals learn best by

demonstration (Cuyamaca College, 2003). Again, as in the lecture, students would be

encouraged and prompted to ask questions to assure the comfort of the student in relation to the

information presented. Questions to prompt critical thinking will be utilized by the instructor.

One such question could be “why is the bevel of the needle pointed up for an IV insertion?”

After the initial demonstration period by the instructor, the students break up into groups to

practice what they have just seen. In order to assure a positive experience with group work, the

instructor will determine the members of each group. This approach should effectively deter any

student from not being chosen to join a group, which would be detrimental to that student’s

group experience. Another way to assure a positive and productive experience is to deliberately

make clear to the class how the groups will operate and how students will be graded, provide

explanation of the objectives of the group work and define any relevant concepts (Gross-Davis,

1993).

Teaching and Learning Evaluation Tools

Evaluation tools have been developed by the instructor in order to allow the instructor to

appraise the learning objectives. “The advantage of internally developed evaluations is that they

can be customized to the program” (Billings & Hallstead, 2005, p. 563). As DeYoung (2003)

states, “Evaluation methods should be based on learning objectives. Objectives might be

evaluated by giving a test of some sort, a behavioral evaluation, or a graded assignment” (p.264).
 IV Line Insertion 7

Faculty need numerous evaluation methods to properly document and demonstrate their teaching

effectiveness (Billings & Hallstead, 2005). One evaluation method to be used here is the

behavioral evaluation, which takes the form of the IV insertion check-off list. The evaluation

tools are meant to provide the instructor with useful feedback in the current and future

design/implementation of his or her course. A formal checklist evaluation tool for the student’s

return demonstration will be provided at the end of this paper (see Appendix A). The checklist

evaluation tool will be used by the instructor evaluating the student nurse’s performance. In

order to be considered competent in IV insertion, the student nurse must achieve a 90% accuracy

rate when completing the checklist. A Likert scale evaluation tool has been devised to evaluate

the student’s perception of learning in regard to IV insertion (see Appendix B). A second Likert

scale evaluation instrument has been developed to gain the student’s perception of the teacher’s

effectiveness for this learning module (see Appendix C). When we want to know the feelings,

and attitudes of our respondent’s we should consider using Likert scale questions (Waddington,

2000).

Conclusion

So, in conclusion, the teaching strategies to be used during the class session on IV

insertion were discussed. It was found that the lecture-discussion method is an appropriate

teaching method to use, especially when combined with other forms of instructional strategy. We

examined the necessary resources for implementation of the teaching plan. These resources

include students, personal computers, use of the nursing skills laboratory, needed supplies for IV

insertion, and mannequins. Multiple approaches for assuring a positive and productive

experience were considered. The importance of evaluation tools is considered, and the instructor

has developed his own instruments which are available for viewing in the appendices following

the text.
 References:

Billings, D., & Halstead, J. (2005). Teaching in nursing a guide for faculty. (2nd ed.). St. Louis,

MO: Elsevier Saunders.

Bradshaw, M., Lowenstein, A. (2007). Innovative teaching strategies in nursing and related

health professions. (4th ed.). Sudbury, MA: Jones and Bartlett Publishers.

Cuyamaca College. (2003). Visual learning [Fact sheet]. Retrieved from

http://www.cuyamaca.edu/eops/dsps/resourcesvis.asp
Daniel, E. (1999). INLS 214: user education--notes lecture-discussion method [Fact sheet].
Retrieve from http://ils.unc.edu/daniel/214/lecture.html#schema

DeYoung, S. (2003). Teaching strategies for nurse educators. Upper Saddle River, NJ:

Pearson Education, Inc.

Gross-Davis, B. (1993). Collaborative learning: group work and study teams. Tools for teaching.

Retrieved from http://teaching.berkeley.edu/bgd/collaborative.html

Perry, A. & Potter, P. (1994). Clinical nursing skills & techniques. (3rd ed.). St. Louis, MO:

Mosby-Year Book, Inc.

Stokes, S. (n.d.). Visual literacy in teaching and learning: a literature perspective. Electronic

Journal for the Integration of Technology in Education, 1(1), 10-18. Retrieved from

http://ejite.isu.edu/Volume1No1/pdfs/stokes.pdf
Waddington, H. (2000). Types of survey questions. Encyclopedia of Educational Technology.

Retrieved March 15, 2008, from http://coe.sdsu.edu/eet/Articles/surveyquest/start.htm

 IV Line Insertion 9

Appendix A

Check-off Competency: IV Insertion

Instructions: This tool is used both to help prepare the student for the final competency evaluation and to
help the instructor fairly, accurately, and consistently rate each student’s performance. The student must perform an
IV insertion for use as a SL, from start to finish achieving 90% accuracy on the check-off competency in order to be
considered competent in IV insertion.

 Gather and organize equipment.

 Wash hands.

 Open sterile packages using aseptic technique.

 Select the appropriate IV insertion device.

 Select the most distal site for peripheral start.

 Place the extremity in a dependent position if possible.

 Initiate tourniquet 5-6 inches above the intended insertion site.

 Check for presence of distal pulse.

 Don gloves.

 Select the appropriate site in a well-dilated vein.

 Cleanse the insertion site with alcohol prep.

 Anchor the vein by placing thumb on the vein and stretching the skin against the direction of the insertion. (do this approx. 2-3 inches
distal to the site)

 Insert the IV cannulazation device with the bevel up at an approximate 20-30 degree angle in the direction of the vein.

 Look for blood return through the flashback chamber of the device.

 Lower the needle until the hub rests upon the venipuncture site.

 Advance the catheter about ¼ inch into the vein and then loosen the stylet.

 Advance the catheter into the vein until the hub rests at the venipuncture site (Do not reinsert the stylet once it has been loosened).

 Stabilizing the catheter with one hand, remove the tourniquet with the other, and remove the stylet.

 Quickly attach needle adapter of the SL to the hub of the catheter.

 Secure IV catheter: a) place narrow strip of tape beneath the hub of the catheter sticky-side up and criss-cross the tape over the
catheter b) place second narrow strip of tape directly across the hub of the catheter c) place 2x2 gauze pad over the insertion site and
cover with a transparent dressing.

 Flush SL with 1-3 milliliters (ML) of sterile saline for infusion.

 Communicate date, time, gauge of catheter, and nurse’s initials on the dressing.

 Doff gloves, discard trash, and wash hands.

Tool is adapted from procedure outlined in Perry & Potter (1994).

Appendix B

Student Evaluation of Learning: IV Insertion

Directions: On a scale of 1 to 10, rate each of the following statements based upon your

level of agreement. On this scale, 1 represents extreme disagreement, 3 represents disagreement,

5 is neither agree nor disagree, 7 represents agreement, and 10 represents extreme agreement.

One must not limit responses to these numbers listed; this is meant to provide understanding of

the rating system. Circle the appropriate choices and turn in before leaving the class. There is no

need to include your name on this form.

1. I feel that learning objectives were achieved………………………………1 2 3 4 5 6 7 8 9 10

2. I feel that the group component of this learning module enhanced the overall learning

experience……………………………………………………………………..1 2 3 4 5 6 7 8 9 10

3. I feel that the knowledge gained from lecture assisted me in the laboratory setting while

performing hands-on actions…………………………………………………..1 2 3 4 5 6 7 8 9 10

4. I feel that the required readings and additional personal research enhanced my understanding

of the subject matter……………………………………………………………1 2 3 4 5 6 7 8 9 10

5. I now feel competent (in the laboratory setting) in starting IV lines………..1 2 3 4 5 6 7 8 9 10

In this section, please provide written feedback of your learning experience.

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Appendix C

Student Evaluation of Teaching Methods

Directions: On a scale of 1 to 10, rate each of the following statements based upon your

level of agreement. On this scale, 1 represents extreme disagreement, 3 represents disagreement,

5 is neither agree nor disagree, 7 represents agreement, and 10 represents extreme agreement.

One must not limit responses to these numbers listed; this is meant to provide understanding of

the rating system. Circle the appropriate choices and turn in before leaving the class. There is no

need to include your name on this form.

1. Reading Assignments/independent research was useful in gaining knowledge prior to the

lecture-discussion………………………………………………………………1 2 3 4 5 6 7 8 9 10

2. I feel the lecture-discussion is necessary for beginning to learn about IV

insertion………………………………………………………………………...1 2 3 4 5 6 7 8 9 10

3. The instructor gained my attention and maintained my attention throughout the course of the

lecture-discussion………………………………………………………………1 2 3 4 5 6 7 8 9 10

4. The initial presentation of an IV insertion by the instructor was valuable to

me………………………………………………………………………………1 2 3 4 5 6 7 8 9 10

5. Small group work was appropriate for the hands-on practice session in the skills

lab………………………………………………………………………………1 2 3 4 5 6 7 8 9 10

6. The instructor allowed adequate time for preparation of IV insertion skills prior to the final

check-off procedure……………………………………………………………1 2 3 4 5 6 7 8 9 10

7. The instructor provided for varied learning opportunities………………….1 2 3 4 5 6 7 8 9 10

8. Please use the space provided below to answer or attach a separate page…Are there any
suggestions/concerns you have that would help the instructor improve his effectiveness?

9. Please make any additional constructive comments about the class/teaching methods here.