title: Venous access in oncology and haematology patients: Part two.
abstract: OBJECTIVE
  To assess the validity and inter-rater reliability of two tools, Venous Assessment Tool (VAT) and Deciding on IntraVenous Access (DIVA), using thematic analysis of feedback from nurses who used the tools,
  
  
  METHODS
  Analysis methods used in grounded theory were employed to investigate the written feedback provided by nurses. Inter-rater reliability was tested statistically using percentage agreement and the kappa (K) statistic.
  
  
  RESULTS
  Thematic analysis of the nurses' feedback generated themes concerning the role of clinical judgement, how theory translates to practice and the role of patient preference when using VAT and DIVA. Exploring these themes confirmed the validity of the tools and highlighted the importance of these considerations when evaluating the usefulness of assessment tools in the clinical environment. When VAT was used by a group of nurses to assess patients, the strength of agreement statistically was 'moderate'. When using DIVA, the tool demonstrated 'very good' agreement statistically.
  
  
  CONCLUSIONS
  When used with oncology and haematology patients, VAT and DIVA have been shown to generate agreement among the nurses who used them beyond that which would be expected by chance. As the only tools of this kind with evidence of inter-rater reliability, they provide clinicians with a useful resource which can be used in practice or research. However, the use of assessment tools cannot replace clinical judgement or override the preferences of patients.
authors.affiliation: Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham. sara.wells@uhb.nhs.uk
authors.forename: Sara
authors.initials: S
authors.lastname: Wells
mesh_terms: D004989:Ethics; D006402:Hematologic Diseases / Q000628:therapy*; D006801:Humans; D007262:Infusions, Intravenous; D009369:Neoplasms / Q000628:therapy*; D009729:Nursing; D015203:Reproducibility of Results