The Effect of Training on Intramuscular Injection Practice Given to Nurses on Determining the VG Site, Using the Air Lock and Z Technique: A Randomized Controlled Trial
Phase: NA
Conditions: Injections
Sponsor: Nazike Duruk

 
ESKISEHIR OSMANGAZI UNIVERSITY 
HEALTH SCIENCES INSTITUTE 
DEPARTMENT OF NURSING 
 
EVOLUATION OF NURSES' SKILL TRAINING ON THE INTRAMUSCULAR 
INJECTION WITH Z TECHNIQUE IN VENTROGLUTEAL REGION 
 
COUNSELOR 
ASSOC. DR. NAZIKE DURUK 
nduruk20@gmail.com 
 
 
MASTER STUDENT 
ARZU GUVEN 
arzuuguvenn48@gmail.com 
 
 
ESKISEHIR, 08 August 2022 
 
 
 
 
 
 

 
 
 
MATERIALS AND METHODS 
Ethics Committee Approval of the Study 
Research, Turkey Research, students working in a Health, Practice and Hospital in Turkey 
and the Hospital Health, Practice and Research, which the researches are connected to, 
23.01.2019 31568761-804.01-E.9833 registered registered (Annex-1). Initiative and 
registered at 05.03.2019 25403353-050.99- to the practice of the research practice for clinical 
trials without ethics2 examination of the trial. (Annex-2). Informed consent was obtained 
from all women who agreed to participate in the study (Annex-3). 
Type of Research 
This study was planned as a randomized study in a pre-test post-test design. 
Location and Features of the Research 
The research is scheduled for April 2019 - August 2019. The hospital consists of a total of 3 
buildings with the main building with 10-storey clinics, the oncology building and the heart 
structure. The hospital has 1010 beds of beds. The research was conducted in outpatient 
clinics, operating rooms, pediatrics and emergency inpatient services. Information about the 
inpatient services of the study is given in (Annex-4). A total of 745 employees are employed 
at the hospital. Number of employees in the services included in the study. 
 Population and Sample of the Research 
His research consisted of 419 courses in the wards (4) of a Health, Practice and Research 
Hospital in Turkey. The sample of the study consisted of the students who read19 educated 
trainings and the nurses who agreed to participate. For sample calculation, reference was 
taken for studies similar to our research. In Şanlıalp-Zeyrek and Kuzu-Kurban's (2017) 
selection study, the correct answer given to the information about Z Technique and VG region 
was determined by the training (10.4±2.17), post-training (14.7±1.48) ) and follow-up 
(14.2±1,) total mean scores did not differ significantly. The sample selection in our research is 
based on this study, with the selection of the students who accepted to participate with the 

sample selection in the survey, and the P 11 (Power Analysis Sampling Software) selection 
program. Chi-square (x²) analysis was used to review the data in the guidelines with 1 
freedom and the operation size would be 0.3. In the analysis, the tip rate will be 0.80% and 5 
percent. Persons volunteering to help and participate in the sample were similarly selected 
prior to selecting the preliminary characteristics of their experiment and control group: doctor 
divided into groups by planned sampling: group: 31, Bachelor: Bachelor and bachelor: 17). 
One of her women is a form of education by lottery method (Önliğlık High School: 25, 
Undergraduate and Doctorate: 5) It is for random experiment and control purposes. The study 
was planned to be conducted with 100 nurses, including 50 women in a group. However, 
today, 3 students (2 of whom are military, 1 due to birth), 2 people in the control group (due 
to appointment and background) and 2 people did not participate in the research team, 47 
control group 48 total 95 women.  
Research Criteria 
-The nurses working in the inpatient services of the hospital where the research was 
conducted were included in the research. 
Exclusion criteria from the study 
Nurses who did not agree to participate in the study and who wanted to quit while the research 
was continuing were excluded. 
Research termination criteria 
The study was terminated when the required sample size was reached. 
Data Collection Tools 
The data of the study were collected using the nurse identification form (Annex 5), the 
Ventrogluteal Region Z Technique and the Intramuscular Injection Application Procedure 
Steps Observation Form (Appendix-6) and the Student Satisfaction and Self-Confidence in 
Learning Scale (Annex-7). 
Nurse introduction form (Annex-5) 
Six of the nurses' socio-demographic characteristics (gender, age, educational status, total 
working time in the profession, service and status), injection practice (frequency of 
intramuscular injection, participation in the in-service training program for intramuscular 

injections and participated in in-service training) consists of a total of nine questions, three of 
which are about time. 
Observation form of the procedure steps of intramuscular injection with the Z technique from 
the ventrogluteal region (Annex-6) 
It is a 20-item form consisting of intramuscular injection application steps from the 
ventroluteal region with the Z technique. This form is in line with the literature (Yapucu 
Güneş, Zaybak, Biçici, & Çevik, 2009; Gülseven-Karabacak, 2010; Kaya & Palloş, 2014; 
Gülnar & Özveren, 2016; Dikmen & Akın-Korhan, 2016; Şanlıalp-Zeyrek & Kuzu-Kurban, 
2017; Göçmen-Baykara, Çalışkan, Öztürk and Karadağ, 2019) were prepared by researchers. 
Opinions of four experts were taken for the validity and reliability of the questions in the form 
(Eşer İ, Şanlıalp-Zeyrek A, Kuzu-Kurban N, Çelik N). In line with the suggestions, the 
observation form was given its final form. 
Student satisfaction and self-confidence in learning scale (ÖMÖKGÖ) (Annex-7) 
The Turkish validity and reliability study was conducted by Karaçay and Kaya (2017) and it 
consists of two sub-dimensions as "Satisfaction in Learning" and "Self-Confidence in 
Learning" and a total of 13 items (Karaçay and Kaya, 2017). There are five sub-items in the 
satisfaction in learning sub-dimension and eight sub-items in the self-confidence in learning 
sub-dimension. The 13th item in the scale was revised by the researchers (Karaçay, P. Kaya, 
H. 2017). The answer options are 1=Strongly Disagree, 2=Disagree, 3=Neither Agree or 
Disagree, 4=Agree, 5=Strongly Agree. The score obtained is obtained from the sum of the 
items of the scale. The highest total score that can be obtained from the scale is 65 and the 
lowest is 13. The Cronbach Alpha value of the scale is 0.85 for "Satisfaction in Learning", 
0.77 for "Self-Confidence in Learning", and 0.89 for the total scale. The sum of the sub-
dimensions of the scale does not give the total score. Scale scores; It is obtained by dividing 
the sum of the sub-dimensions by the number of items. The high score that can be obtained 
from the total of the scale indicates high satisfaction and self-confidence (Ünver et al., 2017). 
In this study, the internal consistency coefficient of the scale was 0.914, the internal 
consistency coefficient of student satisfaction was 0.826, and the internal consistency 
coefficient of the self-confidence in learning sub-dimension was 0.880. Since the reliability 
coefficients of the Student Satisfaction and Self-Confidence in Learning Scale (SMCDS) and 
its sub-dimensions vary between 0.826 and 0.914, the scale was found to be reliable. 
 

Data Collection 
The nurses in the services of Health, Practice and Research Hospital included in the research 
were reached and informed about the research. Nurses who met the sampling criteria of the 
study and agreed to participate in the study were informed verbally and in writing by the 
researcher. 
The nurses were randomized according to their educational status and divided into groups. 
For each training, the place, day and time of the training were announced to the nurses who 
accepted the research, and the nurses who would come to the training were determined in 
advance as the experimental and control groups. Groups of minimum 3 and maximum 12 
nurses were invited to each training. The trainings continued until the number determined for 
the experimental and control groups was reached. All trainings were conducted by the same 
researcher in order to minimize personal error in trainings. Since the single-blind method was 
used while collecting the data, the nurses in the experimental and control groups did not know 
which group they belonged to. In the pre-test, the trainings were carried out in two stages, 
Training I and Training II. A post-test was carried out after at least two and at most four 
weeks (Gülnar & Özveren, 2016; Eroğlu & Çevik, 2019). 
Training I: Nurses in the experimental and control groups were interviewed in advance on the 
day and time they were available. Nurses who were available on the same day and time were 
grouped into small groups of 3-12 people. Theoretical training was given to the nurses in both 
groups, with a 10-minute power-point presentation prepared in line with the literature on 
intramuscular injection, in the training hall of Health, Practice and Research Hospital, which 
was predetermined and permission was obtained by the researcher. The content of the 
presentation includes information about evidence-based applications such as intramuscular 
injection from the VG region, determining the VG region, Z technique, and airlock technique 
(Annex-8). 
Training II: The experimental group was given skill training on applying intramuscular 
injection with the Z technique from the VG region on the simulator, in line with the 
intramuscular injection application steps, by using a low-fidelity intramuscular injection 
simulator immediately after the theoretical training with a powerpoint presentation. 
Afterwards, all nurses were asked to make intramuscular injections on the simulator, 
accompanied by the researcher. In order for this practice to be fully understood and turned 

into a skill, the nurses in the experimental group were allowed to repeat the practice under the 
supervision of the researcher until they did all the steps correctly. 
In order to facilitate the participation of nurses, the trainings were held in the training hall of 
the hospital, with verbal permission from the Chief Physician of Health, Practice and 
Research Hospital. For the use of the low-fidelity intramuscular injection simulator used in 
the trainings,  Faculty of Health Sciences Nursing Department Head was contacted and verbal 
permission was obtained. The training room for the presentation and the materials required for 
the intramuscular injection application (simulator, gloves, injector, needle tip, medicine, 
cotton, alcohol, kidney tub, piercing-cutting waste box) were prepared by the researchers 
before the training. 
Pre-application 
Before the implementation phase of the study, a preliminary application was carried out with 
10 nurses working in the adult inpatient clinics of Health, Application and Research Hospital 
and Kütahya Yoncalı Physical Therapy and Rehabilitation Hospital. These nurses were not 
included in the research sample. Since it was seen that the items were understandable after the 
pre-application, no changes were made in the items. 
Study procedure for the experimental group 
After the nurses who attended the training were informed about the research, they were asked 
to read and sign the informed consent form. Afterwards, the nurses answered the questions in 
the questionnaire. Then, each nurse was asked to make an intramuscular injection from the 
VG region using the Z technique on a low-fidelity intramuscular injection simulator. 
Meanwhile, the nurses were observed by the researcher according to the "Intramuscular 
Injection Application Procedure Steps Observation Form with the Ventrogluteal Region Z 
Technique" (Annex 6), and this form was filled by the researcher (Pre-test). After all the 
nurses who came to the training that day were observed one by one, a 10-minute powerpoint 
presentation was given by the researcher to all the nurses who came to the training at the same 
time regarding the steps of applying intramuscular injection from the VG region with the Z 
technique (Training I) (Annex-8). Immediately afterwards, an injection application was made 
on the simulator by the researcher with the demonstration method according to the "Procedure 
Steps of Intramuscular Injection with the Z Technique from the Ventrogluteal Region". This 
process was first ensured by the nurses, and then each nurse who came to the training that day 
was provided to inject on the simulator one by one in accordance with the "Intramuscular 

Injection Procedure Steps with the Z Technique from the Ventrogluteal Region" (Training II). 
Until each nurse does all the steps correctly under the supervision of the researcher. 
Evaluation of Data 
The data obtained in the research were analyzed using the SPSS (Statistical Package for 
Social Sciences) for Windows 25.0 program. For the information collected from the 
experimental and control groups, the frequency, percentage values, mean and standard 
deviation, which are descriptive statistics, were interpreted. Chi-square analysis was used to 
measure whether the introductory features showed similar distribution in the experimental and 
control groups. Q-Q Plot plot was used to determine the conformity to the normal distribution 
(Chan, 2003:280-285). In addition, the normal distribution of the data used depends on the 
skewness and kurtosis values being between ±3 (Shao, 2002). In this study, it was observed 
that the Student Satisfaction and Self Confidence in Learning scales had a normal distribution. 
Independent sample t-test was used to test whether the scores obtained from two unrelated 
samples differed significantly from each other, and the McNemar test was used for the 
variation of two dependent groups in different time periods. The reliability coefficient of the 
scale of student satisfaction and self-confidence in learning was calculated as 0.914. In cases 
where the error rate was p <0.05 in all tests, the difference between the groups was considered 
statistically significant. Comments were made in the light of the tables created by the analysis 
of the data. 
Budget of the Research 
No fee was paid to the participants in the study, and the participants did not bear any financial 
burden. For the intramuscular injection simulator and other expenses used in the research, the  
Scientific Research Projects Commission was applied to and the project with the code 
201942A115 was created. However, since the purchase could not be made during the 
pandemic, the intramuscular injection simulator was provided by the Vocational Skills 
Laboratory of the Faculty of Health Sciences of university, and the supply of consumables 
was covered by the researcher. 
Limitations of the Research 
This study was conducted only with nurses working in inpatient services at Health, Practice 
and Research Hospital. Therefore, the results of the study can only be generalized to this 
study group. 

Considering the forgetfulness of the training given, the post-test was applied after at least two 
and at most four weeks. 
A single follow-up was made. 
No observation was made while applying to the real patient. Observations were made only 
while practicing in the simulator. 
Evaluator was not blinded (no double blind method was used). 
Due to the intensive work of the nurses in the emergency room, this service was excluded by 
the Health Care Services Manager.