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Martinez-Reviejo R, Tejada S, Jansson M, Ruiz-Spinelli A, Ramirez-Estrada S, Ege D, Vieceli T, Maertens B, Blot S, Rello J. Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis. JOURNAL OF INTENSIVE MEDICINE 2023; 3:352-364. [PMID: 38028633 PMCID: PMC10658042 DOI: 10.1016/j.jointm.2023.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 12/01/2023]
Abstract
Background Ventilator-associated pneumonia (VAP) represents a common hospital-acquired infection among mechanically ventilated patients. We summarized evidence concerning ventilator care bundles to prevent VAP. Methods A systematic review and meta-analysis were performed. Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation (MV) for at least 48 h were considered for inclusion. Outcomes of interest were the number of VAP episodes, duration of MV, hospital and intensive care unit (ICU) length of stay, and mortality. A systematic search was conducted in the MEDLINE, the Cochrane Library, and the Web of Science between 1985 and 2022. Results are reported as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The PROSPERO registration number is CRD42022341780. Results Thirty-six studies including 116,873 MV participants met the inclusion criteria. A total of 84,031 participants underwent care bundles for VAP prevention. The most reported component of the ventilator bundle was head-of-bed elevation (n=83,146), followed by oral care (n=80,787). A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles, compared with the non-care bundle group (OR=0.42, 95% CI: 0.33, 0.54). Additionally, the implementation of care bundles decreased the duration of MV (MD=-0.59, 95% CI: -1.03, -0.15) and hospital length of stay (MD=-1.24, 95% CI: -2.30, -0.18) in studies where educational activities were part of the bundle. Data regarding mortality were inconclusive. Conclusions The implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs. Their application in combination with educational activities seemed to improve clinical outcomes.
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Affiliation(s)
- Raquel Martinez-Reviejo
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Sofia Tejada
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid 28029, Spain
- Clinical Research Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona 08035, Spain
| | - Miia Jansson
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, 90570, Finland
- RMIT University, Melbourne, 3010, Australia
| | - Alfonsina Ruiz-Spinelli
- Critical Care Department, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, 11600, Uruguay
- Medicine Department, Universitat Internacional de Catalunya (UIC), Barcelona, 08017, Spain
| | | | - Duygu Ege
- Emergency Medicine Department, Adnan Menderes University, Aydin, 09010, Turkey
| | - Tarsila Vieceli
- Infectious Diseases Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, 90035-903, Brazil
| | - Bert Maertens
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, 9000, Belgium
| | - Stijn Blot
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, 9000, Belgium
| | - Jordi Rello
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid 28029, Spain
- Clinical Research Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona 08035, Spain
- FOREVA Clinical Research, CHU Nimes, Université de Nîmes-Montpellier, Nîmes, 30012, France
- Medicine Department, Universitat Internacional de Catalunya (UIC), Barcelona, 08017, Spain
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Mpasa F, van Rooyen DRM, Jordan PJ, Venter D, ten Ham-Baloyi W. Malawian critical care nurses' views on the implementation of an educational intervention to enhance sustained use of an evidence-based endotracheal tube cuff pressure management guideline: A survey study. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2023; 39:10.7196/SAJCC.2023.v39i1.550. [PMID: 37521961 PMCID: PMC10378196 DOI: 10.7196/sajcc.2023.v39i1.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 02/09/2023] [Indexed: 08/01/2023] Open
Abstract
Background Evidence-based guidelines can assist critical care nurses in promoting best practices, including those related to endotracheal tube cuff pressure management. However, these guidelines require tailored strategies to enhance their implementation, uptake, and sustained use in practice. Objectives To evaluate Malawian critical care nurses' views on the implementation of an endotracheal tube cuff pressure management guideline to enhance sustained guideline use. Methods An explorative-descriptive survey design was employed, using a questionnaire with closed- and open-ended questions that was distributed after implementation of an educational intervention based on an endotracheal tube cuff pressure management guideline. The questionnaire had a Cronbach's alpha score of 0.85. Results A total of 47 nurses working in four public and two private hospital intensive care units in Malawi participated. Quantitative findings showed that the majority of the participants (92%) indicated that the strategies used for the group that received the full intervention including both active (monitoring visits) and passive (a half-day educational session using a PowerPoint presentation, and a printed guideline and algorithm) strategies (intervention 1 group) were useful, clear and applicable and enhanced implementation of the guideline. These results were statistically significant (mean (standard deviation) 1.86 (0.84); t=6.07; p<0.0005). Qualitative data revealed three major themes related to recommendations for uptake and sustained use of the guideline in nursing practice: the guideline needs to be translated, updated, and made available to ICU staff; implementation strategies (continuous supervision and follow-up); and facilitating factors for successful implementation (education and training on guideline content, resources, and commitment to best practices). Conclusion The study highlighted that although the implementation strategies used were positively received by participants, they need to be further tailored to their context to enhance guideline uptake and sustained use in practice. Further study is required to ensure that tailored implementation strategies facilitate guideline uptake and sustained use, specifically in resource-constrained contexts. Contributions of the study The study findings can be used by nurses and academics when developing educational interventions for critical care units to enhance implementation of guidelines in this context.
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Affiliation(s)
- F Mpasa
- Lecturer, Department of Nursing and Midwifery Science, Faculty of Health Sciences, Mzuzu University, Luwinga, Malawi; Former PhD candidate,
Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - Dalena R M van Rooyen
- Deputy Dean, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - P J Jordan
- Associate Professor and Head, Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town,
South Africa
| | - D Venter
- Consultant Statistician, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - W ten Ham-Baloyi
- Research Associate, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
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Al-Tamimi M, Refaat F, Bani Issa W. Barriers to compliance with evidence-based guidelines for ventilator-associated pneumonia among critical care nurses: A scoping review. F1000Res 2023; 11:1551. [PMID: 37035463 PMCID: PMC10076907 DOI: 10.12688/f1000research.128144.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Healthcare organizations provide evidence-based guidelines designed to support nurses in preventing ventilator-associated pneumonia (VAP) in intensive care units (ICUs), but there are barriers to compliance with such guidelines. This review explicitly explored evidence of compliance barriers among critical care nurses. Methods: A systematic search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and EBSCO databases for relevant English-language studies published between January 2003 and June 2022, focused on barriers to nursing compliance with VAP prevention guidelines. Data was reported according to the Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) guidelines. Results: 230 publications were screened, resulting in 53 full-text articles being retrieved after removing duplicates, of which 13 relevant to the aims of the review and meeting the inclusion criteria were included for data extraction. One was a qualitative study, while the remainder were quantitative. Simple descriptive content analysis identified the barriers to critical care nurses’ compliance with VAP prevention guidelines, and categorized them as: (1) work environment barriers (e.g., lack of equipment and supplies; lack of staff and time; lack of educational support; and ineffective supportive system); (2) nurse-related barriers (limited personal competencies); and (3) situation-related barriers (patient health, discomfort, and adverse events). Conclusions: This review revealed important evidence on barriers to VAP prevention guidelines compliance. Nurses are challenged mainly by work-environmental barriers along, with the presence of nurse and situational barriers. It is evident from the findings that further qualitative and mixed-methodology follow-up studies are recommended to further explore the issues in depth. Healthcare leaders must be aware of these barriers and integrate work policies that assist in overcoming them, to increase compliance.
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Affiliation(s)
- Muna Al-Tamimi
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, Sharjah, 27272, United Arab Emirates
| | - Fatma Refaat
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, Sharjah, 27272, United Arab Emirates
| | - Wegdan Bani Issa
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, Sharjah, 27272, United Arab Emirates
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Oral care to reduce costs and increase clinical effectiveness in preventing nosocomial pneumonia: a systematic review. J Evid Based Dent Pract 2023; 23:101834. [DOI: 10.1016/j.jebdp.2023.101834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/27/2022] [Accepted: 01/19/2023] [Indexed: 01/30/2023]
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Al-Tamimi M, Refaat F, Bani Issa W. Barriers to compliance with evidence-based guidelines for ventilator-associated pneumonia among critical care nurses: A scoping review. F1000Res 2022; 11:1551. [PMID: 37035463 PMCID: PMC10076907 DOI: 10.12688/f1000research.128144.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Healthcare organizations provide evidence-based guidelines designed to support nurses in preventing ventilator-associated pneumonia (VAP) in intensive care units (ICUs), but there are barriers to compliance with such guidelines. This review explicitly explored evidence of compliance barriers among critical care nurses. Methods: A systematic search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and EBSCO databases for relevant English-language studies published between January 2003 and June 2022, focused on barriers to nursing compliance with VAP prevention guidelines. Data was reported according to the Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) guidelines. Results: 230 publications were screened, resulting in 53 full-text articles being retrieved after removing duplicates, of which 13 relevant to the aims of the review and meeting the inclusion criteria were included for data extraction. One was a qualitative study, while the remainder were quantitative. Simple descriptive content analysis identified the barriers to critical care nurses’ compliance with VAP prevention guidelines, and categorized them as: (1) work environment barriers (e.g., lack of equipment and supplies; lack of staff and time; lack of educational support; and ineffective supportive system); (2) nurse-related barriers (limited personal competencies); and (3) situation-related barriers (patient health, discomfort, and adverse events). Conclusions: This review revealed important evidence on barriers to VAP prevention guidelines compliance. Nurses are challenged mainly by work-environmental barriers along, with the presence of nurse and situational barriers. It is evident from the findings that further qualitative and mixed-methodology follow-up studies are recommended to further explore the issues in depth. Healthcare leaders must be aware of these barriers and integrate work policies that assist in overcoming them, to increase compliance.
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Affiliation(s)
- Muna Al-Tamimi
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, Sharjah, 27272, United Arab Emirates
| | - Fatma Refaat
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, Sharjah, 27272, United Arab Emirates
| | - Wegdan Bani Issa
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, Sharjah, 27272, United Arab Emirates
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Dehghan M, Arab M, Akafzadeh T, Malakoutikhah A, Mazallahi M, Forouzi MA. Intensive care unit registered nurses' perceived barriers towards ventilated associated pneumonia prevention in southeast Iran: a cross-sectional descriptive - an analytical study. BMJ Open 2022; 12:e064147. [PMID: 36167371 PMCID: PMC9516162 DOI: 10.1136/bmjopen-2022-064147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Ventilated associated pneumonia (VAP) is one of the most common nosocomial infection and complication occurring in intensive care units (ICUs) worldwide. This study aimed to assess the ICU registered nurses' perceived barriers towards VAP prevention in southeast Iran. SETTING This was a cross-sectional descriptive-an analytical study to examine the registered nurses' perceived barriers towards VAP prevention in southeast Iran. PARTICIPANTS The study population consisted of 242 nurses working in ICU and emergency departments. PRIMARY AND SECONDARY OUTCOME MEASURES The data was collected using demographic characteristics' questionnaire and a researcher-made ventilator-associated pneumonia barriers prevention questionnaire. RESULTS The mean score of nurses' perceived barriers towards VAP prevention was 2.82±0.46. The highest mean score of perceived barriers were related to items of 'lack of staff', 'lack of a team-based approach to care and interventions', and 'lack of support from management'. CONCLUSIONS This study indicates most of the barriers are related to organisational factors and lack of teamwork. Further studies are needed to obtain more accurate results. TRIAL REGISTRATION NUMBER The study protocol was approved by the Ethics Committee of Kerman University of Medical Sciences (IR.KMU.REC.1395.908).
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Affiliation(s)
- Mahlagha Dehghan
- Nursing Research Center, Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansoor Arab
- Bam University of Medical Sciences, Medical Surgical Nursing Department, Bam, Iran
| | - Tayebe Akafzadeh
- Nursing Research center, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Malakoutikhah
- Nursing Research Center, Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahbubeh Mazallahi
- Nursing Research Center, Department of Critical Care Nursing Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansooreh Azizzadeh Forouzi
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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Fataar K, Zweigenthal V, Harries J. Providers' approaches to contraceptive provision in Cape Town. Front Glob Womens Health 2022; 3:917881. [PMID: 36188423 PMCID: PMC9515548 DOI: 10.3389/fgwh.2022.917881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/05/2022] [Indexed: 12/03/2022] Open
Abstract
Background Health care providers can play a significant role in empowering women to make informed decisions when selecting suitable contraceptive methods during contraceptive counseling. This study explores primary care providers' perspectives and approaches to contraceptive service provision for women attending public sector clinics in South Africa, with the intention of ascertaining established practices and training needs. Methods Ten in-depth interviews were conducted at five primary health care facilities in urban areas in Cape Town, South Africa. Eligible participants included nurses providing contraceptive services and willing to participate in the study. The qualitative software package NVivo was used to sort and manage data. Data was analyzed using a thematic analysis approach. Results Overall, providers emphasized supporting women in contraceptive decision-making. Sexual and reproductive health training increased providers confidence to deliver appropriate contraceptive services. Contraceptive prescribing practices were influenced by women's medical history and preferred bleeding patterns. Providers' concerns about adherence to methods for younger women and suspected adverse events for older women impacted on prescribing. Challenges experienced when providing contraceptive services included: contraceptive stockouts; time constraints of employed women accessing the service; and their work pressure due to providing other health services. Discussion Health care providers play a critical role in facilitating women's right to access high quality contraceptive services. Providers saw themselves as negotiators during contraceptive counseling. They considered both women's preferences and their own recommendations for contraception, to provide information that would enable women to make informed contraceptive decisions. By reinforcing this approach to contraceptive counseling and focusing on shared decision-making, should encourage autonomy in method selection and limit the influence of provider's contraceptive method selection.
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Development of a Tool for Measuring Ventilator-Associated Pneumonia Prevention Behaviors of Intensive Care Unit Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148822. [PMID: 35886675 PMCID: PMC9316898 DOI: 10.3390/ijerph19148822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/16/2022] [Accepted: 07/18/2022] [Indexed: 02/01/2023]
Abstract
Introduction: Ventilator-associated pneumonia (VAP) lengthens intensive care unit (ICU) stays and increases medical expenses and mortality risk. Aim: We aimed to develop and validate a tool for measuring VAP prevention behaviors among ICU nurses. Method: This is a methodological study that included a tool development step, based on the procedure suggested by DeVellis, and a tool verification step. Results: Through a literature review and focus interviews, 35 preliminary items were selected. After a content validity examination by experts and a pre-test, 30 items were chosen for this study. In the testing phase of the main survey, the final version tool was used on 452 ICU nurses to assess validity and reliability. From factor analysis, 7 factors and 17 items were selected. The factors included aspiration prevention, ventilator management, oral care, suction system management, subglottic suction, spontaneous awakening trials and spontaneous breathing trials, and standard precautions. The total determination coefficient was 71.6%. These factors were verified using convergent, discriminant, and concurrent validity tests. Internal consistency reliability was acceptable (Cronbach’s α = 0.80); thus, the VAP prevention behavior measurement tool was proven valid and reliable. Conclusions: This tool can be used with ICU nurses to measure behaviors associated with VAP prevention and, in turn, VAP prevention measures can be improved.
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Getahun AB, Belsti Y, Getnet M, Bitew DA, Gela YY, Belay DG, Terefe B, Akalu Y, Diress M. Knowledge of intensive care nurses’ towards prevention of ventilator-associated pneumonia in North West Ethiopia referral hospitals, 2021: A multicenter, cross-sectional study. Ann Med Surg (Lond) 2022; 78:103895. [PMID: 35734742 PMCID: PMC9207106 DOI: 10.1016/j.amsu.2022.103895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/23/2022] [Accepted: 05/29/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Ventilator-associated pneumonia is a common nosocomial infection that occurs in critically ill patients who are on intubation and mechanical ventilation. Nurses' lack of knowledge may be a barrier to adherence to evidence-based guidelines for preventing ventilator-associated pneumonia. This study aimed to assess the knowledge of intensive care nurses’ towards the prevention of ventilator-associated pneumonia. Methods A multicenter cross-sectional study was conducted among nurses working in the intensive care unit from April to July 2021. A pre-tested and structured questionnaire was used to collect data. All intensive care nurses working in the study area were included in the study. Data was entered into Epi-data 4.1 version (EpiData Association, Denmark) and transferred to STATA version 14 (College Station, Texas 77845-4512 USA) statistical software for analysis. Both bi-variable and multivariable binary logistic regression analysis was used to identify factors associated with knowledge of intensive care unit nurse. Variables with a p-value less than <0.2 in the bi-variable analysis were fitted into the multivariable logistic regression analysis. Both Crude and Adjusted Odds Ratio with the corresponding 95% Confidence Interval was calculated to show the strength of association. In multivariable analysis, variables with a p-value of <0.05 were considered statistically significant. Result A total of 213 intensive care nurses were included in the study, with a response rate of 204(95.77%). The mean knowledge score of intensive care nurses regarding the prevention of ventilator-associated pneumonia out of 20 questions is (10.1 ± 2.41). There are 98 (48.04%) of the participants have been found to have good knowledge and 106 (51.96%) of them are rendered poor knowledge about the overall knowledge related to the prevention of ventilator-associated pneumonia. Higher academic qualifications and taking intensive care unit training were significantly associated with good knowledge of ventilator-associated pneumonia prevention in multi-variable logistic regression. Conclusion Our study indicates that the knowledge of intensive care nurses about ventilator-associated pneumonia prevention is not sufficient. Higher academic qualifications and taking intensive care unit training are significantly associated with a good level of knowledge. Therefore it shows the necessity for thorough training and education. The knowledge of intensive care nurses about ventilator-associated pneumonia prevention is not sufficient. Only 98 (48.04%) of the participants have been found to have good knowledge. Higher academic qualifications and taking intensive care unit training are significantly associated with a good level of knowledge. This study shows the necessity of in-service training and continuing education for intensive care nurses about the prevention of ventilator-associated pneumonia.
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Nawaz FA, Deo N, Surani S, Maynard W, Gibbs ML, Kashyap R. Critical care practices in the world: Results of the global intensive care unit need assessment survey 2020. World J Crit Care Med 2022; 11:169-177. [PMID: 36331973 PMCID: PMC9136725 DOI: 10.5492/wjccm.v11.i3.169] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/11/2021] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is variability in intensive care unit (ICU) resources and staffing worldwide. This may reflect variation in practice and outcomes across all health systems.
AIM To improve research and quality improvement measures administrative leaders can create long-term strategies by understanding the nature of ICU practices on a global scale.
METHODS The Global ICU Needs Assessment Research Group was formed on the basis of diversified skill sets. We aimed to survey sites regarding ICU type, availability of staffing, and adherence to critical care protocols. An international survey ‘Global ICU Needs Assessment’ was created using Google Forms, and this was distributed from February 17th, 2020 till September 23rd, 2020. The survey was shared with ICU providers in 34 countries. Various approaches to motivating healthcare providers were implemented in securing submissions, including use of emails, phone calls, social media applications, and WhatsApp™. By completing this survey, providers gave their consent for research purposes. This study was deemed eligible for category-2 Institutional Review Board exempt status.
RESULTS There were a total 121 adult/adult-pediatrics ICU responses from 34 countries in 76 cities. A majority of the ICUs were mixed medical-surgical [92 (76%)]. 108 (89%) were adult-only ICUs. Total 36 respondents (29.8%) were 31-40 years of age, with 79 (65%) male and 41 (35%) female participants. 89 were consultants (74%). A total of 71 (59%) respondents reported having a 24-h in-house intensivist. A total of 87 (72%) ICUs were reported to have either a 2:1 or ≥ 2:1 patient/nurse ratio. About 44% of the ICUs were open and 76% were mixed type (medical-surgical). Protocols followed regularly by the ICUs included sepsis care (82%), ventilator-associated pneumonia (79%); nutrition (76%), deep vein thrombosis prophylaxis (84%), stress ulcer prophylaxis (84%), and glycemic control (89%).
CONCLUSION Based on the findings of this international, multi-dimensional, needs-assessment survey, there is a need for increased recruitment and staffing in critical care facilities, along with improved patient-to-nurse ratios. Future research is warranted in this field with focus on implementing appropriate health standards, protocols and resources for optimal efficiency in critical care worldwide.
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Affiliation(s)
- Faisal A Nawaz
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates
| | - Neha Deo
- Department of Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN 55905, United States
| | - Salim Surani
- Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
- Texas A&M University, College Station, TX 77843, United States
| | - William Maynard
- Internal Medicine, TriStar Centennial Medical Center, HCA Healthcare, Nashville, TN 37203, United States
| | - Martin L Gibbs
- Pulmonary and Critical Care, Tulane University School of Medicine, New Orleans, LA 70112, United States
| | - Rahul Kashyap
- Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
- Internal Medicine, TriStar Centennial Medical Center, HCA Healthcare, Nashville, TN 37203, United States
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Alias N, AwangHarun S, Jamaludin KA. Reconceptualizing the Curriculum for Malaysian Advanced Nursing Education: An Outlook on Mechanical Ventilation Weaning Pedagogy. Front Public Health 2022; 10:856533. [PMID: 35444986 PMCID: PMC9013898 DOI: 10.3389/fpubh.2022.856533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
Although Advanced Nursing Education (ANE) in Malaysia is still in its early stages, the demand for skilled nurses, particularly those who can perform weaning processes from mechanical ventilation (WPMV), is increasing. These nurses, especially in the Cardiothoracic Intensive Care Unit (CICU) need to be equipped with critical thinking skills in order to make decisions on WPMV. However, the Malaysian ANE is still struggling to achieve this. Therefore, this paper is aimed at reconceptualizing the Malaysian ANE with a specific focus on the development of a Mechanical Ventilation Weaning Pedagogy framework. Building upon previous studies, relevant theories, and WPMV best practices outside Malaysia, this study proposed the development of a pedagogy based on four fundamentals: the Fundamental Pattern of Knowing, Curriculum Planning model, an ideal learning content for WPMV skills development, and local experts' opinions. The findings of this study can serve as a reference for stakeholders, nursing education providers, and relevant parties in improving the current ANE.
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Affiliation(s)
- Norlidah Alias
- Department of Curriculum and Instructional Technology, Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia
| | - Sakinah AwangHarun
- Department of Curriculum and Instructional Technology, Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia
| | - Khairul Azhar Jamaludin
- Centre of Education Leadership and Policy, Faculty of Education, Universiti Kebangsaan Malaysia, Bangi, Malaysia
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Kennedy E. Bundling Your Way to Quality Care. J Dr Nurs Pract 2022; 15:11-17. [DOI: 10.1891/jdnp-2021-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundA bundle is defined by IHI as a small set of evidence-based interventions for a defined patient segment/population and care setting that, when implemented together, will result in significantly better outcomes than when implemented individually. It is important to understand that a bundle is not simply a checklist to complete, it is a set of researched interventions that have been shown to work better when completed together. These interventions are usually already well known and utilized in practice by nurses or providers. A bundle places the priority on the entire set of interventions being completed for the at-risk patient.ObjectiveThe focus of this paper is to explain the principles of a bundle, the evidence supporting their utilization in practice, challenges associated with care bundles, how to overcome these challenges, and recommendations for future success.ConclusionsA literature search on the implementation of bundles demonstrates several challenges to their use. Sustaining a comprehensive quality improvement approach within an institution can be challenging but with the guidelines outlined by IHI for requirements of a bundle and the implementation recommendations, great success can be obtained.
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Alkubati SA, Saghir SAM, Al-Sayaghi KM, Alhariri A, Al-Areefi M. Healthcare workers' knowledge of evidence-based guidelines for prevention of ventilator-associated pneumonia in Hodeida, Yemen. J Basic Clin Physiol Pharmacol 2021; 34:321-327. [PMID: 34714992 DOI: 10.1515/jbcpp-2020-0388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 09/30/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients requiring mechanical ventilation in intensive care units (ICUs). VAP is associated with delayed extubation, prolonged hospital stays, increased healthcare costs and mortality rates. The aims of this study to evaluate the level of knowledge for the prevention of VAP among healthcare workers (HCWs) in ICUs and to assess their knowledge in relation to their socio-demographic characteristics. METHODS A descriptive, cross-sectional design was conducted to assess HCWs' knowledge of the guidelines for prevention of VAP in the ICUs of public and private hospitals in Hodeida city, Yemen. Around 140 self-administered multiple-choice questionnaires were distributed between April and July 2017. RESULTS A total of 120 (85.6%) HCWs completed questionnaire were obtained (20 physicians, 20 anesthesia technicians and 80 nurses) in this study. The total mean score of the HCWs' knowledge was low (41 ± 18). A statistically significant difference was found in the HCWs' knowledge scores according to their specialties and gender. Anesthesia technicians had the highest knowledge score followed by physicians and nurses (52.2 ± 16.2, 45.6 ± 21.2 and 37.1 ± 16.9, respectively, p=0.002). Males had higher scores than females (Median [IQR] 4 [3-5] vs. 3 [2-4], p<0.001). Participants who received information about the prevention of VAP had better knowledge than those who did not (46.2 ± 17.7 vs. 36.8 ± 17.3, p=0.006). CONCLUSIONS HCWs had a low knowledge level of the guidelines for the prevention of VAP, which may affect their practice. HCWs' knowledge was affected by their previous received information that increases the necessity to provide them with regular in-service education and training programs.
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Affiliation(s)
- Sameer A Alkubati
- Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida, Yemen.,Faculty of Nursing, University of Ha'il, Hail, Saudi Arabia
| | - Sultan A M Saghir
- Department of Medical Analysis, Princess Aisha Bint Al-Hussein College of Nursing and Medical Sciences, Al-Hussein Bin Talal University, Ma`an, Jordan
| | - Khaled M Al-Sayaghi
- Department of Medical Surgical Nursing, College of Nursing, Taibah University, Madina, Saudi Arabia.,Department of Critical Care and Emergency Nursing, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Abdullah Alhariri
- Preventive Medicine Unit-General Military Hospital (GMH), Hodeida, Yemen
| | - Mahmoud Al-Areefi
- Faculty of Public Health & Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
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14
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Bankanie V, Outwater AH, Wan L, Yinglan L. Assessment of knowledge and compliance to evidence-based guidelines for VAP prevention among ICU nurses in Tanzania. BMC Nurs 2021; 20:209. [PMID: 34696753 PMCID: PMC8543108 DOI: 10.1186/s12912-021-00735-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 09/29/2021] [Indexed: 01/22/2023] Open
Abstract
Background Implementation of evidence-based guidelines (EBGs) related to VAP is an effective measure for the prevention of ventilator-associated pneumonia (VAP). While low knowledge regarding the EBGs related to VAP prevention among ICU nurses is still a major concern among nurses in ICUs globally, the situation in Tanzania is scarcely known. This study aimed to assess the ICU nurses’ knowledge, compliance, and barriers toward evidence-based guidelines for the prevention of VAP in Tanzania. Methods A cross-sectional study, involving ICU nurses of major hospitals in Tanzania, was conducted. A structured questionnaire was administered among 116 ICU nurses. Data analysis included descriptive statistics and the independent sample t-test. Results The mean knowledge score was 3.86(SD = 1.56), based on ten questions (equivalent to 38.6%). Nurses with a degree or higher level of nursing education performed significantly better than the nurses with a diploma or lower level of nursing education (p = 0.004). The mean self-reported compliance score for EBGs for the prevention of VAP was 15.20 (SD = 0.93) which is equivalent to 60.8% based on 25 questions. The main barriers to the implementation of EBGs for VAP prevention were lack of skills (96.6%), lack of adequate staff (95.5%), and lack of knowledge (79.3%). Conclusion Considering the severity and impact of VAP, and the higher risks of HAIs in resource-limited countries like Tanzania, the lower level of knowledge and compliance implies the need for ongoing educational interventions and evaluation of the implementation of the EBGs for VAP prevention by considering the local context.
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Affiliation(s)
- Vicent Bankanie
- XiangYa school of Nursing, Central South University, No.172Tongzi po Road, Changsha, Yuelu District, China.,Department of Clinical Nursing, University of Dodoma, Dodoma, Tanzania
| | - Anne H Outwater
- Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Li Wan
- XiangYa school of Nursing, Central South University, No.172Tongzi po Road, Changsha, Yuelu District, China
| | - Li Yinglan
- XiangYa school of Nursing, Central South University, No.172Tongzi po Road, Changsha, Yuelu District, China.
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15
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Kalyan G, Bibi R, Kaur R, Bhatti R, Kumari R, Rana R, Kumari R, Kaur M, Kaur R. Knowledge and Practices of Intensive Care Unit Nurses Related to Prevention of Ventilator Associated Pneumonia in Selected Intensive Care Units of a Tertiary Care Centre, India. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:369-375. [PMID: 33344206 PMCID: PMC7737830 DOI: 10.4103/ijnmr.ijnmr_128_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/26/2020] [Accepted: 07/06/2020] [Indexed: 11/26/2022]
Abstract
Background: Ventilator-Associated Pneumonia (VAP) is a recognized nosocomial infection and a leading cause of high morbidity and mortality. Intensive Care Unit (ICU) nurses are in the best position to put the known evidence-based strategies into practice to prevent VAP. The aim of the present study is to assess the knowledge and practices of ICU nurses related to prevention of VAP in selected ICUs of a tertiary care centre in India (2013–2014) and to find out the association between knowledge and practices. Materials and Methods: A descriptive survey was conducted in the different ICUs of a tertiary care hospital in India. Purposive sampling technique was used and 108 ICU staff nurses were enrolled during the period of data collection. The tool used for data collection was a self-developed valid and reliable knowledge-based questionnaire and an observational checklist. The descriptive (frequency and percentages) and inferential (Chi-square test) statistics was used. Results Out of the 108 nurses enrolled in the study, 82 (75.93%) had average, 24 (22.22%) had good and only 2 (1.85%) of the ICU nurses had poor knowledge. Assessment of the practices revealed that 68 (94.44%) nurses had average and only 4 (5.55%) nurses had good practice. There was no association between the knowledge and practices of ICU nurses related to prevention of VAP. (χ2 = 0.14, p = 0.710). Conclusions: Although the nurses were having good to average knowledge scores, their practices were not associated with knowledge scores. There is a need to find out the ways that would help the nurses to adhere to good practices.
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Affiliation(s)
- Geetanjli Kalyan
- BSN, MSN, PhD Scholar, Tutor National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravina Bibi
- Nursing Officer, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravinder Kaur
- Nursing Officer, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Bhatti
- Nursing Officer, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reeta Kumari
- Nursing Officer, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Romina Rana
- Nursing Officer, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupa Kumari
- Nursing Officer, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Kaur
- Nursing Student, Post Degree Diploma (2years) in Nursing Practice in Canada at Langrara, Vancouver, BC, Canada
| | - Rupinder Kaur
- BSN, MSN, Tutor National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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16
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Borglin G, Eriksson M, Rosén M, Axelsson M. Registered nurses' experiences of providing respiratory care in relation to hospital- acquired pneumonia at in-patient stroke units: a qualitative descriptive study. BMC Nurs 2020; 19:124. [PMID: 33342427 PMCID: PMC7750009 DOI: 10.1186/s12912-020-00518-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
Objective This study aimed to describe registered nurses’ (RNs) experiences of providing respiratory care in relation to hospital acquired pneumonia (HAP), specifically among patients with acute stroke being cared for at in-patient stroke units. Background One of the most common and serious respiratory complications associated with acute stroke is HAP. Respiratory care is among the fundamentals of patient care, and thus competency in this field is expected as part of nursing training. However, there is a paucity of literature detailing RNs’ experiences with respiratory care in relation to HAP, specifically among patients with acute stroke, in the context of stroke units. As such, there is a need to expand the knowledge base relating to respiratory care focusing on HAP, to assist with evidence-based nursing. Design A qualitative descriptive study. Method Eleven RNs working in four different acute stroke units in Southern Sweden participated in the current study. The data were collected through semi-structured interviews, and the transcribed interviews were analysed using inductive content analysis. Results Three overarching categories were identified: (1), awareness of risk assessments and risk factors for HAP (2) targeting HAP through multiple nursing care actions, and (3) challenges in providing respiratory care to patients in risk of HAP. These reflected the similarities and differences in the experiences that RNs had with providing respiratory care in relation to HAP among in-patients with acute stroke. Conclusions The findings from this study suggest that the RNs experience organisational challenges in providing respiratory care for HAP among patients with acute stroke. Respiratory care plays a vital role in the identification and prevention of HAP, but our findings imply that RNs’ knowledge needs to be improved, the fundamentals of nursing care need to be prioritised, and evidence-based guidelines must be implemented. RNs would also benefit from further education and support, in order to lead point-of-care nursing in multidisciplinary stroke teams.
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Affiliation(s)
- Gunilla Borglin
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06, Malmö, Sweden. .,Department of Nursing Education, Lovisenberg Diaconal University College, 0456, Oslo, Norway.
| | - Miia Eriksson
- Department of Neurology, Skåne University Hospital, SE-222 42, Malmö, Sweden
| | - Madeleine Rosén
- Department of Neurology, Skåne University Hospital, SE-222 42, Malmö, Sweden
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06, Malmö, Sweden
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17
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Mpasa F, van Rooyen DRM, Venter D, Jordan P, Ten Ham-Baloyi W. Improving nurses' knowledge of managing endotracheal tube cuff pressure in intensive care units: A quasi-experimental study. Health SA 2020; 25:1479. [PMID: 33391829 PMCID: PMC7756521 DOI: 10.4102/hsag.v25i0.1479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/20/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Previous studies conducted on nurses' knowledge regarding endotracheal tube cuff pressure revealed that there were differences in intensive care nurses' knowledge, leading to varying practices. AIM This study aimed to evaluate how an educational intervention based on the existing evidence-based guidelines, using both passive and active implementation strategies, could improve the knowledge of nurses regarding managing endotracheal tube cuff pressures in Malawian intensive care units. SETTING Six functional ICUs (four public and two private) in Malawi. METHODS The study followed a quasi-experimental, pre- and post-test design using an educational intervention. Intensive care nurses of six functional intensive care units in Malawi were randomly assigned to two intervention groups. Both groups received a half-day educational session, a printed version of the evidence-based guidelines, a printed and laminated summary of the guidelines and a related algorithm. Additionally, Intervention 2 group received four monitoring visits. Pre- and post-test questionnaires were conducted between February and August 2016. Descriptive and inferential data analyses (a chi-square test and t-test) were utilised. RESULTS An improvement in knowledge was observed on the nursing care practices for the management of endotracheal tube cuff pressure for both groups following the educational intervention, although only the results comparing Intervention 2 group participants indicate that the level of knowledge was significant (t[df = 48] = 2.08, p = 0.043, d = 0.59). CONCLUSION Implementation of a formal training and mentorship programme for Malawian intensive care nurses would be of great benefit to enhance the knowledge and skills managing endotracheal tube cuff pressure. Follow-up studies would also assist in understanding how guidelines could be implemented most effectively to achieve better knowledge outcomes.
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Affiliation(s)
- Ferestas Mpasa
- Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
- Department of Nursing and Midwifery Science, Mzuzu University, Luwinga, Malawi
| | | | - Danie Venter
- Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
| | - Portia Jordan
- Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Wilma Ten Ham-Baloyi
- Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
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18
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Alastalo M, Salminen L, Vahlberg T, Leino-Kilpi H. Knowledge of patient observation among critical care nurses. Nurs Crit Care 2020; 26:341-351. [PMID: 33150722 DOI: 10.1111/nicc.12573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The clinical observations made by critical care nurses are vital for maintaining patient safety and making appropriate decisions in the care of patients who are critically ill. Evaluating the reliability of observations and applying analytical thinking are essential elements of patient observation. Previous studies of critical care nurses' knowledge have focused either on specific aspects of patient observation or on critical care nursing in general; therefore, the findings are not comprehensive. AIM The aim of this study was to evaluate critical care nurses' level of knowledge in patient observation and to explore the factors that are associated with it. STUDY DESIGN A cross-sectional knowledge test survey with critical care nurses in Finland was used. METHODS Data were collected in seven adult intensive care units in all five university hospitals in Finland between September 2017 and January 2018 by using a knowledge test (20 items) developed for this study. All critical care nurses were eligible to participate. The data were analysed using descriptive and inferential statistics. RESULTS Altogether, 372 nurses responded (response rate 49%). Their average scores in the knowledge test were 77% (mean 15.29/20, SD 2.41) for correct answers, 75% (mean 8.2/11, SD 1.54) in the sum-variable "Evaluating the reliability of observation" and 79% (mean 7.08, SD 1.45) for "Analytical thinking." A higher knowledge level was associated with education in special tasks in an intensive care unit. CONCLUSION The critical care nurses' knowledge level was considered to be suboptimal. There is a need for improving knowledge of patient observation among Finnish critical care nurses to ensure safe and good quality care. RELEVANCE TO CLINICAL PRACTICE Finnish critical care nurses' knowledge of patient observation could be improved by providing specific continuing education for new nurses entering intensive care units and for experienced critical care nurses throughout their career.
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Affiliation(s)
- Mika Alastalo
- The Department of Nursing Science, University of Turku, Turku, Finland
| | - Leena Salminen
- The Department of Nursing Science, University of Turku, Turku, Finland
| | - Tero Vahlberg
- The Department of Biostatistics, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- The Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
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19
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Jun J, Kovner CT, Dickson VV, Stimpfel AW, Rosenfeld P. Does unit culture matter? The association between unit culture and the use of evidence-based practice among hospital nurses. Appl Nurs Res 2020; 53:151251. [PMID: 32451012 DOI: 10.1016/j.apnr.2020.151251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Jin Jun
- University of Michigan, School of Nursing and the Institute of Healthcare Policy and Innovation, 400 N. Ingalls St, Room 2183, Ann Arbor, MI 48109, United States of America.
| | - Christine T Kovner
- New York University, Rory Meyers College of Nursing, 433 First Ave, Room 644, New York, NY 40010, United States of America.
| | - Victoria Vaughan Dickson
- New York University, Rory Meyers College of Nursing, 433 First Ave, Office 742, New York, NY 10010, United States of America.
| | - Amy Witkoski Stimpfel
- New York University, Rory Meyers College of Nursing, 433 First Avenue, Office 658, New York, NY 10010, United States of America.
| | - Peri Rosenfeld
- NYU Langone Heath, Departments of Nursing, 545 First Avenue GH-SC1-164, New York, NY 10016, United States of America.
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20
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Ciampoli N, Bouchoucha S, Currey J, Hutchinson A. Evaluation of prevention of ventilator-associated infections in four Australian intensive care units. J Infect Prev 2020; 21:147-154. [PMID: 32655696 DOI: 10.1177/1757177420908006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 01/29/2020] [Indexed: 11/16/2022] Open
Abstract
Background Effective approaches to practice improvement require development of tailored interventions in collaboration with knowledge users. Objectives To explore critical care nurses' knowledge and adherence to best practice guidelines for management of patients with an artificial airway to minimise development of ventilator-associated pneumonia. Methods A cross-sectional study was undertaken across four intensive care units that involved three phases: (1) survey of critical care nurses regarding their current practice; (2) observation of respiratory care delivery; and (3) chart audit. Key care processes evaluated were: (1) technique and adherence to standard precautions when performing endotracheal suction, cuff pressure checks and extubation; and (2) frequency of endotracheal suctioning and mouth care. Results Observational and chart audit data on the provision and documentation of respiratory care were collected for 36 nurse/patient dyads. Forty-six nurses were surveyed and the majority responded that endotracheal suctioning and mouth care should be performed 'as required' or every 2 hours (h). During observations of practice, no patient received mouth care every 2 h, nor had documentation of such. Inconsistent adherence to standard precautions and hand hygiene during respiratory care provision was observed. Chart audit indicated that nurses varied in the frequency of suctioning consistent with documented clinical assessment findings. Conclusion Although nurses had good knowledge for the management of artificial airways, this was not consistently translated into practice. Gaps were identified in relation to respiratory related infection prevention, the prevention of micro-aspiration of oropharyngeal secretions and in the provision of mouth care.
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Affiliation(s)
- Natasha Ciampoli
- Epworth HealthCare, Epworth Eastern Intensive Care Unit, Box Hill, Melbourne, VIC, Australia
| | - Stephane Bouchoucha
- Deakin University, Geelong. Faculty of Health, School of Nursing & Midwifery & The Institute for Health Transformation, Centre for Quality and Patient safety Research. Melbourne, VIC, Australia
| | - Judy Currey
- Deakin University, Geelong. Faculty of Health, School of Nursing & Midwifery & The Institute for Health Transformation, Centre for Quality and Patient safety Research. Melbourne, VIC, Australia
| | - Ana Hutchinson
- Deakin University, Geelong. Faculty of Health, School of Nursing & Midwifery & The Institute for Health Transformation, Centre for Quality and Patient safety Research. Melbourne, VIC, Australia.,Deakin University and Epworth HealthCare Partnership, Centre for Quality and Patient Safety Research, Melbourne, VIC, Australia
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21
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Aloush SM, Al-Rawajfa OM. Prevention of ventilator-associated pneumonia in intensive care units: Barriers and compliance. Int J Nurs Pract 2020; 26:e12838. [PMID: 32293064 DOI: 10.1111/ijn.12838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/22/2020] [Indexed: 12/27/2022]
Abstract
AIM The purpose of this study was to evaluate the compliance of Jordanian nurses with ventilator-associated pneumonia prevention guidelines and the barriers to compliance. METHOD A descriptive, cross-sectional design was used. A convenience sample of 294 nurses from nine hospitals in Jordan completed a self-reported questionnaire. RESULTS According to the study compliance categories, 45.6% of the participants reported 'insufficient compliance,' 24.8% 'weak compliance' and 29.6% 'sufficient compliance.' Nurses with more experience and previous education on ventilator-associated pneumonia reported higher compliance scores than their counterparts with less experience and no previous education. Nurses reported several barriers that limited their own compliance, such as lack of education, lack of policies and protocols, lack of resources and the shortage of staff. CONCLUSION The compliance of nursing staff with the prevention guidelines was poor. Applying tailored educational programs may help improve their level of compliance. These programs must target new graduate nurses and be conducted in those hospitals with limited resources.
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Affiliation(s)
- Sami M Aloush
- School of Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Omar M Al-Rawajfa
- School of Nursing, Al al-Bayt University, Mafraq, Jordan.,College of Nursing, , Sultan Qaboos University, AlKhoud, Oman
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22
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Valiee S, Salehnejad G. Barriers to and Facilitators of Nurses' Adherence to Clinical Practice Guidelines: A Qualitative Study. Creat Nurs 2020; 26:e1-e7. [PMID: 32024742 DOI: 10.1891/1078-4535.26.1.e1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Guidelines for clinical practice are needed in order for nurses to provide consistent, standardized care and avoid preventable harm. AIMS The present study aims to explore the barriers to and facilitators of nurses' adherence to clinical practice guidelines. METHODS Detailed semistructured interviews were conducted with 14 nurses from two educational hospitals in Kurdistan University of Medical Sciences, Sanandaj, Iran, about their involvement with clinical practice guidelines. The text of the interviews was analyzed by qualitative content analysis. FINDINGS Identified barriers to full adherence to clinical practice guidelines were work pressure, lack of facilities, paperwork, lack of motivational environment, and nonapplicability of guidelines. Facilitators identified were encouragement, improving working conditions, conscientiousness, training, and supervision. CONCLUSION Interventions to remove barriers to and provide facilitators of adherence to clinical practice guidelines should be designed and implemented. Removing organizational barriers is the responsibility of nursing managers.
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23
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Gilder E, Parke RL, McGuinness S, Jull A. Study protocol: A randomized controlled trial assessing the avoidance of endotracheal suction in cardiac surgical patients ventilated for ≤ 12 hr. J Adv Nurs 2019; 75:2006-2014. [PMID: 30843238 DOI: 10.1111/jan.13994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/23/2018] [Accepted: 01/21/2019] [Indexed: 11/27/2022]
Abstract
AIMS To assess the safety and efficacy of avoiding endotracheal suction in postoperative cardiac surgical patients mechanically ventilated for ≤ 12 hr. DESIGN A prospective, single centre, single blind, non-inferiority, randomized controlled trial evaluating the safety and efficacy of avoiding suction in uncomplicated, postoperative, adult cardiac surgical patients mechanically ventilated for ≤ 12 hr. METHODS Randomization will be performed on return to intensive care (ICU) with allocation to either usual postoperative care including suction or to usual care with no suction (intervention arm). The primary outcome is the ratio of partial pressure of oxygen (PaO2 ) to fraction of inspired oxygen (FiO2 ) (P/F) 6 hr after extubation. Pain assessments will be performed before, during and after endotracheal suction (ETS) and the patient experience will be investigated with a brief interview the following day. Ethics approval was received in October 2015. DISCUSSION Endotracheal suction is performed as part of airway management but has potential complications and there is little robust evidence to guide practice. This study will add to the evidence base about the need and benefit of endotracheal suction in this patient cohort. IMPACT As there is currently no published evidence about the safety of avoiding endotracheal suction. This study will provide the first evidence about avoidance of endotracheal suction in patients ventilated for less than 1 day. If non-inferior, the results have the capacity to change nursing practice by avoiding a potentially unnecessary procedure, it will build on the body of knowledge about the patient experience.
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Affiliation(s)
- Eileen Gilder
- FANZCA, Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rachael L Parke
- FANZCA, Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,FANZCA, Australian and New Zealand Intensive Care Research Centre, Melbourne, Vic., Australia.,Medical Reseach Institute of New Zealand (MRINZ), Wellington, New Zealand
| | - Shay McGuinness
- FANZCA, Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,FANZCA, Australian and New Zealand Intensive Care Research Centre, Melbourne, Vic., Australia.,Medical Reseach Institute of New Zealand (MRINZ), Wellington, New Zealand
| | - Andrew Jull
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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24
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The Effects of Oral Care Protocol on the Incidence of Ventilation-Associated Pneumonia in Selected Intensive Care Units in Jordan. Dimens Crit Care Nurs 2019; 38:5-12. [PMID: 30499786 DOI: 10.1097/dcc.0000000000000334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study aims to evaluate the effects of oral care protocol on the incidence of ventilator-associated pneumonia (VAP) at selected intensive care units (ICUs) in Jordan using clinical pulmonary infection score. METHODS A quasi-experimental design was used, and 1 large teaching hospital from the Jordanian capital, along with 2 hospitals from the southern region, was selected. A total of 218 patients participated, among which VAP risk in 2 independent groups was evaluated through the Clinical Pulmonary Infection Score sheet. RESULTS The VAP incidence rate was significantly lower in the intervention group (n = 102) as compared with control group (n = 116) (21.6 vs 35.3, respectively; P = .018); in addition, ICU stay and intubation period were significantly shorter among the intervention group. A higher risk of VAP was independently predicted by previous lung diseases (odds ratio [OR], 1.441; 95% confidence interval [CI], 1.185-1.88), open suctioning system (OR, 2.536; 95% CI, 1.261-5.101), and duration of intubation (OR, 1.770; 95% CI, 0.845-2.220). The oral care protocol has effectively improved ventilated patients' oral health, which has statistically reduced the incidence of VAP. It occurred more frequently among patients who have lung disease and those who were intubated for more than 7 days and have an open suctioning system. CONCLUSION Health care teams should ensure that effective care protocol is implemented among patients.
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25
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Grant A, Coyer F. Contextual factors to registered nurse research utilisation in an Australian adult metropolitan tertiary intensive care unit: A descriptive study. Aust Crit Care 2019; 33:71-79. [PMID: 30910478 DOI: 10.1016/j.aucc.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 12/22/2018] [Accepted: 01/07/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Organisational and unit-level context can have a significant impact on implementation of evidence in practice, the latter being particularly important in the complex intensive care context. Evaluating the context may allow modifiable characteristics to be identified and addressed. OBJECTIVES The objective was to examine the relationship between dimensions of the context and research utilisation in one intensive care unit. METHODS This study used a quantitative cross-sectional survey. All registered nurses working in one Australian quaternary referral hospital intensive care unit were surveyed using the Alberta Context Tool and research utilisation instrument. Descriptive statistics were used, and bivariate analysis was undertaken to determine associations among demographic data, dimensions of context, and research utilisation. RESULTS The survey response rate was 33% (67/205). Most respondents were women with a mean of 8 years of intensive care nursing experience. The dimensions of culture, evaluation, informal interactions, structural/electronic resources, and organisational slack (time and space) were positively correlated with research utilisation. CONCLUSIONS Research utilisation was associated with numerous context dimensions, emphasising their effect on knowledge translation in this setting. Intensive care nurses are in a unique position to impact care delivery and provide evidence-based care to ensure optimal outcomes to patients at high risk of morbidity and mortality. Identified dimensions may be targeted and developed in future strategies to optimise the context for translating evidence into this complex practice environment.
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Affiliation(s)
- Anna Grant
- Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Level 3, Ned Hanlon Building, Royal Brisbane and Women's Hospital, Butterfield St, Herston, 4029, Brisbane, QLD, Australia.
| | - Fiona Coyer
- Level 3, Ned Hanlon Building, Royal Brisbane and Women's Hospital, Butterfield St, Herston, 4029, Brisbane, QLD, Australia; Joint Appointment Intensive Care Services, Royal Brisbane and Women's Hospital and School of Nursing, Queensland University of Technology, Australia.
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Yeganeh M, Yekta H, Farmanbar R, Khalili M, Khaleghdoost T, Atrkar Roushan Z. Knowledge of evidence-based guidelines in ventilator-associated pneumonia prevention. J Evid Based Med 2019; 12:16-21. [PMID: 26845460 DOI: 10.1111/jebm.12188] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/15/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the intensive care unit nurses' knowledge of evidence-based guidelines for ventilator-associated pneumonia (VAP) prevention at Guilan University of Medical Sciences (GUMS) hospitals, Guilan Province, northern Iran. METHODS This cross-sectional study included 219 nurses working in 14 intensive care units at 11 Guilan hospitals. The questionnaire consisted of three parts of demographic information, nurses' knowledge of evidence-based guidelines for the prevention of VAP, and the barrier for the implementation of these guidelines. RESULTS Of the 219 nurses, 171 (response rate 78.1%) participated in this study, and their mean knowledge score was 4.6. There was no significant relation between nurses' knowledge score and their work experience (P = 0.327), education degree (P = 0.189), and their position (P = 0.168). CONCLUSION The level of knowledge regarding VAP prevention seems inadequate in this study. Although having knowledge about the principles of evidence-based care cannot guarantee the implementation of these principles, lack of knowledge may be a potential barrier to adherence to evidence-based guidelines for the prevention of VAP.
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Affiliation(s)
- Mohammadreza Yeganeh
- Department of medical-surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Yekta
- Department of Health Education, School of Health, Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Rabiollah Farmanbar
- Department of Health Education, School of Health, Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Malahat Khalili
- Department of Health Education, School of Health, Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Tahereh Khaleghdoost
- Department of Nursing, Faculty of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Atrkar Roushan
- Department of Health Education, School of Health, Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Li Z, Zhou X, Cao J, Li Z, Wan X, Li J, Jiao J, Liu G, Liu Y, Li F, Song B, Jin J, Liu Y, Wen X, Cheng S, Wu X. Nurses' knowledge and attitudes regarding major immobility complications among bedridden patients: A prospective multicentre study. J Clin Nurs 2018; 27:1969-1980. [PMID: 29546731 DOI: 10.1111/jocn.14339] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2018] [Indexed: 01/19/2023]
Abstract
AIMS AND OBJECTIVES To gain insight into nurses' knowledge and attitudes regarding major immobility complications (pressure ulcers, pneumonia, deep vein thrombosis and urinary tract infections) and explore the correlation of nurses' knowledge and attitudes with the incidence of these complications. BACKGROUND Immobility complications have adverse consequences, and effective management requires appropriate knowledge, attitudes and skills. Evidence about nurses' knowledge and attitudes regarding immobility complications is lacking. DESIGN Cross-sectional study. METHODS A total of 3,903 nurses and 21,333 bedridden patients from 25 hospitals in China were surveyed. Nurses' knowledge and attitudes regarding major immobility complications were assessed using researcher-developed questionnaires. The content validity, reliability and internal consistency of the questionnaires were validated through expert review and a pilot study. The incidence of major immobility complications among bedridden patients from selected wards was surveyed by trained investigators. Correlations between knowledge, attitudes and the incidence of major immobility complications were evaluated with multilevel regression models. RESULTS Mean knowledge scores were 64.07% for pressure ulcers, 72.92% for deep vein thrombosis, 76.54% for pneumonia and 83.30% for urinary tract infections. Mean attitude scores for these complications were 86.25%, 84.31%, 85.00% and 84.53%, respectively. Knowledge and attitude scores were significantly higher among nurses with older age, longer employment duration, higher education level, previous training experience and those working in tertiary hospitals or critical care units. Nurses' knowledge about pressure ulcers was negatively related to the incidence of pressure ulcers, and attitude towards pneumonia was negatively correlated with the incidence of pneumonia. CONCLUSION Clinical nurses have relatively positive attitudes but inadequate knowledge regarding major immobility complications. Improved knowledge and attitudes regarding major immobility complications may contribute to reducing these complications. RELEVANCE TO CLINICAL PRACTICE Nursing managers should implement measures to improve nurses' knowledge and attitudes regarding major immobility complications to reduce the incidence of these complications in bedridden patients.
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Affiliation(s)
- Zhen Li
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
| | - Xinmei Zhou
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Dongcheng District, Beijing, China
| | - Jing Cao
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
| | - Zheng Li
- School of Nursing, Peking Union Medical College, Shijingshan District, Beijing, China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Dongcheng District, Beijing, China
| | - Jiaqian Li
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
| | - Ge Liu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
| | - Ying Liu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
| | - Fangfang Li
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People's Hospital, Jinshui District, Zhengzhou, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Jianghan District, Wuhan, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
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Jam R, Mesquida J, Hernández Ó, Sandalinas I, Turégano C, Carrillo E, Pedragosa R, Valls J, Parera A, Ateca B, Salamero M, Jane R, Oliva JC, Delgado-Hito P. Nursing workload and compliance with non-pharmacological measures to prevent ventilator-associated pneumonia: a multicentre study. Nurs Crit Care 2018; 23:291-298. [DOI: 10.1111/nicc.12380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/09/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Rosa Jam
- Critical Care Department; Parc Taulí. Hospital Universitari; Sabadell Spain
| | - Jaume Mesquida
- Critical Care Department; Parc Taulí. Hospital Universitari; Sabadell Spain
| | | | | | | | - Esther Carrillo
- Critical Care Department; Parc Taulí. Hospital Universitari; Sabadell Spain
| | - Rosario Pedragosa
- Critical Care Department; Parc Taulí. Hospital Universitari; Sabadell Spain
| | - Josefa Valls
- Critical Care Department; Hospital Universitari Mútua de Terrassa; Terrassa Spain
| | - Ana Parera
- Critical Care Department; Hospital Universitari Mútua de Terrassa; Terrassa Spain
| | - Begoña Ateca
- Critical Care Department; Hospital Universitari Mútua de Terrassa; Terrassa Spain
| | - Maria Salamero
- Critical Care Department; Hospital Universitari Mútua de Terrassa; Terrassa Spain
| | - Roser Jane
- Critical Care Department; Hospital Universitari Mútua de Terrassa; Terrassa Spain
| | - Joan Carles Oliva
- Department of Results Centers; Fundació Parc Taulí, Unit of Clinical Trials; Sabadell Spain
| | - Pilar Delgado-Hito
- Fundamental and Medical-Surgical Nursing Department, School of Nursing; University of Barcelona; Barcelona Spain
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Jansson MM, Syrjälä HP, Talman K, Meriläinen MH, Ala-Kokko TI. Critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle. Am J Infect Control 2018; 46:1051-1056. [PMID: 29573832 DOI: 10.1016/j.ajic.2018.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although evidence-based practices are known to improve the quality of care, making it cost-efficient and improving clinical results, barriers to transferring research into clinical practice have hindered this process. AIMS To evaluate critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle. MATERIAL AND METHODS In 2015, we conducted an institution-specific, cross-sectional study in a 26-bed adult mixed medical-surgical intensive care unit (ICU) in Finland using quantitative survey of knowledge and self-reported adherence with qualitative gathering of barrier data. A pre-validated multiple-choice Ventilator Bundle Questionnaire was distributed to all registered nurses who were direct care providers (n = 155). RESULTS The final response rate was 55.5% (n = 86), and 47.2% (n = 34) of respondents had more than 10 years of ICU experience. The levels of knowledge and self-reported adherence were 71.1% and 65.8% of the total score, respectively. The level of knowledge was higher among respondents who had received in-service education about ventilator bundle compared with respondents who had not received in-service education (27.0 vs 24.0 [P = .012]). Less experienced nurses reported significantly higher adherence than nurses with more ICU experience (29.0 vs 25.0 [P = .034]). The correlation between knowledge and adherence scores was low (ρ 0.48 [P <.001]). The most well-known and adhered-to guidelines described patient positioning, daily chlorhexidine-based oral care, and strict hand hygiene. The least-known guidelines and those least adhered to described respiratory equipment, management of sedation and analgesia, and practices prior to and during endotracheal suctioning. The main barriers were related to the nurse respondents (e.g., lack of education [25.9%]), environment (e.g., role ambiguities [36.4%] and inadequate resources [21.1%]), and patients (e.g., patient discomfort [4.8%] and fear of adverse effects [4.6%]). CONCLUSIONS Self-reported adherence did not correlate with knowledge and was not related to work experience. Most of the barriers toward evidence-based guidelines indicated a need for changes that are beyond the control of individual nurses.
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Affiliation(s)
- Miia M Jansson
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland.
| | - Hannu P Syrjälä
- Department of Infection Control, Oulu University Hospital, Oulu, Finland
| | - Kirsi Talman
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Merja H Meriläinen
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland
| | - Tero I Ala-Kokko
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland
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Darawad MW, Sa'aleek MA, Shawashi T. Evidence-based guidelines for prevention of ventilator-associated pneumonia: Evaluation of intensive care unit nurses' adherence. Am J Infect Control 2018; 46:711-713. [PMID: 29305283 DOI: 10.1016/j.ajic.2017.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 11/30/2022]
Abstract
Using self-reported questionnaires, this descriptive study assessed nurses' adherence to ventilator-associated pneumonia (VAP) guidelines, which was found to be 81.3%. Although items concerning infection control achieved the highest scores, items concerning the suctioning process achieved the lowest scores. Participants' score of VAP care knowledge had a significant positive correlation with their score of VAP guidelines adherence. Addressing the strength and weakness domains that affect nurses' adherence is crucial for health care administrators at different managerial levels, which may help in executing different strategies to improve nurses' adherence to VAP strategies.
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Yazdannik A, Atashi V, Ghafari S. Performance of ICU Nurses in Providing Respiratory Care. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:178-182. [PMID: 29861754 PMCID: PMC5954637 DOI: 10.4103/ijnmr.ijnmr_205_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Failure to provide proper respiratory care leads to incidence of certain complications such as ventilator-associated pneumonia. Nurses have a crucial role in providing this care. The aim of this study is to assess the performance of ICU (Intensive Care Unit) nurses in providing respiratory care. MATERIALS AND METHODS The present descriptive cross-sectional study recruited 120 nurses working in selected hospitals affiliated to Isfahan University of Medical Sciences from March to August 2016. The questionnaire used included demographic and employment details and performance observation checklist (containing 39 items in four care domains) based on recommendations in clinical guidelines. The performance of each nurse during a working shift was observed. Data were analyzed by SPSS 18, using tables of frequency, mean, and standard deviation. RESULTS According to the results obtained, mean (SD) total performance score of nurses in providing respiratory care was 15.46 (2.16). The highest score was obtained in preventing contamination of respiratory equipment 5 (0), and the lowest score was in oral care 0.68 (0.73). CONCLUSIONS Considering that respiratory care is one of the main pillars of patient care in ICU and that nurses scored poorly in this area, it is imperative to pay greater attention to this area. It is essential to provide necessary training to nurses and adequate facilities for improving the quality of clinical care.
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Affiliation(s)
- Ahmadreza Yazdannik
- Department of Critical Care Nursing, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vajihe Atashi
- Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh Ghafari
- Department of Critical Care Nursing, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Alja'afreh MA, Mosleh SM, Habashneh SS. Nurses' perception and attitudes towards oral care practices for mechanically ventilated patients. Saudi Med J 2018; 39:379-385. [PMID: 29619490 PMCID: PMC5938652 DOI: 10.15537/smj.2018.4.21749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/28/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To explore the perception and attitudes of intensive care unit (ICU) nurses towards oral care practice for mechanically ventilated (MV) patients. METHOD A descriptive cross-sectional design was used in this study. A convenience sample of 96 ICU nurses completed a questionnaire on their perception and attitudes towards oral care. The study setting was 3 representative Jordanian hospitals in Al-Karak and the capital, Amman, over a 6-month period between February and September 2016. RESULTS Ninety-six nurses participated in the study. The response rate was 76.8%. The results revealed that 65% only follow a specific oral care protocol. Nurses did not adhere to minimal standards. Although nurses' attitude towards oral care was strongly positive, 68% of them perceived it as an unpleasant task and 29% agreed that they had insufficient training; 78% agreed to learn more about the best way to perform oral care. Standard descriptive statistics were calculated for all baseline information (sociodemographic characteristics). Binary variables were expressed as proportions, and normally distributed continuous variables as means and standard deviations. CONCLUSION The poor perception and attitudes of ICU nurses regarding oral care for MV patients require the urgent attention of clinical administrators. In-hospital training regarding oral care protocol could improve nurses' perception and attitudes.
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Affiliation(s)
- Mahmoud A Alja'afreh
- Department of Adult Health Nursing, Faculty of Nursing, Mutah University, Alkarak, Jordan. E-mail.
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Rehabilitation Nurses' Knowledge, Attitudes, and Behaviors for Preventing Urinary Tract Infections From Intermittent Catheterization. Rehabil Nurs 2017; 44:171-180. [PMID: 29244034 DOI: 10.1097/rnj.0000000000000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to develop and examine the reliability of a survey to assess knowledge, attitudes, and behaviors (KAB) of rehabilitation nurses for preventing urinary tract infections in persons requiring intermittent catheterization. DESIGN Cross-sectional survey with principal component analysis. METHODS Survey development and administration based on national guidelines. FINDINGS Principal component analysis produced three reliable components of KAB explaining 54.5% of response variance. Results indicate that nurses report adequate knowledge and training. Although the facility had an evidence-based online catheterization procedure, staff reported that the procedure was not helpful nor useable. Twenty-eight percent incorrectly identified the root cause of urinary tract infection, and 45% reported that other nurses always washed their hands. Barriers to using standard intermittent catheterization technique were staff, time, and patient variables. CONCLUSION The modified survey is a reliable measure of KAB. CLINICAL RELEVANCE The survey assists with identifying knowledge gaps, customizing education, and changing practice.
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Jam R, Hernández O, Mesquida J, Turégano C, Carrillo E, Pedragosa R, Gómez V, Martí L, Vallés J, Delgado-Hito P. Nursing workload and adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia. A pilot study. ENFERMERIA INTENSIVA 2017; 28:178-186. [PMID: 28890209 DOI: 10.1016/j.enfi.2017.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyse whether adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia (VAP) is associated with nursing workload. METHODS A prospective observational study performed in a single medical-surgical ICU. Nurses in charge of patients under ventilator support were assessed. VARIABLES knowledge questionnaire, application of non-pharmacological VAP prevention measures, and workload (Nine Equivalents of Nursing Manpower Use Score). Phases: 1) the nurses carried out a educational programme, consisting of 60-minute lectures on non-pharmacological measures for VAP prevention, and at the end completed a questionnaire knowledge; 2) observation period; 3) knowledge questionnaire. RESULTS Among 67 ICU-staff nurses, 54 completed the educational programme and were observed. A total of 160 observations of 49 nurses were made. Adequate knowledge was confirmed in both the initial and final questionnaires. Application of preventive measures ranged from 11% for hand washing pre-aspiration to 97% for the use of a sterile aspiration probe. The Nine Equivalents of Nursing Manpower Use Score was 50±13. No significant differences were observed between the association of the nurses' knowledge and the application of preventive measures or between workload and the application of preventive measures. CONCLUSIONS Nurses' knowledge of VAP prevention measures is not necessarily applied in daily practice. Failure to follow these measures is not subject to lack of knowledge or to increased workload, but presumably to contextual factors.
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Affiliation(s)
- R Jam
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - O Hernández
- Servicio de Atención Primaria, Vallés Occidental, Sabadell, Barcelona, España
| | - J Mesquida
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - C Turégano
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - E Carrillo
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - R Pedragosa
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - V Gómez
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - L Martí
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - J Vallés
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - P Delgado-Hito
- Departamento de Enfermería Fundamental y Médico-Quirúrgica, Escuela de Enfermería, Universidad de Barcelona, Barcelona, España; Miembro del Grupo GRIN-IDIBELL.
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Explaining transgression in respiratory rate observation methods in the emergency department: A classic grounded theory analysis. Int J Nurs Stud 2017. [PMID: 28622531 DOI: 10.1016/j.ijnurstu.2017.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Abnormal respiratory rates are one of the first indicators of clinical deterioration in emergency department(ED) patients. Despite the importance of respiratory rate observations, this vital sign is often inaccurately recorded on ED observation charts, compromising patient safety. Concurrently, there is a paucity of research reporting why this phenomenon occurs. OBJECTIVE To develop a substantive theory explaining ED registered nurses' reasoning when they miss or misreport respiratory rate observations. DESIGN This research project employed a classic grounded theory analysis of qualitative data. PARTICIPANTS Seventy-nine registered nurses currently working in EDs within Australia. Data collected included detailed responses from individual interviews and open-ended responses from an online questionnaire. METHODS Classic grounded theory (CGT) research methods were utilised, therefore coding was central to the abstraction of data and its reintegration as theory. Constant comparison synonymous with CGT methods were employed to code data. This approach facilitated the identification of the main concern of the participants and aided in the generation of theory explaining how the participants processed this issue. RESULTS The main concern identified is that ED registered nurses do not believe that collecting an accurate respiratory rate for ALL patients at EVERY round of observations is a requirement, and yet organizational requirements often dictate that a value for the respiratory rate be included each time vital signs are collected. The theory 'Rationalising Transgression', explains how participants continually resolve this problem. The study found that despite feeling professionally conflicted, nurses often erroneously record respiratory rate observations, and then rationalise this behaviour by employing strategies that adjust the significance of the organisational requirement. These strategies include; Compensating, when nurses believe they are compensating for errant behaviour by enhancing the patient's outcome; Minimalizing, when nurses believe that the patient's outcome would be no different if they recorded an accurate respiratory rate or not and; Trivialising, a strategy that sanctions negligent behaviour and occurs when nurses 'cut corners' to get the job done. Nurses' use these strategies to titrate the level ofemotional discomfort associated with erroneous behaviour, thereby rationalising transgression CONCLUSION: This research reveals that despite continuing education regarding gold standard guidelines for respiratory rate collection, suboptimal practice continues. Ideally, to combat this transgression, a culture shift must occur regarding nurses' understanding of acceptable practice methods. Nurses must receive education in a way that permeates their understanding of the relationship between the regular collection of accurate respiratory rate observations and optimal patient outcomes.
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Abstract
OBJECTIVE As a primary objective, this study purports to develop guidelines to better care for children with autism spectrum disorder (ASD), particularly regarding these children's preparation for anesthesia and radiologic procedures. METHODS Using a Delphi method with an online distribution of questionnaire, guidelines for caring for children with ASD were created. Twenty-one participants were included in the expert panel. These participants were working with children with ASD in several anesthesia and radiology departments in Sweden. A list of items was created from a previous survey and the literature. In the first round, the items with <60% agreement were discarded. Items were merged, and a new list was created. Two more similar rounds were performed. In the last 2 rounds, 21 participants responded, and 80% agreement was considered to be consensus. RESULTS The final guidelines consisted of 14 items and a checklist of 16 factors. The 5 areas covered by the items and the checklist were as follows: planning involving parents/guardians, features in the environment, and use of time, communication, and the health care professionals. The organization was important in making it possible for the health care professional to care for the individual child according to the child's needs. It was important to involve the parents/guardians to obtain knowledge about the functioning of the child. CONCLUSION A caring encounter involving a child with ASD in the anesthesia and radiology contexts requires advance planning, catered specifically to the individual needs of each child. To accomplish this, general knowledge regarding ASD and ASD's particular manifestation in the child entrusted to their care is required from the health care workers. The organization needs to have structures in place to facilitate this process.
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Hassan ZM, Wahsheh MA. Knowledge level of nurses in Jordan on ventilator-associated pneumonia and preventive measures. Nurs Crit Care 2016; 22:125-132. [PMID: 28008700 DOI: 10.1111/nicc.12273] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/07/2016] [Accepted: 11/01/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ventilator-associated pneumonia is the most prevalent infection in Intensive Care Units, with the highest mortality rate; crude mortality rates may be as high as 20-75%. Many practices such as prevention measures (e.g. hand washing, wearing gloves, suctioning, elevated head of bed between 30° and 45°) have demonstrated an effect of reducing the incidence of this infection. AIMS To identify the level of nurses' knowledge of ventilator-associated pneumonia and prevention measures before an educational programme, identify the level of nurses' knowledge on ventilator-associated pneumonia and prevention post an educational programme and identify the reasons for not applying ventilator-associated pneumonia prevention measures among nurses in Jordan. DESIGN Pre- and post-intervention observational study. METHOD Data based on a self-reported questionnaire from 428 nurses who worked in intensive care units were analysed. PowerPoint lectures, videos, printed materials and electronic materials were used in the intervention. Paired t-tests were used to test research questions. RESULTS More than three-quarters of nurses had a low knowledge level regarding pathophysiology, risk factors and ventilator-associated pneumonia preventative measures. Nurses showed significant improvements in mean scores on the knowledge level of ventilator-associated pneumonia and prevention measures after an educational programme (p < 0.05). The main reasons for not applying prevention measures were the lack of time and no followed protocols in the units. CONCLUSION Health education programmes about ventilator-associated pneumonia must be conducted among nurses in Jordan through continuous education. RELEVANCE TO CLINICAL PRACTICE Hospital and nursing administrators should be actively involved in educational programmes and in assuring support for continuing education. Protocol for ventilator-associated pneumonia prevention should be developed based on current evidence-based guidelines.
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Affiliation(s)
| | - Moayad A Wahsheh
- Faculty of Physical Education and Sport Sciences, Hashemite University, Zarqa, Jordan
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Maurya S, Mishra SB, Azim A, Baronia AK, Gurjar M. Ventilator-associated complications: A study to evaluate the effectiveness of a planned teaching program for intensive care unit staff nurses-an Indian experience. Am J Infect Control 2016; 44:1422-1423. [PMID: 27125913 DOI: 10.1016/j.ajic.2016.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/25/2016] [Accepted: 03/02/2016] [Indexed: 01/01/2023]
Abstract
The role of nursing staff is important for both prevention and early diagnosis of complications associated with mechanical ventilation. The objective of our study was to assess the knowledge of nurses working in an intensive care unit for at least 6 months regarding ventilator-associated complications and its prevention. A quasiexperimental study was conducted using a questionnaire with 50 questions formulated by the panel of experts. A planned teaching program was developed based on related literature regarding ventilator-associated complications and its prevention and was presented to the staff nurses. The level of knowledge of the nursing staff was assessed before and after the workshop. Fifty nurses were included in the study. Among the staff nurses, 53.40% had average knowledge regarding ventilator-associated complications. Posttest, 77.20% of the total score was obtained for ventilator-associated complications. Regular training programs can be effective in improving the knowledge of nursing staff.
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Affiliation(s)
- Sunil Maurya
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India
| | - Shakti B Mishra
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India
| | - Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India.
| | - Arvind K Baronia
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India
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Jansson MM, Syrjälä HP, Ohtonen PP, Meriläinen MH, Kyngäs HA, Ala-Kokko TI. Simulation education as a single intervention does not improve hand hygiene practices: A randomized controlled follow-up study. Am J Infect Control 2016; 44:625-30. [PMID: 26899529 DOI: 10.1016/j.ajic.2015.12.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/10/2015] [Accepted: 12/17/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND To evaluate how critical nurses' knowledge of and adherence to current care hand hygiene (HH) guidelines differ between randomly allocated intervention and control groups before and after simulation education in both a simulation setting and clinical practice during a 2-year follow-up period. It was hypothesized that intervention group knowledge of and adherence to current HH guidelines might increase compared with a control group after simulation education. METHODS A prospective, parallel, randomized controlled trial with repeated measurements was conducted in a 22-bed adult mixed medical-surgical intensive care unit in Oulu, Finland. Thirty out of 40 initially randomized critical care nurses participated in the baseline measurements; of these, 17 completed all the study procedures. Participants' HH adherence was observed only in high-risk contact situations prior to and postendotracheal suctioning events using a direct, nonparticipatory method of observation. Participants' HH knowledge was evaluated at the end of each observational session. RESULTS The overall HH adherence increased from a baseline value of 40.8% to 50.8% in the final postintervention measurement at 24 months (P = .002). However, the linear mixed model did not identify any significant group (P = .77) or time-group interactions (P = .17) between the study groups after 2 years of simulation education. In addition, simulation education had no impact on participants' HH knowledge. CONCLUSIONS After a single simulation education session, critical care nurses' knowledge of and adherence to current HH guidelines remained below targeted behavior rates.
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Affiliation(s)
- Miia M Jansson
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland; Unit of Nursing Science and Health Management, University of Oulu, Finland; Medical Research Center Oulu, Oulu, Finland.
| | | | - Pasi P Ohtonen
- Department of Infection Control, Oulu University Hospital, Oulu, Finland
| | - Merja H Meriläinen
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
| | - Helvi A Kyngäs
- Unit of Nursing Science and Health Management, University of Oulu, Finland; Northern Ostrobothnia Hospital District, Medical Research Center Oulu, Oulu, Finland
| | - Tero I Ala-Kokko
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu, Finland
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Jun J, Kovner CT, Stimpfel AW. Barriers and facilitators of nurses' use of clinical practice guidelines: An integrative review. Int J Nurs Stud 2016; 60:54-68. [PMID: 27297368 DOI: 10.1016/j.ijnurstu.2016.03.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 03/06/2016] [Accepted: 03/08/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Preventable harm continues to be one of the leading causes of patient death. Each year about 400,000 patients die from sepsis, hospital acquired infections, venous thromboembolism, and pulmonary embolism. However, as shown in the recent reduction in hospital acquired infections, the number of deaths could be reduced if healthcare providers used evidence-based therapies, which are often included in clinical practice guidelines (CPGs). PURPOSE The purpose of this integrative review is to appraise and synthesize the current literature on barriers to and facilitators in the use of clinical practice guidelines (CPGs) by registered nurses. DESIGN Whittemore and Knafl integrative review methodology was used. Primary quantitative and qualitative studies about the nurses' use of CPGs and published in peer-reviewed journals between January 2000 and August 2015 were included. METHODS The Critical Skills Appraisal Program (CASP) was used to critically appraise the quality of sixteen selected quantitative and qualitative studies. RESULTS Internal factors were attitudes, perceptions, and knowledge whereas format and usability of CPGs, resources, leadership, and organizational culture were external factors influencing CPG use. CONCLUSION Given each barrier and facilitator, interventions and policies can be designed to increase nurses' use of CPGs to deliver more evidence based therapy. In order to improve the use of CPGs and to ensure high quality care for all patients, nurses must actively participate in development, implementation, and maintenance of CPGs.
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Affiliation(s)
- Jin Jun
- New York University, College of Nursing, United States.
| | - Christine T Kovner
- Mathy Mezey Professor of Geriatric Nursing, New York University, College of Nursing, United States.
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Basuni EM, Bayoumi MM. Improvement critical care patient safety: using nursing staff development strategies, at Saudi Arabia. Glob J Health Sci 2015; 7:335-43. [PMID: 25716409 PMCID: PMC4796447 DOI: 10.5539/gjhs.v7n2p335] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/18/2014] [Indexed: 12/04/2022] Open
Abstract
Intensive care units (ICUs) provide lifesaving care for the critically ill patients and are associated with significant risks. Moreover complexity of care within ICUs requires that the health care professionals exhibit a trans-disciplinary level of competency to improve patient safety. This study aimed at using staff development strategies through implementing patient safety educational program that may minimize the medical errors and improve patient outcome in hospital. The study was carried out using a quasi experimental design. The settings included the intensive care units at General Mohail Hospital and National Mohail Hospital, King Khalid University, Saudi Arabia. The study was conducted from March to June 2012. A convenience sample of all prevalent nurses at three shifts in the aforementioned settings during the study period was recruited. The program was implemented on 50 staff nurses in different ICUs. Their age ranged between 25-40 years. Statistically significant relation was revealed between safety climate and job satisfaction among nurses in the study sample (p=0.001). The years of experiences in ICU ranged between one year 11 (16.4) to 10 years 20 (29.8), most of them (68%) were working in variable shift, while 32% were day shift only. Improvements were observed in safety climate, teamwork climate, and nurse turnover rates on ICUs after implementing a safety program. On the heels of this improvement; nurses’ total knowledge, skills and attitude were enhanced regarding patient safety dimensions. Continuous educational program for ICUs nursing staff through organized in-service training is needed to increase their knowledge and skills about the importance of improving patient safety measure. Emphasizing on effective collaborative system also will improve patient safety measures in ICUS.
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Lin HL, Lai CC, Yang LY. Critical care nurses' knowledge of measures to prevent ventilator-associated pneumonia. Am J Infect Control 2014; 42:923-5. [PMID: 25087147 DOI: 10.1016/j.ajic.2014.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/14/2014] [Accepted: 05/14/2014] [Indexed: 10/25/2022]
Abstract
We queried critical care nurses at a hospital about their level of knowledge of interventions designed to prevent ventilator-associated pneumonia (VAP). The mean score was 7.87 ± 1.36 (65.6%) among 133 questionnaires. Multivariate analysis revealed that intensive care unit (ICU) license (P = .03) and ranking of registered nurses (RNs) (P = .041) were significantly associated with higher knowledge level (≥8 correct answers of 12 items) of respondents. This surveillance study revealed that non-ICU-licensed nurses and junior RNs lack the knowledge necessary to prevent VAP in critical care settings.
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Jansson MM, Ala-Kokko TI, Ohtonen PP, Meriläinen MH, Syrjälä HP, Kyngäs HA. Human patient simulation education in the nursing management of patients requiring mechanical ventilation: a randomized, controlled trial. Am J Infect Control 2014; 42:271-6. [PMID: 24581015 DOI: 10.1016/j.ajic.2013.11.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Knowledge among critical care nurses and their adherence to evidence-based guidelines for preventing ventilator-associated pneumonia is reported to be low. The aim of our study was to evaluate the effectiveness of human patient simulation (HPS) education in the nursing management of patients requiring mechanical ventilation. METHODS A prospective, parallel, randomized controlled trial with repeated measurements was conducted in a 22-bed adult mixed medical-surgical intensive care unit in Finland from February-October 2012. Thirty critical care nurses were allocated evenly to intervention and control groups (n = 15 each). The effectiveness of HPS education was evaluated through the validated Ventilator Bundle Questionnaire and Ventilator Bundle Observation Schedule at baseline and repeated twice-after the clinical and simulation settings, respectivley. RESULTS After HPS education, the average skill scores (Ventilator Bundle Observation Schedule) in the intervention group increased significantly (46.8%-60.0% of the total score) in the final postintervention observation. In the average skill scores, a linear mixed model identified significant time (Pt < .001) and group (P(g) = .03) differences and time-group interactions (P(t*g) = .02) between the study groups after the HPS education. In contrast, the model did not identify any significant change over time (P(t) = .29) or time-group interactions (P(t) = .69) between groups in average knowledge scores (Ventilator Bundle Questionnaire). CONCLUSIONS Our study identified significant transfer of learned skills to clinical practice following HPS education but no influence on the level of participants' factual knowledge.
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Affiliation(s)
- Miia M Jansson
- University of Oulu Graduate School, University of Oulu, Faculty of Medicine, Institute of Health Sciences, Nursing Science, Oulu, Finland; Medical Research Center Oulu, Oulu, Finland; Division of Intensive Care Medicine, Department of Anesthesia, Oulu University Hospital, Oulu, Finland.
| | - Tero I Ala-Kokko
- Division of Intensive Care Medicine, Department of Anesthesia, Oulu University Hospital, Oulu, Finland
| | - Pasi P Ohtonen
- Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
| | - Merja H Meriläinen
- Division of Intensive Care Medicine, Department of Anesthesia, Oulu University Hospital, Oulu, Finland
| | - Hannu P Syrjälä
- Department of Infection Control, Oulu University Hospital, Oulu, Finland
| | - Helvi A Kyngäs
- Institute of Health Science, University of Oulu, Medical Research Center Oulu, Oulu, Finland
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