Emergency Nurse Responsibilities for Mechanical Ventilation: A National Survey

Emergency nurses' knowledge about ventilator-associated pneumonia

INTRODUCTION

Given the increasing number of patients requiring mechanical ventilation in emergency departments in recent years, prevention of ventilator-associated pneumonia is very important. Nurses play a significant role in prevention of ventilator-associated pneumonia. This study aimed to determine the emergency nurses knowledge about prevention of ventilator-associated pneumonia.

METHODS

The present descriptive study was conducted in Iran, from July to October 2018. All the nurses with at least a bachelor degree, who are working in two emergency departments of two teaching hospitals, were asked to participate in this study. The "knowledge about ventilator-associated pneumonia" questionnaire consisting of 9 items was used to assess the knowledge of nurses. The results were analyzed using SPSS-16.

RESULTS

In total, 53 nurses participated in this study. The mean score of correct answers of nurses to these 9 items was 4.4 ± 1.6. Nurses give the most correct answer to the item about patient's position on the bed so as to reduce the risk of pneumonia with a correct answer of 72.9%. The least correct answer was also given to the item about how humidifier was changed with a correct answer of 1.9%. None of the nurses participating in the study were able to answer all the items correctly. The mean score of knowledge of nurses who had participated in workshops about taking care of patients on mechanical ventilation was significantly higher than those who had not participated in such workshops (4.8 vs. 3.8) (p = 0.045). The mean score of knowledge in nurses who were familiar with the international guidelines for ventilator-associated pneumonia prevention was significantly higher than those who were not familiar with such guidelines (5.1 vs. 4.1) (p = 0.045).

CONCLUSION

Emergency nurses participated in this study had inadequate knowledge about the prevention of ventilator-associated pneumonia. Nurse's knowledge affected by participation in related workshop and familiarity with ventilator-associated pneumonia guidelines. Considering the importance of this issue, it is necessary to improve the knowledge of the emergency nurses in this matter by holding training courses.

Protective lung strategies: A cross sectional survey of nurses knowledge and use in the emergency department

BACKGROUND

Mechanical ventilation (MV) is commonly used in emergency departments (EDs). Protective lung strategies (PLS), comprising of low tidal volume (6mL/kg), control of oxygen and plateau pressures, and administration of positive end expiratory pressure (PEEP) has been shown to reduces the risks associated with MV but there is little evidence exists about nurses' knowledge or application of PLS. Our aim was to explore nurses knowledge and application of PLS in Australian EDs.

METHODS

Descriptive, exploratory design utilising an online questionnaire. A convenience sample was recruited via the College of Emergency Nursing Australasia mailing list and secondary snowball sampling was used to optimise response rate.

RESULTS

There were 157 participants. PLS are being used in most EDs (n=104, 75%) and clinical practice guidelines (CPG) are often available (n=86, 62%). Most ED ventilators are capable of implementing PLS, but measurement of plateau pressures was infrequent (n=46%). Participants demonstrate appropriate knowledge, but reported varying levels of confidence and perceived autonomy when implementing PLS in the ED.

CONCLUSION

PLS are being used in Australian EDs, aligning with best available evidence. Nursing staff have good levels of PLS knowledge. Development of an evidence-based CPG may improve confidence when implementing PLS and may pave the way for ED nurses to expand their scope of practice.