The effect of education on hypothetical and actual oxygen administration decisions

Barriers to Safe Oxygen Therapy and the Effect of the Training on the Knowledge and Performance of ICU Nurses

Introduction

Proper oxygen therapy is crucial in hospitals, particularly intensive care units, to ensure safety and accuracy. The role of nurses during oxygen therapy is vital, as their knowledge and correct performance significantly impact patients' clinical conditions. A study was carried out to examine the knowledge and performance of nurses regarding safe oxygen therapy. The study aimed to identify the obstacles hindering safe oxygen therapy and assess the impact of training on the knowledge and performance of intensive care nurses.

Methods

This study was conducted among the ICU nurses at Shahid Rahnemoun Teaching Hospital in Yazd, Iran. The study method is a sequential combination of descriptive, qualitative, and educational phases. The first stage involved examining the knowledge and performance of 80 ICU nurses in oxygen therapy. The study employed content analysis to elaborate on participants' perspectives on safe oxygen therapy challenges and potential solutions. The third phase involved a two-group study with pre- and post-tests to examine the effect of training on ICU nurses' knowledge and performance in oxygen therapy.

Results

The study found that intervention and control groups had low average scores in knowledge, performance, and total score of oxygen therapy before the study, with no significant difference. There was a significant difference between intervention and control groups one and three months after the intervention in the areas of knowledge (after-1 month 24.41 vs. 20.29, 95% CI [3.144-5.098], after-3 month 22.13 vs. 20.24, 95% CI [0.729-3.053]), performance (after-1 month 21.54 vs. 18.05, 95% CI [2.898-4.073], after-3 month 19.74 vs. 18.63, 95% CI [0.400-1.824]), and total score of oxygen therapy (after-1 month 45.95 vs. 38.34, 95% CI [6.288-8.925], after-3 month 41.87 vs. 38.87, 95% CI [1.394-4.613]).

Conclusion

The study's findings revealed that nurses in ICUs lack the appropriate knowledge and performance in oxygen therapy. A lack of knowledge and correct practice, insufficient monitoring of oxygen therapy, and defects in hospital equipment are contributing factors. The training was found to improve the knowledge and performance of nurses significantly. Consistent training at shorter intervals is suggested for nurses to keep their knowledge current.

Educational interventions promoting evidence-based practice among emergency nurses: A systematic review

INTRODUCTION

Emergency nurses are expected to adopt evidence-based practice (EBP). The aim of this systematic review was to describe educational interventions promoting EBP and their outcomes among emergency nurses, compared with no education, to inform clinicians and researchers about effective educational interventions suitable for use in emergency departments (EDs).

METHODS

CINAHL, Cochrane, PubMed and Scopus were systematically searched to identify studies published between January 1, 2006 and October 20, 2016 describing educational interventions designed to promote EBP among emergency nurses. 711 studies were identified and screened; 10 were selected for inclusion and quality assessment. The studies were analyzed using deductive content analysis, and the review's results are presented in accordance with the PRISMA guidelines.

RESULTS

Ten relevant studies on nine different self-developed educational interventions were identified. Eight studies had highly significant or significant results. Interventions involving face-to-face contact led to significant or highly significant effects on patient benefits and emergency nurses' knowledge, skills, and behavior. Interventions using written self-directed learning material led to significant improvements in nurses' knowledge of EBP. All the descriptions of the interventions were incomplete, and the reported details varied considerably between the studies.

CONCLUSIONS

There have been few studies on educational interventions to promote EBP among emergency nurses but the available results are promising.

Low-flow oxygen therapy in intensive care: an observational study

BACKGROUND

There is scant published evidence that explains how ICU nurses' manage low-flow oxygen therapy; and, hence little is known about how low-flow oxygen therapy is delivered on a daily basis.

AIM

The aims of this study were first to observe how ICU nurses' manage low-flow oxygen therapy and then to compare observed nursing practice on the management of oxygen therapy with patients' documented measures of oxygen saturation (SpO2) and respiratory rate (RR).

METHOD

From May to July 2009, eight 2h observation periods were conducted in one ICU of a metropolitan hospital in Melbourne, Victoria. Data were collected at using a structured observation tool, field notes and chart review. Quantitative data were analysed using descriptive and frequency statistics, and textual data were reviewed using a content analysis procedure.

RESULTS

Over the 16 h of observed nursing practice, there were 96 points of measurement involving 16 patients and 16 ICU nurses. The management of low-flow oxygen therapy varied between nurses and data revealed that nurses did not always promote effective oxygenation. Documented SpO2 was 98.0% (SD 2.8%) and observed SpO2 was 96.3% (SD 1.8%). Documented RR was 19.6 breaths/min (SD 3.5) and observed RR was 21.0 breaths/min (SD 16.8). Episodes of hypoxaemia and tachypnoea occurred while patients were receiving oxygen and nurses did not always respond appropriately.

CONCLUSION

ICU nurses' management of low-flow oxygen therapy was suboptimal and documentation of oxygenation and respiratory rate was inaccurate. Further exploration of how ICU nurses manage low-flow oxygen therapy is a necessary prelude to the conduct of interventional studies and the development of better guidance to support low-flow oxygen therapy in the ICU.

What is provided and what the registered nurse needs--bioscience learning through the pre-registration curriculum

Registered nurses undertaking programmes of study to become non-medical prescribers appear to have limited biological science knowledge. A case study was undertaken to determine whether the nurses entering Prescriber programmes considered studies in bioscience in their pre-registration nursing courses had been sufficient, linked to practice, and had prepared them for their roles as registered nurses. The literature identifies a continuing trend amongst nursing students describing a lack of sufficient bioscience in initial nurse education; there is limited literature on the views of experienced registered nurses. The participants in this study were 42 registered nurses from adult and mental health nursing, community and inpatient services. The results obtained from questionnaires and interviews are described. Questionnaire analysis identified that 57.1% of participants indicated bioscience in their pre-registration nursing programme had been limited and 40.5% stated the bioscience content had not prepared them for their roles on registration. Those reporting extensive coverage of bioscience were all aged over 41 years and had qualified before 1995. Greatest coverage of bioscience in pre-registration programmes was reported in relation to anatomy and physiology, with relatively limited coverage of microbiology, pharmacology or biochemistry. Respondents considered all five topics to be important. Interviews supported the questionnaire findings.

Does specialist respiratory education make a difference to practice?

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) poses a huge burden to society. Continued professional development can be regarded as a requisite for implementing quality care. Within the literature the effectiveness of COPD care is evident, yet it is seldom attributed to the educational attainment of healthcare professionals. This study aimed to examine whether a nationally delivered COPD module is perceived to impact on clinical practice.

METHODS

As part of a mixed methods study (Cresswell et al., 2003), qualitative data were gathered post-intervention from 68 students utilising a semi-structured, self-completed questionnaire. Data were analysed using a themed content analysis and a quasi-statistical approach.

RESULTS

The major themes that emerged from the analysis were: changes in personal practice, evidence of changes implemented and changes in participants' personal views regarding disease management. These findings suggest that when students gain knowledge they use it to the benefit of patients.

DISCUSSION

Overall students reported an increase in knowledge and confidence regarding COPD management and an impact on practice was reported. The findings will add to a mounting body of evidence that supports the value of continuing professional learning and will aim to satisfy consumers of education of the efficacy of knowledge in terms of direct patient impact.

Nursing involvement improves compliance with tight blood glucose control in the trauma ICU: a prospective observational study

INTRODUCTION

The importance of tight glycaemic control has gained acceptance over the last 5 years as a critical component of routine intensive care unit (ICU) measures. In an environment already strained for resources and staffing, however, effective strategies providing for increased input and responsibility of bedside nursing personnel are paramount to successful implementation.

HYPOTHESIS

Increasing input and responsibilities of ICU nursing staff in tight glycaemic control policies improves glucose control in the trauma ICU.

METHODS

After Institutional Review Board approval, we conducted a prospective "before-after" trial examining the effect of nursing education and input on outcome of a tight (goal 80-120 mg/dL) glycaemic control protocol. After a three month assessment of compliance with a previously physician-developed protocol, an educational in-service was conducted for all trauma ICU nursing staff. Nursing staff were then asked to provide input on the development of a new protocol using multiple-choice ballots to define 7 components of protocol criteria. Using nursing input, we developed and implemented a new glycaemic protocol that shifted much of the responsibility for initiation and subsequent adjustment of insulin infusion to the bedside nurse, allowing them to more liberally utilise their bedside clinical judgment and knowledge of the specific patient.

RESULTS

Nursing input on seven factors of protocol criteria did not differ significantly from the previously existing protocol, except with reference to nursing desire for increased responsibility in the implementation and maintenance of tight glycaemic control. After three months implementation of a new protocol developed utilising nursing input, both mean blood glucose levels achieved (137.8 mg/dL vs. 128.2mg/dL, p=0.028) and time to first hourly blood glucose within goal range (<120 mg/dL) was improved (36 h vs. 9h). The number of hypoglycaemic (BS <60) episodes increased slightly after revision (1 event vs. 5 event), with no hypoglycaemic seizures or coma occurring during either period.

CONCLUSION

Nursing input and increased responsibility improved the results of a tight glycaemic control in our trauma ICU. Increasing nursing input in the development and implementation of a tight glycaemic policies can result in safe and effective improved glucose control in the trauma ICU.