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  3. A comparative study of the training of clinical guidelines for the prevention of ventilator-associated pneumonia by two face-to-face and workshop methods, on the knowledge and performance of nurses working in the intensive care unit in 2013

A comparative study of the training of clinical guidelines for the prevention of ventilator-associated pneumonia by two face-to-face and workshop methods, on the knowledge and performance of nurses working in the intensive care unit in 2013

Number of pages: 84 File Format: word File Code: 32042
Year: 2013 University Degree: Master's degree Category: Medical Sciences
Tags/Keywords: Clinical guidance training - face to face - Prevention of pneumonia - Special care - ventilator-associated pneumonia - Workshop training
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  • Summary of A comparative study of the training of clinical guidelines for the prevention of ventilator-associated pneumonia by two face-to-face and workshop methods, on the knowledge and performance of nurses working in the intensive care unit in 2013

    Master's course in intensive care nursing

    Abstract

    Introduction: In the intensive care unit, ventilator-associated pneumonia ranks first among hospital infections. Since the role of nurses in preventing this complication is very important, the present study aims to compare the effect of two face training methods. A clinical guideline for the prevention of ventilator-associated pneumonia has been conducted on the knowledge and performance of nurses.

    Materials and methods: In this semi-experimental study, the performance and knowledge level of nurses in the ICU departments of one of the hospitals affiliated to Shiraz University of Medical Sciences in two groups of face-to-face training (35 nurses) and workshop training (40) (nurse) clinical guidelines for the prevention of ventilator-associated pneumonia were measured. The performance and knowledge level of the research samples of each group was evaluated with the help of direct performance observation, self-report questionnaire and knowledge measurement questionnaire before and after. The data were analyzed with the help of descriptive statistics (mean and frequency) and analytical tests (paired t-test, independent t-test, McNemar, Fisher's exact test, sine and chi-square test).

    Findings: The frequency of inappropriate cuff pressure of tracheostomy and tracheostomy tubes decreased significantly after the training compared to before and the findings indicate a difference It was significant in both face-to-face and workshop groups (P<0.001). The frequency of suctions not performed by the nurse before the training in the face-to-face group (P=0.008) and the workshop group (P=0.002) showed a significant difference compared to after. The average knowledge of nurses in two groups was significantly improved from 36.22 (before training) to 93.93 (after training) (P<0.001). However, the frequency of hand washing or disinfection in contact with the patient, before and after training, was weak and inappropriate, and no significant difference was observed. There was no significant difference with the studied variables.

    Conclusion: Monitoring and evaluation of the intensive care unit in terms of compliance with the principles of ventilator-associated pneumonia prevention, especially regarding cuff pressure and hand disinfection, is essential, and training nurses in face-to-face methods, a workshop, is very effective in preventing the occurrence of this disease.

     

    Key words: ventilator-associated pneumonia, intensive care unit, face-to-face education, nurse, knowledge, performance.

     

    Pneumonia, which refers to the inflammation of the lung parenchyma by microbial agents, is the most common respiratory infection. Among the types of pneumonia, we can mention community-acquired pneumonia and hospital-acquired pneumonia. Ventilator-associated pneumonia [1] (VAP) is a subset of nosocomial pneumonia that occurs 48 hours or more after intubation and connecting the patient to a ventilator. Pneumonia is the most common hospital infection in the intensive care unit, and 90% of cases of acquired pneumonia in the intensive care unit occur during mechanical ventilation, and it is worth noting that pneumonia is one of the common causes of respiratory failure [1]. It is the formation of a bacterial colony within 24 hours in the stomach, pharynx and mouth of these patients with Gram-negative bacteria. Decreased level of consciousness, lack of ciliary reflex, decreased motility of the gastrointestinal tract, accumulation of secretions, hemodynamic disorders, frequent intubation of the trachea and stomach, decrease in gastric acid following the administration of antacids, H2 inhibitors and proton pump inhibitors are among the reasons for colonization of the stomach, mouth and pharynx areas of these patients, and it occurs in approximately 25% of patients with colonization of a clinical infection, tracheobronchitis or pneumonia. VAP is the second nosocomial infection in America [3].In developed countries, the prevalence of VAP has been reported between 9 and 27%, and in Iran, although exact statistics are not available, most sources have reported the prevalence of VAP to be higher than that of developed countries [5 and 4]. The length of stay in the ICU of patients diagnosed with VAP is increased between 4 and 19 days compared to patients who are mechanically ventilated but not diagnosed with VAP. And the cost of treating these patients is estimated to be about 40,000 to 57,000 dollars more than the patients who are mechanically ventilated but are not affected by VAP [8 and 7]. wards, and especially the reduction of problems and complications of ICU patients.

    In a research conducted by Mehr Ali et al., about the amount of evidence-based knowledge nurses had in preventing ventilator-associated pneumonia before and after training, they used the 2003 guidelines of the US Centers for Disease Control and Prevention 1 (CDC) for training, and the nurse's knowledge with a questionnaire tool, once before training, and the second time exactly After the training and the third time one month after the training [9].

    In the Brazilian study conducted by Martin and his colleagues [2] under the title of the effect of training on cuff pressure in the intensive care unit, the cuff pressure was collected retrospectively once before the training of nurses and once after the training in the morning, evening and night shifts separately, and the cuff pressure was higher than 30 cm of water is considered inappropriate cuff pressure. The obtained results indicated that the changes in the evening and night shift were significant but not in the morning shift [10]. However, in the discussion of education, individual education in the form of face-to-face education is one of the direct and face-to-face methods of education and can be implemented with a variety of explanatory or practical methods in different places and on different occasions. The advantage of individual training is that you can discuss with people and encourage them to change their behavior. And the educational workshop is a way to solve problems and problems in which a small number of people (between 25 and 40 people) who are interested in a specific field or subject, scientific, technical, etc. They are dependent and placed next to each other]11[.

    Abstract

    BACKGROUND:

    Ventilator-associated pneumonia (VAP) is the most nosocomial infection in the intensive care. units(ICU). For as much as, the nurse's role in preventing this complication is very important. The present study was conducted to compare the effect of face to face training and workshops by clinical guidline in prevention of VAP, on the nurse's level of knowledge and practice.

    METHODS AND MATERIALS:

    In this quasi experimental study, the nurse's level of knowledge and practice in ICUs were measured in two groups of face to face training (35 nurses) and workshops (40 nurses) by using clinical guidline in prevention of VAP in one of the hospitals of Shiraz University of Medical Science. The level of knowledge and practice in each group, was assessed by self report questionnaire, knowledge questionnaire and also direct observation of practice, before and after training. Data were analyzed with descriptive statistics (mean and frequency) and analytical tests (paired t-test, independent t-test, McNemar test, Fisher's exact, sign and Chi-square test) Tracheostomy tube

    Were significantly reduced after training compared with before training. While, results indicated the significant differences in two groups of face to face training and workshop (p<0/001).

  • Contents & References of A comparative study of the training of clinical guidelines for the prevention of ventilator-associated pneumonia by two face-to-face and workshop methods, on the knowledge and performance of nurses working in the intensive care unit in 2013

    List:

    Chapter One: Introduction and statement of the problem. 1

    Statement of the problem and the necessity of conducting research. 2

    Chapter Two: conceptual framework and review of texts. 5

    2-1. ventilator-associated pneumonia. 6

    2-2. Etiology of ventilator-associated pneumonia. 7

    2-3. Pathophysiology of ventilator-associated pneumonia. 7

    2-4. Risk factors for VAP. 8

    2-5. Symptoms of ventilator-associated pneumonia. 8

    2-6. Clinical guidelines for the prevention of ventilator-associated pneumonia in Ireland in 2011. 8

    2-6-1. Importance. 8

    2-6-2. Training. 9

    2-6-3. Clinical care control and infection prevention. 9

    2-6-4. Tracheal intubation. 10

    2-6-5. Positive pressure ventilation. 10

    2-6-6. Pharmaceutical strategy. 10

    2-6-7. Prevention of aspiration. 10

    2-6-8. Prevention of equipment contamination. 11

    2-6-9. Prevention of gastrointestinal colonization. 12

    2-7. Investigating and controlling tracheal and tracheostomy tube cuff pressure. 12

    2-7-1. Tracheal injuries due to high pressure of tracheal tube cuff. 13

    2-7-2. Tracheal cartilage softening. 13

    2-8. Washing and disinfecting hands. 14

    2-9. Nursing care in the prevention of ventilator-associated pneumonia 14

    2-10. Face-to-face and workshop training in nursing. 15

    2- 11. Summary. 15

    2-12. Review of texts. 16

    Chapter three: materials and methods. 20

    3-1. Goals. 21

    3-1-1. General purpose. 21

    3-1-2. Partial objectives. 21

    3-2. Assumptions. 22

    3-3. Sample acceptance and exclusion criteria. 22

    3-3-1. Entry criteria. 22

    3-3-2. Exit criteria: 22

    3-4. Research materials and methods. 23

    3-4-1. Study population and sampling method. 23

    3-4-2. Implementation method. 23

    3-4-3. Information analysis method. 25

    3-4-4. sample size 26

    3-5. Limitations. 26

    3-6. Ethical considerations. 26

    Chapter four: results and findings. 27

    4-1. Comparison of sex, age, educational qualification and the amount of work experience in ICU. 28

    4-2. Observation findings and results. 29

    4-2-1. The cuff pressure of tracheal tubes or tracheostomy patients 29

    4-2-2 The results of the preparation of disinfectant liquid by the patient's bed. 31

    4-2-3. Appropriateness of the patient's head position (30 to 45 degrees if there is no prohibition) 32

    4-2-4. Observing the replacement of the antibacterial filter. 33

    4-2-5. Observing wearing examination gloves, washing hands or disinfecting hands.  33

    4-2-6. Observation of the nurse's suction not done. 34

    4-3. Self-report findings and results. 36

    4-3-1. General questions related to routine parts. 36

    4-3-2. Personal performance results of nurses. 38

    4-4. The results of the nurse's knowledge. 42

    Chapter five: discussion and conclusion. 44

    5-1. view 45

    5-1-1. Tracheostomy tube cuff pressure. 45

    5-1-2. Disinfection and hand washing. 46

    5-1-3. Disinfectant liquid is ready and the patient's bed is suitable. 46

    5-1-4. Replacing the antibacterial filter. 47

    5-1-5. The nurse did not perform suction. 47

    5-2. self reporting 47

    5-3. Knowledge of nurses in preventing VAP. 48

    5-4. Comparison of before and after training of each group. 48

    5-5. Comparison of face-to-face group with workshop. 48

    5-6. Conclusion. 49

    5-7. Application of research in nursing profession. 49

    5-8. Suggestions for future research. 50

    List of sources. 51

    Attachments. 56

    Source:

    1- Marino P. The complete book of ICU. Translated by Puran Sami. Fourth edition, Tehran, Bushra Publishing House, 2010, pp. 429-421. 2- Cholai M. Burns S. Essentials of special care nursing. Translator: Shurideh Atashzadeh, first edition, Tehran, Jamianagar Publications, 1390. pp. 269-267.

    3- Pobo A, Garc?a-Esquirol O, Mariscal D, Real J, Vallés J, Fern?ndez R. Excess ICU mortality attributable to ventilator-associated pneumonia: the role of early vs late onset. Intensive Care Med 2008;33(8):1363–1368.

    4- Mcnabb B, Isakow W. probiotics for the prevention of nosocomial pneumonia: current evidence and opinions. Curr Opin Pulm Med 2008; 14:168-175.

    5- Salimi P. Evaluation of the effect of standardization of careEvaluation of the effect of standardization of nursing care on the rate of nosocomial infections in the MICU department. Urmia Medical Journal 2017; 4 (19): p. 310

    6- Jacobi C, Schulz C, Mal Fertheiner P, Treating critically ill patients with probiotics Beneficial or dangerous?. Gut pathogens 2011,3:2 oi:10.1186/1757-4749-3-2 7-Restrepo M, Anzueto A, Arrogliga A. Economic burden of ventilator-associated pneumonia based on total resource utilization. Infect Control Hosp Epidemiol 2010;31: 509–515.

    8-Sedwick M, Smith M, Sara J, Nardi J. Using Evidence-Based Practice to Prevent Ventilator-Associated Pneumonia. Crit Care Nurse 2012;32:441-51

    9- Meherali S, Parpio Y, Tazeen S. nurses, knowledge evidence based Guidelines for the prevention of ventilator associated pneumonia in critical care areas: a pre and post design. J Ayub Med Coll Abbottabad 2011;23(1): 146-149

    10- Renata DE, Martin P. Cuff pressure control in intensive care unit: training effects. Rev. bras ter 2010;22(2):192-195

    11- Khorasani P, Saeed al-Zhakrin M. Active and effective teaching method with conceptual map. Sabz Magazine 2018; Number 10

    12-Buczk. Ventilator-associated pneumonia among elderly Medicare beneficiaries in long-term care hospitals. Health Care Financ Rev 2009;31(1):1-10.

    13-Afkhamzadeh A, Lahorepour F, Del Pisheh A. Investigating the incidence of ventilator-associated pneumonia and its bacterial resistance pattern in the adult intensive care unit of Ba'ath Hospital, Sanandaj. Scientific Journal of Kurdistan University of Medical Sciences, 1390; Volume 16: pp. 20-26

    14- Nadi A, Nekoui B, Mobin A. Investigating the causes of nosocomial pneumonias in the special care departments of Hamedan University of Medical Sciences teaching hospitals. Scientific Journal of Hamedan University of Medical Sciences and Health Services 2019; Volume 18, No. 59: pp. 11-16. 15-Torpy JM, Lynm C, Glass RM Ventilator-associated pneumonia. JAMA 2008;300(7):864.               

    16- SARI working group. Guidelines for the prevention of ventilator associated pneumonia in adults in Ireland [internet]. 2011 February [cited 2013, 6, 13]. Availabel from: http: //www.hpsc.ie

    17-Nik Rovan Mofard M, Shiri H. Principles of Special Care in ICU, CCU and Dialysis, third edition, Tehran, Noor Danesh Publications, 1387, pp. 280-259

    18- WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety, Challenge Clean Care is Safer Care. World Health Organization & World Alliance for Patient Safety [internet]. 2009 February [cited 2014.1.2]. Available from: www.cdc.gov/handhygiene.

    19-Metheny N, Clouse R, Chang U, Stewart B, Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: frequency, outcomes, and risks. Crit Care Med 2006;34(4):1007–101

    20-Chan E, Ruest A, Meade MO, Cook DJ. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ 2007;334:889.

    21-Trick WE, Vernon MO, Welbel SF, Demarais P, Hayden MK, Weinstein RA. Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance. Infect Control Hosp Epidemiol 2007;28(1):42–49.

    22-Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T. Using a bundle approach to improve ventilator care process and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf 2005;31(5):243–248.

    23-Cason C, Tyner T, Sunder S, Broome L. Nurses' implementation of guidelines for ventilator-associated pneumonia from the Centers for Disease Control and Prevention. Am J Crit Care 2007;16(1):28–36

    24- Hasanpour Dehkordi A, Khairi S, Shahrani M. Investigating the effect of learning method based on problem solving and lectures on learning, attitude and performance of undergraduate nursing students. Journal of Shahrekord University of Medical Sciences 1385; 8 (3): 82-76

    25- Kandeel N, Tantawy N. Current Nursing Practice for Prevention of Ventilator Associated Pneumonia in ICUs. Life science journal 2012;9(3):966-75

    26- Carolyn L, Tyner T, Saunders S, Broom L.

A comparative study of the training of clinical guidelines for the prevention of ventilator-associated pneumonia by two face-to-face and workshop methods, on the knowledge and performance of nurses working in the intensive care unit in 2013
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