Helvi Kyngäs

Critical care nurses’ knowledge of, adherence to and barriers towards evidence-based guidelines for the prevention of ventilator-associated pneumonia – A survey study

OBJECTIVESnTo explore critical care nurses knowledge of, adherence to and barriers towards evidence-based guidelines for prevention of ventilator-associated pneumonia.nnnDESIGNnA quantitative cross-sectional survey.nnnMETHODSnTwo multiple-choice questionnaires were distributed to critical care nurses (n=101) in a single academic centre in Finland in the autumn of 2010. An independent-samples t-test was used to compare critical care nurses knowledge and adherence within different groups. The principles of inductive content analysis were used to analyse the barriers towards evidence-based guidelines for prevention of ventilator-associated pneumonia.nnnRESULTSnThe mean score in the knowledge test was 59.9%. More experienced nurses performed significantly better than their less-experienced colleagues (p=0.029). The overall, self-reported adherence was 84.0%. The main self-reported barriers towards evidence-based guidelines were inadequate resources and disagreement with the results as well as lack of time, skills, knowledge and guidance.nnnCONCLUSIONnThere is an ongoing need for improvements in education and effective implementation strategies.nnnCLINICAL IMPLICATIONSnThe results could be used to inform local practice and stimulate debate on measures to prevent ventilator-associated pneumonia. Education, guidelines as well as ventilator bundles and instruments should be developed and updated to improve infection control.

Human patient simulation education in the nursing management of patients requiring mechanical ventilation: A randomized, controlled trial

BACKGROUNDnKnowledge 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.nnnMETHODSnA 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.nnnRESULTSnAfter 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).nnnCONCLUSIONSnOur study identified significant transfer of learned skills to clinical practice following HPS education but no influence on the level of participants factual knowledge.

Effectiveness of educational programmes in preventing ventilator-associated pneumonia: a systematic review

BACKGROUNDnVentilator-associated pneumonia (VAP) is the most frequent device-associated, nosocomial infection encountered in critical-care settings, associated with substantial morbidity, a two-fold increase in mortality rates and excess costs. According to previous studies, critical-care nurses knowledge of and adherence to guidelines for preventing VAP is low in the absence of educational interventions.nnnAIMnThe aim of this study was to assess the current body of literature regarding the effectiveness of educational programmes, with a focus on learning and clinical outcomes, in order to identify ways to intensify current research.nnnMETHODSnStudies published between 2003 and 2012 contained in seven multi-disciplinary databases (Medline Ovid(®), the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Scopus, Web of Science, Medic, and Academic Search Premier) were reviewed. A comprehensive literature search strategy was conducted in association with an information specialist. The study selection process was carried out by two researchers independently and objectively.nnnFINDINGSnEight original studies were included in the final review. Increasing the education of intensive care unit (ICU) personnel was linked to a significant improvement in the level of knowledge and adherence to guidelines and significant improvement in clinical outcomes, i.e. decreased incidence of VAP, length of ICU and hospital stays, mortality and costs.nnnCONCLUSIONSnEducation has significant benefits for improving patient safety, and thus the quality of care. Active implementation strategies involving repeated lectures and regular surveys of VAP occurrence would be beneficial. Further research is needed to design multi-centre, randomized, controlled, follow-up studies. Development of a universal method of outcome measurement is required to facilitate further evaluation of the relationship between educational programmes and clinical outcomes.

Randomized, controlled trial of the effectiveness of simulation education: A 24-month follow-up study in a clinical setting.

BACKGROUNDnCritical care nurses knowledge and skills in adhering to evidence-based guidelines for avoiding complications associated with intubation and mechanical ventilation are currently limited. We hypothesized that single simulation education session would lead to a long-lasting higher level of skills among critical care nurses.nnnMATERIAL AND METHODSnA randomized controlled trial was conducted in a 22-bed adult mixed medical-surgical intensive care unit in Finland during the period February 2012-March 2014. Thirty out of 40 initially randomized critical care nurses participated in a 24-month follow-up study. Behavior and cognitive development was evaluated through a validated Ventilator Bundle Observation Schedule and Questionnaire at the baseline measurement and repeated 3 times during simulation and real-life clinic settings.nnnRESULTSnAfter simulation education, the average skills score increased from 46.8%-58.8% of the total score in the final postintervention measurement (Ptimeu2009<u2009.001, Ptime × groupu2009=u2009.040, and Pgroupu2009=u2009.11). The average knowledge scores within groups did not change significantly. The average between-group difference in skills scores was significant only at the measurement taken at 6 months (Pu2009=u2009.006).nnnCONCLUSIONSnCritical care nurses skills in adhering to evidence-based guidelines improved in both groups over time, but the improvements between the study groups was significantly different only at 6 months and was no longer evident after 2 years following a single simulation education.

Identification of tele-ICU system requirements using a content validity assessment

OBJECTIVESnTelemedicine in intensive care (tele-ICU) involves the use of information technologies to deliver care instructions from a command center to remote hospitals. To ensure acceptance and usability, clinicians should participate early in the design. This study surveyed clinical professionals to identify and rank important functions for a tele-ICU system.nnnMETHODSnThis cross-sectional, prospective, structured, two-round survey included European intensive-care professionals that were not familiar with tele-ICU systems. In the first round, statements of system function specifications were evaluated for validity; in the second round, unclear items were rephrased and new items were added. Item-level content validity indexes (I-CVI) were calculated, and values above a 0.75 threshold were considered relevant. Weighted ranking points (WRP) was calculated from the ranking data.nnnRESULTSnA total of 26 responses were received from professionals for four European countries; the majority were intensive-care specialists (77%). A total set of 50 items were selected for the survey. Thirty-six functional specifications were identified with I-CVIs above 0.75, including online access to all patient data (13 items), related risks and alarms (8 items), audio-visual contact for consultations and for monitoring patient beds (5 items), information security (5 items), and resource allocation (5 items). The highest ranking system functions were real time monitoring, alarms, audio-visual connections, and data security.nnnCONCLUSIONSnProfessionals not familiar with tele-ICUs regarded full patient data access, alarms, data security, and audio-visual connections the most important functions in pre-implementation phase.

Longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on endotracheal suctioning knowledge and skills: A randomized controlled trial

HighlightsInsufficient knowledge and non‐recommended practices were observed prior to and post ETS events both in a simulation and clinical settings.Certain aspects of suctioning, such as assessment technique, pain management, suction pressure, shallow suctioning as well as nursing documentation and infection control practices seem to require more reinforcement than others.The need for regularly repeated educational interventions with audio‐visual or individualized performance feedback and repeated bedside demonstrations is evident. &NA; We evaluated the longitudinal effects of single‐dose simulation education with structured debriefing and verbal feedback on critical care nurses endotracheal suctioning knowledge and skills. To do this we used an experimental design without other competing intervention. Twenty‐four months after simulation education, no significant time and group differences or time × group interactions were identified between the study groups. The need for regularly repeated educational interventions with audiovisual or individualized performance feedback and repeated bedside demonstrations is evident.