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The Survey And Effect Of Intervention On Evidence-based Nursing For Preventing Ventilator-associated Pneumonia In Intensive Care Unit

Posted on:2010-08-07Degree:MasterType:Thesis
Country:ChinaCandidate:T WangFull Text:PDF
GTID:2154330302455781Subject:Nursing
Abstract/Summary:PDF Full Text Request
Background:Ventilator-associated pneumonia is the most common infectious complication among patients admitted to intensive care units (ICUs) and accounts for up to 47% of all infections among ICU patients, the estimated mortality rate is between 20% and 70%.Ventilator-associated pneumonia results in increases in ventilatory support requirements,ICU stay,prolonged hospitalization,costs and nosocomial infectious rate.Recent research suggested the effectual application of multi-module interventions which contain the specific prevention measures and general infection controlmeasures,such as surveillance,education and other quality management strategies.They are useful for the reduction of VAP morbidity rates,mortality rates and costs.There was no evidence-based nursing guideline for the prevention of VAP which was suitable for our clinical practice in China.The best nursing practices were recommended in the evidence-based guidelines for the prevention of VAP from America and Canada, which included handwashing, elevation of the head of the bed (HOB) to 30°to 45°unless medically contraindicated ,continuous removal of subglottic secretions,change of ventilator circuit only when soiled or malfunctioning, maintaining the endotracheal tube cuff pressure at greater than 20 cmH2O, oral care and subpyloric nutrition .These preventive practices may be associated with improved clinical outcomes ,easier implementation and lower health care costs.There are few reports and reseaches on the current knowledge, practice, influencing factors, the effects of educational programme and the criterion of quality care focusing on evidence-based nursing for preventing VAP in intensive care unit in China. Objectives: The purpose of of this study was to evaluate the current knowledge and practice of evidence-based nursing for preventing VAP and influencing factors in intensive care unit nurses,to establish the effective educational programme and evaluation criterion to promote the application of evidence-based nursing for preventing VAP, so as to improve the quality of care.Methords:1. To test the reliability and validitiy for the self-administered structured questionnaire of the knowledge and practice of evidence-based nursing for preventing VAP and influencing factors.2. Self-administered structured questionnaire was used in ICU nurses working in a general hospital in Nanjing by convenience sampling method(n=101).3. The observational pre and post-intervention study was undertook to assess whether the short-term educational programme focusing on preventive practices for VAP could improve the knowledge in ICU nurses (n=71).4. 17 ICU nurses were received the long-term educational programme, we used the quality indicators which was identified by Delphi as tool to evaluate the performance before and after intervention.5. 62 patients with oral endotracheal tube were randomly divided into two groups. Intervention group (n=32) was performed the evidence-based oral care by powered toothbrush with fluoride toothpaste and dentilave with sterile water. Contrast group (n=30) was performed traditional oral care. The dental plaque clearance and the complications of oral were analyzed and compared between the two groups.Results:1. The reliability and validity of the self-administered structured questionnaire are acceptable. The questionnaire can be used to assess the knowledge and practice of evidence-based nursing for preventing VAP and influencing factors in ICU nurses.2. The mean score of cognitive levels was 4.75±1.42(total score=10),the mean score of item in practice was 3.32±0.32(total score=4). The differences of the cognitive levels of the nurses in different divisions or with different ICU working years were significant(P<0.05),The different ICU working years in practice was significant (P<0.01).Most nurses(92.1%) considered that the nursing work was too busy due to serious condition in patient was the principal interfere factor in practice.3. The right ratio of the cognitive levels rose 44.7%, from a mean of 4.38±1.45 in the pre period to 8.85±1.56 in the post period after short-term educational programme (Z=-7.307,P=0.000).4. After long-term educational programme, nurse'cognitive levels and practice of preventing VAP were improved (Z=-3.624,P=0.000).There were significant increases in the mean scores of the head of the bed elevation, endotracheal tube with secretions removal, enteral nutrition, maintaining the tube cuff pressure, oral care, ventilator equipment changes(P<0.01), except handwashing item.5. The dental plaque clearance and the incidence of occurring with combined halitosis, stomatitis and stomatocace in intervention group were lower than those in contrast group.There are significant difference between the two groups (P<0.05).Conclusions: The survey indicated that the current knowledge and practice of evidence-based nursing for preventing VAP was unsatisfied.The short-term educational programme can improve the cognitive levels,long-term educational programme can enhance nurses to implement preventive practices for VAP,and what is more, the evidence-based nursing for preventing VAP is applied comprehensively, such as oral care which is performed effectively.In addition, nurse's performance of preventing VAP can also be promoted by more attention to nosocomial control and inproved supply of essential facilities in hospital.
Keywords/Search Tags:Evidence-based nursing, Ventilator-associated pneumonia, Intensive Care Unit, Survey, Nurse education
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