Yoğun bakım hemşirelerine verilen eğitimin, bakım paketi, aspirasyon bilgi düzeyi ve kanıta dayalı hemşireliğe yönelik tutuma etkisi

Ventilatör ilişkili pnömoni, yoğun bakım ünitelerinde (YBÜ) mekanik ventilasyon uygulanan hastalarda sık görülen bir komplikasyondur. Bakım setlerinin yoğun bakımda hemşireler tarafından kullanılması bu komplikasyonu azaltabilir. Bu çalışmanın amacı, yoğun bakım hemşirelerinin bakım paketi kullanımı ve aspirasyon uygulamalarına ilişkin eğitim öncesi ve eğitim sonrası performanslarını karşılaştırmak, bakım paketi uygulamaları ve kanıta dayalı uygulamalara yönelik tutumlarını incelemektir. Bu çalışma, tek grup ön test-son test modeli kullanılarak yapılmıştır. Mezun hemşireler ile 0-2 hasta sorumluluğu olan hemşirelerin EBNAQ puanları yüksek bulundu. Ventilatör bakım paketi ve aspirasyon izlem formu çıktılarının değerlendirilmesi “Trakea üzerinden oskültasyon ile fizik muayene yapıldı” parametresi dışında tüm alanlarda yapılan hemşirelik girişimlerine ilişkin eğitim sonrası farklılık olduğu belirlendi (p<0,05). Tüm bakım seti ve aspirasyon parametrelerinde eğitim öncesine göre eğitim sonrası uygulama oranlarında artış olduğu belirlendi.

Anahtar Kelimeler:

Aspirasyon uygulaması, bakım paketi, kanıta dayalı hemşirelik

The effect of the training provided to intensive care nurses on the ventilator care bundle, aspiration knowledge level, and attitudes towards evidence-based nursing

Ventilator-associated pneumonia are common complication for patients in intensive care units [ICU] receiving mechanical ventilation. Care bundles's using by nurses in ICU can reduce this complication. The aim of this study is to compare the pre-training and post-training performance of intensive care nurses on the use of care bundle and aspiration practices, and to examine the effects of the training on their attitudes towards care bundle practices and evidence-based nursing. This study has been conducted by using the single group pretest-final test model. The EBNAQ scores of the nurses with a graduate degree and the nurses with responsibility for 0-2 patients were found to be high. Evaluation of the outputs from the ventilator care bundle and aspiration monitoring form showed a difference after the training regarding the nursing interventions conducted in all areas except for the “Performed a physical examination with auscultation over the trachea" parameter (p<0.05). It was determined that there was an increase in the application rates after the training compared to the pre-training in all care bundle and aspiration parameters.

Keywords:

Aspiration practice, care bundles, evidence-based nursing,

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Abdulkerim, S., Oz, A., Aslan, G., Kavak, P. B., Fakili, D., & Topeli, A. (2017). Evaluation of nursing workload in intensive care unit. Journal of Medical and Surgical Intensive Care Medicine, 8(1), 1-6. https:// doi.org/10.5152/dcbybd.2017.1353
Abuejheisheh, A., Tarawneh, O., Qaddumi, J. A., Almahmoud, O., & Darawad, M. W. (2020). Predictors of intensive care unit nurses’ practice of evidence-based practice guidelines. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 57, 1–7.
American Association for Respiratory Care (2010). AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respiratory care, 55(6), 758-764. Accessed 05. 09. 2022 https://doi.org/rc.rcjournal.com/content/55/6/758/tab-pdf
Ayhan, Y., Kocaman, G., & Bektaş, M. (2015). The validity and reliability of attitude towards evidence based nursing questionnaire for Turkish. Journal of Research and Development in Nursing, 17(2-3), 21-35. https://dergipark.org.tr/en/pub/hemarge/issue/52741/695897
Birks, M., Cant, R., James, A., Chung, C., & Davis, J. (2013). The use of physical assessment skills by registered nurses in Australia: issues for nursing education. Collegian, 20(1), 27-33. https://doi.org/10.1016/j.colegn.2012.02.004
Bozan, S., & Güven, Ş. D. (2020). Evaluation of knowledge and behavior of nurses working in intensive care units for endotracheal aspiration application. Journal of Surgery and Medicine, 4(4), 296-300.
Candas, B., & Gursoy, A. (2017). Time for nurses to make the move: from evidence based practice to care bundle. Journal of Education and Research in Nursing, 14(3), 233-239. https://doi.org/10.5222/HEAD.2017.233
Carroll, S. M. (2007). Silent, slow lifeworld: The communication experience of nonvocal ventilated patients. Qualitative Health Research, 17(9), 1165-1177. https://doi.org/10.1177/1049732307307334.
Çelik, S. S., & Elbas, N. Ö. (2000). The standard of suction for patients undergoing endotracheal intubation. Intensive and Critical Care Nursing, 16(3), 191-198.
Çevik, B., Uğurlu, Z., Akyüz, E., Sultan, K. A .V., & Ersayın, A. (2018). Hemşirelerin fiziksel değerlendirme becerileri ve uygulamaya ilişkin görüşleri. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi, 5(1), 39-48. https://doi.org/10.31125/hunhemsire.431127
Çınar, F., & Eti Aslan, F. (2017). Spiritualism and nursing: The importance of spiritual care in intensive care patients. Journal of Academic Research in Nursing, 3(1), 37-42. https://doi.org/10.5222/jaren.2017.037
Daştan, B., & Hintistan, S. (2018). Determination of the attitudes of nurses working in internal clinics for evidence based nursing: Rural region example. Ordu University Journal of Nursing Studies, 1(1), 1-9. https://dergipark.org.tr/en/download/article-file/613958
Day, T., Wainwright, S. P., & Wilson‐Barnett, J. (2001). An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units. Journal of clinical nursing, 10(5), 682-696.
Ergan, B., Tokur, M. E., Coban, S., Tursunoglu, S., Ergun, R., Ergun, D., & Comoglu, S. (2016). The Relationship between Nurse Workload and Mortality in Two Different ICUs. Journal of Medical and Surgical Intensive Care Medicine, 7(1), 21-28. https://doi.org/10.5152/dcbybd.2016.1154
Ersoy, E. O., Abdulkerim, S., Oz, A., Aslan, G., Kavak, P. B., Fakili, D., & Topeli, A. (2017). Evaluation of nursing workload in intesive care unit/ Yoğun bakım ünitelerinde hemsire iş yükünün değerlendirilmesi. Dahili ve Cerrahi Bilimler Yoğun Bakım Dergisi (Journal of Medical and Surgical Intensive Care Medicine), 8(1), 1-6. https://doi.org/ 10.5152/dcbybd.2017.1353
Giddens, J. F. (2007). A survey of physical assessment techniques performed by RNs: lessons for nursing education. The Journal of nursing education, 46(2), 83-87. https://doi.org/10.3928/01484834-20070201-09
Gillespie, R. (2009). Prevention and management of ventilator-associated pneumonia–the Care Bundle approach. Southern African Journal of Critical Care, 25(2). https://www.ajol.info/index.php/sajcc/article/view/52974
Ibrahem, S. E., Morsy, W. Y. M., Mohamed, R. B., & Seloma, Y. A. E. (2021). Arterial Blood Gases Interpretation: critical care nurses’ knowledge and practices at a university hospital− Kafr-elsheikh Governorate. Egyptian Nursing Journal, 18(3), 120.
Institute for Healthcare Improvement [IHI]. (2012). How-to guide: prevent ventilator-associated pneumonia. http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventVAP.aspx
Intensive Care Society [ICS]. (2021). Levels of adult critical care second edition consensus statement. https://www.cc3n.org.uk/uploads/9/8/4/2/98425184/2021-03__levels_of_care_second_edition.pdf
Kelleher, S., & Andrews, T. (2008). An observational study on the open‐system endotracheal suctioning practices of critical care nurses. Journal of Clinical Nursing, 17(3), 360-369. https://doi.org/10.1111/j.1365-2702.2007.01990.x
Krag, M., Perner, A., Wetterslev, J., Wise, M. P., Borthwick, M., Bendel, S., ... & SUP‐ICU Collaborators. (2015). Stress ulcer prophylaxis in the intensive care unit: An international survey of 97 units in 11 countries. Acta Anaesthesiologica Scandinavica, 59(5), 576-585.
Kurutkan, M. N. (2014). An application of patient safety in the context of evidence based practice: care bundles. Sağlık Akademisyenleri Dergisi, 1(2), 83-88. https://dergipark.org.tr/en/download/article-file/752347
Menekli, T., Korkmaz, M. (2021). Internal medicine nurses' attitudes towards evidence-based nursing. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi, 4(1), 38-47. https://dergipark.org.tr/en/download/article-file/1246118.
Onarıcı, M., Karadağ, M. (2015). Importance of positioning on prevention of ventilator-associated pneumonia among patients undergoing mechanical ventilation. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi, 2 (2), 70-74. https://dergipark.org.tr/en/pub/hunhemsire/issue/7859/103410
Özden, D., & Görgülü, R. S. (2012). Development of standard practice guidelines for open and closed system suctioning. Journal of Clinical Nursing, 21(9‐10), 1327-1338.
Patak, L., Gawlinski, A., Fung, N. I., Doering, L., & Berg, J. (2004). Patients’ reports of health care practitioner interventions that are related to communication during mechanical ventilation. Heart & Lung, 33(5), 308-320. https://doi.org/10.1016/j.hrtlng.2004.02.002
Pedersen, C. M., Rosendahl-Nielsen, M., Hjermind, J., & Egerod, I. (2009). Endotracheal suctioning of the adult intubated patient—what is the evidence?. Intensive and Critical Care Nursing, 25(1), 21-30. https://doi.org/10.1016/j.iccn.2008.05.004
Rello, J., Lode, H., Cornaglia, G., Masterton, R., & VAP Care Bundle Contributors (2010). A European care bundle for prevention of ventilator-associated pneumonia. Intensive Care Medicine, 36, 773-780.
Resar, R., Griffin, F. A., Haraden, C., Nolan, T. W. (2012). Care bundles to improve health care quality. IHI innovation series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement. http://www.ihi.org/resources/Pages/IHIWhitePapers/UsingCareBundles.aspx
Richens, Y., Rycroft-Malone, J., Morrell, C. (2004). Getting guidelines into practice: A literature review. Nursing Standard, 18 (50), 33–37. https://doi.org/ 10.7748/ns2004.08.18.50.33.c3677
Ruzafa‐Martínez, M., López‐Iborra, L., & Madrigal‐Torres, M. (2011). Attitude towards Evidence‐Based Nursing Questionnaire: development and psychometric testing in Spanish community nurses. Journal of Evaluation in Clinical Practice, 17(4), 664-670.https://doi.org/10.1111/j.1365-2753.2011.01677.x
Şadi Şen, E., Yurt, S. (2021). Determining the attitudes of nurses towards evidence-based practices. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi, 14(2), 102-107. https://app.trdizin.gov.tr/publication/paper/detail/TkRJME1UZzFOUT09
Scurlock-Evans, L., Upton, P., & Upton, D. (2014). Evidence-based practice in physiotherapy: A systematic review of barriers, enablers and interventions. Physiotherapy, 100(3), 208-219. https://doi.org/10.1016/j.physio.2014.03.001 Şenyuva, E. (2016). Nursing education and evidence based practice. Florence Nightingale Hemşirelik Dergisi, 24(1), 59-65. https://fnjn.org/Content/files/sayilar/130/130-558.pdf
Sharma, S., Sarin, J., & Bala, G. K. (2014). Effectiveness of “endotracheal suctioning protocol” in terms of knowledge and practices of nursing personnel. Nursing & Midwifery Research Journal, 10(2), 47-60.
Smith, S. F., Duell, D. J., & Martin B. C. (2012). Clinical Nursing Skills (8th ed.). Pearson.
Sulis, C. A., Walkey, A. J., Abadi, Y., Reardon, C. C., & Joyce-Brady, M. (2014). Outcomes of a ventilator-associated pneumonia bundle on rates of ventilator-associated pneumonia and other health care-associated infections in a long-term acute care hospital setting. American journal of infection control, 42(5), 536-538. https://doi.org/10.1016/j.ajic.2014.01.020
Yıldırım, M. S., Yıldız, E. The determination of attitude towards evidence based nursing of nurses (2020). Journal of Nursing Science, 3(2), 24-29. https://dergipark.org.tr/en/download/article-file/1108760
Yılmaz, D., Düzgün, F., Dikmen, Y. (2019). An investigation into nurses’ attitudes towards evidence-based nursing. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi, 10(4), 713-719. https://doi.org/10.31067/0.2018.91
Yilmaz, E., Cecen, D., Aslan, A., Kara, H., Togac, H. K., & Mutlu, S. (2018). Attitudes towards evidence-based nursing and perceptions of obstacles in using research of nurses working in surgical clinics. Hemşirelikte Eğitim ve Araştırma Dergisi, 15(4), 235-241. https://doi.org/ 10.5222/HEAD.2018.235
Yilmaz, M., & Gürler, H. (2017). Opinions of nurses in relation to evidence-based practice. Florence Nightingale Journal of Nursing, 25(1), 1-12. https://doi.org/ 10.17672/fnhd.12049
Zeb, A., Ul Haq, S., Ali, F., Hussain, N., Haidar Ali Shah, S., & Faisal, S. (2017). Knowledge and practice of ICU nurses regarding endotracheal suctioning in tertiary care hospitals, Peshawar. JOJ Nurse Health Care, 2(4), 555-595. https://www.researchgate.net/profile/Aurang-Zeb-4/publication/321911146