Ventilatör İlişkili Pnömoninin Önlenmesinde Hemşirelik Girişimlerinin Uygulanma Durumu

Yıl 2022, Cilt: 15 Sayı: 4, 507 - 526, 15.10.2022

Duygu Özdemir Gülengün Türk

https://doi.org/10.46483/deuhfed.868285

Öz

Giriş: Yoğun bakım ünitelerinde mekanik ventilasyona bağlı hastalarda en sık görülen sağlık hizmetiyle ilişkili enfeksiyonlardan biri olan ventilatör ilişkili pnömoniyi (VİP) önlemeye yönelik farmakolojik ve nonfarmakolojik olmak üzere birçok girişim uygulanmaktadır. Hemşireler nonfarmakolojik girişimlerin uygulanmasından doğrudan sorumlu oldukları için VİP in önlenmesinde önemli bir etkiye sahiptir.

Amaç: Ventilatör ilişkili pnömoniyi önleyici girişimlerin hemşireler tarafından uygulanma durumu ve etkileyen faktörlerin belirlenmesidir.

Yöntem: Analitik-kesitsel tipte tasarlanan araştırma Ocak 2019- Aralık 2019 tarihleri arasında bir üniversite hastanesi ve iki devlet hastanesinde toplam 189 hemşire ile gerçekleştirilmiştir. Verilerin toplanmasında Hemşire Tanıtım Formu ve VİP’i Önleyici Hemşirelik Girişimlerini Değerlendirme Formu kullanılmıştır. Verilerin değerlendirilmesinde tanımlayıcı istatistiksel testler ve Ki-kare testi kullanılmıştır.

Bulgular: Araştırmaya katılan hemşirelerin %55’inin 20-29 yaş grubunda ve yaş ortalamalarının 31,15 ± 7,71 (min: 20, max: 49) olduğu belirlenmiştir. Hemşirelerin %85.7’si kadın olup %63.5’i lisans mezunudur. Araştırmaya katılan hemşirelerin %97.4’ü VİP’i önlemede el hijyeninin etkili olduğunu, %77.2’si ağız bakımında sodyum bikarbonat kullandığını belirtmişlerdir. Mekanik ventilatör desteğindeki hastalara hemşirelerin %55.6’sı günde 4 kez ağız bakımı verdiği ve %67.2’si ağız bakımında abeslang kullandığını ifade etmişlerdir. Araştırmaya katılan hemşirelerin %89.9’u endotrakeal aspirasyonda açık aspirasyon yöntemini uyguladıklarını belirtmişlerdir. Hemşirelerin %99.5’i hastanın yatak başını yükselttiğini ve %83.1’i bu yüksekliği 15°-30° sağladıklarını, %66.7’si kaf basıncını 20-30 Cm H2O arasında tuttuklarını ifade etmişlerdir.

Sonuç: Araştırmada hemşirelerin büyük çoğunluğunun el yıkamanın öneminin farkında olduğu, ağız bakımında sodyum bikarbonat solüsyonunu kullandığı, açık aspirasyon yöntemini uyguladığı, yatak başı yüksekliğini 15°-30° arasında uyguladığı sonucuna varılmıştır. Kurumlarda VİP’i önleyici kanıta dayalı hemşirelik girişimlerinden oluşan protokollerinin oluşturulması ve uygulanabilirliğinin sağlanması önerilmektedir.

Anahtar Kelimeler

hemşirelik girişimleri, hemşirelik bakımı, mekanik ventilasyon, ventilatör ilişkili pnömoni

Destekleyen Kurum

Bilimsel Araştırma Projeleri (BAP)

Proje Numarası

HF-19014

The Status of Implementions of Nursing Interventions on Prevention of Ventilator Associated Pneumonia

Öz

Background: Many interventions, pharmacological and non-pharmacological, are applied to prevent ventilator-associated pneumonia (VAP), which is one of the most common healthcare-associated infections in patients on mechanical ventilation in intensive care units. Since nurses are directly responsible for the implementation of non-pharmacological interventions, they have an important effect on the prevention of VAP.

Objectives: The aim of this study is to determine the implementation of preventive interventions for ventilator-associated pneumonia by nurses and the factors affecting it.

Methods: The research, which was designed as analytical-cross-sectional type, was carried out between January 2019 and December 2019 in a university hospital and two public hospitals with a total of 189 nurses. Nurse Identification Form and VAP Preventive Nursing Interventions Evaluation Form were used to collect data. Descriptive statistical tests and Chi-square test were used in the evaluation of the data.

Results: It was determined that 55% of the nurses participating in the study were in the 20-29 age group and their average age was 31.15 ± 7.71 (min: 20, max: 49). 85.7% of the nurses are women and 63.5% of them are undergraduate graduates. 97.4% of the nurses participating in the study stated that hand hygiene was effective in preventing VAP, and 77.2% of them stated that they used sodium bicarbonate in oral care. 55.6% of the nurses stated that they gave oral care 4 times a day to the patients under mechanical ventilator support, and 67.2% stated that they used abeslang in oral care. 89.9% of the nurses participating in the study stated that they used the open aspiration method in endotracheal aspiration. 99.5% of the nurses stated that the patient raised the head of the bed, 83.1% of them stated that they achieved this height at 15°-30°, 66.7% of them stated that they kept the cuff pressure between 20-30 Cm H2O.

Conclusion: In the study, it was concluded that the majority of the nurses were aware of the importance of hand washing, used sodium bicarbonate solution in oral care, applied the open aspiration method, and applied the bed head height between 15°-30°. It is recommended to establish and implement protocols consisting of evidence-based nursing interventions to prevent VAP in institutions.

Anahtar Kelimeler

nursing interventions, nursing care, mechanical ventilation, ventilator-associated pneumonia

Proje Numarası

HF-19014

Kaynakça

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