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THE EFFECT OF NURSES' EVIDENCE-BASED PRACTICES, EDUCATION AND ATTITUDES IN PREVENTING VENTILATOR-ASSOCIATED PNEUMONIA

Yıl 2023, Cilt: 2 Sayı: 2, 24 - 41, 01.12.2023

Onur Çor , Arzu İlçe

Öz

Our study aimed to examine the attitudes of nurses working in intensive care units (ICU) towards evidence-based nursing (EBN) and evidence-based practices (EBP) to prevent ventilator-associated pneumonia (VAP). This prospective descriptive type research was conducted between February and November 2022 in a university hospital and a state hospital in Düzce. The population of the study is 182 nurses working in adult ICUs; The sample consisted of 146 nurses who agreed to participate in the research between the data collection dates. “Introductory Characteristics of Nurses”, “Questionnaire on Preventing Ventilator-Associated Pneumonia” and “Attitude Scale Towards Evidence-Based Nursing” forms were used to collect data. In statistical analysis, the Shapiro Wilk test was used to examine whether the data were normally distributed. Nonparametric tests were used for data that did not show normal distribution. Data were analyzed using number and percentage distributions, item averages, Chi Square, Mann-Whitney U and Kruskal-Wallis tests. Statistical significance level was accepted as p<0.05. 146 nurses participated in the study. It was found that nurses' knowledge about the prevention of VAP was low (4.88 ± 2.28), and within the scope of the study, three quarters of the nurses did not have an ICU certificate and did not receive training on VAP and EBN. The knowledge of those who received ICU certificate, VAP training and training on EBN regarding the prevention of VAP was found to be high (p<0.05). In the study, it was found that the nurses working in the ICU had low knowledge of EBPs to prevent VAP, and their attitudes towards EBN were below average. VAP can be prevented with effective nursing care and EBP. In this regard, it is recommended to increase the number of nurses receiving ICU nursing certificate, VAP and EBN training.

Anahtar Kelimeler

Ventilator-associated pneumonia (VAP) Evidence-based practices (EBP) Evidence-based nursing (EBN)

Kaynakça

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  • 6.Kharel, S., Bist, A., & Mishra, S. K. (2021).Ventilator-associated pneumonia among ICUpatients in WHO Southeast Asian region: Asystematic review. PLoS One, 16(3), e0247832.
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HEMŞİRELERİN VENTİLATÖR İLİŞKİLİ PNÖMONİYİ ÖNLEMEDE KANITA DAYALI UYGULAMALARI İLE EĞİTİM VE TUTUMLARININ ETKİSİ

Yıl 2023, Cilt: 2 Sayı: 2, 24 - 41, 01.12.2023

Onur Çor , Arzu İlçe

Öz

Çalışmamızda yoğun bakım ünitelerinde (YBÜ) çalışan hemşirelerin ventilatör ilişkili pnömoniyi (VİP) önlemeye yönelik kanıta dayalı uygulamaları (KDU) ile kanıta dayalı hemşireliğe (KDH) ilişkin tutumlarını incelemek amaçlanmıştır. Prospektif tanımlayıcı tipteki bu araştırma Şubat-Kasım 2022 tarihleri arasında Düzce’deki bir üniversite hastanesi ve bir devlet hastanesinde yapıldı. Araştırmanın evrenini yetişkin YBÜ’lerinde çalışan 182 hemşire; örneklemi ise veri toplama tarihleri arasında araştırmaya katılmayı kabul eden 146 hemşire oluşturdu. Verilerin toplanmasında “Hemşirelere Ait Tanıtıcı Özellikler”, “Ventilatör İlişkili Pnömoniyi Önleme ile İlgili Soru Formu” ve “Kanıta Dayalı Hemşireliğe Yönelik Tutum Ölçeği” formları kullanıldı. İstatistiksel analizde verilerin normal dağılıp dağılmadığı Shapiro Wilk testiyle incelendi. Normal dağılım göstermeyen veriler için nonparametrik testler kullanıldı. Veriler sayı ve yüzde dağılımları, madde ortalaması, Chi Square, Mann-Whitney U ve Kruskal-Wallis testleri kullanılarak analiz edildi. İstatiksel anlamlılık düzeyi p<0.05 kabul edildi. Çalışmaya 146 hemşire katıldı. Hemşirelerin VİP’in önlenmesi konusunda bilgilerinin düşük olduğu (4.88 ± 2.28) ile çalışma kapsamında hemşirelerin dörtte üçünün YBÜ sertifikasına sahip olmadığı, VİP ve KDH ile ilgili eğitimi almadığı bulundu. YBÜ sertifikası, VİP eğitimi ve KDH ile ilgili eğitim alanların VİP’i önlemeye yönelik bilgileri ise yüksek bulundu (p<0.05). Çalışma da YBÜ’nde çalışan hemşirelerin VİP’i önlemeye yönelik KDU’lara ait bilgilerinin düşük olduğu, KDH’e ait tutumlarının ise ortalamanın altında olduğu bulundu. VİP etkili bir hemşirelik bakımı ve KDU’lar ile önlenebilir. Bu doğrultuda YBÜ hemşireliği sertifikası, VİP ve KDH eğitimi alan hemşirelerin sayısının arttırılması önerilmektedir.

Anahtar Kelimeler

Ventilatör ilişkili pnömoni (VİP) Kanıta dayalı uygulamalar (KDU) Kanıta dayalı hemşirelik (KDH)

Kaynakça

  • 1.Sharma, S., Deo, A. S., & Raman, P. (2018).Effectiveness of standard fasting guidelines asassessed by gastric ultrasound examination: Aclinical audit. Indian journal ofanaesthesia, 62(10), 747.
  • 2.YILDIRIM, D., NAMIK, E., Karahan, Y., AKINKORHAN, E., & Ceylan, B. (2019). Ventilatörİlişkili Pnömoniyi Önlemede Klinik Protokoller:Bir Sistematik Çalışma. Türk Yoğun BakımDergisi, 17(1), 1-17.
  • 3.CoNSENS, D. D. (2018). Documento deconsenso: prevención de Neumonía asociada aVentilación Mecánica del adulto. Revistachilena de medicina intensiva, 33(1), 15-28.
  • 4.Bonell, A., Azarrafiy, R., Huong, V. T. L., Viet, T.L., Phu, V. D., Dat, V. Q., ... & Nadjm, B. (2019).A systematic review and meta-analysis ofventilator-associated pneumonia in adults inAsia: an analysis of national income level onincidence and etiology. Clinical InfectiousDiseases, 68(3), 511-518.
  • 5.Hatton, G. E., Mollett, P. J., Du, R. E., Wei, S.,Korupolu, R., Wade, C. E., ... & Kao, L. S. (2021).High tidal volume ventilation is associated withventilator-associated pneumonia in acutecervical spinal cord injury. The Journal of SpinalCord Medicine, 44(5), 775-781.
  • 6.Kharel, S., Bist, A., & Mishra, S. K. (2021).Ventilator-associated pneumonia among ICUpatients in WHO Southeast Asian region: Asystematic review. PLoS One, 16(3), e0247832.
  • 7.Li, Y., Liu, C., Xiao, W., Song, T., & Wang, S.(2020). Incidence, risk factors, and outcomes of ventilator-associated pneumonia in traumatic brain injury: a meta-analysis. Neurocritical care, 32(1), 272-285.
  • 8.Türkiye Cumhuriyeti Sağlık Bakanlığı TürkiyeHalk Sağlığı Kurumu Mikrobiyoloji ReferansLaboratuvarı Daire Başkanlığı Ulusal HastaneEnfeksiyonları Sürveyans Ağı Özet Raporu2021, Haziran 2022, 16-21.
  • 9.Ory, J., Raybaud, E., Chabanne, R., Cosserant,B., Faure, J. S., Guérin, R., ... & Traore, O.(2017). Comparative study of 2 oral careprotocols in intensive care units. AmericanJournal of Infection Control, 45(3), 245-250.
  • 10.Ezzeldin, Z., Mansi, Y., Gaber, M., Zakaria, R.,Fawzy, R., & Mohamed, M. A. (2018).Nebulized hypertonic saline to preventventilator associated pneumonia in prematureinfants, a randomized trial. The Journal ofMaternal-Fetal & Neonatal Medicine, 31(22),2947-2952.
  • 11.Khudaidad, F., Saeed, A., & Khudaidad, H.(2020). Burden of ventilator-associatedpneumonia and other hospital-acquiredinfections in a tertiary care hospital in Quetta,Pakistan. Journal of Infection and PublicHealth, 13(3), 458.
  • 12.Osti, C., Wosti, D., Pandey, B., & Zhao, Q.(2017). Ventilator-Associated Pneumonia andRole of Nurses in Its Prevention. Journal of theNepal Medical Association, 56(208).
  • 13.Özen, N., & Armutçu, B. (2018). Ventilatörİlişkili Pnömonin Önlenmesinde Yoğun BakımHemşirelerinin Kanıta Dayalı Uygulamalara İlişkin Bilgi Düzeyleri. Dahili ve Cerrahi Bilimler Yoğun Bakım Dergisi, 9(3), 78-83.
  • 14. Jam, R., Hernández, O., Mesquida, J., Turégano, C., Carrillo, E., Pedragosa, R., ... & Delgado-Hito, P. (2017). Nursing workload and adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia. A pilot study. Enfermería Intensiva (English Ed.), 28(4), 178-186.
  • 15. Jadot, L., Huyghens, L., De Jaeger, A., Bourgeois, M., Biarent, D., Higuet, A., ... & Damas, P. (2018). Impact of a VAP bundle in Belgian intensive care units. Annals of intensive care, 8(1), 1-7.
  • 16. Polat, F., Sahinoglu, A. H., Dilek, A., Köksal, E., Üstün, Y. B., Kaya, C., ... & Esen, S. (2014). Rehberlere Dayali Önlem ve Bakim Paketlerinin Yogun Bakim Ünitesinde Santral Venöz Kateter Enfeksiyonlari Üzerine Etkisi/The Effect of Care Bundles Based on Guidelines Over the Central Venous Catheter Infections in an Intensive Care Unit. Türk Yogun Bakim Dergisi, 12(3), 86.
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  • 24. AYHAN, Y., KOCAMAN, G., & BEKTAŞ, M. (2015). Kanıta dayalı hemşireliğe yönelik tutum ölçeği” nin Türkçe’ye uyarlanması: geçerlik ve güvenirlik çalışması. Hemşirelikte Araştırma Geliştirme Dergisi, 17(2/3), 21-35.
  • 25. Calderon J, Gonzales E. Methods of research and dissertation writing. Mandaluyong City:National Bookstore.2011.
  • 26. Madhuvu, A., Endacott, R., Plummer, V., & Morphet, J. (2020). Nurses’ knowledge, experience and self-reported adherence to evidence-based guidelines for prevention of ventilator-associated events: A national online survey. Intensive and Critical Care Nursing, 59, 102827.
  • 27. Celik A ysegul, R . N ., O znur, U . Y ., & A siye, A . (2020). Evidence-Based Practices for Preventing Ventilator-Associated Pneumonia in Intensive Care Nursing: Knowledge and Practice. International Journal of Caring Sciences, 13(3), 1794-1798.
  • 28. Labeau, S., Vandijck, D. M., Claes, B., Van Aken, P., Blot, S. I., & Executive Board of the Flemish Society for Critical Care Nurses. (2007). Critical care nurses’ knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia: an evaluation questionnaire. American Journal of Critical Care, 16(4), 371-377.
  • 29. Akıncı, C., Çakar, N., Ayyıldız, A., Atalan, K. H., & Ayyıldız, A. (2010). Yoğun bakım hemşirelerinin ventilatör İlişkili pnömoni ile ilgili bilgilerinin değerlendirilmesi. Türk Anest Rean Der Dergisi, 38, 45-51.
  • 30. 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.
  • 31. Sanaie, S., Rahnemayan, S., Azizi, S., Saghaleini, S. H., Ghamari, A. A., Ghojazadeh, M., & Mahmoodpoor, A. (2022). Comparison of subglottic vs. non-subglottic secretion drainage in prevention of Ventilator Associated Pneumonia: A systematic review and metaanalysis. Trends in Anaesthesia and Critical Care, 43, 23-29.
  • 32. Price, R ., M acLennan, G ., & G len, J . ( 2014). Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis. Bmj, 348.
  • 33. Deschepper, M., Waegeman, W., Eeckloo, K., Vogelaers, D., & Blot, S. (2018). Effects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study. Intensive care medicine, 44, 1017-1026.
  • 34. Bouadma, L., & Klompas, M. (2018). Oral care with chlorhexidine: beware!. Intensive Care Medicine, 44, 1153-1155.
  • 35. Garnier, M., Constantin, J. M., Heming, N., Camous, L., Ferré, A., Razazi, K., ... & COVID-ICU Investigators. (2023). Epidemiology, risk factors and prognosis of ventilator-associated pneumonia during severe COVID-19: Multicenter observational study across 149 European Intensive Care Units. Anaesthesia Critical Care & Pain Medicine, 42(1), 101184.
  • 36. Pearce, J. M. (2020). A review of open source ventilators for COVID-19 and future pandemics. F1000Research, 9.
  • 37. Ergün, Y. A., Demir, H., & Sağnak, N. (2007). YOĞUN BAKIM HEMŞİRELERİNİN GÖREV TANIMLARI İLE İLGİLİ ÇALIŞMA. Yoğun Bakım Hemşireliği Dergisi, 11(2), 102-113.
  • 38. ALANKAYA, N., KARADAKOVAN, A., URAN, B. N. Ö., & BAYRAM, H. (2019). HEMŞİRELERİN VENTİLATÖR İLİŞKİLİ PNÖMONİNİN ÖNLENMESİNDE KANITA DAYALI UYGULAMALAR KONUSUNDA BİLGİLERİ: İZMİR ÖRNEĞİ. Ankara Sağlık Bilimleri Dergisi, 8(2), 55-63.
  • 39. Guidelines for Preventing Health-Care-- Associated Pneumonia, 2003. Erişim Tarihi: 15.09.2022. https://www.cdc.gov/mmwr/preview/mmwrh tml/rr5303a1.htm
  • 40. American Thoracic Society and Infectious Diseases Society of America [ATS-IDSA]. (2005). Guidelines for the management of adults with hospital-acquired, ventilatorassociated, and healthcare-associated pneumonia. American Journal of Respiratory and Critical Care Medicine, 171(4), 388–416. doi:10.1164/rccm.200405-644ST Erişim tarihi: 25.09.2022. https://www.atsjournals.org/doi/epdf/10.116 4/rccm.200405-644ST
  • 41. Bankanie, V., Outwater, A. H., Wan, L., & Yinglan, L. (2021). Assessment of knowledge and compliance to evidence-based guidelines for VAP prevention among ICU nurses in Tanzania. BMC nursing, 20(1), 1-12.
  • 42. Getahun, A. B., Belsti, Y., Getnet, M., Bitew, D. A., Gela, Y. Y., Belay, D. G., ... & Diress, M. (2022). Knowledge of intensive care nurses’ towards prevention of ventilator-associated pneumonia in North West Ethiopia referral hospitals, 2021: A multicenter, cross-sectional study. Annals of Medicine and Surgery, 78, 103895.
  • 43. Kalanuria, A. A., Zai, W., & Mirski, M. (2014). Ventilator-associated pneumonia in the ICU. Critical care, 18, 1-8.
  • 44. Strategies_to_Prevent_VentilatorAssociated_ Pneumonia_in_Acute_Care_Hospitals_2014_ Update. Erişim Tarihi: 15.09.2022. https://www.researchgate.net/publication/26 3936774_Strategies_to_Prevent_Ventilator- Associated_Pneumonia_in_Acute_Care_Hospi tals_2014_Update
  • 45. DELEN, L. A., DERYA, S., & TETİK, B. K. Determination of Knowledge Levels of Nurses Working in the Emergency Department and Intensive Care Units about Evidence-Based Practices in the Prevention of Ventilator- Associated Pneumonia. The Journal of Cognitive Systems, 6(2), 55-58.
  • 46. Sağlık Hizmeti İlişkili Pnömoninin Önlenmesi Kılavuzu. Hastane Enfeksiyonları Dergisi 2008; 12. Erişim Tarihi: 15.09.2022. http://www.hider.org.tr/global/Dernek_Kilav uzlari/2008-12-Ek2-003-014.pdf
  • 47. Abin, M., Shiri Qidari, P., Hanifi, N., & Faqihzadeh, S. (2018). The Comparative Evaluation of Active and Passive Humidifiers on Ventilator-associated Pneumonia. Preventive Care in Nursing & Midwifery Journal, 7(4), 57-63.
  • 48. Ab Manap, N. (2019). Critical Care Nurses Knowledge in Prevention of Ventilator- Associated Pneumonia: Critical Care Nurses Knowledge in Prevention of Ventilator- Associated Pneumonia. ILKKM Journal of Medical and Health Sciences, 1(1), 25-30.
  • 49.Coppadoro, A., Bellani, G., & Foti, G. (2019).Non-pharmacological interventions to preventventilator-associated pneumonia: a literaturereview. Respiratory care, 64(12), 1586-1595.
  • 50.Pozuelo-Carrascosa, D. P., Herráiz-Adillo, Á.,Alvarez-Bueno, C., Añón, J. M., Martínez-Vizcaíno, V., & Cavero-Redondo, I. (2020).Subglottic secretion drainage for preventingventilator-associated pneumonia: an overviewof systematic reviews and an updated meta-analysis. European RespiratoryReview, 29(155).
  • 51.Pozuelo-Carrascosa, D. P., Cobo-Cuenca, A. I.,Carmona-Torres, J. M., Laredo-Aguilera, J. A.,Santacruz-Salas, E., & Fernandez-Rodriguez, R.(2022). Body position for preventingventilator-associated pneumonia for criticallyill patients: a systematic review and networkmeta-analysis. Journal of intensive care, 10(1),1-14.
  • 52.Zhuo, X., Pan, L., & Zeng, X. (2021). The effectsof the 45° semi-recumbent position on theclinical outcomes of mechanically ventilatedpatients: a systematic review and meta-analysis study. Annals of PalliativeMedicine, 10(10), 10643-10651.
  • 53.Blot, S. I., Poelaert, J., & Kollef, M. (2014).How to avoid microaspiration? A key elementfor the prevention of ventilator-associatedpneumonia in intubated ICU patients. BMCinfectious diseases, 14(1), 1-6.
  • 54.National Institute for Health and CareExcellence [NICE], 2019, Medical technologyconsultation: MT273 PneuX, viewed 31 March 2020, from https://www.nice.org. uk/guidance/GID-MT528/documents/supporting-documentation.
  • 55.Soyer, Ö., & Van Giersbergen, M. Y. (2020).The Effect of Endotracheal Tube Cuff PressureControl on the Development ofMicroaspiration and Ventilator-AssociatedPneumonia: Systematic Review. Türk YogunBakim Dergisi, 18(3), 129.
  • 56.Kamrani, F., Feizi, A., Khalkhali, H. R., &Valizadeh, M. A. (2017). Impact ofendotracheal tube cuff pressure monitoring onmicro aspiration of gastric contents. International Journal of Pharmaceutical and Phytopharmacological Research, 7(2), 43-9.
  • 57.Morales, P. (2000). Medición de actitudes enPsicología y Educación. Segunda ediciónrevisada. Madrid: Universidad PontificiaComillas.
  • 58.YILMAZ, D., Düzgün, F., & Dikmen, Y. (2019).Hemşirelerin kanıta dayalı hemşireliğe yöneliktutumlarının incelenmesi. AcıbademÜniversitesi Sağlık Bilimleri Dergisi, (4), 713-719.
  • 59.KARAAHMETOĞLU, G. U., & SOFTA, H. K.(2018). Hemşirelik öğrencilerinin kanıta dayalıhemşireliğe yönelik tutumlarınınincelenmesi. Anadolu Hemşirelik ve SağlıkBilimleri Dergisi, 21(4), 256-263.
  • 60.Australian College of Critical Care Nurses,2017.Australian College of Critical CareNurses. ACCCN position statement critical care nurse education, accessed 6.17.19 (2017). https://www.acccn.com.au/documents/item/ 715
  • 61. De Wandel, D. (2017). Key factors for hand hygiene promotion in intensive care units. Intensive & critical care nursing, 42, 3-4.
  • 62. Cooper, A. L., & Brown, J. (2017). Maximising nurses’ and midwives’ response rates to surveys. Nurse Researcher (2014+), 25(3), 31.
Toplam 62 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Cerrahi Hastalıklar Hemşireliği
Bölüm Araştırma Makalesi
Yazarlar

Onur Çor 0000-0002-4832-523X

Arzu İlçe 0000-0001-8428-9865

Yayımlanma Tarihi 1 Aralık 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 2 Sayı: 2

Kaynak Göster

APA Çor, O., & İlçe, A. (2023). HEMŞİRELERİN VENTİLATÖR İLİŞKİLİ PNÖMONİYİ ÖNLEMEDE KANITA DAYALI UYGULAMALARI İLE EĞİTİM VE TUTUMLARININ ETKİSİ. Sağlık Bakım Ve Rehabilitasyon Dergisi, 2(2), 24-41.