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

Critical care nurses' knowledge of, adherence to and barriers towards evidence-based quidelines for the prevention of ventilator-associated pneumonia-A survey study Paper details: Follow the critique guidelines, critique the article in a narrative document written in APA 6th edition format by using the critique template and you can not change formatting from the template (critically appraise the article) be sure to respond to each of the critique guidelines. Minimum of 6 pages excluding title and reference page. Please evaluate my paper and make appropriate changes. Due by Oct 1, 2015 QUANTITATIVE RESEARCH ARTICLE CRITIQUE                            2 Quantitative Research Article Critique Introduction Reference Intensive and Critical care Nursing (2013) 29,216-222. Critical care nurses’ knowledge of, adherence to and barriers towards evidence-based guidelines for the prevention of ventilator-associated pneumonia-A survey study. Journal homepage: www.elsevier.com/iccn Authors Qualifications MiiaJansso: Institute of Health Science, University of Oulu, Finland. Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland Tero Ala-Kokko: Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland PekkaYlipalosaar: Department of Infection Control, University Hospital, Oulu, Finland HannuSyrjala: Department of Infection Control, University Hospital, Oulu, Finland HelviKyngas: Institute of Health Science, University of Oulu, Finland. Oulu University Hospital, Oulu, Finland Title Critical care nurses’ knowledge of, adherence to and barriers towards evidence-based guidelines for the prevention of ventilator-associated pneumonia-A survey study Abstract This paper is an academic critique of a nursing article written by Miia Janson, Tero Ala-Kokko, Pekka Ylipalosaari, HannuSyrjala, and HelviKyngas (2013) titled: Critical care nurses’ knowledge of, adherence to and barriers towards evidence-based guidelines for the prevention of ventilator-associated pneumonia – A survey study. The authors undertook a survey study to explore critical care nurses’ knowledge of, adherence to and barriers to prevention of ventilator-associated pneumonia.The rationale and the purpose of the study were clearly stated. My examination of the study focuses on specific aspects of the article including evidence-based research of preventing ventilator-associated pneumonia. I have attempted to explain the evidence-based survey study which uses an independent-samples t-test to compare critical care nurses’ knowledge and QUANTITATIVE RESEARCH ARTICLE CRITIQUE                        3 adherence within different groups and principles of inductive content analysis used to analyze the barriers towards evidence-based guidelines for prevention of ventilator-associated pneumonia.The study was conducted in a single academic centre in Finland in a 22-bed mixed adult general ICU. Participants were selected for the survey using convenience (accidental) sampling. The spot testing questionnaires were distributed among all nursing staff by the nurses in charge and completed anonymously in a 30 minute allotted time acquiring the average knowledge level. The results of the knowledge test showed a mean scoreof 59.9%. Problem In this article, Critical care nurses’ knowledge of, adherence to and barriers towards evidence- based guidelines for the prevention of ventilator-associated pneumonia-A survey study,the authors notethrough research thatventilator-associated pneumonia (VAP) is the commonly encountered (12- 33.8%)nonsocomial infection in critical care situations (Karhu et al., 2011; Ylipalosarri et al., 2006). Previous studies have shown that (VAP) is associated with high morbidity and mortality rates as well as prolonged lengths in the intensive care units (ICU) and hospital stay (Babcock et al., 2004; Ylipalosaari et al., 2006). Prevention of this nonsocomial infection could reduce costs and improve patient-related outcomes and patient safety and the quality of care (Babcock et al., 2004; Marra et al., 2009; Safdar et al., 2005). The main barriers shown in Table 4 were inadequate resources, lack of time, knowledge, skills, and forgetfulness. Due to these facts, it is imperative that we constantly monitor nurse’ education and the barriers that play a role in patient care. It is realistic to believe that similar studies can be conducted and analyzed to improve nurse’s knowledge of evidence-based guidelines (EBG) for the prevention of ventilator-associated pneumonia. Purpose This article discusses previous studies, which show critical care nurses’ knowledge about EBGs for preventing VAP is currently limited (Blot et al., 2007; Labeau et al., 2008). The lack of knowledge may be a barrier towards adherence to EBGs (El-Khatib et al., 2010). The purpose of this study is to collect QUANTITATIVE RESEARCH ARTICLE CRITIQUE                            4 data from critical care nurses of their knowledge of, adherence to and barriers towards EBGs for the prevention of VAP. The results of these studies could be used to educate and stimulate further discussions in order to implement new guidelinesand resources to improve infection control and break the barriers towards EBGs for the prevention of VAP. Literature Review The authors drew on relevant previous studies to formulate the purpose of their own study and variables were clear and precise. An independent-samples t-test was used to compare the knowledge and adherence of critical care nurses with different levels of ICU experience ( < 5yrs vs > 5yrs), education (registered nurses vs nursing assistants) and employment, permanent vs non-permanent. The study was conducted in a single academiccentre in Finland in a 22 bed mixed adult general ICU. Two multiple-choice questionnaires wereused to evaluate critical care nurses’ knowledge of (Labeau et al., 2007), adherence to and barriers towards EBGs for prevention of VAP (Ricart et al., 2003). The principles of inductive content analysis were used to analyze, categorize and qualify the barriers towards EBG for prevention of VAP (Elo and Kyngas, 2008). This has helped me understand the amount of research that had been done for this article. Theoretical Framework In organizing the framework, the authors identify therelevant nurse variables to include work experience in the ICU, education, registered nurse vs nursing assistant, and employment, permanent vs non-permanent. (Table 2). In this study, as in several other studies (Blot et al., 2007; Labeau et al., 2008), more experienced nurses (ICU experience > 5 yrs) performed significantly better in the knowledge test than their less experienced (ICU experience < 5 yrs) coleagues. Research Questions, Objectives, or Hypothesis During this study, the authors noted three key research questions: (1) What do critical care nurses know about EBGs for prevention of VAP? (2) To what extent do critical care nurses adhere to QUANTITATIVE RESEARCH ARTICLE CRITIQUE                            5 EBGs for prevention of VAP? (3) What are the carriers towards EBGs for prevention of VAP (p 217)? When discussing barriers, questions arose regarding the use of sodium chloride with ventilator patients. According to previous literature, the routine use of sodium chloride should be avoided (AARC, 2010; CHP, 2010). The self-reported adherence to sodium chloride instillation before tracheal suctioning was68.3% (Table 4). The reasons for non-adherence were related to the lack of guidance, and time and outcomeexpectancy. However, recent reports provided new information about the safety (Overend ET AL., 2009; Paraz and Stockton, 2009) and efficancy (Caruso et al., 2009; Christensen et al., 2010) of sodium chloride instillation, used also in bronchoalveolar lavages. Study Variables/Concepts Thedesign of this research study is indicated as being quasi-experimental. The survey was based on two pre-validated multiple-choice questionnaires in order to explore the critical care nurses’ knowledge of, adherence to and barriers towards EBGs for prevention of VAP. The demographics of this article of study show nurse variablesto include ICU nurses with experience varying from <1yr- >10yrs, education of registered nurses vs nursing assistants, and employment whether it be permanent or non-permanent (Table 2). There is no treatment or intervention discussed only questionnaires. The majorityof participants (89.1%) were registered nurses, often with >10yrs ICU experience. The population of this research article are considered to have inclusive criteria as follows (1) informed consent was obtained, (2) participants were direct care providers at bedside.The questionnaires were distributed to all nursing staff (n=173) by the head nurse in charge (p217). Nursing assistants were included in the sampling of this study because they provide care for mechanically ventilated adult patients. The final response rates ranged from 56.4% registered nurses to 100% nursing assistants (p219). Study Measures After reading thisarticle, I interpret the measurement strategyto involve ameasurement of statistics using the Likert scale (questionnaires) at a nominal level. The main strengths of this study are the high response rate, which means the results closely represent the local target population, and of the QUANTITATIVE RESEARCH ARTICLE CRITIQUE                            6 nurses in different departments with a range of ICU experience (Polit and Beck, 2011). Data/Analysis Collection For this article the authors used both descriptive statistics and inferential statistics. Descriptive statisticsincluded frequency ratings and percentages to describe demographics, adherence and perceived barriers of participants. The authors used inferential statistics to analyze other variables which included an independent-sample t-test used to compare the knowledge and adherence of critical care nurses with different levels of experience and education. A p value less than 0.05 was considered statistically significant (p218). Researchers’ Interpretations of Findings After the calculations, the conclusions were average with a mean score in the knowledge test of 59.9%, whereas previous studies have reported mean scores ranging from 41.2% (Blot et al., 2007) to 78.1% (El-Khatib et al., 2010). Study Limitations Even though the sample size was small the questionnaire was for a specific group of nurses in the ICU. Limitations were very little only three participants did not respond to the study. The nursing assistants were included in the study but the sample size was less than 10% leaving the results to be interpreted with caution. Generalizability of Findings This study showed in general, the most common self-reported adherences were adequate hand washing. Hand hygiene, oral care and ETS practices were actually higher than in previous studies. Implications for Further Studies QUANTITATIVE RESEARCH ARTICLE CRITIQUE                            7 The authors acknowledgefurther studies will be needed to assess the effect of new VAP bundlesbeing put into place by the Centers for Disease Control and Prevention. These bundles are designed to help reduce or eliminate VAP and promote adherence to EBG to improve patient care. Conclusion According to the study, the average knowledge level was low. It is important to evaluate critical care nurses’ knowledge, attitudes and beliefs so that current practices can be improved (Ajzen, 2005). With these studies they can be used to guide local practice and education and contribute to the nurses’ adherence and knowledge of methods in preventing VAP. QUANTITATIVE RESEARCH ARTICLE CRITIQUE                                8 REFERENCES: American Association for Respiratory Care (AARC). Critical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways. Respir Care 2010;55:758-64. Ajzen I. Attitudes, personality and behavior. 2nd ed. Mcgraw Hill Education, Open University Press; 2005. Babcock H, Zack J, Garrison T, Trovillion E, Jones M, Fraser V, et al. An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects. Chest 2004;125:2224-31. Blot S, Labeau S, Vandijck D, Claes B. Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among intensive care nurses. Int Care Med 2007; 33: 1463-7. Caruso P, Denari S, Ruiz S, Demarzo E, Deheinzelin D. Saline instillation before tracheal suctioning decreases the incidence of ventilator-associated pneumonia. Crit Care Med 2009; 37: 32-8. El-Khatib M, Zeineldine S, Ayoub C, Husari A, Bou-Khalil P. Critical care clinicians’ knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia. AJCC 2010; 19: 272-7. Elo S, Kyngas H. The qualitative content analysis process. Jan 2008; 62: 107-15. Karhu J, Ala-KokkoTi, Ylipalosaari P, Ohtonen P, Laurila JJ, Syrjala H. Hospital and long-term outcomes of ICU-treated severe community and hospital-acquired, and ventilator-associated pneumonia patients. ActaAnaesthScand 2011; 55: 1254-60. Labeau S, Vandijck B, Claes P, Van Aken P, Blot S. Critical care nurses’ knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia: an evaluation questionnaire. AJCC 2007; 16: 371-7. Overend TJ, Anderson CM, Brooks D, Cicutto L, Keim M, McAuslan D, et al. Updating the evidence base for suctioning adult patients: a systemic review. Can Respir J 2009; 16: e6-17. Polit D, Beck C. Nursing research. Generating and assessing evidence for nursing practice. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2011. Ricart M, Lorente C, Diaz E, Kollef MH, Rello J. Nursing adherence with evidence-based guidelines for preventing ventilator-associated pneumonia. Crit Care Med 2003; 31: 2693-6.

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