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The Gap Between Knowledge and Practices in Standard Endotracheal DOI: 10.21276/sjmps Saudi Journal of Medical and Pharmaceutical Sciences ISSN 2413-4929 (Print) Scholars Middle East Publishers ISSN 2413-4910 (Online) Dubai, United Arab Emirates Website: http://scholarsmepub.com/ Original Research Article The Gap between Knowledge and Practices in Standard Endotracheal Suctioning of Intensive Care Unit Nurses in Children’s Hospital Lahore Tasnim Zainib, M Afzal, Hajra Sarwar, Ali Waqas Lahore School of Nursing (LSN), Faculty of Allied Health Sciences, The University of Lahore *Corresponding Author: Tasnim Zainib Email: [email protected] Abstract: Endotracheal suctioning is a crucial element in the management of the airway in intensive care units. The effectiveness and complication of the endotracheal suctioning procedure is associated with the method of performing. The procedure requires clinical expertise, so the nurses should perform this procedure safely and effectively. The present study was carried out to assess the gap between knowledge and practice in standard endotracheal suctioning of intensive care unit nurses. In this cross sectional descriptive study knowledge and practice of 118 nurses in the 11 ICU’s of children hospital Lahore, Pakistan was analyzed. The sampling method is purposive. Data were collected using 35 item questionnaire and 31 item checklist. Descriptive and inferential statistics was used to analyze the data. The result of the study revealed that the participant have good level of knowledge (mean score 24 ±3.0) and fair level of practice as (mean practice score was 17.85± 5.67) showing that there is a gap between knowledge and practice. There is no relationship between knowledge and practice score. Significant relationship was found between practice score, total experience (p=0.007) and ICU type (p=0.004). The study describes that despite the presence of good knowledge their practice level is not up to the mark. The result shows that there is a need for training in this skill and continue feedback until desire level of skill achieved. Keywords: Gap, Knowledge, Practice, Endotracheal Suctioning, Standard guidelines Intensive Care Nurses INTRODUCTION ventilation, and 2 ways on the insertion of catheter, Airway management is primary care given to deep and shallow [2]. If endotracheal suctioning is not the patient admit in intensive care unit. It includes performed accurately it will lead to several placement of endotracheal tube into the patient’s airway complication such as respiratory and cardiac defects, in those who are unable to breathe [3]. The secretion of tracheal endothelial trauma, bleeding, hypoxemia and intubated patient is retained in the airway due to cardiac arrhythmias, increased intracranial pressure may decrease cough reflex; impair normal function of ciliary cause cardiac arrest and death [1]. Nurses should work cells and increase production of mucous [13].The carefully with evidence based knowledge, before, accumulated secretion causes increased airway during and after suctioning. Complication arises due to resistance and respiratory distress, hypercapnia, mistakes in the practices. Nurses who are adhering to hypoxia,atelectasis and infection. So mechanical evidence based guideline can decrease the prevalence of removal of secretion from trachea and lower airway the complication [11].The decrease level of knowledge through suctioning is necessary [9, 2]. This procedure is about endotracheal suctioning among intensive care unit performed by intensive care nurses in order to provide nurses could be dangerous for the patient who have adequate oxygenation, increase alveolar ventilation and artificial airway [10]. maintain gaseous exchange [10]. It is important that the nurse’s practices should be based on scientific Nurses are not aware of current suctioning evidences associated with different aspects of recommendations and practices they follow, are on suctioning [12]. traditional base rather than on evidence [4]. There were significant irregularity between the practices of ICU This procedure involves preparation of the nurses regarding hyper oxygenation, infection control patient, the suctioning event and care after the measures and negative pressures was found to be low procedure. It is performed by 2 ways on the selection of [6]. catheter: open and closed, open system includes disconnection of the patient from ventilator and closed A study found that the staff nurses set the suctioning does not require removal from artificial suction pressure at more than 150mmhg although Available Online: http://scholarsmepub.com/sjmps/ 454 Tasnim Zainib et al.; Saudi J. Med. Pharm. Sci.; Vol-3, Iss-6A (Jun, 2017):454-463 70.8% staff nurses knew that suctioning pressure should care for the benefit of the patient. This study will not exceed more than 150mmhg[9]. Another study helpful to clarify the status of knowledge and practices conducted on assessing knowledge of nurses about of ICU nurse regarding endotracheal suctioning in the endotracheal suctioning describe that experienced children hospital, finding weakness and offer nurses have answered the question about internal recommendations. The result of the study will be useful diameter and insertion of the catheter better than the to identify care given in the ICU. It will also helpful to nurses who having less experience [10]. Infection convince the hospital management that nurses require control practices are compromised resulting in infection education and training related to endotracheal and potential risk of aspiration of colonized bacteria. suctioning. The most important deficiency lies in hand washing before and after the procedure. So there is a need to The study was plan to accomplish following increase quality of care among ICU nurses regarding purposes endotracheal suctioning [6]. To assess knowledge regarding endotracheal suctioning in ICU nurses. Furthermore A study describe that majority of To observe practices of endotracheal the nurses do not auscultate the lung sound for the suctioning in ICU nurses. presence of secretion similarly many of the participants To assess gap between knowledge and practice does not provide hyper oxygenation to the patient [7]. in standard endotracheal suctioning. To determine relationship between knowledge An exploratory study by on knowledge and and practice and demographic variables. skill regarding endotracheal suctioning describes that there are deficient areas of knowledge and skill between METHODOLOGY observed practices and best practices. This study Place of work indicates that even though nurses knowledge score was The study was conducted in ICU’s of the acceptable deficiency exist in some areas of suctioning children hospital and institute of child health Lahore. It (actual event and post suctioning). It may be due to that has 11 ICU (including specialty ICU e.g. CICU and the nurses get the knowledge from others or due to ward ICU) with 140 beds capacity. The number of beds inadequate training [14]. in ICU varied between minimum of 6 and maximum of 32. The nurse to patient ratio is 1:4 per shift within Despite the importance of endotracheal these ICU’s. The study was carried out in all ICU’s suctioning there are few studies documented in where endotracheal suctioning is performing in the Pakistan. A literature review of practices of patient with artificial airway. endotracheal suctioning demonstrated that knowledge and practice of health care professional related to Research design endotracheal suctioning play a vital role to enhance Cross sectional, Descriptive. patient’s safety [8]. There is a need to do more work in this perspective to provide evidence based care. Total population 1200 nurses in hospital. Nursing practice in Pakistan facing many challenges one of them is to improve clinical Target population performance. Knowledge is not only the way to 168 nurses working in ICU improve clinical skill; assessment of performance at bed side is required. On the part of endotracheal suctioning, Sample technique it is observed that nurse’s knowledge and practice Purposive sampling method was used in the regarding endotracheal suctioning was poor. Studies study. suggested that most of the nurses in the intensive care unit perform according to their own suctioning practice Sample size rather to rely on the scientific evidence [7]. As 118 nurses working in intensive care unit of endotracheal suctioning is associated with several children hospital Lahore. complications there is a need to assess gap between knowledge and practice in standard endotracheal Inclusion criteria suctioning of nurses. Evidence based guideline is Nurses who are currently working in the required in all intensive care setting and nurses should critical care ICU (e.g. MICU) or working in the ward be motivated to follow them. ICU with more than 3-month experience, age between 18-50 years, both male and female, Diploma in nursing, Intensive care unit nurses are expected to care midwifery, specialization, or BSCN are in inclusion efficiently in order to improve outcome of the patient so criteria. this is their primary responsibility to deliver nursing Available Online: http://scholarsmepub.com/sjmps/ 455 Tasnim Zainib et al.; Saudi J. Med. Pharm. Sci.; Vol-3, Iss-6A (Jun, 2017):454-463 Exclusion criteria And these participants were also observed for their The nurses who have experience less than 3 practices about endotracheal suctioning. (Using non months in ICU or who are not working in ICU. The participant’s observation) the participants were asked to nurses who do not
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