Nurses' compliance of evidence-based guidelines for preventing VAP in CCUs

Critically ill patients in critical care units [CCUs] are at high risk for infections associated with increased morbidity, mortality, and health care costs. The overall infection rate in critically ill patients approaches 40% and may be as high as 50% or 60% in patients who remain in the CCU for more than 5 days. Ventilator-associated pneumonia [VAP] in mechanically ventilated patients ranges from 8% to 28%. VAP refers to an infection that develops during mechanical ventilation after 48 hours of intubation. Nurses play a pivotal role in decreasing patients'risk of acquiring VAP. Keeping pace, in this instance, is really about turning focus back to the more basic aspects of critical care nursing. Evidence now demonstrates how important basic nursing care is to the prevention of VAP by using strategies for the prevention of VAP. Therefore, the aim of this study was to assess nurses' compliance of evidence-based guidelines for preventing VAP in CCUs. The study was conducted at the CCUs of Alexandria Main University Hospital namely,Casualty Intensive Care Unit [unit I] and General Intensive Care Unit [unit III]. The sample of this study consisted of 60 nurses working in the previously mentioned CCUs. Two tools were used for data collection VAP Preventive interventions Observation Checklist [VAPPIOC] and VAP knowledge questionnaire [VAPKQ]. Nurses had different levels of adherence for many non-pharmacologic strategies. All nurses responses to the questionnaire, rates and reasons for non adherence were addressed. The most important barriers to implementation were environment-related. Other reasons for non-adherence were patient-related barriers being significantly important for nurses. Overall, the most important barriers to adherence were unavailability of resources. Our findings suggest the need for development of guidelines to reduce variability and the need to include the nursing point of view in these guidelines

Critical care nurses' knowledge and attitudes regarding the [Do Not Resuscitate [DNR] status]

Patients in the critical care unit [CCU] are, by definition, the sickest patients in acute care hospitals and face higher risk of death than any other hospital population and usually require advanced life support such as mechanical ventilation, inotropes, or dialysis. Since every day critical care nurses encounter death and dying in the critical care units, Nurses are vital to end-of-life care as they are the ones present at the bedside, they have an opportunity to observe behaviours and actions that are barriers to a peaceful and dignified death while they provide end-of-life care. Do-not- resuscitate orders [DNR] are used in many countries to limit the use of cardiopulmonary resuscitation [CPR] in certain situations. There is still a continuing debate about the ethics, legalities and the appropriate medical indications for use of DNR. The status of DNR can raise many issues for nurses, including ethical dilemmas, conflict, and power struggles among members of the health care team. Therefore, this study was carried out to describe critical care nurses' knowledge and attitudes regarding the Do not resuscitate [DNR] status in Critical Care Units. A descriptive design was used and The study was conducted in the critical care units of Alexandria Main University Hospital, namely the: Casualty Care Unit [Unit I], General intensive Care Unit [Unit III], Chest intensive Care Unit, Coronary care unit, Neurosurgery intensive Care Unit, Triage and the Burn intensive care unit. A convenient sample consisting of one hundred and forty [140] critical care nurses working in the previously mentioned intensive care units were included. They were interviewed by using knowledge and attitudes regarding do not resuscitate [DNR] status structured interview schedule. Results showed that: the majority of critical care nurses have knowledge about DNR status regarding the following: the meaning of DNR as withholding CPR, provided care as administering oxygen, the medical management as defibrillation / cardioversion and documentation. Regarding critical care nurses attitudes towards DNR status, most of them were of the opinion of continuing monitoring patients' vital signs, providing care as suctioning artificial airway. Conclusions: Clear policy and documentation for DNR status are suggested to reduce confusion and promoting nurses involvement in decision making process of DNR and improving nursing practice