Effects of active and passive implementation of ventilator associated pneumonia guideline on nurses' performance in critical care units: a controlled clinical trial

Ventilator associated pneumonia [VAP] is the most common infections in critical care units, which leads to more length of hospital stay, costs, and high mortality. Therefore, prevention is a priority according to clinical guidelines. The aim of this study is determine the effects of passive versus active implementation of VAP guidelines on nurses' performance in critical care units. In this controlled clinical trial, 110 nurses who working in critical care units in selected hospitals affiliated to Tehran University of Medical Sciences were enrolled to study by convenience sampling at three groups, including active intervention group [n = 40], passive intervention [n = 36], and control [n = 34]. First, nurses' performance in prevention of VAP was evaluated by an observational checklist. In passive intervention group, posters containing recommendations of prevention of VAP was installed over the wall for each bed. In active intervention group, in addition to poster installation, there were training sessions with feedback on nurses' performance. In control group without any intervention, just nurses' preventative performance was evaluated before and 1 month later. A month later the nurses' performance were observed. Data were analyzed by descriptive and inferential tests [Fisher's exact test, chi-square, ANOVA, and paired t-test] in SPSS version 16. Results showed that the nurses' mean percentage score in three groups was 46.80 +/- 5.79 and after intervention it changed from 47.76 +/- 4.61 to 63.32 +/- 6.97 [P < 0.001] in active group, from 45.24 +/- 5.72 to 55.03 +/- 10.20 [P < 0.001] in passive group and 47.33 +/- 6.86 to 47.90 +/- 6.06 in control group [P = 0.263]. Nurses' performance in active group improved significantly in comparison to passive group and in passive group, it improved significantly in comparison to control group [P < 0.001]. The results of this study showed that both active and passive methods are effective on nurses' performance in prevention of VAP. Therefore, considering the existing situation in the country and the high workload of nurses, we can offer VAP guideline as a protocol in critical care units

[Nurses performance in prevention of ventilator associated pneumonia]

The ventilator associated pneumonia is a common problem in critical care units. It is associated with increased mortality, cost and length of stay. Nurses have great role in preventing the ventilator associated pneumonia. The aim of this study was to assess nurses' performance in prevention of ventilator associated pneumonia. In this descriptive study, 110 nurses working in selected hospitals affiliated to Tehran University of Medical Sciences were selected using convenience sampling method. A 32-item observational checklist was provided based on the ventilator associated pneumonia prevention guideline. The nurses' performance was observed three times. Data were analyzed using descriptive statistics in the SPSS-16. This study showed that the mean score of the nurses' prevention was 46.8 +/- 5.79. Most of the nurses [66.4%] had poor performance; and 36.6% had relatively good performance. There were no nurses with favorable performance in the prevention of ventilator associated pneumonia. The highest score was in contact precaution [72 +/- 9.67] and the lowest score was in mouth hygiene [18.78 +/- 17.4]. The majority of nurses had poor performance in prevention of ventilator associated pneumonia. More attention should be paid for planning appropriate training programs for nurses and giving adequate facilities to improve health care quality

[Modification of environmental factors on quality of sleep among patients admitted to CCU]

Poor sleep quality is a common problem among patients hospitalized in the CCUs. This study aimed to determine the effect of environmental factors modification strategies on quality of sleep among patients admitted to CCU. This was a quasi-experimental study with a single-blinded design. Sixty patients admitted to the CCU of Shariati hospital were divided into two experiment and control groups. Sleep quality was measured in the first day of admission and three days later using the Pittsburgh sleep quality index in both groups. In the intervention group, we implemented a modified work environment between the two measurements. Data were analyzed using the Chi squared and t-test in the SPSS v.18. Findings showed a significant decrease in sleep quality in the control group after hospitalization, compared with the intervention group [P<0.001]. There were no statistically significant changes in the sleep quality before and after hospitalization in the intervention group [P=0.053]. Using environmental factors mitigation strategies can improve sleep quality of patients admitted to CCUs

[Effect of application of critical-care pain observation tool in patients with decreased level of consciousness on performance of nurses in documentation and reassessment of pain]

The presence of pain is a common phenomenon among patients in critical care units. Critically ill patients are often unable to communicate because of illness or sedation; so, recognition and assessment of their pain is difficult. In these patients, observational behavioral indices can be used to evaluate pain. The aim of this study was to investigate the effect of application of critical-care pain observation tool in patients with decreased level of consciousness on performance of nurses in documentation and reassessment of pain after palliative intervention. In this before and after quasi-experimental study, 106 nurses working in general intensive care units in selected hospitals affiliated to Tehran University of Medical Sciences were selected. First, we examined the nurses' performance three times in relation to documentation and reassessment of pain after palliative intervention, position change and suction procedure in patients with decreased level of consciousness using a researcher-made check list. Then, we taught nurses individually, how to use this tool to investigate the pain of patient in a session lasting an hour. A week after the training, the researcher reevaluated performance of trained nurses in relation to documentation and reassessment of pain after palliative intervention in patients with decreased level of consciousness. Finally, those data collected before and after the training of the CPOT to nurses were compared using the Wilcoxon test. Findings showed that the CPOT could not lead to improved nurses' function in relation to documentation of pain in the patients records [P=0.209] and recording palliative measures related to pain [P=0.117]. However, there were significant statistical differences between nurses' function in relation to reassessment of pain after palliative intervention, before and after the training and application of the CPOT. Comparing the mean function scores before and after the intervention, demonstrated that the performance of nurses in this area has been improved after the intervention. The critical-care pain observation tool can increase nurses' sensitivity to pain in patients with decreased level of consciousness. It forces the nurses to reassess the pain after palliative intervention. This tool does not motivate in nurses to document pain palliative process. So it is recommended that future studies investigate the impact of this tool on other aspects of pain management, such as diagnosis of pain and using of drugs and non-drug measures