The evidence-based problem

The evidence-based problem

PICOT question:

In adults intubated patients at the intensive care unit (ICU), is Nurses’ Knowledge regarding their hospitals’ requirements for assessment and accommodation more useful in relative to acquired impaired communication?

Nurses have shown plenty of challenges during the decision-making process when accommodating and assessing patients who are intubated. Patients who are intubated are placed on a ventilator gadget to help them with breathing when illness conditions get severe. The Knowledge of Nursing should be taken up to assist other health experts during the assessment and in making options for accommodation (Haljamăe et al., 2003). Over a prolonged period, acquired communications use has been a replacement for the input of nursing on the decision making process for the management of patients. Patients who are intubated are those in the ICU intensive care unit. At many times, they require an assessment of their airways to be able to fathom their accommodation procedures and needs to be expected. In relevance to Simpson et al. (2012), the Intensive care unit environment isn’t very favorable for the management of complicated airway procedures because of the lack of additional staff who are experienced enough. However, it is established that the utility of Knowledge on nursing on intubation is majorly utilized to provide threat minimization of marked oxygenation abnormality.

Nurses have achieved management skills of patients, which are very useful, which are beneficial during the decision-making process and during the process of assessing patients who are intubated. Therefore, their consultation is crucial in the helping of patients during the procedures of accommodation and assessment options. The Knowledge of Nursing is more useful than relying on communication, which is acquired, which is proved to be highly inadequate most crucially for patients who are intubated (Haljamăe et al., 2003). This particular intervention is essential in helping to manage patients who are intubated very effectively and reduce the time patients are scheduled for the process of treatment under a ventilation gadget. Intensive Care Unit (ICU) adult intubated patient’s treatment often needs Knowledge of nursing in the adoption of effective communication, patient assessment, and the decision-making process on accommodation procedures. The selected topic is on the Knowledge of nurses for intubated patients in the Intensive care unit of the evaluation and accommodation. It is more useful when relating to impaired communication, which is acquired. The purpose of this topic is to bring an understanding of the role of nurses in caring for the patients in the ICU. The chosen problem is critical due to its vitality in promoting better healthcare by reducing essential challenges faced in the decision process of the accommodation and assessment of the patient who is intubated (Atrkar Roushan et al., 2019).  Our topic has significance in the provision of care and enhancing critical skills, specifically by nurses. Knowledge by nurses is essential in healthcare improvement by helping other experts in the assessment and the making of crucial choices in accommodation.

When Referring to Tarimo, E. A. (2018), research, Nurse Knowledge was found to be critical in assessing and making essential recommendations on accommodation, which in turn led to increased intubated adult patient chances in the intensive care unit by at most 12%. Apart from that, acquired communications use over time was used to replace nurses’ input on the management of patients, which is essential in the decision making process on matters concerning healthcare. The study by Tarimo on Endotracheal suctioning; which is administered to patients by the mechanical removal of pulmonary secretions with artificial airways shows that among the 103 ICU nurses investigated in Dar es Salaam, Tanzania, 57% of them had ICU training which gave them higher Knowledge of ETS than the non-trained. Using a descriptive cross-sectional study, the research infers that training ICU nurses on the skills of ETS are very crucial in the procedure of endotracheal suction.

The (ICU) is a place that gives particular care to a patient who is critically ill, through support and treatment, continued observation to prevent complications and ensure health restoration (De Beer et al. 2011). ICU patients are in highly vulnerable due to the criticality of the illness they have, which leads to the high dependency on the nursing staff to assist with in-day activities and aid in the reduction of discomfort as a result of treatments, bacteria growth and secretions, and dry mouth (Mykhalovsky et al., 2013). Concerning the problems occurring in the ICU (VAP), ventilator-associated pneumonia is the primary factor that results in providing oral hygiene from nurses (Dale et al. 2013). The leading cause of death in ICUs is VAP. In accordance to Davidson (2006), Berry et al. (2007); and Berry and Cutler and Davis (2005), the occurrence of ventilator-associated pneumonia is 10% to 29% of the patients intubated and the levels of mortality for VAP range from 25% to 51%. However, despite the nurses knowing this fact, oropharyngeal secretions suctioning isn’t customarily practiced in critical care (Berry et al. 2007) However, oral care administration in ICU helps in the reduction of discomfort (Schuerer et al., 2009). Oral care is a nursing activity that is essential and that it helps in creating comfort and health for patients. A clear example of the role played by oral care is the evidence supported by AACN Practice Alert, 2007. The evidence shows that despite the role played by mouth wash Chlorhexidine in reducing infections during the process of cardiac surgery, Oral care helps in overcoming the real problem, which is the effect of respiratory infections in intubated and mechanically ventilated patients. Chlorhexidine only reduces the risk of disease of VAP pathogens, which is not the main problem. Oral care plays a crucial role in reducing the rate of bacteria colonization; hence the overall costs and the stay in hospitals are reduced. According to the literature review, evidence-based oral care improves health not only through the prevention of infection but also promoting comfort. It says, “EBP aims to deliver appropriate care efficiently to every patient” (Brink 2006). Therefore, the effort into improving and implementing EBP should be put by the healthcare staff. As researchers on healthcare ensure EBP quality standards by the establishment of guidelines and protocol through the process of EBP that helps in guiding the process of ICU oral care, the delivery of oral care by nurses relying on the set patient guidelines who are very ill leading to an outcome of quality in patients.

In the third article, {Yeganeh et al., Knowledge of evidence-based guidelines in ventilator-associated pneumonia prevention, 2015} the primary purpose of this assignment was to assess the Knowledge of nurses in the evidence-based practice guidelines in the VAP prevention, and the importance of the Knowledge in the treatment process. Out of the 219 nurses in the area of research, 171 participated in the study. The mean knowledge score was 4.6. Collected information was from 16 intensive care unit centers of education and health. Variations in scores may be contributed to the fact that there was a considerable disparity in the healthcare models, the lack of guidelines on an international and national level, and a policy that was not consistent. In this context, the Knowledge of nurses is very inadequate in our research, and there is a need for extensive training concerning the new guidelines set. The sections that posted the highest scores were Knowledge concerning the systems of suctioning (open or closed) at 73%, the type of moisturizer at 70%, the positioning of the patients at 87%, the least knowledgeable areas were the suctioning gadgets replacement time at 19%, the alternative time for the ventilator gadget replacement at 34%, the endotracheal tubes subglottic suction at 29%. The results outline that the most crucial procedures for VAP prevention, like the subglottic suctioning and ventilator gadget replacement time, are not known to the nurses.   The outcomes of the research were the Knowledge of oral practice by nurses in the treatment of VAP was inadequate. The lack of oral practice in adherence to the evidence-based guidelines proved to be a fatal barrier that put the lives of patients undergoing VAP treatment at risk.

In conclusion, the studies identified above have given us a clear picture that the incidences of VAP are high today because nurses of ICU have inadequate Knowledge of the evidence-based guidelines. Using this factual practice element, it has been noted that the Knowledge of nurses is crucial when treating patients in the Intubated Intensive Care Unit (ICU). The application of analysis in a PICOT question created a complete understanding of the role played by nurse knowledge in patient quality care improvement. Therefore, the evidence-based nursing scenario problem is raised by the lack of the ability of nurses in analyzing and collecting information for improved clinical care of the Intubated Intensive Care Unit (ICU) patients because of the lack of knowledge of nurses on the scenario resulting to the unfortunate outcome of the treatment.

Appendix

References

Mwakanyanga, E. T., Masika, G. M., & Tarimo, E. A. (2018). Intensive care nurses’ Knowledge and practice on endotracheal suctioning of the intubated patient: A quantitative cross-sectional observational study. PloS one, 13(8).

Tembo, E. (2016). Intensive care nurses’ Knowledge, attitudes, and practices of oral care for patients with oral endotracheal intubation (Doctoral dissertation).

Yeganeh, M., Yekta, H., Farmanbar, R., Khalili, M., Khaleghdoost, T., & Atrkar Roushan, Z. (2019). Knowledge of evidence‐based guidelines in Ventilator‐Associated Pneumonia prevention. Journal of Evidence‐Based Medicine, 12(1), 16-21.

Simpson, G. D., Ross, M. J., McKeown, D. W., & Ray, D. C. (2012). Tracheal intubation in the critically ill: a multi-center national study of practice and complications. British journal of anesthesia, 108(5), 792-799.

Bergbom-Engberg, I., & Haljamăe, H. (2003). The communication process with ventilator patients in the ICU as perceived by the nursing staff. Intensive and Critical Care Nursing, 9(1), 40-47.