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Getahun AB, Belsti Y, Getnet M, Bitew DA, Gela YY, Belay DG, Terefe B, Akalu Y, Diress M. Knowledge of intensive care nurses’ towards prevention of ventilator-associated pneumonia in North West Ethiopia referral hospitals, 2021: A multicenter, cross-sectional study. Ann Med Surg (Lond) 2022; 78:103895. [PMID: 35734742 PMCID: PMC9207106 DOI: 10.1016/j.amsu.2022.103895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/23/2022] [Accepted: 05/29/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Ventilator-associated pneumonia is a common nosocomial infection that occurs in critically ill patients who are on intubation and mechanical ventilation. Nurses' lack of knowledge may be a barrier to adherence to evidence-based guidelines for preventing ventilator-associated pneumonia. This study aimed to assess the knowledge of intensive care nurses’ towards the prevention of ventilator-associated pneumonia. Methods A multicenter cross-sectional study was conducted among nurses working in the intensive care unit from April to July 2021. A pre-tested and structured questionnaire was used to collect data. All intensive care nurses working in the study area were included in the study. Data was entered into Epi-data 4.1 version (EpiData Association, Denmark) and transferred to STATA version 14 (College Station, Texas 77845-4512 USA) statistical software for analysis. Both bi-variable and multivariable binary logistic regression analysis was used to identify factors associated with knowledge of intensive care unit nurse. Variables with a p-value less than <0.2 in the bi-variable analysis were fitted into the multivariable logistic regression analysis. Both Crude and Adjusted Odds Ratio with the corresponding 95% Confidence Interval was calculated to show the strength of association. In multivariable analysis, variables with a p-value of <0.05 were considered statistically significant. Result A total of 213 intensive care nurses were included in the study, with a response rate of 204(95.77%). The mean knowledge score of intensive care nurses regarding the prevention of ventilator-associated pneumonia out of 20 questions is (10.1 ± 2.41). There are 98 (48.04%) of the participants have been found to have good knowledge and 106 (51.96%) of them are rendered poor knowledge about the overall knowledge related to the prevention of ventilator-associated pneumonia. Higher academic qualifications and taking intensive care unit training were significantly associated with good knowledge of ventilator-associated pneumonia prevention in multi-variable logistic regression. Conclusion Our study indicates that the knowledge of intensive care nurses about ventilator-associated pneumonia prevention is not sufficient. Higher academic qualifications and taking intensive care unit training are significantly associated with a good level of knowledge. Therefore it shows the necessity for thorough training and education. The knowledge of intensive care nurses about ventilator-associated pneumonia prevention is not sufficient. Only 98 (48.04%) of the participants have been found to have good knowledge. Higher academic qualifications and taking intensive care unit training are significantly associated with a good level of knowledge. This study shows the necessity of in-service training and continuing education for intensive care nurses about the prevention of ventilator-associated pneumonia.
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Bayoumi M, ALaswad Z. Improvement of the nurses' awareness toward ventilator-associated pneumonia based on evidence guidelines. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2022. [DOI: 10.4103/injms.injms_124_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Madhuvu A, Endacott R, Plummer V, Morphet J. Healthcare professional views on barriers to implementation of evidence-based practice in prevention of ventilator-associated events: A qualitative descriptive study. Intensive Crit Care Nurs 2021; 68:103133. [PMID: 34756476 DOI: 10.1016/j.iccn.2021.103133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/26/2021] [Accepted: 08/09/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore health professional views of barriers to the use of evidence-based practice to prevent ventilator-associated events in intensive care units. DESIGN A qualitative descriptive study was conducted with nurses and doctors with more than six months experience caring for mechanically ventilated patients. SETTING The study was conducted in two intensive care units, in large metropolitan health services in Victoria, Australia. METHODS Individual semi-structured interviews were undertaken with 20 participants (16 nurses and 4 doctors) in 2019. Purposive sampling method was used until data saturation was reached. The interviews were held at the hospital in a private room away from their place of employment. The interview data were analysed using thematic analysis. FINDINGS Four major themes were inductively identified from nine subthemes: i) prioritising specific situations, ii) inadequate use of evidence to underpin practice, iii) perception of inadequate staffing and equipment and, iv) inadequate training and knowledge of evidence-based guidelines. CONCLUSIONS These themes helped to explain previously reported deficits in nurses' knowledge of and adherence to evidence-based practice in intensive care. Findings suggest the need for a well-established policy to underpin practice. The barriers faced by nurses and doctors in preventing ventilator associated events need to be addressed to optimise quality of patient care in intensive care units.
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Affiliation(s)
- Auxillia Madhuvu
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Monash Health, Dandenong Hospital, 135 David Street, Dandenong, Victoria, Australia. https://twitter.com/@AuxilliaMadhuvu
| | - Ruth Endacott
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Plymouth University/Royal Devon and Exeter Hospital Clinical School, Drake Circus, Plymouth, Devon PL4 8AA, United Kingdom
| | - Virginia Plummer
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; School of Nursing and Healthcare Professions, Federation University Australia, Australia
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Monash Health, Dandenong Hospital, 135 David Street, Dandenong, Victoria, Australia
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Bankanie V, Outwater AH, Wan L, Yinglan L. Assessment of knowledge and compliance to evidence-based guidelines for VAP prevention among ICU nurses in Tanzania. BMC Nurs 2021; 20:209. [PMID: 34696753 PMCID: PMC8543108 DOI: 10.1186/s12912-021-00735-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 09/29/2021] [Indexed: 01/22/2023] Open
Abstract
Background Implementation of evidence-based guidelines (EBGs) related to VAP is an effective measure for the prevention of ventilator-associated pneumonia (VAP). While low knowledge regarding the EBGs related to VAP prevention among ICU nurses is still a major concern among nurses in ICUs globally, the situation in Tanzania is scarcely known. This study aimed to assess the ICU nurses’ knowledge, compliance, and barriers toward evidence-based guidelines for the prevention of VAP in Tanzania. Methods A cross-sectional study, involving ICU nurses of major hospitals in Tanzania, was conducted. A structured questionnaire was administered among 116 ICU nurses. Data analysis included descriptive statistics and the independent sample t-test. Results The mean knowledge score was 3.86(SD = 1.56), based on ten questions (equivalent to 38.6%). Nurses with a degree or higher level of nursing education performed significantly better than the nurses with a diploma or lower level of nursing education (p = 0.004). The mean self-reported compliance score for EBGs for the prevention of VAP was 15.20 (SD = 0.93) which is equivalent to 60.8% based on 25 questions. The main barriers to the implementation of EBGs for VAP prevention were lack of skills (96.6%), lack of adequate staff (95.5%), and lack of knowledge (79.3%). Conclusion Considering the severity and impact of VAP, and the higher risks of HAIs in resource-limited countries like Tanzania, the lower level of knowledge and compliance implies the need for ongoing educational interventions and evaluation of the implementation of the EBGs for VAP prevention by considering the local context.
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Affiliation(s)
- Vicent Bankanie
- XiangYa school of Nursing, Central South University, No.172Tongzi po Road, Changsha, Yuelu District, China.,Department of Clinical Nursing, University of Dodoma, Dodoma, Tanzania
| | - Anne H Outwater
- Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Li Wan
- XiangYa school of Nursing, Central South University, No.172Tongzi po Road, Changsha, Yuelu District, China
| | - Li Yinglan
- XiangYa school of Nursing, Central South University, No.172Tongzi po Road, Changsha, Yuelu District, China.
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Madhuvu A, Endacott R, Plummer V, Morphet J. Nurses' knowledge, experience and self-reported adherence to evidence-based guidelines for prevention of ventilator-associated events: A national online survey. Intensive Crit Care Nurs 2020; 59:102827. [PMID: 32151484 DOI: 10.1016/j.iccn.2020.102827] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore Australian intensive care nurses' knowledge of ventilator-associated pneumonia and self-reported adherence to evidence-based guidelines for the prevention of ventilator-associated events. DESIGN A quantitative cross-sectional online survey was used. SETTING The study was conducted in two Australia intensive care units, in large health services in Victoria and an Australia-wide nurses' professional association (Australian College of Critical Care Nurses). MAIN OUTCOME MEASURES Participants' knowledge and self-reported adherence to evidence-based guidelines. RESULTS The median knowledge score was 6/10 (IQR: 5-7). There was a significant positive association between completion of post graduate qualification and their overall knowledge score p = 0.014). However, there was no association (p = 0.674) between participants' years of experience in intensive care nursing and their overall score. The median self-reported adherence was 8/10 (IQR: 6-8). The most adhered to procedures were performing oral care on mechanically ventilated patients (n = 259, 90.9%) and semi-fowlers positioning of the patient (n = 241, 84.6%). There was no relationship between participants' knowledge and adherence to evidence-based guidelines (p = 0.144). CONCLUSION Participants lack knowledge of evidence-based guidelines for the prevention of ventilator-associated pneumonia. Specific education on ventilator-associated events may improve awareness and guideline adherence.
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Affiliation(s)
- Auxillia Madhuvu
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Monash Health, Dandenong Hospital, 135 David Street, Dandenong, Victoria, Australia.
| | - Ruth Endacott
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Plymouth University/Royal Devon and Exeter Hospital Clinical School, Drake Circus, Plymouth, Devon PL4 8AA, United Kingdom
| | - Virginia Plummer
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria, Australia
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Monash Health, Dandenong Hospital, 135 David Street, Dandenong, Victoria, Australia
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BommaReddy RR, Patel R, Smalley T, Acevedo-Duncan M. Effects of Atypical Protein Kinase C Inhibitor (DNDA) on Lung Cancer Proliferation and Migration by PKC-ι/FAK Ubiquitination Through the Cbl-b Pathway. Onco Targets Ther 2020; 13:1661-1676. [PMID: 32158232 PMCID: PMC7047975 DOI: 10.2147/ott.s224866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/03/2020] [Indexed: 01/23/2023] Open
Abstract
Purpose The options for treating lung cancers are limited, as diagnosis typically occurs during the late stages of the disease. There is a dire need to develop aPKC (atypical Protein Kinase C) inhibitors due to aPKC overexpression and contributions to lung cancer malignancies. In this study, we investigate the role of atypical PKCs (aPKCs) in cell proliferation and migration in lung cancer cell lines and the effect of the novel aPKC inhibitor DNDA (3,4-amino-2,7 napthalene disulfonic acid). Methods The normal and lung cancer cells were treated with various concentrations of DNDA. We used a WST assay to determine lung cell viability, then analyzed cell apoptosis through Annexin V/PI staining and flow cytometry. Immunoprecipitation determined the proteins' associations, and Western blot allowed testing of the expression of interest proteins. We also employed the UbiTest to identify the ubiquitination of the FAK. The scratch and transwell assays measured cell migration and invasion of lung cancer cells. Results Our data from cell viability and flow cytometry showed a significant reduction in cell proliferation and induction of apoptosis with DNDA treatment in lung cancer cells, as well as no toxic effect on normal BEAS-2B lung cells. Western blot results showed that the phosphorylation of PKC-iota and phosphorylation of FAK decreased in A549 lung cancer cells upon DNDA treatment. Immunoprecipitation (IP) data revealed an association of PKC-ι with FAK and FAK with Casitas B-lineage lymphoma proto-oncogene-b (Cbl-b). UbiTest results suggest that PKC-ι regulates FAK cleavage through its ubiquitination by Cbl-b, thereby inhibiting A549 lung cancer cells' migration. This was evident from scratch, invasion, and migration assays. Conclusion Our study data suggest that DNDA inhibits cell proliferation and induces apoptosis in lung cancer cells. Moreover, DNDA inhibit A549 lung cancer cells' migration by PKC- ι/FAK ubiquitination via Cbl-b.
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Affiliation(s)
| | - Rekha Patel
- Department of Chemistry, University of South Florida, Tampa, FL 33620, USA
| | - Tracess Smalley
- Department of Chemistry, University of South Florida, Tampa, FL 33620, USA
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Yeganeh M, Yekta H, Farmanbar R, Khalili M, Khaleghdoost T, Atrkar Roushan Z. Knowledge of evidence-based guidelines in ventilator-associated pneumonia prevention. J Evid Based Med 2019; 12:16-21. [PMID: 26845460 DOI: 10.1111/jebm.12188] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/15/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the intensive care unit nurses' knowledge of evidence-based guidelines for ventilator-associated pneumonia (VAP) prevention at Guilan University of Medical Sciences (GUMS) hospitals, Guilan Province, northern Iran. METHODS This cross-sectional study included 219 nurses working in 14 intensive care units at 11 Guilan hospitals. The questionnaire consisted of three parts of demographic information, nurses' knowledge of evidence-based guidelines for the prevention of VAP, and the barrier for the implementation of these guidelines. RESULTS Of the 219 nurses, 171 (response rate 78.1%) participated in this study, and their mean knowledge score was 4.6. There was no significant relation between nurses' knowledge score and their work experience (P = 0.327), education degree (P = 0.189), and their position (P = 0.168). CONCLUSION The level of knowledge regarding VAP prevention seems inadequate in this study. Although having knowledge about the principles of evidence-based care cannot guarantee the implementation of these principles, lack of knowledge may be a potential barrier to adherence to evidence-based guidelines for the prevention of VAP.
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Affiliation(s)
- Mohammadreza Yeganeh
- Department of medical-surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Yekta
- Department of Health Education, School of Health, Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Rabiollah Farmanbar
- Department of Health Education, School of Health, Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Malahat Khalili
- Department of Health Education, School of Health, Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Tahereh Khaleghdoost
- Department of Nursing, Faculty of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Atrkar Roushan
- Department of Health Education, School of Health, Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Jansson MM, Syrjälä HP, Talman K, Meriläinen MH, Ala-Kokko TI. Critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle. Am J Infect Control 2018; 46:1051-1056. [PMID: 29573832 DOI: 10.1016/j.ajic.2018.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although evidence-based practices are known to improve the quality of care, making it cost-efficient and improving clinical results, barriers to transferring research into clinical practice have hindered this process. AIMS To evaluate critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle. MATERIAL AND METHODS In 2015, we conducted an institution-specific, cross-sectional study in a 26-bed adult mixed medical-surgical intensive care unit (ICU) in Finland using quantitative survey of knowledge and self-reported adherence with qualitative gathering of barrier data. A pre-validated multiple-choice Ventilator Bundle Questionnaire was distributed to all registered nurses who were direct care providers (n = 155). RESULTS The final response rate was 55.5% (n = 86), and 47.2% (n = 34) of respondents had more than 10 years of ICU experience. The levels of knowledge and self-reported adherence were 71.1% and 65.8% of the total score, respectively. The level of knowledge was higher among respondents who had received in-service education about ventilator bundle compared with respondents who had not received in-service education (27.0 vs 24.0 [P = .012]). Less experienced nurses reported significantly higher adherence than nurses with more ICU experience (29.0 vs 25.0 [P = .034]). The correlation between knowledge and adherence scores was low (ρ 0.48 [P <.001]). The most well-known and adhered-to guidelines described patient positioning, daily chlorhexidine-based oral care, and strict hand hygiene. The least-known guidelines and those least adhered to described respiratory equipment, management of sedation and analgesia, and practices prior to and during endotracheal suctioning. The main barriers were related to the nurse respondents (e.g., lack of education [25.9%]), environment (e.g., role ambiguities [36.4%] and inadequate resources [21.1%]), and patients (e.g., patient discomfort [4.8%] and fear of adverse effects [4.6%]). CONCLUSIONS Self-reported adherence did not correlate with knowledge and was not related to work experience. Most of the barriers toward evidence-based guidelines indicated a need for changes that are beyond the control of individual nurses.
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Affiliation(s)
- Miia M Jansson
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland.
| | - Hannu P Syrjälä
- Department of Infection Control, Oulu University Hospital, Oulu, Finland
| | - Kirsi Talman
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Merja H Meriläinen
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland
| | - Tero I Ala-Kokko
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland
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Optimizing educational initiatives to prevent ventilator-associated complications. Am J Infect Control 2017; 45:102-103. [PMID: 28065326 DOI: 10.1016/j.ajic.2016.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 11/20/2022]
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