Introduction
One of the central health problems is hospital-acquired diseases (HAI). Ventilator-associated pneumonia (VAP) is one of the leading HAI, which has become an even more severe problem with the COVID-19 pandemic. However, official policies and scientific research for preventing VAP offer a set of measures to avoid the development of the disease. These include the choice of non-invasive methods of providing oxygen, shortening the ventilation period, cleaning a patient’s oral cavity, correct positioning, and subglottic secretion suctioning. Therefore, the purpose of this paper is to define the intervention for the prevention of VAP based on the analysis of a facility’s activity and literature.
Learning Objectives
However, before researching the issue, one should define and describe the learning objectives of this assignment. Objectives are formulated based on Bloom’s taxonomy and correspond to its levels of cognitive skills as well as types of knowledge. Students must use factual, conceptual, procedural, and metacognitive knowledge specific to the nursing profession and strategic planning to meet these learning objectives. At the same time, the goals include simple skills from memorizing concepts to applying them in analysis, synthesis, and evaluation necessary to formulate an intervention plan.
Background and Reasons of VAP
Ventilator-associated pneumonia (VAP) is one of the most common hospital-acquired infections globally and in the USA. VAP causes higher mortality and increases the length of hospital stay and the cost of treatment. The most common causes of VAP are bacterial colonization of the oral cavity, the subglottic area, and, as a consequence, the lower respiratory tract due to insufficient movement and accumulation of fluids. However, one of the most effective interventions is subglottic secretion suctioning, as it reduces the likelihood of VAP by 45%. However, most nurses have low compliance with the procedure due to insufficient knowledge or staff shortage in contrast to other preventive measures. Therefore, this evidence demonstrates that the intervention should be aimed at improving nurses’ knowledge in subglottic secretion suctioning.
Research Question
The problem: Insufficient knowledge and use of the subglottic secretion suctioning procedure by nurses
The problem’s importance: VAP prevention
The focus of the problem: Clinical
Scope of the problem: Institution
PICO Question: In patients requiring mechanical ventilation (P), how does the subglottic secretion suctioning applied by nurses (I) compared with no intervention (C) affect the reduction of ventilator-associated pneumonia?
The EBP Question: Does nursing training on the subglottic secretion suction improve the prevention of ventilator-associated pneumonia?
Subglottic secretion suctioning is the most problematic for nurses, since it requires knowledge of techniques and is usually performed by a respiratory therapist. Thus, the main problem is Insufficient knowledge and use of the subglottic secretion suctioning procedure by nurses. This problem could be solved by providing training for nurses to achieve sufficient competence and promote the application of the procedure. Therefore, the research question is whether nursing training on the subglottic secretion suctioning improve prevention of ventilator-associated pneumonia.
Intervention: In the first planning stage of the intervention, it is necessary to determine the most effective drainage tools and techniques. For example, Rouzé et al. highlight such devices as silver-coated tracheal tubes, low-volume low-pressure tracheal tubes, and the mucus shaver. The second step is to determine the level of skills and knowledge in using these techniques and devices and prepare training by a responsible person. The next stage includes direct theoretical and practical training under the supervision of the responsible person for a group of nurses.
After completing the training and implementation of the practice for the group of the nurse, it is necessary to evaluate the effectiveness of education and intervention in general. This approach will demonstrate whether there are problems in the course or barriers to knowledge application and whether the intervention, in general, is effective. At this stage, changes can also be made if there are deficiencies. However, if the intervention is effective, training should be provided for nurses in all departments to apply the subglottic secretion suctioning procedure and reduce the level of VAP in the hospital.
Responsibilities
The nurse manager can be the initiator and the main project leader, who will assemble the interprofessional team after coordination with the administration. The team must determine the best drainage techniques, as well as evaluate the quality of the training provided by a respiratory therapist. The training in the first stage will be conducted by a respiratory therapist, and in the “Act” stage, nurses who have already acquired suction skills can train colleagues. The nursing manager should also evaluate the intervention, although the director of nursing should assess its financial benefits.
Measures
These measures to evaluate the intervention were chosen because they cover three critical aspects of understanding healthcare quality, such as structure, process, and outcomes. Nurses’ skills and treatment cost are measures of the structure and demonstrate qualitative changes in personnel qualifications. The level of VAP and the frequency of using the procedure show qualitative changes in the process of treating patients who need ventilation. At that time, the rate of mortality, development of diseases and disabilities resulting from VAP, and dissatisfaction and discomfort of the patient due to the duration of treatment are health outcomes. Therefore, the measurement of these indicators before the start of the intervention and after three and six months of its application will assess the intervention’s effectiveness.
Costs and Ethical Considerations
This project almost does not require financial investments for implementation. The only cost may be additional hours of work for the interprofessional team and a respiratory therapist involved in the design and delivery of the training. In addition, the price can also increase if the hospital does not have the equipment to perform the procedures; however, all investments are long-term and will pay off if the intervention is successful. The project does not have ethical consideration or conflict of interest because subglottic secretion suctioning is a safe procedure that requires minimal physical intervention and is acceptable to most beliefs. The choice of a nurse in the group for the first training may be a problem; however, the manager will recruit volunteers or select nurses based on their experience and teaching ability.
Conclusion
Therefore, this intervention aims to train nurses in the skills necessary to reduce the risks of developing VAP. Subglottic secretion suctioning procedures and other preventive methods will reduce the likelihood of colonization of bacteria that cause pneumonia. This intervention is low cost and easy to implement as it only requires development training for nurses. Several measures covering the structure, process, and results of health care quality will be used to assess the intervention. At the same time, the suctioning procedure is highly effective in preventing VAP. Consequently, reducing VAP development contributes to lower patient mortality, length, and cost of treatment and also increases patients’ satisfaction.
References
Haque M, Sartelli M, McKimm J, Abu Bakar M. Health care-associated infections – an overview. Infect Drug Resist. 2018;11:2321-2333.
Boltey E, Yakusheva O, Costa DK. 5 Nursing strategies to prevent ventilator-associated pneumonia. Am Nurse Today. 2017;12(6):42-43.
Bloom’s taxonomy. University of Central Florida. Web.
Al-Sayaghi KM. Critical care nurses’ compliance and barriers toward ventilator-associated pneumonia prevention guidelines: cross-sectional survey. Journal of Taibah University Medical Sciences. 2021;16(2):274-282.
Rouzé A, Martin-Loeches I, Nseir S. Airway devices in ventilator-associated pneumonia pathogenesis and prevention. Clin Chest Med. 2018;39(4):775-783.
Holly C. Practice-based scholarly inquiry and the DNP project. 2nd ed. New York, NY: Springer Publishing; 2019.