RESUMO
PURPOSE: To examine critical care nurses' knowledge about the use of the ventilator bundle to prevent ventilator-associated pneumonia. METHOD: Published reports were reviewed for current evidence on the use of the ventilator bundle to prevent ventilator-associated pneumonia, and education sessions were held to present the findings to 61 nurses in coronary care and surgical intensive care units. Changes in the nurses' knowledge were evaluated by using a 10-item test, given both before and after the sessions. Changes in the nurses' practices related to ventilator-associated pneumonia, including elevation of the head of the bed to 30 degrees to 45 degrees , were observed in 99 intubated patients. RESULTS: After the education sessions, the nurses performed better on 8 of the 10 items tested (P from .03 to <.001). The areas of most significant improvement were elevation of the head of the bed (P < .001), charting of the elevation of the head of the bed (P= .009), oral care (P= .009), checking of the nasogastric tube for residual volume (P = .008), washing of hands before contact with patients (P < .001), and limiting the wearing of rings (P < .001) and nail polish (P = .04). Even after the education sessions, the nurses' compliance with hand-washing recommendations before contact with patients was low, though statistically some improvement was apparent. Contraindications to elevation of the head of the bed did not appear to affect the nurses' practices (P= .38). CONCLUSION: Education sessions designed to inform nurses about the ventilator bundle and its use to prevent ventilator-associated pneumonia have a significant effect on participants' knowledge and subsequent clinical practice.
Assuntos
Competência Clínica , Cuidados Críticos/normas , Educação Continuada em Enfermagem/métodos , Medicina Baseada em Evidências/educação , Capacitação em Serviço/métodos , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Respiração Artificial/enfermagem , Ventiladores Mecânicos/normas , Adulto , Cuidados Críticos/métodos , Feminino , Fidelidade a Diretrizes , Hospitais Urbanos , Humanos , Unidades de Terapia Intensiva/normas , Masculino , Pessoa de Meia-Idade , Auditoria de Enfermagem , Avaliação de Programas e Projetos de Saúde , Respiração Artificial/efeitos adversos , Ventiladores Mecânicos/efeitos adversosRESUMO
This article features the Coronary Care Unit of The Methodist Hospital of Houston, Texas. This unit was one of the first Beacon Critical Care Units recognized by the American Association of Critical Care Nurses. This article focuses on how to achieve this award. The Coronary Care Unit nursing infrastructure is described, and specific unit examples are included.