The effects of open and closed system endotracheal suctioning methods on suctioning frequency, amount of secretion, and haemodynamics: A single-blind, randomised, 2 × 2 crossover trial.

BACKGROUND: Several studies have revealed that clinicians cannot suction all available secretion in the trachea and perform more frequent suctioning with a closed suctioning system (CSS) than with an open suctioning system (OSS). There are also studies claiming that the CSS is as effective as the OSS, based on either the amount of secretion, the frequency of suctioning, or haemodynamic parameters alone. However, there is no study examining all at once. OBJECTIVES: This study aims to determine whether the CSS is as effective for secretion removal, suctioning frequency, tidal volume (VT), and peripheral oxygen saturation (SpO2) as the OSS. METHODS: The study used a single-blind, randomised, 2 × 2 crossover (2-method, 2-arm, 2-period) design. One hundred intubated patients were randomly assigned to two study arms. Thirty-four were randomised to the CSS on the first day and the OSS on the second day (AB arm), and 35 were randomised to the OSS on the first day and the CSS on the second day (BA arm). A 12-h washout period was set between them. Haemodynamic parameters were measured just before suctioning and in the 5th minute after suctioning. The secretions obtained after suctioning were weighed, and the frequency of suctioning was recorded. RESULTS: There were no effects of method, period, or carryover on suctioning frequency and amount of secretion in the 2 × 2 crossover design t-test (p > 0.05). In the OSS, there was a weak, linear, and negative correlation between the amount of secretion and SpO2, and between VT and SpO2 measured before and after suctioning (p < 0.05 for all). CONCLUSIONS: Open and closed suctioning systems were similar in terms of haemodynamic alterations, amounts of secretion, and frequency of suctioning. The CSS was as effective as the OSS. REGISTRATION NUMBER: NCT04053751.

Evidence-based knowledge and emotional experiences of undergraduate nursing students regarding endotracheal suctioning: A cross-sectional, descriptive study.

AIM: This study evaluated the evidence-based knowledge and emotional experiences of undergraduate nursing students regarding endotracheal suctioning. RESEARCH METHODOLOGY/DESIGN: A cross-sectional, descriptive, survey design was used. Nursing students' knowledge level was measured using the Suctioning Knowledge Questionnaire, and emotions were assessed using the Clinical Stress Questionnaire. SETTING: University undergraduate nursing programme. RESULTS: The study included 445 undergraduate nurses. Students' mean knowledge score was 36.86 ± 14.45, and 85.8% of the total knowledge scores were 50 or less indicating a low level of knowledge. The mean score of the students who had experienced the suctioning procedure (44.5%, n = 198) was statistically higher than that of the students without experience (38.78 ± 12.62 and 35.32 ± 15.62, respectively) (p < 0.05). Students who performed the suctioning procedure expressed their emotions relating to suctioning as follows: I felt nervous (79.3%), worried (77.8%), frightened (70.2%), daunted (53.0%) and disgusted (51.0%). CONCLUSION: The majority of nursing students' knowledge levels were insufficient. That they felt frightened or disgusted performing the procedure was noteworthy. Students should be given the opportunity to perform endotracheal suctioning and express their feelings about the procedure.

Examination of nursing drug administration practices via central venous catheter: An observational study.

AIM: To determine the compliance with nursing drug administration procedure steps associated with access to the central venous catheter for bolus infusion in intensive care units. METHODS: This observational study was conducted with 30 nurses working in an intensive care unit of a university hospital. The drug administrations practiced by nurses via central venous catheter were monitored simultaneously at 12:00 a.m., 02:00 p.m., and 06:00 p.m. by two observers. The data were collected using a data collection form and central venous catheter drug administration procedure steps. RESULTS: A total of 90 different drug administrations were observed in three different treatment hours from 30 nurses. The interobserver conformity was found to be moderate in two steps (kappa = 0.520-0.627, P = 0.01) and perfect in all other steps (kappa = 0.821-1.000, P = 0.000). According to the drug administration procedure steps via a central venous catheter, all nurses applied the following steps correctly during all treatment hours: drug card control, preparation of treatment materials, checking the patient's identity, and steps of drug treatment administration. The following tasks were frequently performed incorrectly or not at all: hand hygiene (before treatment 87.8%; after treatment 82.2%), scrubbing the three-way stopcock entrance with an alcohol swab (55.6%), waiting for the alcohol to dry (81.1%), and flushing the lumen with a compatible fluid (before treatment 84.4%: after treatment 75.6%). CONCLUSION: Observation of drug administration procedure steps via central venous catheter according to the treatment hours showed that the nurses performed many incomplete or inaccurate drug administration procedure steps and the mistakes increased toward the evening hours.

Sacral Skin Temperature and Pressure Ulcer Development: A Descriptive Study.

Existing evidence is inadequate to assume increased skin temperature is a risk factor for the development of pressure ulcers (PUs). PURPOSE: The purpose of this prospective, descriptive study was to examine the relationship between sacral skin temperature and PU development. METHODS: Using convenience sampling methods, patients who were hospitalized in the tertiary intensive care unit (ICU) of the internal medicine department of a university hospital in Izmir, Turkey, between April and December 2015 were eligible to participate if they were ⟩18 years of age, had an expected hospital stay of at least 5 days, a Braden score ≤12, and were admitted without a PU. Demographic and clinical data collected included age, gender, body mass index, diagnosis, mattress type, length of follow-up (days), systolic and diastolic blood pressure, body temperature, hemoglobin level, sacral skin temperatures in the supine and lateral positions, room temperature, PU stage and duration, and Braden score. Temperature was measured the day of hospitalization as a baseline measurement (day 1) and once every day thereafter up to 22 days, until the patient did or did not develop a PU, died, was no longer undergoing position change, or was discharged. Sacral skin temperature was taken immediately after the patient was moved to a lateral position following 120 minutes of supine position (referred to as supine position sacral skin temperature measurement) and after 30 minutes in lateral position (referred to as lateral position sacral skin temperature measurement). Data were collected using paper-and-pencil questionnaires and entered into a software program for analysis. Descriptive statistics, Student's t test, one-way analysis of variance test, Pearson product-moment correlation analysis, and Spearman's rank-order correlation analysis were used for data analysis. RESULTS: Of the 37 patients who met the inclusion criteria and were monitored for at least 5 days, 21 (56.8%) developed PUs. No statistically significant difference in supine position sacral skin temperature on day 1 or day 5 was found between patients who did and did not develop a PU (36.90° C ± 0.29° C and 37.15° C ± 0.53° C, respectively, on day 1; t = -1.656, P = .112; and 37.37° C ± 0.53° C and 37.30° C ± 0.79° C, respectively, on day 5; t = 0.259, P = .798). Day 5 lateral position skin temperatures also did not differ significantly between the 2 groups (37.44° C ± 0.44° C and 37.31° C ± 0.75° C, respectively; t = 1.306, P = .621). A statistically significant difference was noted between mean sacral skin temperature in the supine position among patients ages 75 to 90 years compared with patients 38 to 64 years and 65 to 74 years (36.93° C ± 0.39° C; F = 13.221, P = .000) and with use of a viscoelastic mattress compared with an alternating pressure air mattress and continuous lateral rotation alternating pressure air mattress (37.85° C ± 0.54° C; F = 14.039, P = .000). No statistically significant differences in sacral skin temperatures were found for any of the of the other variables assessed. CONCLUSION: Sacral skin temperatures were not statistically different between ICU patients who did and did not develop a PU. Additional research may help increase understanding of the relationship between skin temperature and PU development.

The impact of forensic nursing course on students' knowledge level on forensic evidence.

The study is designed as quasi experimental including pre-test and post-test. The sample of the study is consisted of 98 students who are taking the Forensic Nursing course in the second year of the School of Nursing at a university. The mean score obtained from the test on the knowledge of forensic evidence before the training was 23.63 ±â€¯5.24 while the mean score after the training was 33.32 ±â€¯4.54. A statistically significant difference was found when the average scores of the students were compared before and after the course of forensic nursing. It was revealed that the course of forensic nursing taken by the students has a positive effect on the knowledge of forensic evidence of students and increases their knowledge level. The results suggest to add a course of forensic nursing as an elective or mandatory course to the curriculum of nursing programs and disseminate the postgraduate education on forensic nursing.