This document summarizes a study that assessed critical care nurses' knowledge of adult mechanical ventilation management at B.P. Koirala Institute of Health Sciences in Nepal. The study found that most nurses had adequate knowledge in areas like ventilation definitions, tracheotomy care, and acidosis management. However, knowledge was limited in less common areas like indications for CPR, laryngeal mask airway use, and continuous positive airway pressure. The study concluded regular continuing education is needed for ICU nurses to ensure optimal patient care given younger, less experienced staff and knowledge gaps identified.

1. Critical Care Nurses’ Knowledge on Adult Mechanical Ventilation Management
Mehta*1 RS, Bhattari*2 BK.
B.P. Koirala Institute of Health Sciences, Nepal
Abstract:
Introduction: Critical care nursing is that specialty within nursing that deals specifically with
human responses to life-threatening problems. Critical care nurses account for an estimated 37%
of the total number of nurses working in the hospital setting. B P Koirala Institute of Health
Sciences (BPKIHS) has 700 bedded tertiary care hospital having 8 beds ICU and 6 beds CCU
with modern facilities.
Objectives: The objective of this study was to find out the knowledge on adult mechanical
ventilation management among the nurses working in Intensive care unit of B.P. Koirala Institute
of Heath Sciences.
Methodology: It was hospital based descriptive study conducted among all the 35 nurses
working in critical care unit of BPKIHS having work experiences at least 3 months in the same
unit. Using pre-tested questionnaire having 50 items of knowledge, the data was collected during
the period of 1-7-2010 to 7-7-2010 for a week maintaining all the formalities.
Results: Most of the nurses had adequate knowledge on the items like, definition of mechanical
ventilation (100%), care of tracheotomy (88.6%), risk of 100% oxygen (85.7%), management of
acidosis (91.4%), weaning (82.9%), where as the limited nurses had knowledge on indication of
CPR (25.7%), indication of laryngeal mask air-way (LMA) (5.7%), and indication of continuous
positive air-way pressure (CPAP) (5.7%). The association calculated with items of knowledge
score and other variables, it was found significant association between indication of non-invasive
mechanical ventilation (MV) and training institute (p=0.034), LMA and ICU experiences
(p=0.047), synchronized intermediate mandatory ventilation (SIMV) use and ICU experiences
(p=0.042) and goal of tracheostomy care and ICU experiences (p=0.046).
Conclusions: Most of the nurses had average (score-1,2) knowledge on common knowledge
components and very limited nurses had knowledge on the components that was not performed
in our setting or very less frequently performed like, use of LMA, pacing and CPAP. Regular
CNE is mandatory for the nurses working in ICU.
Key Words: Knowledge, Critical Care Nurse, Mechanical Ventilation
Key: *1 Ram Sharan Mehta, ramsharanmehta@hotmail.com, Associate Professor, Medical-Surgical
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Nursing Department, * Prof. Dr. Bal Krishna Bhattari, HOD, Department of Anesthesiology and Critical
Care. B. P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal. www.bpkihs.edu
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2. Introduction:
A critical care nurse is responsible for ensuring that acutely and critically ill patients and their
families receive optimal care. Critically ill patients are defined as those patients who are at high
risk for actual or potential life-threatening health problems. The more critically ill the patient is,
the more likely he or she is to be highly vulnerable, unstable and complex, thereby requiring
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intense and vigilant nursing care.
Critical care units, may be thought of as having context (the demographics and characteristics of the kind
of work they do), structure (the grouping of people and the allocation of responsibility through
specialization, expertise, formalization, and some degree of centralization or decentralization),
process (intraorganizational relationships such as the flow of information and coordination), and
outcomes (productivity, goal attainment, morale, and satisfaction of the members. 2
The first intensive care units emerged in the 1950s to provide care to very ill patients who
needed one-to-one care from a nurse, from this environment the specialty of critical care nursing
emerged.3 As issues relating to patient care become increasingly complex and new technologies
and treatments are introduced, critical care nurses will need to become ever more
knowledgeable. 4 Nurses need to develop a thorough understanding of these modes including
their effects on underlying respiratory physiology to be able to deliver safe and appropriate
patient care.5
Objective: The objective of this study was to find out the knowledge about adult mechanical
ventilation management among the nurses working in Intensive Care Unit of B.P. Koirala
Institute of Heath Sciences.
Methodology: It was hospital based descriptive study, conducted among the nurses (staff-
nurses) involved in the care of patients on ventilator, working in ICU for more than three
months. Using total enumerative sampling technique all the 35 nurses working in ICU of
BPKIHS was selected for study. Informed verbal consent was obtained from the subjects prior to
data collection. Subjects were assured about the confidentiality of the Informations they were
provided and used for the study purpose only. Using pre-tested questionnaire having 50
knowledge items, the data was collected during the period of 1-7-2010 to 7-7-2010 for one week
and special consideration was maintained to avoid the contamination of data. The collected data
was entered in Excel and analyzed using SPSS-11.5 software package.
Results:
Age and experiences of the subjects: it was found that most of the subjects (71.4%) were of age
group of 21-25 years, with mean age 22.26, SD 2.187 and range 19-30 years. Only 3(5.7%)
subjects had the ICU experiences of more than 3 years. The mean ICU experience was 13.29,
with age SD 12.335 and range 3-60 months. Similarly, only (3)8.6% nurses had total nursing
experiences of more than 3 years, with mean 16.66, SD 123.604 and range 3-60 months. It was
found that only 2(5.7%) nurses had received BLS as well as ALS training and 11(31.4%) nurses
working in PBKIHS was trained from this institute it self. The details are depicted in table 1-4.
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3. Knowledge about Adult Mechanical Ventilator: Using 50 MCQs the knowledge of nurses
regarding adult mechanical ventilator was assessed. It was found that most of the nurses had
adequate knowledge regarding definition of mechanical ventilation (100%), care of tracheotomy
(88.6%), risk of 100% oxygen (85.7%), drugs used to correct acidosis (91.4%), definition of
weaning (82.9%), indication of checking carotid pulse (88.6%), and respiratory status after
extubation (85.7%); where as the limited nurses had knowledge on indication of CPR(25.7%),
indication of LMA (5.7%), management of accidently extubated patients (17.1%), and indication
of CPAP (5.7%). The details are depicted in table 5-11.
Association between variables: the association calculated between the items of knowledge
score (0,1) with other variables and it was found significant association between indication of
non-invasive mechanical ventilation and training institute (BPKIHS, Others) (p=0.034), similarly
with use of LMA and ICU experiences (≤ 6 months, > 6 months) (p=0.047), SIMV use and ICU
experiences (p=0.042), indication of non-invasive mechanical ventilation and ICU experiences
(p=0.042), goal of tracheotomy care and ICU experiences (p=0.046), and correct positioning of
ETT and total nursing experiences (≤ 6 months, > 6 months) (p=0.030). Except these mentioned
variables there is no significant association between other variables.
Discussion:
Most of the nurses working in critical care unit were below age 25 years (94.3%). Most of the
nurses had job experiences in ICU is up to 3 years (94.3%), and had total job experiences up to 3
years (91.4%). Only 2 nurses (5.7%) had received BLS and ALS training.
Most of the nurses had average knowledge (score-1, 2) on common knowledge components and
very limited nurses had knowledge on the components that was not performed in this setting very
frequently like use of LMA, pacing and CPAP. Most of the nurses had adequate knowledge
regarding definition of MV (100%), tracheotomy care (88.6%), correction of acidosis (91.4%),
weaning (82.9%), and checking carotid pulse (88.6%). The limited nurses had knowledge on
indications of CPR (25.73%), indication of LMA (7%), and indication of CPAP (5.7%). The
study conducted by Khatib6 among physicians, nurses, and respiratory therapists reported similar
findings. Similarly study conducted by Labeau7 among the European nurses reported that average
score was 45.1% and knowledge about oral route of intubation among 55%, ventilator circuit
should be changed for each patients (35%), close suctioning (46%), and suction tube should be
changed in each patient separately, which is the similar findings to our study.
Study conducted by Perrie8 reported pain management, glycemic control and weaning from
mechanical ventilation are nursing care areas that can impact on patient outcome and are
commonly guided by protocols. However, in order to ensure safe, optimal management of
patients even when care is guided by protocols, nurses require a sound knowledge base.
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4. Conclusions:
Most of the nurses were younger (<25) years and had lesser critical care experiences (<3Yrs) and
very limited had received BLS and ALS training. The nurses had deficiencies in knowledge and
application of mechanical ventilation, as evidenced by low scores on the assessment test. It is in
the recognition of knowledge gaps that a foundation for remedial education can be built. This
suggests that the quality of patient care cannot be assumed. More importantly, continued
objective-based professional staff development that measures content, educational method and
retention rate is critical to guide the teaching of concepts that are associated with lower mortality,
improved patient outcomes and reduced health care costs.
Recommendations:
Regular continuous nursing education is mandatory for the nurses working in ICU. Periodical
continuous medical education by the Anesthetics and other doctors from specialty department
will be beneficial for the nurses to keep up to date the knowledge required for quality patient
care in the unit.
References:
1. Yaseen A, Venkatesh S, Samir H, Abdullah Al S, Salim Al M. A Prospective Study of
Prolonged Stay in the Intensive Care Unit: Predictors and Impact on Resource
Utilization. International Journal for Quality in Health Care, 2002, 14:403-410.
2. Weissman C. Analyzing intensive care unit length of stay data: problems and possible
solutions. Crit Care Med. 1997; 25: 1594–1600.
3. Mehta NJ, Khan IA. Cardiology's 10 greatest discoveries of the 20th century. Texas
Heart Institute J. 2002; 29:164-71.
4. Wong DT, Gomez M, McGuire GP, Kavanagh B. Utilization of intensive care unit days
in a Canadian medical-surgical intensive care unit. Crit Care Med. 1999; 27: 1319–1324.
5. Brilli, R. J., A. Spevetz, R. D. Branson, et al. Critical Care Delivery in the Intensive Care
Unit: Defining Clinical Roles and the Best Practice Model. Critical Care Medicine. 2001,
29:7-9.
6. Khatib MF, Zeineldines, Ayoub C, Husan A. Critical care clinicians’ knowledge of
evidence-based guidelines for preventing ventilator associated pneumonia. American
journal of critical care. 2010; 19: 272-276.
7. Labeau S, Vandijck D, Rello J et al. Evidence-Based guidelines for the prevention of
ventilator associated pneumonia: results of a knowledge test among European Intensive
care nurse. Journal of Hospital Infection. 2008; 70(2): 180-5.
8. Perrie H, Schmollgruber S. Knowledge of ICU nurses regarding selected care areas
commonly guided by protocols. Critical Care. 2010; 14:446.
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5. Table 1
Knowledge about Various Aspects of Mechanical Ventilation
N=35
SN Knowledge about Adult Mechanical Ventilation Correct
Responses
1 Basic Knowledge on Mechanical Ventilation Number (%)
Indication of MV 26(74.3)
Responsibility of care for MV 7(20)
Indication of Non-invasive MV 12(34.3)
Oxygen concentration in mouth to mouth respiration 10(28.6)
2 Knowledge about air-way management
Indication of LMA 2(5.7)
Confirmation of ETT placement 23(65.7)
Communication during artificial airway 19(54.3)
Goal of tracheotomy 22(62.9)
3 Drugs used during MV
Indication of potassium 14(40)
Use of sedation and neuromuscular blockage 23(65.7)
Advantages of neuromuscular blockage 20(57.1)
Drugs used to correct acidosis (sodium bicarbonate) 32(91.4)
4 Modes of MV
Differences between SIMV with AC 12(34.3)
Effects of PEEP 26(74.3)
Modes of Ventilator 26(74.3)
Knowledge about supported ventilator 22(62.9)
5 Knowledge about weaning
Definition of weaning 29(82.9)
Components of weaning criteria 14(40)
6 Management of complications
Management of ETT bite 22(62.9)
Management of suctioning complications 6(17.1)
ABG values during acidosis 23(65.7)
Management of accidently extubated patients 6(17.1)
Complications of high I:E ration 9(25.7)
Complications of high level PEEP 9(25.7)
Decrease in TV 13(37.1)
Results of circuit leak, disconnection, & T-tube 10(28.6)
Indication of detoriation of patient on ventilator 18(51.4)
7 Knowledge CPR
Displacement of sternum during CPR (4-5 cm) 10(28.6)
Indication of checking carotid pulse 31(88.6)
Drug of choice during CPR (adrenaline) 17(48.6)
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