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Most of critically ill patients need mechanical ventilator (MV) which assists or replaces spontaneous breathing. Mechanically ventilated patients are more likely to develop pulmonary infection and ventilated associated pneumonia (VAP). Intubation bypasses the normal airway protective mechanisms and acts as a direct route for bacterial invasion to the airway. VAP has been associated with increased morbidity, longer hospital stay, increased health care costs, and higher mortality rates. Critical care nurse has an important and crucial role in preventing VAP. Evidence indicates that training of critical care nurses about the implementation of VAP Prevention Bundle had a great effect on decreasing the incidence of VAP. Therefore, this study was conducted to determine the effect of nurses training on VAP Prevention Bundle on VAP incidence Rate at a Critical Care Unit.

Objective: To compare physiologic measures and the incidence of ventilator associated pneumonia (VAP) using different modalities of endotrachael tube (ETT) suctioning. Methods: A Quasi-experimental design was used with 80 adults in an intensive care unit. Two modalities of suctioning were compared: 1) not instilling normal saline (NS) into the ETT before suctioning, and 2) instilling NS into the ETT tube before suctioning. The outcome variables were: physiologic measures (heart rate, respiratory rate and blood pressure and oxygen saturation), the incidence of Ventilator Associated Condition (VAC) and Possible Ventilator Associated Pneumonia (PVAP) at day 5 after mechanical ventilation. Results: There were no differences in the physiologic measures assessed at day 5 and a significantly higher rate of VAC in patients who had NS installed (p = .009). Four patients developed PVAP compared to 10 patients in group 2 where NS was installed but that did to reach significance (p = .077). Factors associated with VAC were age, WBC > 12,000, antibiotic use, amount of secretions, and NS installation. The same factors were associated with the development of PVAP with the exception of NS installation which did not reach significance. Conclusions: Installing NS in the ETT tube did not result in significant physiologic changes at day 5, and more rates of VAC and PVAP were noted. Therefore, the use of this procedure is questionable and further studies are needed to provide conclusive evidence.

Background/Objective: Objective Structured Clinical Examinations (OSCEs) are an effective assessment strategy for assessing clinical skills and for highlighting curriculum problem areas Since its inception, the OSCE has been increasingly used to provide formative and summative assessment in various medical disciplines. Methods: The study was conducted at Critical Care Nursing and emergency Department, the Faculty of Nursing, Alexandria University, Specifically in emergency nursing course. Data were collected using questionnaire comprised 26 items to determine students' feedback in relation to OSCE as an assessment method in acute care. Results: The majority of students agreed that the OSCE was comprehensive and covered a wide range of knowledge and clinical skills taught and in addition the exam was less stressful than other exams and the students felt the OSCE exam highlighting their strengths and weaknesses. Moreover, the exam increased their self confidence to face real situations. Conclusion and Recommendations: OSCE as an assessment method is an effective method to test students' competencies and teachers can diagnose the teaching defects and OSCE provides opportunities for students to learn from mistakes and increase their self confidence. OSCE can be implemented in different nursing specialties.