Purpose The purpose of this paper is to critically analyze empirical studies related to the implementation strategies for clinical practice guidelines (CPGs) in intensive care units (ICUs). Design/methodology/approach A systematic review with a narrative synthesis adapted from Popay et al.'s method for a narrative synthesis was conducted. A search using CINAHL, Google Scholar, Academic search complete, Cochrane Register for Randomized Controlled Trials, MEDLINE via PUBMED and grey literature was conducted in 2014 and updated in 2016 (August). After reading the abstracts, titles and full-text articles, 11 ( n=11) research studies met the inclusion criteria. Findings After critical appraisal, using the Joanna Briggs Critical Appraisal Tools, eight randomized controlled trials conducted in adult and neonatal ICUs using implementation strategies remained. Popay et al.'s method for narrative synthesis was adapted and used to analyze and synthesize the data and formulate concluding statements. Included studies found that multi-faceted strategies appear to be more effective than single strategies. Strategies mostly used were printed educational materials, information/ sessions, audit, feedback, use of champion leaders, educational outreach visits, and computer or internet usage. Practical training, monitoring visits and grand rounds were less used. Practical implications Findings can be used by clinicians to implement the best combination of multi-faceted implementation strategies in the ICUs in order to enhance the optimal use of CPGs. Originality/value No systematic review was previously done on the implementation strategies that should be used best for optimal CPG implementation in the ICU.
Background Previous studies conducted on nurses’ knowledge regarding endotracheal tube cuff pressure revealed that there were differences in intensive care nurses’ knowledge, leading to varying practices. Aim This study aimed to evaluate how an educational intervention based on the existing evidence-based guidelines, using both passive and active implementation strategies, could improve the knowledge of nurses regarding managing endotracheal tube cuff pressures in Malawian intensive care units. Setting Six functional ICUs (four public and two private) in Malawi. Methods The study followed a quasi-experimental, pre- and post-test design using an educational intervention. Intensive care nurses of six functional intensive care units in Malawi were randomly assigned to two intervention groups. Both groups received a half-day educational session, a printed version of the evidence-based guidelines, a printed and laminated summary of the guidelines and a related algorithm. Additionally, Intervention 2 group received four monitoring visits. Pre- and post-test questionnaires were conducted between February and August 2016. Descriptive and inferential data analyses (a chi-square test and t -test) were utilised. Results An improvement in knowledge was observed on the nursing care practices for the management of endotracheal tube cuff pressure for both groups following the educational intervention, although only the results comparing Intervention 2 group participants indicate that the level of knowledge was significant ( t [df = 48] = 2.08, p = 0.043, d = 0.59). Conclusion Implementation of a formal training and mentorship programme for Malawian intensive care nurses would be of great benefit to enhance the knowledge and skills managing endotracheal tube cuff pressure. Follow-up studies would also assist in understanding how guidelines could be implemented most effectively to achieve better knowledge outcomes.
Purpose: Fears of the Covid-19 pandemic have brought additional psychological pressure among nursing students. Nursing students at Mzuzu University in Malawi resumed clinical practice amidst the first wave of the pandemic and completed their rotation from September to December 2020. However, it was not known how they were coping with fears of the Covid-19 pandemic during clinical practice and this had set the impetus for conducting this study. Methods: The study used qualitative approach employing a descriptive phenomenological design. Four focus group discussions (FGDs) were conducted on students who had completed a clinical rotation during the first wave of the Covid-19 pandemic. Results: Four themes emerged from the data analysis, and these were staying positive amidst the Covid-19 pandemic; applying the Covid-19 preventive measures; the role of religion and use of avoidance strategies. Conclusion:Students should be encouraged to use coping strategies that have been proven to promote psychological well-being in times of crisis such as the Covid-19 pandemic.
Purpose: Clinical practice during pandemics is known to bring additional fears to nursing students. The purpose of this study was to explore fears of Mzuzu University's nursing students nurses regarding resumption of clinical practice amidst the Coronavirus disease (COVID-19) pandemic. Methods: The study used a qualitative approach employing a descriptive phenomenological design. Mzuzu University Research Ethics Committee (MZUNIREC) approved the study and issued MZUNIREC/DOR/20/06 as approval number. An independent person collected data through four focus group discussions with a purposefully selected sample of 40 consented nursing students who had completed clinical practice during the first wave of the COVID-19 pandemic. Data analysis was done manually using content analysis. The analysis started with transcription of the interviews. Following this, data were coded and categorized into themes and subthemes were established from participants' significant statements. Results: Four major themes about the fears amongst the student nurses emerged. These were as follows: equipment and supplies; increased perceived risk for acquiring and transmitting COVID-19; stigma and discrimination and perceived fear of not having adequate learning. Conclusion: Clinical practice during the COVID-19 pandemic brings fear among nursing students and requires that implementers of nursing and midwifery programs prioritize ascertaining student's skill, emotional wellbeing and provision of adequate resources before deploying them to clinical areas.
Background Previous studies conducted on nurses’ knowledge regarding endotracheal tube cuff pressure revealed that there were differences in intensive care nurses’ knowledge, leading to varying practices. This study aimed to evaluate the effect of an educational intervention based on existing evidence-based guidelines, on the knowledge of nurses regarding managing endotracheal tube cuff pressures in Malawian intensive care units.Methods The study followed a quasi-experimental approach, with a pre- and post-test design using an educational intervention. Intensive care unit nurses were randomly assigned to two intervention groups. Both groups received a half-day educational session, a printed version of the evidence-based guidelines, a printed and laminated summary of the guidelines and a related algorithm. Additionally, Group 2 received four monitoring visits. Pre-and post-test questionnaires were conducted between February and August 2016. Descriptive and inferential data analysis (a chi-square test and t-test) were utilised.Results Knowledge on the nursing care practices for the management of endotracheal tube cuff pressure was improved for both groups following the educational intervention, although only the results comparing the Intervention 2 group participants’ indicate that the level of knowledge were significant (t(d.f.=48)=2.08, p=0.043, d=0.59).Conclusions The implementation of a formal training programme and mentorship programme for nurses working in the intensive care unit in Malawi would be of great benefit to equip nurses with adequate knowledge and skills for managing endotracheal tube cuff pressure. Follow-up studies would also assist in understanding how the implementation of guidelines could be done most effectively to achieve better knowledge outcomes among nurses concerning nursing care practices in this context.
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