An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units

Abstract

Endotracheal suctioning is a frequently performed procedure that has many associated risks and complications. It is imperative that nurses are aware of these risks and are able to practise according to current research recommendations. This study was designed to examine to what extent intensive care nurses' knowledge and practice of endotracheal suctioning is based on research evidence, to investigate the relationships between knowledge and practice, and to evaluate the effectiveness of a research-based teaching programme. This quasi-experimental study was a randomized, controlled, single-blinded comparison of two research-based teaching programmes, with 16 intensive care nurses, using non-participant observation and a self-report questionnaire. Initial baseline data revealed a low level of knowledge for many participants, which was also reflected in practice, as suctioning was performed against many of the research recommendations. Following teaching, significant improvements were seen in both knowledge and practice. Four weeks later these differences were generally sustained, and provide evidence of the effectiveness of the educational intervention. The study raised concern about all aspects of endotracheal suctioning and highlighted the need for changes in nursing practice, with clinical guidelines and focused practice-based education.

Determining standard criteria for endotracheal suctioning in the paediatric intensive care patient: An exploratory study

“…These articles varied in their description of respiratory assessment. Fifteen of the articles reviewed identified auscultation of the chest or changes in ventilation airway specific clinical assessment parameters (Ahrens & Sona, 2003;Baun,1984;Blackwood,1999;Chang, 1995;Curley & Thompson, 1995;Hodge, 1991;Day, Wainwright & Wilson-Barnett, 2001;Day, Farnell, Haynes, Wainwright & Wilson, 2002;Gilbert, 1999;Moore, 2003;Place & Fell, 1998;Tolles & Stone, 1990;Dougherty-Wrightson and Askin, 1999;Wainwright & Gould, 1996;Wood, 1998). Knox (1992), Place andFell (1998), Dougherty-Wrightson andAskin (1999) and Gilbert (1999) expanded on the process of respiratory assessment to include signs of respiratory distress and diminished breath sounds.…”

“…These included: poor proficiency of assessment skills; errors in physical diagnosis and poor quality of nursing judgement in making a respiratory assessment. Compounding these issues was inadequate knowledge of protocols and practices that directly impact on the quality of patient care (Blackwood, 1999;Day, Farnell, Haynes, Wainwright & Wilson-Barnett, 2002;Day, Wainwright & Wilson-Barnett, 2001;Cousins & Power, 1999;Jacobe, Denessen & Postma, 2004;Lester & Tritter, 2001;Mangione & Neiman, 1997;McGlynn & Brook, 2003;Moore, 2003). To address these issues, strategies such as continuing education, evidence based practice, use of assessment tools and maintenance of clinical support in the PIC arena have been shown to improve both patient care and outcome (McGlynn & Brook, 2003;Moore, 2003).…”

“…The more serious but less common complications associated with ETT suction include cardiac arrest and sudden death. A comprehensive list of potential complications categorised as either respiratory and haemodynamic effects is presented in Table 2.7 (Carhuapoma & Williams, 1999;Day et al, 2001;Dougherty, Wrightson & Askin, 1999;Durand, Sangha, Cabal, Hoppenbrouwers & Hodgeman, 1989;Dyhr, Bonde & Larsson, 2003;Gilbert, 1999;Hodge, 1991;Knox, 1992;Kondo & Horiuchi, 1999;Lim et al, 2004;Oh & Sea, 2003;Place & Fell, 1998;Salvatore et al, 2003;Walsh et al, 1989;Young-Ra, Hee-Seung & Jeong-Hwan, 2002). These adverse effects are potentially serious complications that can affect the outcome of the patient"s recovery from his/her illness.…”

“…There is a consensus of opinion among researchers that a patient"s clinical stability requires careful assessment and that in conjunction with the underlying diagnosis, may affect the frequency and need for ETT suction (Carhuapoma & Williams, 1999;Day et al, 2001;Dougherty, Wrightson & Askin, 1999;Durand, Sangha, Cabal, Hoppenbrouwers & Hodgeman, 1989;Dyhr, Bonde & Larsson, 2003;Gilbert, 1999;Hodge, 1991;Knox, 1992). It is critical that nurses understand these issues and the use of an Endotracheal Suction Assessment Tool (ESAT) could potentially provide guidance for nursing practice.…”

“…Further in-depth analysis showed these "clinical indicators" included "visible or audible secretions" in the endotracheal tube which contributed to the respiratory assessment process and are attributed to the "physical signs" identified in the initial review of the literature (Dougherty-Wrightson & Askin, 1999;Baun, 1984;Carhuapoma & Williams, 1999;Copnell & Fergusson, 1995;Day, Wainwright & Wilson-Barnett, 2001;Dyhr, Bonde & Larsson, 2003;Gilbert, 1999;Moore, 2003;Place & Fell, 1998;Runton, 1992;Swartz, Noonan & Edward-Beckett, 1996;Wood, 1998).…”