Improving nurses’ knowledge of managing endotracheal tube cuff pressure in intensive care units: A quasi-experimental study

Abstract

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.

Effect of an educational programme on critical care nurses’ competence at two tertiary hospitals in Malawi

“…The results support findings of previous studies that assessed the effect of training interventions on similar competencies; management of endotracheal tube cuff pressure 19 , cardiac life support skills of nursing staff in critical areas of care 18,31 , the care of a patient who is intubated and undergoing mechanical ventilation 32 , knowledge and practices of electrocardiogram interpretation 31,33 . As an example, the study by Bojsen et al 33 It is worth mentioning that the study was conducted before the corona virus disease (COVID-19) pandemic which has increased the demand for competent critical care nurses worldwide 35 .…”

“…The significant increase in the participants' overall competence and scores on three domains of competence; knowledge, skill and experience after the training is consistent with the outcome of similar training programmes in critical care settings in Malawi and other developing countries 16 , 19 , 28 – 30 . For example, the study by Pubudu 30 on nursing intensive care skills training in Sri Lanka, reported that post-test scores of participants were significantly higher than pre-test scores.…”

“…The participants considered the training relevant and expressed satisfaction with the content and approach. The significant increase in the participants' overall competence and scores on three domains of competence; knowledge, skill and experience after the training is consistent with the outcome of similar training programmes in critical care settings in Malawi and other developing countries 16,19,[28][29][30] .…”

“…In the absence of critical care nurse training programmes, training and skill acquisition programs are some of the highly valued priorities to be considered for the improvement of critical care nursing in the developing countries. Different authors have reported an improvement in nurses' knowledge, a reduction of nursing errors in critical care settings and positive patient outcomes following staff training on different aspects of patient care 16 , 18 , 19 . The study by Mpasa 19 was conducted in Malawi and reported an improvement in nurses' knowledge on the management of endotracheal tube cuff pressure after an educational intervention.…”

“…Different authors have reported an improvement in nurses' knowledge, a reduction of nursing errors in critical care settings and positive patient outcomes following staff training on different aspects of patient care 16 , 18 , 19 . The study by Mpasa 19 was conducted in Malawi and reported an improvement in nurses' knowledge on the management of endotracheal tube cuff pressure after an educational intervention. However, it is not known whether an educational intervention using available resources could improve the nurses' overall competence in critical care.…”