Malawian critical care nurses’ views on the implementation of an educational intervention to enhance sustained use of an evidence-based endotracheal tube cuff pressure management guideline: A survey study
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Abstract
Background. Evidence-based guidelines can assist critical care nurses in promoting best practices, including those related to endotracheal tube cuff pressure management. However, these guidelines require tailored strategies to enhance their implementation, uptake, and sustained use in practice.
Objectives. To evaluate Malawian critical care nurses’ views on the implementation of an endotracheal tube cuff pressure management guideline to enhance sustained guideline use.
Methods. An explorative-descriptive survey design was employed, using a questionnaire with closed- and open-ended questions that was distributed after implementation of an educational intervention based on an endotracheal tube cuff pressure management guideline. The questionnaire had a Cronbach’s alpha score of 0.85.
Results. A total of 47 nurses working in four public and two private hospital intensive care units in Malawi participated. Quantitative findings showed that the majority of the participants (92%) indicated that the strategies used for the group that received the full intervention including both active (monitoring visits) and passive (a half-day educational session using a PowerPoint presentation, and a printed guideline and algorithm) strategies (intervention 1 group) were useful, clear and applicable and enhanced implementation of the guideline. These results were statistically significant (mean (standard deviation) 1.86 (0.84); t=6.07; p<0.0005). Qualitative data revealed three major themes related to recommendations for uptake and sustained use of the guideline in nursing practice: the guideline needs to be translated, updated, and made available to ICU staff; implementation strategies (continuous supervision and follow-up); and facilitating factors for successful implementation (education and training on guideline content, resources, and commitment to best practices).
Conclusion. The study highlighted that although the implementation strategies used were positively received by participants, they need to be further tailored to their context to enhance guideline uptake and sustained use in practice. Further study is required to ensure that tailored implementation strategies facilitate guideline uptake and sustained use, specifically in resource-constrained contexts.
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References
Bent S, Toschlog E. Reducing the risk for microaspiration and postintubation pulmonary complications in the surgical and critical care settings. Anesthesiology News, 2012. https://www. anesthesiologynews.com/download/SR1217_Covidien_WM.pdf (accessed 3 March 2022).
Jaillette E, Zerimech F, de Jonckheere J, et al. Efficiency of a pneumatic device in controlling cuff pressure of polyurethane-cuffed tracheal tubes: A randomised controlled study. BMC Anesthesiol 2013;13(1):50. https://doi.org/10.1186/1471-2253-13-50
Fischer F, Lange K, Klose K, Greiner W, Kraemer A. Barriers and strategies in guideline implementation – a scoping review. Healthcare 2016;4(3):1-36. https://doi.org/10.3390/ healthcare4030036
BusseR,KlazingaN,PanteliD,QuentinW.ImprovinghealthcarequalityinEurope:Characteristics, effectiveness and implementation of different strategies. World Health Organization Regional Office for Europe, 2019. https://apps.who.int/iris/handle/10665/327356 (accessed 22 February 2022).
Cairney P. The myth of ‘evidence-based policymaking’ in a decentred state. Public Policy Admin 2022;37(1):46-66. https://doi.org/10.1177/0952076720905016
JanssonMM,SyrjäläHP,TalmanK,MeriläinenMH,Ala-KokkoTI.Criticalcarenurses’knowledge of, adherence to, and barriers toward institution-specific ventilator bundle. Am J Infect Control 2018;46(9):1051-1056. https://doi.org/10.1177/0952076720905016
Jansson M, Ala-Kokko T, Ylipalosaari P, Syrjälä H, Kyngäs H. Critical care nurses’ knowledge of, adherence to and barriers towards evidence-based guidelines for the prevention of ventilator- associated pneumonia – a survey study. Intensive Crit Care Nurs 2013;29(4):216-227. https://doi. org/10.1016/j.iccn.2013.02.006
Feng TR, Ye Y, Doyle DJ. Critical importance of tracheal tube cuff pressure management. World J Anesthesiol 2015;4(2):10-12. https://doi.org/10.5313/wja.v4.i2.10
Rosero EB, Ozayar E, Eslava-Schmalbach J, Minhajuddin A, Joshi GP. Effects of increasing airway pressures on the pressure of the endotracheal tube cuff during pelvic laparoscopic surgery. Anesth Analg 2018;127(1):120-125. https://doi.org/10.1213/ANE.0000000000002657
Eccles MP, Armstrong D, Baker R, et al. An implementation research agenda. Implement Sci 2009;4:18. https://doi.org/10.1186/1748-5908-4-18
Leeman J, Birken SA, Powell BJ, Rohweder C, Shea CM. Beyond ‘implementation strategies’: Classifying the full range of strategies used in implementation science and practice. Implement Sci 2017;12(1):125. https://doi.org/10.1186/s13012-017-0657-x
Harrison MB, Légaré F, Graham ID, Fervers B. Adapting clinical practice guidelines to local context and assessing barriers to their use. CMAJ 2010;182(2):E78-E84. https://doi.org/10.1503/ cmaj.081232
Pereira VC, Silva SN, Carvalho VK, Zanghelini F, Barreto JO. Strategies for the implementation of clinical practice guidelines in public health: An overview of systematic reviews. Health Res Policy Syst 2022;20(1):13. https://doi.org/10.1186/s12961-022-00815-4
Jordan P, Mpasa F, ten Ham-Baloyi W, Bowers C. Implementation strategies for guidelines at ICUs: A systematic review. Int J Health Care Quality Assur 2017;30(4):358-372. https://doi.org/10.1108/ IJHCQA-08-2016-0119
Villarosa AR, Maneze D, Ramjan LM, Srinivas R, Camilleri M, George A. The effectiveness of guideline implementation strategies in the dental setting: A systematic review. Implement Sci 2019;14(1):106. https://doi.org/10.1186/s13012-019-0954-7
McArthur C, Bai Y, Hewston P, Giangregorio L, Straus S, Papaioannou A. Barriers and facilitators to implementing evidence-based guidelines in long-term care: A qualitative evidence synthesis. Implement Sci 2021;16(1):70. https://doi.org/10.1186/s13012-021-01140-0
Kwok EY, Moodie ST, Cunningham BJ, Cardy JE. Selecting and tailoring implementation interventions: A concept mapping approach. BMC Health Serv Res 2020;20(1):385. https://doi. org/10.1186/s12913-020-05270-x
Wang Z, Norris SL, Bero L. The advantages and limitations of guideline adaptation frameworks. Implement Sci 2018;13:72. https://doi.org/10.1186/s13012-018-0763-4
Powell BJ, Beidas RS, Lewis CC, Aarons GA, McMillen JC, Proctor EK, Mandell DS. Methods to improve the selection and tailoring of implementation strategies. J Behav Health Serv Res 2017;44(2):177-194. https://doi.org/10.1007/s11414-015-9475-6
World Bank. Malawi overview. https://www.worldbank.org/en/country/malawi/overview#1. 2022 (accessed 1 March 2022).
Jordan PJ. Evidence-informed clinical guidelines for nursing care practices related to the safety of the mechanically ventilated patient. PhD thesis. Nelson Mandela Metropolitan University, Port Elizabeth, South Africa, 2011.
Jordan P, Bowers C, Morton D. Barriers to implementing evidence-based practice in a private intensive care unit in the Eastern Cape. South Afr J Crit Care 2016;32(2):50-54. https://doi. org/10.7196/SAJCC.2016.v32i2.253
MpasaF.Managementofendotrachealtubecuffpressureinmechanicallyventilatedadultpatientsin intensive care units in Malawi. Unpublished PhD thesis. Nelson Mandela University, Port Elizabeth, South Africa, 2017.
Tesch R. Qualitative Research: Analysis Types and Software Tools. London: Elsevier, 1990.
ReynoldsSS.Implementationstrategiestoimprovecriticalcarenurses’knowledgeofandadherence to evidence-based guidelines. PhD thesis. Indiana University-Purdue University Indianapolis, 2016. https://doi.org/10.7912/C2/1285
Spoon D, Rietbergen T, Huis A, et al. Implementation strategies used to implement nursing guidelines in daily practice: A systematic review. Int J Nurs Stud 2020;111:103748. https://doi. org/10.1016/j.ijnurstu.2020.103748
Almarhabi M, Cornish J, Lee G. The effectiveness of educational interventions on trauma intensive care unit nurses’ competence: A systematic review and meta-analysis. Intensive Crit Care Nurs 2021;64:102931. https://doi.org/10.1016/j.iccn.2020.102931
Khojastehfar S, Ghezeljeh TN, Haghani S. Factors related to knowledge, attitude, and practice of nurses in intensive care unit in the area of pressure ulcer prevention: A multicenter study. J Tissue Viability 2020;29(2):76-81. https://doi.org/10.1016/j.jtv.2020.02.002
Kahn JM. Bringing implementation science to the intensive care unit. Curr Opin Crit Care 2017;23(5):398-399. https://doi.org/10.1097/MCC.0000000000000446
ReynoldsHW,SutherlandEG.Asystematicapproachtotheplanning,implementation,monitoring, and evaluation of integrated health services. BMC Health Serv Res 2013;13:168. https://doi. org/10.1186/1472-6963-13-168
Alotaibi YK, Federico F. The impact of health information technology on patient safety. Saudi Med J 2017;38(12):1173-1180. https://doi.org/10.15537/smj.2017.12.20631
Keyworth C, Hart J, Armitage CJ, Tully MP. What maximises the effectiveness and implementation of technology-based interventions to support healthcare professional practice? A systematic literature review. BMC Med Inform Decis Mak 2018;18(1):93. https://doi.org/10.1186/s12911- 018-0661-3
Jun J, Kovner CT, Stimpfel AW. Barriers and facilitators of nurses’ use of clinical practice guidelines: An integrative review. Int J Nurs Stud 2016;60:54-68. https://doi.org/10.1016/j.ijnurstu.2016.03.006
Bajnok I, McConnell H, Grinspun D, Stewart-Pyne A. An evidence-based approach to
successful practice change, the Toolkit: Implementation of best practice guidelines. https:// sigma.nursingrepository.org/bitstream/handle/10755/335652/Slides.pdf ?sequence=1&isAllowed=y (accessed 6 March 2023).
Joint Professional Standards Committee. Guidelines for the provision of intensive care services. https://www.rcslt.org/wp-content/uploads/media/docs/clinical-guidance/critical- care-gpics-v2.pdf 2019 (accessed 15 July 2022).
Docherty M, Shaw K, Goulding L, et al. Evidence-based guideline implementation in low and middle income countries: Lessons for mental health care. Int J Mental Health Syst 2017;11:8. https://doi.org/10.1186/s13033-016-0115-1
Spears TL, Allen L. Evidence-based care sheet: Accountability in nursing practice. 6 April 2018. https://www.ebscohost.com/assets-sample-content/NRCP_EBCS_Accountability-in- NursingPractice.pdf (accessed 6 March 2023).
RosaRG,TeixeiraC,SjodingM.Novelapproachestofacilitatetheimplementationofguidelines in the ICU. J Crit Care 2020;60:1-5. https://doi.org/10.1016/j.jcrc.2020.07.014
Grol R, Wensing M. Effective implementation of change in healthcare: A systematic approach. In: Wensing M, Grol R, Grimshaw J, eds. Improving Patient Care: The Implementation of Change in Health Care. Pondicherry, India: John Wiley & Sons, 2020.
Webb-Anderson K, Daley P, Isenor C, Kelly E, Ash M, McMullen S. Supporting critical care best practice with an integrated approach to quality improvement. Can J Crit Care Nurs 2018;29(2):44. https://cjccn.ca/wp-content/uploads/2022/02/29-2-CJCCNSummer2018.pdf (accessed 6 March 2023).