Development of Nursing Standard for Prevention of Ventilator Associated Pneumonia in Newborns

Abstract

          A Neonatal Intensive Care Unit (NICU) had no nursing standards for prevention of ventilator associated pneumonia resulting in diversity of practices. This development research aimed to develop nursing standard for prevention of ventilator associated pneumonia in the NICU. The nursing standard was developed based on Mason by reviewing related literatures and gathering the data from a focus group with 10 neonatal nurses. The content validity of this standard was assessed by three experts. The criterion validity was evaluated by 21 registered nurses implemented the nursing standard 3 times, each with 10 newborns. The nursing activities of the process standards were recorded using the nursing care activities to prevent the ventilator associated pneumonia in newborns form. The outcome standards were evaluated using the outcome evaluation form. The nursing activities of the process standards and the outcome evaluation were analyzed in terms of frequency and percentage.

          The findings revealed that the nursing standards for prevention of ventilator associated pneumonia consisted of 4 standards. The first nursing standard was newborns safety from ventilator associated pneumonia caused by infections (13 items, 88 sub-items). The second was newborns safety from ventilator associated pneumonia caused by aspiration of microorganisms in the mouth or throat through the trachea to the lung (2 items, 20 sub-items). The third was newborns safety from ventilator associated pneumonia caused by frequent re-intubation due to the endotracheal slippage (4 items, 13 sub-items). The fourth was newborns safety from ventilator associated pneumonia caused by long duration of having an endotracheal tube and ventilator (4 items, 16 sub-items). For its quality, all nurses could implement all items of the process standards and evaluate all items of the outcome standards (100%) except one sub item (Standard 1, sub item 3.7.7) could not be implemented and evaluated because of no longer practice. Based on Mason, this nursing standard had a criterion- related validity. Thus, this nursing standard can be used for prevention of ventilator associated pneumonia in newborns.