Development of Nursing Practice Guideline for Prevention of Unplanned Extubation in the Medicine Department
Article Sidebar
Main Article Content
Abstract
BACKGROUND: Critically ill patients with respiratory failure who require intubation must receive care according to established standards to prevent complications. Figures concerning the incidence of unplanned extubation (UPE) at the Internal Medicine Department of Phrapokklao Hospital exceed the hospital's target of fewer than 2 per 1,000 intubation days.
OBJECTIVES: This study aimed to evaluate the effect of nursing practice guidelines for preventing UPE based on the skills and feasibility of nurses to follow the guidelines in clinical practice.
METHODS: This research was conducted using a research and development (R&D) design. The study included two sample groups comprising 30 registered nurses working in the intermediate care unit, and 46 new patients intubated and ventilated who were admitted to the same unit between May and August 2023. The nursing practice guidelines were developed based on Soukup’s (2000) framework, which consists of three phases: Phase 1 involves identifying clinical problems and reviewing evidence-based literature. Phase 2 involves the implementation of the guideline. Data were collected before and after the implementation using a questionnaire to assess the nurses' skills and the feasibility of preventing UPE. Phase 3 evaluated the implementation process and outcomes, with data analyzed using paired t-tests.
RESULTS: After implementing the nursing practice guidelines to prevent UPE, the sample group showed significantly improved mean scores for nurses' knowledge and skills (t=12.88, df=29, p<0.001 and t=11.34, df=29, p<0.001, respectively). The feasibility of implementing these nursing practice guidelines in caring for patients with endotracheal tubes to prevent UPE was rated at the highest level, (mean=4.59). Additionally, the incidence of UPE decreased significantly (t=6.78, p<0.007).
CONCLUSIONS: Department at hospitals charged with caring for intubated patients with ventilator can use these nursing practices guideline to reduce the incidence of UPE
Thaiclinicaltrials.org number, TCTR20240908009
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
da Silva PSL, Reis ME, Farah D, Andrade TRM, Fonseca MCM. Care bundles to reduce unplanned extubation in critically ill children: a systematic review, critical appraisal and meta-analysis. Arch Dis Child 2022;107:271-6.
Cosentino C, Fama M, Foà C, Bromuri G, Giannini S, Saraceno M, et al. Unplanned extubations in intensive care unit: evidences for risk factors. a literature review. Acta Biomed 2017;88:55-65.
Soukup SM. The center for advanced nursing practice evidence-based practice model: promoting the scholarship of practice. Nurs Clin North Am 2000;35:301-9.
Kimnarak S, Sukhong R, Pimdee Y, Jaigra S. Effectiveness of implementing clinical nursing practice guideline for preventing unplanned extubation in intensive care unit at nakhonpathom hospital. Regions 4-5 Medical Journal 2019;38:210-25.
Thongjam R. Development of clinical nursing practice guideline for prevention unplanned extubation. Journal of Vongchavalitkul University 2020;33(1):31–9.
Suttason M, Kaewkullay K, Naiyapatana W. Effects of utilizing clinical nursing practice guideline on the incidence of unplanned extubation in critically ill patients. Journal of Nursing and Education 2017;10(2):58-70.
Krasao P. The effect of clinical nursing practice on the prevention of unplanned endotracheal extubation in general medical wards, Phrae hospital. Journal of the Phrae Hospital 2020;28(1):27-41.
Mart MF, Williams Roberson S, Salas B, Pandharipande PP, Ely EW. Prevention and management of delirium in the intensive care unit. Semin Respir Crit Care Med 2021;42:112-26.
Cui N, Zhang Y, Liu Y, Zhou Y, Sun H, Jin J, et al. Protocol for the adaptation of clinical practice guidelines for the management of physical restraints in critically ill patients. Ann Palliat Med 2021;10:4889-96.
Sanitlou N, Sartphet W, Naphaarrak Y. Sample size calculation using g*power program. Journal of Suvarnabhumi Institute of Technology 2019;5(1):496-507.
Melnyk BM, Fineout-Overholt E. Evidence-based practice in nursing & healthcare: a guide to best practice. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2023.
Chanthateero K, Tanomwat P, Jamsangtong M, Boonmark P. The development of nursing practice guidelines by using evidence-based practice to reduce catheter-associated urinary tract infection in Prapokklao hospital. J Prapokklao Hosp Clin Med Educat Center 2022;39
