Intervention to improve intensive care nurses' knowledge of sedation assessment and management.

Sedation management is an integral component of critical care practice. It requires the greatest attention of critical care practitioners because it carries significant risks to patients. Therefore, it is imperative that nurses are aware of potential adverse consequences of sedation therapy and current sedation practice recommendations. To evaluate the impact of an educational intervention on nurses' knowledge of sedation assessment and management. A quasi-experimental design with a pre- and post-test method was used. The educational intervention included theoretical sessions on assessing and managing sedation and hands-on sedation assessment practice using the Richmond Agitation Sedation Scale. Its effect was measured using self-administered questionnaire, completed at the baseline level and 3 months following the intervention. Participants were 68 registered nurses from an intensive care unit of a teaching hospital in Malaysia. Significant increases in overall mean knowledge scores were observed from pre- to post-intervention phases (mean of 79·00 versus 102·00, p < 0·001). Nurses with fewer than 5 years of work experience, less than 26 years old, and with a only basic nursing education had significantly greater level of knowledge improvement at the post-intervention phase compared to other colleagues, with mean differences of 24·64 (p = 0·001), 23·81 (p = 0·027) and 27·25 (p = 0·0001), respectively. A repeated-measures analysis of variance revealed a statistically significant effect of educational intervention on knowledge score after controlling for age, years of work and level of nursing education (p = 0·0001, ηp (2) = 0·431). An educational intervention consisting of theoretical sessions and hands-on sedation assessment practice was found effective in improving nurses' knowledge and understanding of sedation management. This study highlighted the importance of continuing education to increase nurses' understanding of intensive care practices, which is vital for improving the quality of patient care.

Ramoo V ，Abdullah KL ，Tan PS ，Wong LP ，Chua PY ... -  《-》

Sedation scoring and managing abilities of intensive care nurses post educational intervention.

Inappropriate sedation assessment can jeopardize patient comfort and safety. Therefore, nurses' abilities in assessing and managing sedation are vital for effective care of mechanically ventilated patients. This study assessed nurses' sedation scoring and management abilities as primary outcomes following educational interventions. Nurses' perceived self-confidence and barriers to effective sedation management were assessed as secondary outcomes. A post-test-only quasi-experimental design was used. Data were collected at 3 and 9 months post-intervention. A total of 66 nurses from a 14-bed intensive care unit of a Malaysian teaching hospital participated. The educational interventions included theoretical sessions, hands-on sedation assessment practice using the Richmond Agitation Sedation Scale, and a brief sedation assessment tool. Nurses' sedation scoring and management abilities and perceived self-confidence level were assessed at both time points using self-administered questionnaires with case scenarios. Sedation assessment and management barriers were assessed once at 9 months post-intervention. Median scores for overall accurate sedation scoring (9 months: 4·00; 3 months: 2·00, p = 0·0001) and overall sedation management (9 months: 14·0; 3 months: 7·0, p = 0·0001) were significantly higher at 9 months compared to 3 months post-intervention. There were no significant differences in the perceived self-confidence level for rating sedation level. Overall perceived barrier scores were low (M = 27·78, SD = 6·26, possible range = 11·0-55·0). Patient conditions (M = 3·68, SD = 1·13) and nurses' workload (M = 3·54, SD = 0·95) were the greatest barriers to effective sedation assessment and management. Demographic variables did not affect sedation scoring or management abilities. Positive changes in nurses' sedation assessment and management abilities were observed, indicating that adequate hands-on clinical practice following educational interventions can improve nurses' knowledge and skills. Educational initiatives are necessary to improve ICU practice, particularly in ICUs with inexperienced nurses.

Ramoo V ，Abdullah KL ，Tan PS ，Wong LP ，Chua YP ，Tang LY ... -  《-》

Educational intervention on delirium assessment using confusion assessment method-ICU (CAM-ICU) in a general intensive care unit.

To assess intensive care unit nurses' knowledge of intensive care unit delirium and delirium assessment before and after an educational intervention. In addition, nurses' perception on the usefulness of a delirium assessment tool and barriers against delirium assessment were assessed as secondary objectives. Early identification of delirium in intensive care units is crucial for patient care. Hence, nurses require adequate knowledge to enable appropriate evaluation of delirium using standardised practice and assessment tools. This study, performed in Malaysia, used a single-group pretest-posttest study design to assess the effect of educational interventions and hands-on practices on nurses' knowledge of intensive care unit delirium and delirium assessment. Sixty-one nurses participated in educational intervention sessions, including classroom learning, demonstrations and hands-on practices on the Confusion Assessment Method-Intensive Care Unit. Data were collected using self-administered questionnaires for the pre- and postintervention assessments. Analysis to determine the effect of the educational intervention consisted of the repeated-measures analysis of covariance. There were significant differences in the knowledge scores pre- and postintervention, after controlling for demographic characteristics. The two most common perceived barriers to the adoption of the intensive care unit delirium assessment tool were "physicians did not use nurses' delirium assessment in decision-making" and "difficult to interpret delirium in intubated patients". Educational intervention and hands-on practices increased nurses' knowledge of delirium assessment. Teaching and interprofessional involvements are essential for a successful implementation of intensive care unit delirium assessment practice. This study supports existing evidences, indicating that education and training could increase nurses' knowledge of delirium and delirium assessment. Improving nurses' knowledge could potentially lead to better delirium management practice and improve ICU patient care. Thus, continuous efforts to improve and sustain nurses' knowledge become relevant in ICU settings.

Ramoo V ，Abu H ，Rai V ，Surat Singh SK ，Baharudin AA ，Danaee M ，Thinagaran RRR ... -  《-》

Knowledge acquisition and retention among nurses after an educational intervention on endotracheal cuff pressure.

Nurses play a key role in the proper management of endotracheal tube (ETT) cuff pressure, which is important for patients' safety, so it is vital to improve nurses' knowledge on safe cuff management practices. This study aimed to evaluate the effectiveness of an educational intervention related to ETT cuff pressure management on improving and retaining critical care nurses' knowledge. A single group pre-post interventional study was conducted involving 112 registered nurses (RNs) from a 24-bed adult general intensive care unit at a teaching hospital in Malaysia. The educational intervention included a theoretical session on endotracheal cuff pressure management and demonstration plus hands-on practice with the conventional cuff pressure monitoring method. Nurses' knowledge was measured using a self-administered questionnaire pre- and post-intervention. Data were analysed using repeated measure analysis of variance and bivariate analysis. In this study, 92% of the total number of RNs in the unit participated. A significant difference in mean knowledge score was noted between the pre- (mean = 8.13; SD = 1.53) and post-intervention phases (3 months [mean = 8.97; SD = 1.57) and 9 months post-intervention [mean = 10.34; SD = 1.08), P < .001), indicating significant knowledge acquisition and retention between the phases. Knowledge gained between the pre- and 9 months post-intervention phases significantly differed according to nurses' educational level. This study supports existing evidence that ongoing educational interventions are essential to improve nurses' knowledge. However, further exploration is suggested to assess how well this knowledge is translated into clinical practice. Regular educational programmes with current updates would enhance nurses' knowledge through proper practice and clinical decision-making skills; this, in turn, would help to standardize cuff management practices.

Murugiah UR ，Ramoo V ，Jamaluddin MFH ，Yahya A ，Baharudin AA ，Abu H ，Thinagaran RRR ... -  《-》

Newborn care in Nepal: the effects of an educational intervention on nurses' knowledge and practice.

To determine the effectiveness of an educational intervention for improving nurses' knowledge and practice regarding newborn care in Kathmandu, Nepal. Four million neonatal deaths occur annually, especially in developing countries. In 2010 in Nepal, the neonatal mortality rate was 28/1000 births. Modern nursing and research education is still developing in Nepal, but the country's nurses are in a unique position to help combat avoidable morbidity and mortality. This study was designed to assist nurses working in maternity units to obtain and/or sustain knowledge and competence in practice to ensure the health and safety of vulnerable newborns, and thereby to help reduce mortality and morbidity. Concepts from the Transtheoretical Model of behaviour change developed in the USA informed this study in the belief that an educational intervention would assist in behaviour changes in nurses caring for newborns. Quasi-experimental, time-series pre-test/post-test. Maternity and women's hospitals in Kathmandu, Nepal. Convenience sample of 30 nurses working in emergency room, delivery room and birthing centre. Nurses were measured on study outcomes at multiple time points: before a self-directed educational intervention and discussion, immediately, 1 and 3 months after intervention. Data were collected using three instruments: a demographics questionnaire, the Knowledge Survey Questionnaire and the Skills Learning Checklist (SLC). The SLC was completed during nursing practice in observations by the researcher. Significant findings suggested that this educational intervention was effective for improving nurses' knowledge and practice regarding newborn care, and there was a positive correlation between knowledge and practice. This was the first study of its kind in Nepal, a small step in enhancing nurses' abilities to improve their knowledge and competence regarding care of newborns. However, continued education and guidance are required to sustain knowledge and competence in practice, and our educational intervention needs further testing with other populations of nurses. There are various policy implications required to enable this to happen. This includes health ministry funding and support for in-service education; hospitals and universities working together to offer in-service education, competency testing and revised curricula; and nurse registering authorities requiring ongoing nurse education programmes and competency testing.

Shrestha S ，Petrini M ，Turale S 《-》