Clinical Research Directory

Effect of Implementing Evidence-based Practice and Nurse's Behavior Change on Quality of Care in Intensive Care Unit: Focus on Ventilator Associated Pneumonia in a Tertiary Hospital in Bangladesh

Quality of care is crucial for preventing adverse events such as infection in the intensive care units (ICUs). The most common ICU-acquired infections include pneumonia such as ventilator-associated pneumonia (VAP), Central Line Bloodstream Infection (CLABSI), catheter-associated urinary tract in, Medical Device Related Pressure Ulcer (MDRPU) and Pressure Ulcer (PU). This study explores the patient outcome in ICU by examining the causes and prevalence of ICU-acquired infection. The implementation of evidence-based practice (EBP) to reduce infection and change the nurses practice (behavioral changes) to adhere with EBP based on simulation-based training. General objective: To evaluate the effect of EBP by using recent technologies-based equipment to prevent VAP and promote behavior change among nurses for better outcome of the patient in ICU. Specific Objectives: 1. To determine the incidence of adverse events (VAP rate, MDRPU rate, PU rate, CLABSI rate), length of stay and survival rate in ICU. 2. To evaluate the effectiveness of EBP education by changing nurses' behavior and determine its impact on improving patient outcomes in the ICU. 3. To evaluate the effectiveness of EBP including proper equipment use and changed nurses behavior acquired through the training for better patient outcome (VAP ratio) in the ICU. 4. To examine the feasibility of evaluation process and outcomes and successful implementation of EBP in ICU. Hypothesis: It is hypothesize that implementing EBP in ICU, including new equipment use and nurses training, will improve patient outcome. These research consist of three studies: Phase 1: Incidence of adverse events (VAP rate, MDRPU rate, PU rate, CLABSI rate), length of stay and survival rate in ICU. The patients of General ICU will be followed up after admission up to discharge or death at ICU. The investigators use the study findings for our subsequent intervention study 3 as historical data. Phase 2: A pre- and post- quasi-experimental study will be conducted for 6 months to evaluate the nurse's competency on EBP after getting 1-month EBP training. This study has 3 steps: (1) Pre-observation period to measure nurse's competency level for 2-month, (2) nurse's EBP training period with preparation for 1 month, and (3) post-implementation period to measure nurse's competency and implementation of EBP practice for 2 months. Study nurses will receive EBP training, EBP and proper equipment for patient management. The nurses will receive EBP education and training with necessary equipment, such as a close suction catheter, an endotracheal tube, a suction device, and a mouth care brush. In this study, use global standard equipment for the patients safety. Phase 3: A pre- and post- quasi-experimental study will be implemented to evaluate the efficacy of EBP implementation. The investigators use new equipment and implement EBP for patients and assess the patient outcomes. The investigators compare the findings from study 1 (as historical data) with the data from this study 3. The investigators will compare the VAP infection prevalence and patients' outcomes related to ICU-acquired infection between pre- and post- test phase.

Education Program on Evidence-based Practices on Nurses' Competencies and Clinical Decision-Making Levels

This clinical trial aims to develop an online education program and an educational booklet for nurses on EBP and to compare the evidence-based competencies and clinical decision-making levels of nurses trained with these two methods. Hypotheses of the Study Ho: There is no statistically significant difference between the nurses' competency levels who participated in the online education developed for evidence-based practices and those who were informed of the educational booklet. H1. The nurses' competency levels who participated in the online education developed for evidence-based practices are statistically higher than those who were informed of the educational booklet. Ho: There is no statistically significant difference between the clinical decision-making levels of nurses who participated in the online education developed for evidence-based practices and nurses who were informed with the educational booklet. H1: The clinical decision-making levels of the nurses who participated in the online education developed for evidence-based practices are statistically higher than those informed with the educational booklet. Participants will: The nurses in the intervention group are expected to fill in the data collection tools (Introductory Information Form for Nurses, Evidence-Based Practice Competency Scale, Clinical Decision Making Scale in Nursing) before the education and then participate in the education about evidence-based practices on the online platform and fill in the data collection tools (Evidence-Based Practice Competency Scale, Clinical Decision Making Scale in Nursing and Education Evaluation Form) 20 days after the education. The nurses in the control group were expected to complete the data collection tools (Introductory Information Form for Nurses, Evidence-Based Practice Competency Scale, Clinical Decision Making Scale in Nursing) before the education booklet was given and 20 days after the education.