Evidence-informed clinical guidelines for nursing care practices related to the safety of the mechanically ventilated patient

An evidence-based approach to clinical practice aims to deliver appropriate care in an efficient manner to individual patients. This approach entails the integration of research evidence, clinical expertise and the interpretation of patients' needs and perspectives in making decisions about the best care modalities. The increased emphasis internationally on improved patient care and cost effectiveness in health care delivery highlighted the need for quality health services that have to be built upon the use of best evidence to inform practice and patient-care decision-making (McKenna, Ashton and Keeney, 2004:178). Critical care nursing science, a specialised branch of nursing, focusing on the care of the critically ill patient in a designated unit, is no exception to the drive to provide improved quality and cost-effective patient care. Critical care practitioners are seen to have a specialised knowledge base, specific skills in delivering advanced health care and a commitment to serve the critically ill patient. It is expected of them to be aware of new and emerging evidence about health disease processes, treatment modalities and technology used in the critical-care units. Due to the dynamic nature of a critical care unit, it is essential that every practitioner working in the unit, whether a novice professional nurse or senior unit manager, needs to be aware of the current evidence guiding their practices (Elliot, Aitken, Chaboyer, 2007:18). With reference to the critically ill patient who is connected to a mechanical ventilator, practices related to the nursing care of this group of patients, who mostly occupy the critical care units, should be based on the best evidence in order to provide cost-effective and quality care. The research study aimed to explore and describe four identified nursing care practices related to safety of a mechanically ventilated patient as performed by professional nurses in the critical care units in the Nelson Mandela Metropole. The identified nursing-care practices include: endotrachael tube placement verification, endotracheal tube cuff pressure monitoring, endotrachael tube suctioning and mechanical ventilator settings. This objective was operationalized in Stage One of the study, by using a quantitative, explorative, descriptive and contextual approach. A structured questionnaire was utilised to collect data from professional nurses working in critical care units. From the analysed data, it was decided to select the two nursing care practices that were done least according to the best recommended practice, namely endotracheal tube suctioning and endotracheal tube cuff pressure monitoring. Based on the results, systematic reviews were done respectively on the two nursing care practices. On completion of Stage One of the study, evidence-informed clinical guidelines for the two identified nursing care practices were developed. The clinical guidelines were based on the evidence found in conducting the systematic reviews. The draft clinical guidelines were reviewed by an expert panel. Feedback from the reviewers was considered to prepare the final evidence-informed clinical guidelines. Based on the clinical guidelines, two clinical algorithms were developed, which might be used at the patient's bedside and can assist in quick dissemination of the recommendations for practice. Ethical considerations were maintained throughout the study. The quality of the study was ensured in applying the principles of validity and reliability as well as performing a critical appraisal of all data collected during the systematic review. It is envisaged that the study findings be disseminated in the critical care units in the Nelson Mandela Metropole and published in peer reviewed journal