TABLE OF CONTENTS
Page
Title
page i
Approval
page
ii
Certification iii
Dedication
iv
Acknowledgement
v
Table of contents vi
List
of Tables
ix
List
of Figures x
Abstract
xi
CHAPTER ONE:
INTRODUCTION
Background
to the Study
1
Statement of Problem 4
Purpose of theStudy
4
Specific Objectives
5
Hypotheses
5
Significance of the Study
6
Scope of the Study
6
Operational Definition of Terms 7
CHAPTER TWO: LITERATURE REVIEW
Conceptual
Review
9
Current Guidelines 10
Types of Endotracheal Suctioning 11
Preparation for Endotracheal Suctioning Procedure 13
Equipments/Devices Used During Suctioning 14
Hyper-oxygenation 14
Suction Catheter Size
15
Depth of Catheter Insertion 15
Frequency of Suctioning 16
Documentation 17
Complications Associated with Endotracheal Suctioning 17
Theoretical Review 18
Application of the Model to the Study 20
Empirical Review 24
Summary of Literature Review 34
CHAPTRE
THREE: RESEARCH METHOD
Research Design 36
Area of Study
36
Target Population 38
Sample and Sampling Technique 38
Inclusion Criteria 39
Instrument for Data Collection 39
Validity of Instrument 39
Reliability of Instrument 40
Ethical Consideration 40
Procedure for Data Collection 41
Method of Data Analysis 41
CHAPTER
FOUR: PRESENTATION OF RESULTS
Presentation of Results 43
Summary of Major Findings 58
CHAPTER
FIVE: DISCUSSION OF FINDINGS
Discussion of Major Findings 60
Conclusion 63
Implication of the Study 63
Limitation of the Study 64 Suggestion for further Studies 64
Summary of the Study 64
Recommendations 65
References 66
APPENDICES
Appendix I: Questionnaire 71
Appendix II: Observational Checklist 77
Appendix III: Ethical Clearance 78
LIST
OF TABLES
Table 1: Showing Socio-Demographic Data of Participants 38
Table 2: Respondents’ knowledge of Endotracheal Suctioning knowledge Procedure 45
Table 3: Knowledge of Endotracheal Suctioning Procedure 49
Table 4: Overall Knowledge of Endotracheal Procedure 52
Table 5: Relationship between Demographic Data and Knowledge of Endotracheal Suctioning Procedure 52
Table 6: Observational checklist on adherence to practice and competence in endotracheal suctioning 55
Table 7: Showing Level of Competence in Endotracheal Suctioning Procedure 57
Table 8: Showing Relationship between Profession and Level of Adherence (Practice) 57
LIST OF FIGURES
Figure 1: Application of Orem’s Self Care Deficit
Theory to the Study 23
ABSTRACT
This
study was carried out to determine endotracheal suctioning knowledge and
practice among critical care practitioners in intensive care units of
University of Calabar Teaching Hospital. The objectives of the study were to
identify critical care practitioners’ knowledge of endotracheal suctioning,
evaluate adherence to procedure in
endotracheal suctioning, assess their competence in performing endotracheal
suctioning, determine if there is an association between knowledge and
competence in performing endotracheal suctioning and determine if there are
differences in knowledge and practice between the critical care practitioners.
A descriptive survey and observational designs were adopted for the study .A
total population study of 96 respondents was used for the study. The instrument
for data collection was a structured questionnaire and observational checklist.
The face and content validity were determined by the supervisor, and two
consultant Anaesthetists in UCTH. The results were presented in tables as
percentages. Pearson Chi-square test was used to determine the association
between the knowledge distribution for doctors and nurses, a Chi-Square Test of
Association revealed no significant difference between them, p = .803 at 0.05
level of significance. Majority of practitioners Age
between 31-35 years (85.2%) had low knowledge while few (14.8%) had high knowledge.
Likewise, practitioners between 36-40 years, (85.2%) had low knowledge while
few (14.8%) had high knowledge and those above 40 years, (48.8%), had low knowledge while (51.2%)
had high knowledge. However, findings from the study revealed that few
physicians, (21.7%) had inadequate adherence to practice of endotracheal
suctioning procedure while majority (78.3%) had moderately adequate adherence.
Likewise, nurses, (40.7%) had inadequate adherence while (59.3%) had moderately
adequate adherence. Out of the 50 critical care practitioners that were
assessed using the check-list, all had poor competence in endotracheal
suctioning procedure. In conclusion, the overall knowledge of practitioner was
low and there was no difference between knowledge and practice among
practitioners. However, knowledge did not significantly influence practice of
critical care practitioners. It was recommended that a fully equipped modern
laboratory be put in place for continuous practice and simulation.
CHAPTER
ONE
INTRODUCTION
Background
to the Study
Endotracheal suctioning is a clinical procedure that helps to clear airways in the respiratory system by mechanically removing accumulated pulmonary secretions in patients with artificial airways (Sharma, Sarin & Bala, 2014). Critically ill patients with artificial airways require endotracheal suctioning to remove secretions and prevent airway obstruction, without which the patient may experience inadequate oxygenation and ventilation. Endotracheal intubation is an artificial airway that inhibits cough reflex and interferes with normal muco-ciliary function, therefore increasing airway secretion production and decreasing the ability to clear such secretions (The Royal Children’s Hospital Melbourne, 2012). Although endotracheal suctioning is an essential way of maintaining ventilation and oxygenation in patients with such artificial airways, it can result in adverse effects and serious complications when performed inappropriately or incorrectly (Kelleher & Andrews, 2008).
Patients on mechanical ventilation are vulnerable to disease complications
such as alveolar hypoventilation, alveolar hyperventilation, fluid and
electrolyte imbalance, pneumothorax and ventilator associated pneumonia, a most
common infectious complication accounting for about 47% of all infections among
critical care patients (Sharma, Sarin & Bala, 2014). In spite of the fact
that most of the technical aspects of managing mechanical ventilator is the
responsibility of respiratory care practitioners (physiotherapist who
specialized in respiratory care), nurses provide holistic care to patients,
including the management of clinical symptoms and responses to mechanical ventilator
support (Chlan, 2011).
Critical
care practitioners (anesthetists and nurses) are professionals that provide
evidence-based assistance in critical care units of healthcare facilities in order
to promote quality healthcare services to clients. Such practitioners monitor
client’s responses to ventilation intervene to maintain oxygenation and
ventilation and ensure that the complex needs of critically ill patients are
met. It is very important that critical care practitioners are aware of
endotracheal suctioning procedure and are able to practice according to current
evidence based recommendations. Knowledge and experience can determine a
critical care practitioner’s ability to adequately perform endotracheal tube
suctioning. However, some researchers have documented that some critical care practitioners
do not have sufficient knowledge about the current recommendations for
endotracheal suctioning and, their practice is often based on rituals and
traditions (Frota, Loureiro & Ferreira, 2013). Others
observed that the critical care practitioners do not
often adhere to the recommended procedures by the World Health Organisation and
their level of competence in endotracheal suctioning practices is below
expectation (Akram, Negin, Mohsen & Mohammadreza, 2012; Bighamian,
Zarkeshan & Rafieeano, 2010; George & Sequiera, 2010).
Also, it was
reported in a multisite survey of suctioning techniques and airway management
practices by Sole, Byers and Ludy (2009) that the
management practices were inadequate; compliance with
hand washing guidelines was 82%, wearing gloves was 75%, elevating head of bed
was 50%, and proper oral care protocol was 50%. Day, Farrell and Hayes (2012)
observed that the mean score for knowledge was 11.1 and 10.3 for practice among
critical care practitioner; and majority of the subjects failed to perform
suctioning as accurately as they had claimed.
Similarly,
in Cairo, a study by Nahla (2013), revealed that less than half of the nurses
recognized closed system suctioning as recommended, while the rest were
unfamiliar with closed system suctioning. Heyland, Cook and Dodek (2012) also
reported on prevention of ventilator associated pneumonia practice in Canadian
critical care units that nurses were familiar with closed suctioning practices
because such practices were common in 88% of the ICUs. Sierra (2010) reported
that in Spain open tracheal suctioning was reported in 96% of the ICUs and
added that closed suction systems are not commonly used, and thus nurses were
unfamiliar with those systems. More than half of the nurses in the study knew
that frequent change in suction systems, and kinetic beds decrease the risk and
occurrence of pneumonia. While only 48% of nurses knew that semi-recumbent
positioning help in prevention of pneumonia.
Despite the recognition that endotracheal suctioning is an effective technique that clears the airways by mechanically removing accumulated pulmonary secretions in critically ill patients with artificial airways, the adherence to established guidelines on endotracheal suctioning by critical care practitioners is not impressive. Studies by Day, Farnell, Haynes, Wainwright and Wilson-Barnett (2012); Negro, Ranzani and Manara (2014) have shown that critical care practitioners’ lack of adequate knowledge about endotracheal suctioning may be a barrier to adhere to evidenced based guidelines.
The
researcher is unaware of any empirical evidence of endotracheal suctioning
knowledge and practices of critical care practitioners and has not come across
any study on endotracheal tube suctioning in Nigeria. Hence, this research was
undertaken to evaluate the effectiveness of endotracheal suctioning in terms of
knowledge and practices of critical care practitioners in University of Calabar
Teaching Hospital, Calabar.
Statement
of the Problem
ENDOTRACHEAL SUCTIONING KNOWLEDGE AND PRACTICE AMONG CRITICAL CARE PRACTITIONERS IN INTENSIVE CARE UNITS IN UNIVERSITY OF CALABAR TEACHING HOSPITAL, CALABAR, CROSS RIVER STATE
