Improving the Endotracheal Tube Cuff Pressure Control Knowledge
Condition: Nurse's Role
Study type: Interventional

Summary: 
      This study aimed to evaluate how an educational intervention based on the existing
      evidence-based guidelines, using both active and passive educational implementetion
      strategies, could improve the knowledge of nurses regarding managing ETT cuff pressure
      control.

      Hypothesis H1: There is a difference between the training given with the active and passive
      implementation strategies method in improving the endotracheal cuff pressure control
      knowledge of intensive care nurses.
    

Detailed description: 
      This study was carried out as a quasi-experimental two-group pretest-posttest research design
      to evaluate the effect of endotracheal tube cuff pressure control training given with the
      active and passive implementation strategies methods on the knowledge level of nurses. The
      research was carried out in the intensive care units of a Training and Research Hospital,
      between June and December 2022, in 6 intensive care units (General ICU 1-General ICU 2-
      General ICU 3, CVC ICU, 2nd Level ICU, Coronary ICU).

      In the intensive care unit of the hospital where the study was conducted, the endotracheal
      tube cuff pressure is controlled by the pilot balloon finger palpation method in four hours.
      In addition, pressure measurement was not made with the cuff manometer. However, in
      endotracheal tube cuff control, cuff pressure should be monitored to prevent aspiration and
      the cuff pressure should be kept between 20-30 cmH2O. Before the data of the study started to
      be collected, a cuff manometer was purchased by the hospital management to be used in the
      intensive care units.

      The universe of the research consisted of 120 nurses working in the intensive care units
      where the study was conducted. The necessary sample of the study was determined by using
      G*Power computer software program version 3.0.1 as recommended to be used in calculating the
      desired sample by previous studies. The sample consisted of 90 nurses scheduled for, with a
      power value to represent 95% of the study population at a 80% confidence interval, 0.05 error
      level, and 0.6 effect size according to power analysis. Research Randomizer software
      (http://www.randomizer.org.) was used to generate a randomized list by applying a simple
      randomization technique to each participant's allocation. The 90 participants were divided
      into two even groups (Intervention Group =45, Control Group =43 nurses).

      Sociodemographic and occupational characteristics form and knowledge level evaluation form
      regarding endotracheal tube cuff pressure control were used to collect the data of the study.

      Since the nurses working in the intensive care unit work in day and night shifts, the
      sociodemographic and occupational characteristics form to be applied before the training and
      the knowledge level evaluation form on endotracheal tube cuff pressure control (pretest) were
      collected by the researchers after the nurses' shift delivery hours. After applying the
      pre-test questionnaires (experimental /Control group), on the days determined together with
      the intensive care unit nurses in charge and the nursing services directorate, all nurses
      were given theoretical training on endotracheal tube cuff pressure management through a
      4-hour presentation prepared with evidence-based guide and literature. Thus, all nurses
      gained equal knowledge. A PowerPoint presentation including endotracheal tube cuff pressure
      normal values, complications related to endotracheal tube cuff pressure, management of
      endotracheal tube cuff pressure, endotracheal tube cuff pressure control methods, methods
      affecting endotracheal tube cuff pressure, how to measure endotracheal tube cuff pressure was
      made.

      Nurses included in experimental group were trained through a 4-hour presentation (passive
      implementation strategy) prepared in the presence of evidence-based guidelines and
      literature, in addition, they were given a brochure about cuff pressure measurement and a
      brochure about cuff pressure was hung in the intensive care units where there are handwashing
      sinks. In addition, 4 follow-up visits (active implementation strategy) were carried out for
      ETT cuff pressure management using the one-on-one demonstration technique every 21 days.
      These follow-ups included adherence to evidence-based guidelines, nurses' application of
      endotracheal cuff pressure measurement and solving the problems encountered during its
      implementation. Uncertainties associated with evidence-based guidance on endotracheal tube
      cuff pressure control were clarified during these sessions. Nurses included in control group
      were trained through a 4-hour presentation (passive implamentation strategy) prepared in the
      presence of evidence-based guidelines and literature, in addition, they were given a brochure
      about cuff pressure measurement and a brochure about cuff pressure was hung in the intensive
      care units where there are handwashing sinks. No follow-up visits were made to this group. 3
      months after the training, the Knowledge Level Evaluation Form (post-test) on Endotracheal
      Tube Cuff Pressure Control was re-applied to all nurses working in intensive care units and
      participating in the study.

      The results of the study were analyzed in the IBM SPSS Statistics 23.0 (Statistical Package
      for Social Sciences IBM Corp., Armonk, NYC, USA) package program. Number, percentages, means,
      standard deviations, were used for descriptive statistics of demographic and occupational
      characteristics of the nurses. Correct answers to the questions on the knowledge level form
      were given one point each while incorrect ones were given zero points. The knowledge level
      scores were calculated by averaging the number of correct answers. The Shapiro-Wilk test was
      used for normality. The t-test was used to evaluate the education level between the
      intervention groups before and after the training. The Paired Sample t Test was used to
      compare the pre-training and post-training average scores for each groups. In all results,
      p<0.05 was considered statistically significant.
    

Intervention name(s): Active implementational educational strategy; Passive implementational educational strategy
Intervention type(s): Other; Other
Intervention description(s): 4 follow-up visits (active implemantation strategy) were carried out for ETT cuff pressure management using the one-on-one demonstration technique every 21 days. These follow-ups included adherence to evidence-based guidelines, nurses' application of endotracheal cuff pressure measurement and solving the problems encountered during its implementation. Uncertainties associated with evidence-based guidance on endotracheal tube cuff pressure control were clarified during these sessions.; Theoretical training on endotracheal tube cuff pressure management through a 4-hour presentation prepared with evidence-based guide and literature. A PowerPoint presentation including endotracheal tube cuff pressure normal values, complications related to endotracheal tube cuff pressure, management of endotracheal tube cuff pressure, endotracheal tube cuff pressure control methods, methods affecting endotracheal tube cuff pressure, how to measure endotracheal tube cuff pressure was made.
Other intervention name(s): Experimental group; Control group
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: cuff pressure management; endotracheal tube cuff; educational intervention; intensive care nurses; nurses' knowledge