Development of standard practice guidelines for open and closed system suctioning. 
This study was carried out to determine the knowledge and practice of nurses before and after training and the development of standard practice guidelines for open and closed system suctioning methods in patients with endotracheal tubes.  Many life-threatening complications can occur when a suctioning procedure is not performed with the correct technique.  It has been reported that standard practice guidelines for suctioning are insufficient in clinical practice.  Non-participant structured observational study.  We assessed a total of 48 nurses who were employed in the cardiovascular surgery intensive care unit of a state hospital in Turkey.  We used a questionnaire and nurse observation forms to assess the use of the open and closed system suctioning.  There was a significant difference between the mean scores of the answers ('true', 'wrong' and 'I do not know') for the use of open and closed system suctioning before and after training.  In addition, all steps of both suctioning procedures were carried out correctly during the third observation.  The compliance of the nurses to the standard practice guidelines for open and closed suctioning and their knowledge levels on the subject were increased after training, while the implementation of standards was satisfactory.  The development of open and closed system suctioning standard practice guidelines directly contributed to the enhancement of patient safety and the quality of nursing care.  It is suggested that, as in other nursing care practices, suctioning should be carried out in accordance with standard practice guidelines, and health institutions should develop their standard practice guidelines and work in accordance with them.