INTRODUCTION:

The patients in the ICUs often requires mechanical assistance to maintain airway patency.¹ Endotracheal suctioning is an intervention to remove accumulated mucus from the endotracheal tube, trachea, and lower airways in patients who require intubation for mechanical ventilation.

Intubation and mechanical ventilation impair the transport of mucus in the airways, and interfere with effective expectoration by coughing since the glottis cannot be closed. This has been the rationale behind the practice of applying routine endotracheal suctioning to these patients.²Endotracheal suctioning is therefore important in order to reduce the risk of consolidation and atlectasis that may lead to inadequate ventilation.³It is therefore imperative that professionals are aware of these risks and are able to practice according to current best evidence.⁴

As demand of intensive care beds increase more nurses in acute and high dependency ward areas are expected to provide safe care of patient with endotracheal tube. The Audit commission (1999) suggested that general wards nurses should be able to care for patients with endotracheal tube as long as they have no other respiratory problems. However there is evidence that the practioners are not adequately educated or experienced to care for patients with endotracheal tube in general ward. These findings not only have serious legal implication but they hamper the intent of comprehensive critical care, which aims to prevent the readmission to intensive care units, facilitate discharge and share critical care skills.⁵

A descriptive study was conducted in UK to explore the knowledge and competence of nurses in performing endotracheal suctioning. Twenty eight nurses were observed using nonparticipant observation and structured observation schedule. The study demonstrated that the majority of the subjects (n=14) failed to perform the suctioning as accurately as they had reported. The mean score for knowledge was 11.1 and 10.3 for practice (maximum score 20). Knowledge and practice were compared using Spearman’s correlation coefficient (r=0.338) and found that was not statistically significant (p>0.05). The study found a poor level of knowledge for many subjects, that was reflected in practice. The study suggested that nurses require support, education, and training relating to tracheal suctioning.⁵

Many researchers have identified that nurses are unaware of the current suctioning recommendations and practice, is often based on ritual and tradition as opposed to empirical evidence. In a study by Day (2002) in UK, many nurses have failed to demonstrate an acceptable level of competence and some of the practices observed were potentially unsafe.⁶ Hence it was felt that a planned teaching programme on endotracheal suctioning would enable the staff nurses to improve their knowledge and skill and also practice it according to the current research recommendations.

MATERIALS AND METHODS:

Objectives: To determine the knowledge and practice of staff nurses regarding endotracheal suctioning. To evaluate the effect of planned teaching programme in terms of gain in knowledge and practice scores. To find out the correlation of knowledge scores with practice scores on endotracheal suctioning among staff nurses. To find out the association of knowledge and practice with selected demographic variables.

Hypotheses:

H₁: The mean post-test knowledge score of staff nurses regarding endotracheal suctioning will be higher than the mean pre-test knowledge score.

H₂: The mean post-test practice score of staff nurses regarding endotracheal suctioning will be significantly higher than the mean pre-test practice score.

H₃: There is a significant correlation between knowledge and practice of staff nurses.

H₄:There is a significant association of knowledge and practice of staff nurses with demographic variables.

Research design:

The study was carried out using pre-experimental one group pre-test post-test design.

Setting of the Study

The study was conducted in the medical and surgical wards of three selected hospitals at Mangalore – A.J Hospital and Research centre, K. M. C. Hospital, Unity Hospital and City Hospital Research and Diagnostic Centre.

Sample :

By using purposive sampling technique 30 staff nurses were selected.

Ethical clearance:

Ethical clearance has been obtained from ethical committee.

Data collection tools:

Based on the objectives, baseline proforma, the structured knowledge questionnaire, and observational checklist were prepared and administered to the staff nurses at selected hospitals in Mangalore. Content validity of tool was established by submitting to nine experts. The coefficient of internal consistency of the knowledge questionnaire was checked by using Cronbach’s alpha and inter-rater reliability method was used to establish the equivalence of the observational checklist. Correlations between the observations were measured by using Spearman rank correlation method. The internal consistency of the knowledge questionnaire was, α=0.793 and observational checklist was, r=0.94. Hence the tools were found to be reliable.

Method of Data Collection

Prior to the data collection permission was obtained from the concerned authority of the organization for conducting the study. The data collection period extended from 1-11-12 to 30-11-12. Prior to the data collection, permission was obtained from the concerned hospitals authorities for conducting the study. Subjects were selected according to the selection criteria and confidentiality was assured. Written consent was obtained from the subjects. Subjects were assigned through purposive sampling technique. After obtaining the informed consent for the study, on the first day, pre-test data was obtained using self-administered structured knowledge questionnaire and observational checklist. On the second day, planned teaching programme was administered. On the seventh day post-test was conducted using the same knowledge questionnaire to assess the knowledge on endotracheal suctioning and using the same observation checklist the practice on endotracheal suctioning was assessed.

RESULTS:

Table 1: Frequency and percentage distribution of samples according to demographic variables

Sl No

Variables

Age( in years)

21- 25

26-35

26-45

45 and above

46.66

33.33

Qualification

GNM

B. Sc. nursing

P. C. B. Sc. nursing

43.33

13.33

Work experience (in years)

1-5

6-10

>10

33.33

36.66

23.33

6.66

Table 2: Frequency and percentage distribution of practice of staff nurses regarding endotracheal suctioning

Level of Knowledge	Range of Score	Pre-test		Post-test
Level of Knowledge		Frequency (f)	Percentage (%)	Frequency (f)	Percentage (%)
Poor	0-8	3	10.00	-	-
Average	9-16	26	86.66	-	-
Good	17-24	1	3.33	30	100.00

Section A: Description of demographic variables of samples

Majority (46.66%) of staff nurses were within the age group of 21-25 years, and least (20%) were in the age group of 36-45 years. Majority of the participants (43.33%) were with the qualification of GNM and BSc nursing and the least (13.33%) were with P. C. B. Sc. nursing. Highest percentage of subjects (36.66%) had 1-5 years of experience and the least percentage had (6.66%) more than 10 years of experience.

Section B: Description of knowledge and practice of staff nurses regarding endotracheal suctioning

In pre-test, highest percentage (50%) of staff nurses had average knowledge, 46.66% of staff nurses had poor knowledge whereas only one staff nurse (3.33%) had good knowledge. In the post-test, all staff nurses, i.e., 100% had good knowledge

In pre-test, highest percentage (86.66%) of staff nurses had average level of practice in performing endotracheal suctioning, 10% of staff nurses had poor level of practice whereas only one staff nurse (3.33%) had good level of practice of performing endotracheal suctioning. In the post-test, all staff nurses, i.e., 100% had good level of practice and none had poor level of practice in performing endotracheal suctioning.

Section – C: Effectiveness of planned teaching programme on endotracheal suctioning

i. Comparison of pre-test and post-test knowledge scores of staff nurses regarding endotracheal suctioning

Table 3: Mean, mean difference, standard deviation and ‘t’ values of pre-test and post-test knowledge scores

Parameters	Mean	SD	Mean Difference	‘t’ value	P value
Pre-test	13.23	4.302	15.3	18.804*	0.001
Post-test	28.53	1.14	15.3	18.804*	0.001

Table value: t₂₉=2.048, p<0.05 * Significant

The data in the Table 3 shows that the mean post-test knowledge score (28.53) was higher than the mean pre-test knowledge score (13.23). The calculated ‘t’ value (18.804) was higher than the table value (t₂₉₌2.048) at 0.05 level of significance.

ii. Comparison of pre-test and post-test practice scores of staff nurses regarding endotracheal suctioning

Table 4: Mean, mean difference, standard deviation and ‘t’ value of pre-test and post-test practice scores

Para-meters	Mean	SD	Mean Difference	‘t’ value	P value
Pre-test	11.63	2.40	11.1	16.71*	0.001
Post-test	22.73	1.09	11.1	16.71*	0.001

Table value: t₂₉=2.048, p<0.05 * Significant

The data in the Table 4 show that the mean post-test practice score (22.73) was higher than the mean pre-test practice score (11.63). The calculated ‘t’ value (16.71) was higher than the table value (t₂₉₌2.048) at 0.05 level of significance.

Section –D: Correlation between knowledge and practice scores of staff nurses regarding endotracheal suctioning

Karl Pearson correlation coefficient was computed in order to find the correlation between knowledge score and practice score of staff nurses on endotracheal suctioning. The data showed that there was a positive correlation between knowledge and practice (r=0.76).

Section E: Association of post-test knowledge scores with selected demographic variables

Table 5: Chi-Square test showing association of post-test knowledge score with selected demographic variables

Sl. No	Demographic Variables	χ²	df	Table Value	Inference
1.	Age in years	0.045	1	3.841	Not significant
2.	Qualification	0.065	1	3.841	Not significant
3.	Work experience (in years)	7.10	2	5.991	Significant

The data in the Table 5 show that significant association was found between work experience and the post-test level of knowledge (χ²=7.1, p≤0.05), however, there was no significant association was found between age , qualification and the post-test level of knowledge.

Association of post-test practice scores with selected demographic variables

Table 6: Chi-Square test showing association of post-test practice score with selected demographic variables

Sl. No.	Demographic Variables	χ²	df	Table Value	Inference
1.	Age in years	3.67	2	5.991	Not significant
2.	Qualification	0.05	1	3.841	Not significant
3.	Work experience (in years)	8.45	2	5.991	Significant

The data in the Table 6 shows that significant association was found between work experience and the post-test practice score (χ²=8.45,p≤0.05), however, there was no significant association between age and qualification.

DISCUSSION:

In the present study, the majority (46.66%) of staff nurses were within the age group of 21-25 years. Equal percentages of the participants (43.33%) were with the qualification of GNM and B. Sc. nursing. Highest percentage of subjects (36.66%) had 1-5 years of experience. The findings of the study can be compared with a cross-sectional study conducted to assess knowledge and performance of 44 nurses working in three ICUs in Shahid Beheshti Hospital, Kashan, Iran, has shown that most of the samples (95.5%) were females, and all samples held the BS degree and most of the samples (52.2%) were having the work experience of less than 4 years.⁷

The findings of the present study showed that in the pre-test, highest percentage (50%) of staff nurses had average knowledge, 46.66% of staff nurses had poor knowledge whereas the least percentage (3.33%) of them had good knowledge. In the post-test, all staff nurses, i.e., 100% had good knowledge. The findings of the study can be compared with the study that was conducted to assess the knowledge of endotracheal suctioning among 34 nurses in ICU in Spain. The total mean score obtained was 14.24%. Among 34 nurses 28 nurses had average knowledge and six had good knowledge on endotracheal suctioning.⁸

The findings of the present study showed that in the pre-test, the highest percentage (86.66%) of staff nurses had average level of practice in performing endotracheal suctioning, 10% of staff nurses had poor level of practice whereas the least percentage (3.33%) of them had good level of practice of performing endotracheal suctioning. The findings of the study can be compared with the study that was conducted to explore the knowledge and competence of nurses in performing endotracheal suctioning in acute and high dependency ward areas in UK. The mean score for practice was 10.3 (maximum score 20). The study demonstrated that the majority of the subjects (n=14) failed to perform the suctioning as accurately as they had reported.⁵

In this study, the significance difference between the pre-test and the post-test knowledge and practice scores of staff nurses was analysed using paired ‘t’ test. The mean post-test knowledge score (28.53±1.14) was significantly higher than the mean pre-test knowledge score (13.23±4.302), t₂₉=2.048, p<0.05. The mean post-test practice score (22.73±1.09) was significantly higher than the mean pre-test score (11.63±2.40), t₂₉=2.048, p<0.05. This indicated that the PTP was effective in improving the knowledge and practice of staff nurses.The findings of the study can also be compared with the another study that was conducted to assess the impact of instruction on the knowledge and performance of NICU nursing staff on endotracheal suctioning in Shiraz University of Medical Sciences. The study result showed that means for knowledge and performance of experimental group, respectively, two days and two months after instruction was 16.56 and arrived from this score to 28.48 and 27.4 and from 20.6 arrived to 39.14 and 38.34. The study concluded that instructing the principles of endotracheal tube suctioning improves the level of knowledge and performance in nurses.⁹

According to the present study, there is a positive correlation (r=0.76) between the knowledge and practice of endotracheal suctioning. This indicates that the knowledge of endotracheal suctioning can influence the practice of endotracheal suctioning in staff nurses.The findings of the study can be compared with the study that was conducted to assess the effectiveness of planned teaching programme on knowledge and practice of endotracheal suctioning among staff nurses in different ICU of St. John’s National Academy of Health Science, Bangalore. The study result showed that there was a significant positive relationship (r=0.82) found when knowledge and practice were compared.¹⁰

The present study results revealed that there was significant association of the post-test knowledge score (χ²=7.1, p≤0.05) and the post-test practice score (χ²=8.45, p≤0.05) with the selected demographic variable, i.e., work experience and there was no significant association between age and qualification. This study also can be compared with a study conducted in Shahid Beheshti Hospital, Kashan, Iran. The findings of the study revealed that the type of ICU (χ2=32.6, p<0.05) and nurses’ working experience (χ₂=38.53, p≤0.05) were significantly related to their knowledge and performance.⁷

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Received on 25.05.2013 Modified on 20.07.2013

Asian J. Nur. Edu. and Research 3(4): Oct.- Dec., 2013; Page 243-247