Factors That Promote the Practice of Airway Suctioning of Clinical Nurse

Background

 Airway suctioning practices have been standardized in accordance with evidence-based guidelines (American Association for Respiratory Care,2010, Japan Society of Respiratory Care Medicine,2013). Evidence-based procedures in guidelines, has been reported to reduce the physical invasion of the patient. However, there have been few studies on airway suctioning procedure performed by clinical nurses in Japan.  It has not been clarified whether the clinical nurse to properly perform evidence-based procedures in guidelines. And not disclosed also factors related to performing the procedures.

Purpose

 To clarify the performance of procedure according to the evidence-based guidelines on airway suctioning practices by clinical nurses in japan.

Method

 Registered nurses who provided respiratory care to patients were recruited to complete an anonymous questionnaire.  The questionnaire was composed 15 items on airway suctioning procedures based on Nursing Interventions Classification.

Results

 The subjects were 602 nurses (experience range: 1-35 years). 31.2% nurses worked in intensive care unit (ICU), and 68.8% nurses worked in general nursing unit. 26.9% nurses had physical assessment education in school, and 54.5% nurses had after graduation.

 Eight among the 15 items in the questionnaire were procedures that were recommended in the guidelines, in accordance with the GRADE criteria. For four items, ‘Observation of secretions’, ‘Assessment of need’, ‘Infection prevention’, and ‘Monitoring of oxygenation and hemodynamics’, the rate of implementation was more than 80%. However, for four items, ‘Pre-Oxygenation’, ‘Decision on time of suctioning‘, ‘Decision on minimum pressure’, and ‘Choice of catheter size’, the rate of implementation was less than 80%.

 Physical assessment education after graduation increased the rate of implementation of the following techniques:  ‘Assessment of need’, ‘Monitoring of breath sounds before suctioning’, and ‘Monitoring of breath sounds after suctioning’. No correlations were found in regard to the physical assessment education in school.

 ICU nurses increased the rate of implementation of the following items:  ‘Monitoring of breath sounds before suctioning’, ‘Monitoring of breath sounds after suctioning’, ‘Monitoring of oxygenation and hemodynamics, and ‘Discontinue and Oxygenation in hazardous situations’.

Conclusions

 Most nurses practiced procedures for infection prevention, monitoring and observation in airway suctioning. However, procedures for minimally invasive suctioning were less practice in japan.

 To promote airway suctioning practice effective, nurses need to have more education program after graduation.