The Implementation of Evidence-Based Care of the Ventilated Patient in South Africa

Purpose:

The purpose of this presentation is to share with you how poor compliance to evidence based care of the mechanically ventilated patient was addressed through action research cycles.

Methods:

An explorative, descriptive and qualitative design was used to provide a full picture of the problem observed. Stringer’s action research routine of LOOK, THINK and ACT was followed to reach the objectives. The researchers used two populations:  Population 1 included all patients who were mechanically ventilated, through an endo-tracheal or tracheostomy tube, in the selected private health care institutions in South Africa. Population 2 included all nurses who cared for mechanically ventilated patients in the selected private health care institutions in South Africa.

Sampling for population 1 and 2 were convenient due to time constraints and the availability of mechanically ventilated patients.

The care of 12 ventilated patients was observed against an evidence based observation guideline.  Thereafter an interview was done with the nurses using an interview guide.  In data obtained the poor compliance to evidence based care of mechanically ventilated patients was evident.  The data was then used to identify factors that influence current evidence based care of the mechanically ventilated patient.  A participative action plan was formulated, implemented and evaluated to address the poor compliance to evidence based care of the mechanically ventilated patient. 

Results:

The researchers found that nurses are attempting to adhere to evidence based practice in most cases and with most criteria. The evidence based practice criteria that were mostly not being adhered to can be summarized as:

• The Recording of actions completed
• The Recording of the existence and absence of certain appropriate factors of taking care of a mechanically ventilated patient
• The planning and setting of appropriate goals
• Management and care of ventilation equipment and consumables
• Setting of alarms
• Knowledge of certain ventilator specific principles and factors

The importance and action of changing the patient’s position regularly

Researchers found very specific factors and themes from the interviews conducted with the nursing participants. The factors that were identified were:

• Attitude and / or demotivation
• Lack of support from shift leaders
• Lack of knowledge and understanding
• Lack of team work
• Too high work load

Researchers found that an implementation plan to change or improve evidence based practice care of the mechanically ventilated patients, does make a difference to adherence to evidence based practice.

Conclusion:

The researchers confirmed the lack of implementation of evidence based care of the mechanically ventilated patient and identified specific factors contributing to this behaviour.  The researchers furhter found that implementation of a participative action plan can positively impact on adherence to evidence based care of the mechanically ventilated patient.