Critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle

Am J Infect Control. 2018 Sep;46(9):1051-1056. doi: 10.1016/j.ajic.2018.02.004. Epub 2018 Mar 21.


Background: Although evidence-based practices are known to improve the quality of care, making it cost-efficient and improving clinical results, barriers to transferring research into clinical practice have hindered this process.

Aims: To evaluate critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle.

Material and methods: In 2015, we conducted an institution-specific, cross-sectional study in a 26-bed adult mixed medical-surgical intensive care unit (ICU) in Finland using quantitative survey of knowledge and self-reported adherence with qualitative gathering of barrier data. A pre-validated multiple-choice Ventilator Bundle Questionnaire was distributed to all registered nurses who were direct care providers (n = 155).

Results: The final response rate was 55.5% (n = 86), and 47.2% (n = 34) of respondents had more than 10 years of ICU experience. The levels of knowledge and self-reported adherence were 71.1% and 65.8% of the total score, respectively. The level of knowledge was higher among respondents who had received in-service education about ventilator bundle compared with respondents who had not received in-service education (27.0 vs 24.0 [P = .012]). Less experienced nurses reported significantly higher adherence than nurses with more ICU experience (29.0 vs 25.0 [P = .034]). The correlation between knowledge and adherence scores was low (ρ 0.48 [P <.001]). The most well-known and adhered-to guidelines described patient positioning, daily chlorhexidine-based oral care, and strict hand hygiene. The least-known guidelines and those least adhered to described respiratory equipment, management of sedation and analgesia, and practices prior to and during endotracheal suctioning. The main barriers were related to the nurse respondents (e.g., lack of education [25.9%]), environment (e.g., role ambiguities [36.4%] and inadequate resources [21.1%]), and patients (e.g., patient discomfort [4.8%] and fear of adverse effects [4.6%]).

Conclusions: Self-reported adherence did not correlate with knowledge and was not related to work experience. Most of the barriers toward evidence-based guidelines indicated a need for changes that are beyond the control of individual nurses.

Keywords: Adherence; Barriers; Evidence-based practice; Nursing; Ventilator bundle.

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Critical Care / methods*
  • Cross-Sectional Studies
  • Female
  • Finland
  • Guideline Adherence*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Infection Control / methods*
  • Male
  • Middle Aged
  • Nurses / psychology*
  • Patient Care Bundles / methods
  • Pneumonia, Ventilator-Associated / prevention & control*
  • Professional Competence
  • Surveys and Questionnaires