Effectiveness of an Evidence-Based Respiratory and Renal Care Training With Case-Based Discussion on Nurses' Clinical Reasoning, Knowledge & Practice, Nurse-Physician Collaboration and Mechanically Ventilated Patient Outcomes in a Tertiary-Level ICU in Bangladesh
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 140
- 试验地点
- 1
- 主要终点
- Incidence Rate of Ventilator-Associated Events
研究概览
简要总结
This study will evaluate the effectiveness of an evidence-based respiratory and renal care training program combined with case-based discussion on nurses' clinical reasoning, knowledge & practice, nurse-physician collaboration, as well as selected clinical outcomes among mechanically ventilated patients in a tertiary-level ICU in Bangladesh.
The intervention will provide structured education and practical training to ICU nurses on evidence-based respiratory and renal care for mechanically ventilated patients. Case-based discussions will be conducted to promote clinical reasoning, evidence-based decision-making, and nurse-physician collaboration during daily ICU rounds.
Nurses' outcomes will be assessed before and after the intervention, focusing on clinical reasoning, knowledge, practice, and nurse-physician collaboration.
Patient outcomes will be assessed using historical pre-intervention data and post-intervention data among eligible mechanically ventilated ICU patients, focusing on ventilator-associated events (VAE), ventilator-associated pneumonia (VAP), Acute Kidney Injury (AKI), duration of mechanical ventilation, ICU length of stay, and ICU mortality.
The study is intended to determine whether evidence-based respiratory and renal care training with case-based discussion can improve ICU nurses' clinical reasoning, knowledge, practice, nurse-physician collaboration and contribute to improved outcomes among mechanically ventilated patients.
详细描述
Background and Rationale:
Critically ill patients requiring mechanical ventilation are at high risk of complications related to respiratory and renal dysfunction, including ventilator-associated events (VAE), ventilator-associated pneumonia (VAP), acute kidney injury (AKI), prolonged mechanical ventilation, prolonged intensive care unit (ICU) stay, and death. Prevention, early recognition, and appropriate management of these complications require ICU nurses to possess adequate knowledge, clinical reasoning ability, practical skills, and effective communication and collaboration with physicians and other members of the ICU team.
In resource-limited settings, including Bangladesh, gaps in ICU staffing, continuing professional education, standardized clinical practices, and multidisciplinary communication may affect the quality and safety of care provided to mechanically ventilated patients. Evidence-based training that combines theoretical education with practical application and case-based clinical discussion may improve nurses' ability to recognize patient deterioration, interpret clinical findings, apply evidence-based interventions, and communicate effectively with physicians and other ICU professionals.
This study will evaluate an evidence-based respiratory and renal care training program combined with structured case-based discussion for ICU nurses in a tertiary-level ICU in Bangladesh. The intervention is designed to strengthen nurses' clinical reasoning, knowledge, clinical practice, and nurse-physician collaboration in the care of mechanically ventilated patients.
The study will also examine whether improvements in nursing competency and collaborative clinical decision-making are associated with improved patient outcomes.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Sequential
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •For nurses:
- •Registered nurses employed in the ICU at the time of enrollment
- •Involved in direct patient care
- •Willing to participate and provide informed written consent
- •For Patients:
- •Age ≥18 years
- •Patients receive mechanical ventilation for at least ≥ 48 hours
- •Legal guardian of the patients who will provide informed written consent
排除标准
- •For nurses:
- •Nurses on long-term leave and study leave during the intervention period
- •Nurses working exclusively in administrative or managerial roles
- •Nurses who did not complete the pre-test assessment
- •For Patients:
- •Patients mechanically ventilated for less than 48 hours.
- •Patients who have already developed VAE or VAP at ICU admission
- •Patients with end-stage renal disease on chronic dialysis prior to ICU admission
- •Readmissions to ICU during the same hospital stay
研究组 & 干预措施
Historical Control group-Eligible mechanically ventilated ICU patients with usual standard care
Eligible mechanically ventilated ICU patients received usual standard ICU care before implementation of the intervention. Historical patient data will be collected from medical records. ICU nurses will be assessed at baseline before receiving the intervention. No study intervention was administered during this phase.
Experimental-Eligible mechanically ventilated ICU patients with intervention
ICU nurses will receive evidence-based respiratory and renal care training with case-based discussion to strengthen clinical reasoning, nurse-physician collaboration, and application of evidence-based ICU care. Eligible mechanically ventilated ICU patients will receive evidence based care after implementation of the intervention, and their outcomes will be measured.
干预措施: evidence-based respiratory and renal care training with case-based discussion (Behavioral)
结局指标
主要结局
Incidence Rate of Ventilator-Associated Events
时间窗: During the 2-month pre-intervention and the 2-month post-intervention observation period
The incidence rate of ventilator-associated events (VAE) among eligible mechanically ventilated ICU patients will be calculated as the number of VAE cases divided by the total number of ventilator days, multiplied by 1,000. VAE incidence will be compared between the pre-intervention and post-intervention periods.
Change in Clinical Reasoning Competency Score
时间窗: Baseline, midline, and 2-month post-intervention follow-up (endline)
Clinical reasoning will be measured among participating ICU nurses using the 22-item Clinical Reasoning Competency Scale developed by Bae et al. (2023). Each item is rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), with a total score ranging from 22 to 110. Higher scores indicate greater clinical reasoning competency. The total CRCS score will be assessed at baseline, midline, and endline. Baseline assessment will be conducted before the intervention, midline assessment will be conducted during the intervention period, and endline assessment will be conducted 2 months after completion of the intervention as a post-intervention follow-up. Changes in clinical reasoning competency across the three assessment time points will be evaluated.
次要结局
- Change in Knowledge Score(Baseline, immediately post-intervention (midline), and 2-month post-intervention follow-up (endline))
- Change in Nurses Practice Score(Baseline, immediately post-intervention (midline), and 2-month post-intervention follow-up (endline))
- Incidence Rate of Ventilator-Associated Pneumonia(During the 2-month pre-intervention and the 2-month post-intervention observation period)
- Incidence of Acute Kidney Injury(During the 2-month pre-intervention and the 2-month post-intervention observation period)
- ICU Mortality(During the 2-month pre-intervention and the 2-month post-intervention observation period)
- Duration of Mechanical Ventilation(During the 2-month pre-intervention and the 2-month post-intervention observation period)
- ICU Length of Stay(During the 2-month pre-intervention and the 2-month post-intervention observation period)
- Change in Nurse-Physician Collaboration Score(Baseline, immediately post-intervention (midline), and 2-month post-intervention follow-up (endline))
研究者
MINA AKTER
Principal Investigator
Hiroshima University