Intensive care nurses’ perceptions of the continuing education regarding mechanical ventilation at a major regional tertiary-referral hospital in Australia
Author(s)Guilhermino, Michelle Copede
Contributor(s)University of Newcastle. Faculty of Health & Medicine, School of Nursing and Midwifery
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AbstractResearch Doctorate - Doctor of Philosophy (PhD)
Mechanical Ventilation is arguably one of the most common practices in Intensive Care Units and one of the main reason patients need admission to Intensive Care. The research in this thesis focuses on the provision of structured continuing education on mechanical ventilation undertaken in the clinical workplace as a component of nurses’ continuing professional development. A systematic review of the literature was conducted to determine whether the implementation of continuing education on mechanical ventilation for intensive care nurses results in the transfer of learning beyond the individual level and towards better patient outcomes. The aim of the review was to appraise and establish the best available evidence on the effectiveness of education programs that resulted in the improvement of patient outcomes. The next step taken in the research was the investigation of : (1) the role that intensive care unit nurses play in managing ventilated patients; (2) the knowledge registered nurses have about mechanical ventilation after finishing the undergraduate course in Australia; (3) and the quality of continuing education on mechanical ventilation at a post-registration level concerning building on, and maintaining nurses’ knowledge and skills looking after ventilated patients, and potentially influencing patient outcomes. This thesis reports the results of a sequential, two phase mixed methods study, which includes a cross-sectional study (Phase One), followed by individual interviews and focus groups (Phase Two). The research aims are to describe the provision of the continuing education program on mechanical ventilation provided at a major tertiary referral hospital, to explore the intensive care unit nurses’ perceptions of this education, their views of their scope of practice, to identify the barriers and motivators to participating in continuing education, and to investigate the nurses’ recommendations for improvement or change in the program. The research setting during Phase One and Two was a 22 bed intensive care unit of a large, regional tertiary referral hospital in Australia, which employed approximately 160 registered nurses. For Phase One applied in 2011, all nurses from the study intensive care unit were sampled for the survey and asked about their perception of the continuing education on invasive mechanical ventilation with focus on two main components: a <i>Self-directed learning package (SDLP) titled Adult ventilation management and the Recognition in Prior Professional Learning, Experiences, and Skills program (RIPPLES) – titled Care of a ventilated patient in intensive care</i>. The results of Phase One were used to inform Phase Two which was undertaken in 2015 where all nurse managers and nurse educators were sampled for individual interviews and three focus groups with purposively selected samples of expert, experienced and novice intensive care unit nurses were undertaken. The interviews and focus groups explored in-depth the managers’ educators’, and intensive care nurses’ overall perceptions of the continuing education on mechanical ventilation to provide a broader and more comprehensive picture of the phenomenon. The survey addressed content, methods of education, learning styles, factors associated with the completion of the main educational components, and the nurses’ recommendations on the continuing education on invasive mechanical ventilation. The data was collected through a mix of structured closed questions and fewer open-ended questions, where respondents could provide more detailed answers as a better way of getting to the nuances of opinions, which sometimes may be missed when only structured questions with limited responses, are used. Descriptive statistics and multivariate statistical tests were used to analyse the quantitative component, whereas content analysis was used for the open-ended questions. The interviews and focus groups explored in-depth the survey findings and portrayed mechanical ventilation as a whole topic including invasive and non-invasive ventilation. In addition, they included the nurse’s perception of: (1) how important they though this education was, (2) the program and support available for all levels of nursing experience, (3) the responsibility for continuing professional development, and (4) the nurses’ role when looking after ventilated patients. The interview and focus group data were collected by the Candidate using semi-structured and open-ended questions and interpreted using thematic analysis. The findings from the systematic review shows limited empirical evidence of the effectiveness of the continuing education on invasive mechanical on patient outcomes. Phase One and Two suggests there is a mechanical ventilation knowledge gap between students finishing the undergraduate Bachelor of Nursing course and becoming a registered nurse in intensive care. Thus, nurses rely strongly on continuing education provided by their workplace to guarantee patient safety and currency with evidence based practice in the intensive care setting. The two main components used for the continuing education on invasive mechanical ventilation were perceived to be valuable and beneficial. However, experienced nurses perceived them to be relevant mostly at an introductory level. Overall, intensive care unit nurses perceived that the education delivered matched their learning style and acknowledged the diverse education programs available, but they perceived that more interactive and hands-on practice education such as bedside teaching should be more available. Nurses managers’ and nurses educators’ support was viewed as a necessity to increase nurses’ participation in workplace education opportunities, and more funded study days should be offered. Managers and educators on the other hand, perceived that nurses should be willing to participate in education opportunities outside their working hours in their own time. Experienced nurses perceived that most of education opportunities targeted novice nurses. In addition, managers and educators reported more difficulty engaging with experienced nurses about their learning needs and education opportunities than with novice nurses. The intensive care unit nurses, independent of their role and job position perceived that most of the ventilated patient management was within the nurses’ scope of practice. However, managers and educators were hesitant as to whether this scope of practice was supported by the national nursing board and critical care nurse association. Nurses’ autonomy was dependent on organization structure, nurses’ knowledge and individual characteristics. Finally, ICU nurses, managers and educators agreed that nurses have responsibility for their own education and professional development; however, ICU nurses perceived that managers and educators had to facilitate and provide education opportunities and resources for them. In conclusion, this work indicates a need for improvements in the continuing education on mechanical ventilation to match all nurses’ level of experience, and to increase nurses’ participation, especially experienced nurses. Three other points are also important, namely the provision of more interactive teaching activities, more funding to support nurses’ education, and more detailed regulation regarding the ICU nurse’s scope of practice for the management of ventilated patients. These conclusions, along with the detailed analysis of the survey, interviews and focus group responses, might be a valuable source of information for nurses managers, educators, and other health stakeholder involved in the provision of continuing education on mechanical ventilation in similar ICU environments, both in Australia and overseas.