Performance of ICU Nurses in Providing Respiratory Care

Ahmadreza Yazdannik, Vajihe Atashi, Somayeh Ghafari


Background: Failure to provide proper respiratory care leads to incidence of certain complications such as ventilator‑associated pneumonia. Nurses have a crucial role in providing this care. The aim of this study is to assess the performance of ICU (Intensive Care Unit) nurses in providing respiratory care.

Materials and Methods: The present descriptive cross‑sectional study recruited 120 nurses working in selected hospitals affiliated to Isfahan University of Medical Sciences from March to August 2016. The questionnaire used included demographic and employment details and performance observation checklist (containing 39 items in four care domains) based on recommendations in clinical guidelines. The performance of each nurse during a working shift was observed. Data were analyzed by SPSS 18, using tables of frequency, mean, and standard deviation.

Results: According to the results obtained, mean (SD) total performance score of nurses in providing respiratory care was 15.46 (2.16). The highest score was obtained in preventing contamination of respiratory equipment 5 (0), and the lowest score was in oral care 0.68 (0.73).

Conclusions: Considering that respiratory care is one of the main pillars of patient care in ICU and that nurses scored poorly in this area, it is imperative to pay greater attention to this area. It is essential to provide necessary training to nurses and adequate facilities for improving the quality of clinical care.


Intensive care unit, nursing, respiratory care

Full Text:



Sole ML, Klein DG, Moseley MJ. Introduction to critical care nursing6: Introduction to Critical Care Nursing: Elsevier Health Sciences; 2013.

Khorasgan I. A survey on nursing process barriers from the nurses’ view of intensive care units. Iran J Crit Care Nurs 2011;4:181‑6.

Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, et al. Guidelines for the management of adult lower respiratory tract infections‑Full version. Clin Microbiol Infect 2011;17:E1‑59.

Hov R, Hedelin B, Athlin E. Good nursing care to ICU patients on the edge of life. Intensive Crit Care Nurs 2007;23:331‑41.

Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT, et al. Attributable mortality of ventilator‑associated pneumonia: A meta‑analysis of individual patient data from randomised prevention studies. Lancet Infect Dis 2013;13:665‑71.

Goutier JM, Holzmueller CG, Edwards KC, Klompas M, Speck K, Berenholtz SM. Strategies to enhance adoption of ventilator‑associated pneumonia prevention interventions: A systematic literature review. Infect Control Hosp Epidemiol 2014;35:998‑1005.

Behesht Aeen F, Zolfaghari M, Asadi Noghabi AA, Mehran A. Nurses’ performance in prevention of ventilator associated pneumonia. Journal of Hayat 2013;19:17‑27.

Dehghani K, Nasiriani K, Mousavi T. Investigating intensive care unit nurses’ performance and its adjusting with standard. SSU Journals 2014;21:808‑15.

Zolfaghari M, Behesht‑Aeen F, Asadi‑Noghabi A, Mehran A. Effects of active and passive implementation of ventilator associated pneumonia guideline on nurses’ performance in critical care units: A controlled clinical trial. Nursing Practice Today 2015;1:126‑34.

Jordan A, Badovinac A, Špalj S, Par M, Šlaj M, Plančak D. Factors influencing intensive care nurses’ knowledge and attitudes regarding ventilator‑associated pneumonia and oral care practice in intubated patients in Croatia. Am J Infect Control 2014;42:1115‑7.

Lim KP, Kuo SW, Ko WJ, Sheng WH, Chang YY, Hong MC, et al. Efficacy of ventilator‑associated pneumonia care bundle for prevention of ventilator‑associated pneumonia in the surgical intensive care units of a medical center. J Microbiol Immunol Infect 2015;48:316‑21.

Aysha ZM, El‑Din SM, Attia NR, Ibrahim M. Efficacy of implementing nursing care protocol on the incidence of ventilator associated pneumonia in Intensive Care Unit at Tanta emergency hospital. Journal of American Science 2016;12.

Sinuff T, Muscedere J, Cook DJ, Dodek PM, Anderson W, Keenan SP, et al. Implementation of clinical practice guidelines for ventilator‑associated pneumonia: A multicenter prospective study. Crit Care Med 2013;41:15‑23.

Kollef MH, Hamilton CW, Ernst FR. Economic impact of ventilator‑associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol 2012;33:250‑6.

Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, et al. Health care‑associated infections: A meta‑analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039‑46.

Koulenti D, Tsigou E, Rello J. Nosocomial pneumonia in 27 ICUs in Europe: Prespective from the EU‑VAP/CAP study. Eur J Clin Microbiol Infect Dis 2016.

Dessap AM, Katsahian S, Roche‑Campo F, Varet H, Kouatchet A, Tomicic V, et al. Ventilator‑associated pneumonia during weaning from mechanical ventilation: Role of fluid management. Chest 2014;146:58‑65.

Gallagher JA. Implementation of ventilator‑associated pneumonia clinical guideline (Bundle). The Journal for Nurse Practitioners 2012;8:377‑82.

Ban KO. The effectiveness of an evidence‑based nursing care program to reduce ventilator‑associated pneumonia in a Korean ICU. Intensive Crit Care Nurs 2011;27:226‑32.

Ruffell A, Adamcova L. Ventilator‑associated pneumonia: Prevention is better than cure. Nurs Crit Care 2008;13:44‑53.

Akın Korhan E, Hakverdioğlu Yönt G, Parlar Kılıç S, Uzelli D. Knowledge levels of intensive care nurses on prevention of ventilator‑associated pneumonia. Nurs Crit Care 2014;19:26‑33.

Hughes JM, Cardo DM, Cohen ML. Guidelines for preventing health‑care‑associated pneumonia, 2003 recommendations of the CDC and the Healthcare Infection Control Practices Advisory Committee. Respir Care 2004;49:926‑39.

Campaign ML. Getting started kit: Prevent ventilator‑associated pneumonia how‑to guide. Cambridge: Institute for Healthcare Improvement, 2008.

Hong SW, Yin P, Leung HP, Cho J, Man R. Recommendations on prevention of ventilator‑associated pneumonia. Hong Kong Centre for Health Protection; June 2010, 2010.

Rotstein C, Evans G, Born A, Grossman R, Light RB, Magder S, et al. Clinical practice guidelines for hospital‑acquired pneumonia and ventilator‑associated pneumonia in adults. Can J Infect Dis Med Microbiol 2008;19:19‑53.

Group SW. Guidelines for the prevention of ventilator‑associated pneumonia in adults in Ireland: HSE Health Protection Surveillance Centre (HPSC); 2011.

Yazdani M. Comparison of Clinical Training Guide prevention of ventilator‑associated pneumonia in two ways: Face‑to‑face workshop, the knowledge and practice of nurses working in intensive care in: Lorestan; 2013.

Turkestani F, Dietz J, Kim Y, Vines D, Dubosky M. Oral care kits used during mechanical ventilation in the intensive care unit (ICU): A retrospective comparison of outcomes. Age (yr) 2016;60:61‑15.

Adib‑Hajbaghery M, Ansari A, Azizi‑Fini E. Oral care in ICU patients: A review of research evidence. KAUMS Journal (FEYZ) 2011;15:280‑93.

Yeung KY, Chui YY. An exploration of factors affecting Hong Kong ICU nurses in providing oral care. J Clin Nurs 2010;19:3063‑72.

Jansson M, Ala‑Kokko T, Ylipalosaari P, Syrjälä H, Kyngäs H. Critical care nurses’ knowledge of, adherence to and barriers towards evidence‑based guidelines for the prevention of ventilator‑associated pneumonia‑A survey study. Intensive Crit Care Nurs 2013;29:216‑27.

Mol D, De Villiers G, Claassen A, Joubert G. Use and care of an endotracheal/tracheostomy tube cuff‑are intensive care unit staff adequately informed? S Afr J Surg 2004;42:14‑6.

Kelleher S, Andrews T. An observational study on the open‑system endotracheal suctioning practices of critical care nurses. J Clin Nurs 2008;17:360‑9.

Ansari A, Masoudi Alavi N, Adib‑Hajbagheri M, Afazel M. The gap between knowledge and practice in standard endo‑tracheal suctioning of ICU nurses, Shahid Beheshti Hospital. Journal of Critical Care Nursing 2012;5:71‑6.

Thompson DR, Chan D, Chung L, Au WL, Tam S, Fung G, et al. An evaluation of the implementation of a best practice guideline on tracheal suctioning in intensive care units. Int J Evid Based Healthc 2007;5:354‑9.

Sole ML, Bennett M, Ashworth S. Clinical indicators for endotracheal suctioning in adult patients receiving mechanical ventilation. Am J Crit Care 2015;24:318‑24


  • There are currently no refbacks.