The Impact of Group Reflection on Preventive Behaviors for Ventilator Associated Pneumonia Among ICU Nurses

Mohadese Habibollahi, Mahdi B.Moghaddam, Farid Zand3,, Mehrsa Basiri Moghadam

Abstract


Background: Reflection is a fundamental component of nursing education and professional practice. This study aimed to evaluate the impact of structured group reflection sessions on ICU nurses’ adherence to Ventilator‑Associated Pneumonia (VAP) prevention practices. Materials and Methods: This quasiexperimental study a total of 44 ICU nurses from Namazi Hospital in Shiraz, Iran, participated. Two ICUs were randomly selected. The intervention consisted of four group reflection sessions, each comprising 7–8 participants, conducted over 2 weeks and guided by VAP prevention protocols. Nurses’ performance was assessed before the intervention and at 1, 4, and 8 weeks afterward using the Behesht Aeen checklist. Data were analyzed using SPSS v. 16. Results: The findings revealed that the intervention group demonstrated a significant improvement and an upward trajectory in all dimensions of nurses’ performance across the postintervention follow‑up periods (p < 0.001). In sharp contrast, the control group’s performance remained stable across all time points (p > 0.05) for all dimensions, with the sole exception being endotracheal tube protection. One week after the intervention, the control group scored 18.13 (5.30), whereas the intervention group scored 28.59 (1.65) (t42= −12.64, p < 0.001(. This divergence was maintained at 4 weeks, with scores of 17.22 (3.71) for the control group and 30.00 (1.77) for the intervention group (U42 = 00.00, p < 0.001(. At eight weeks later, the scores were 15.86 (3.94) for the control group and 29.31 (1.49) for the intervention group (U42 = 00.00, p < 0.01). Conclusions: The findings indicate that structured group reflection sessions are an effective educational strategy to enhance ICU nurses’ preventive behaviors for VAP, thereby improving clinical performance and quality of care

Keywords


Group reflection, infection control, intensive care unit, nurses, performance, prevention, ventilator‑associated pneumonia

Full Text:

PDF

References


Alslamah T, Abalkhail A. The national strategies for and challenges in infection prevention and control of the healthcare system in the Kingdom of Saudi Arabia (Review Study). Expert Rev Vaccines 2022;10:1302.

Jain V, Vashisht R, Yilmaz G, Bhardwaj A. Pneumonia pathology. StatPearls. Treasure Island, FL: StatPearls Publishing; 2024.

Iosifidis E, Pitsava G, Roilides E. Ventilator associated pneumonia in neonates and children: A systematic analysis of diagnostic methods and prevention. Future Microbiol 2018;13:1431 46.

Kepekci A. Ventilator associated pneumonia rates and distribution of causative microorganisms in the second stage intensive care unit. Int Med J 2020;9:635 39.

Papazian L, Klompas M, Luyt C. Ventilator associated pneumonia in adults: A narrative review. Intensive Care Med 2020;46:888 906.

Noorifard M, Farahani RH, Hazrati E. The incidence and risk factors of ventilator associated pneumonia in ICU. Acta Med Iran 2020;58:439 44.

Jam R, Mesquida J, Hernández Ó, Sandalinas I, Turégano C, Carrillo E, et al. Nursing workload and compliance with non pharmacological measures to prevent ventilator associated pneumonia: A multicentre study. Nurs Crit Care 2018;23:291 8.

Munro S, Haile Mariam A, Greenwell C, Demirci S, Farooqi O, Vasudeva S. Implementation and dissemination of a department of veterans affairs oral care initiative to prevent hospital acquired pneumonia among nonventilated patients. Nurs Adm Q 2018;42:363 72.

Jeengar RK, Choudhary B, Khera D, Singh S, Purohit SP, Singh K. Ventilator associated pneumonia bundle of care training of nursing officers using simulation and its impact on their knowledge and incidence of ventilator associated pneumonia: A quasi experimental study. J Pediatr Intensive Care 2021;13:168 73.

Aloush SM. Nursing students’ knowledge about ventilator associated pneumonia prevention guidelines: Effectiveness of a teaching program. Am J Infect Control 2017;45:544 6.

Nikbakht S, Hejazi SS, Azizi TH, Kameli A, Pour AK, RoshanNezhad M. Effect of text messaging via cell phone on the knowledge of critical care nurses regarding ventilator associated pneumonia. Evid Based Care 2022;11:63 70.

Rahimi M, Haghani F. Reflection in medical education: A review of concepts, models, principles and methods of teaching reflection in medical education. Res Med Educ 2017;9:13 24. (in Persian). Available from: http://rme.gums.ac.ir/article-1-499-en. html. [Last accessed on 2026 Mar 06].

Patel KM, Metersky K. Reflective practice in nursing: A concept analysis. Int J Nurs Knowl 2022;33:180 7.

Ingham Broomfield B. A nurses’ guide to using models of reflection. Aust J Adv Nurs 2021;38:384 95.

Anvari HM, Eidy M, Montazer M, Alvandfar D. Impact of nurses’ training based on clinical guidelines on the prevention of ventilator associated pneumonia in ICU. IJNR 2019;14:35 42. (in Persian). Available from: http://ijnr.ir/article-1-2184-en.html. [Last accessed on 2026 Mar 06].

Aeen FB, Zolfaghari M, Noghabi AA, Mehran A. Nurses’ performance in prevention of ventilator associated pneumonia. J Hayat 2013; 19:17 27. (in Persian). Available from: http:// hayat.tums.ac.ir/article-1-612-en.html. [Last accessed on 2026 Mar 06].

Goljabini S, Maslakpak MH, Khalkhali H, Valizadeh H. Effect of education based clinical guidelines on function of nurses in the prevention of ventilator associated pneumonia (VAP). Nurs Midwifery J 2017;15:559 66. (in Persian). Available from: http://unmf.umsu.ac.ir/ article-1-2839-en.html. [Last accessed on 2026 Mar 06].

Vahedi S, Davoudi B. Effect of clinical guideline based education on practice of nurses in the prevention of ventilator associated pneumonia (VAP) in ICU Tabriz University of Medical Sciences. Eurasian J Chem Med Pet Res 2024;3:1431 41.

Al Fazli HK, Manzari ZS, Adai Al Jubouri MG. Effect of a training package for the prevention of ventilator associated pneumonia using a blended online learning method on the knowledge and performance of nurses working in the intensive care unit. J Med Edu Dev 2024;17:89 100. Available from: http:// edujournal.zums.ac.ir/article-1-1701-en.html. [Last accessed on 2026 Mar 06].

Alvina A, Afzal M, Ali A. Effect of educational guidelines on nurses’ knowledge and practices regarding ventilator associated pneumonia at tertiary care hospital Lahore: Practices regarding ventilator associated pneumonia. Pak J Health Sci 2023;4:104 7.

El Sayed S, Khalil A, Elkazaz R. Effect of an educational program for nurses about prevention of ventilator associated pneumonia in neonatal intensive care units. Port Said Sci J Nurs 2023;10:236 62.

Golaghaie F, Asgari S, Khosravi S, Ebrahimimonfared M, Mohtarami A, Rafiei F. Integrating case based learning with collective reflection: Outcomes of inter professional continuing education. Reflect Pract 2019;20:42 55.

Aloush SM. Does educating nurses with ventilator associated pneumonia prevention guidelines improve their compliance? Am J Infect Control 2017;45:969 73.


Refbacks

  • There are currently no refbacks.