Question

You are a staff nurse working in an intensive care unit and assigned to care for a 75-year-old man who had coronary artery bypass graft surgery 4 days ago. The patient has a history of chronic obstructive pulmonary disease exacerbated by heavy smoking. His postoperative course has been difficult, and he has suffered a number of setbacks. The staff, despite their diligent efforts, have not been able to wean him off the ventilator since the surgery. He has required frequent suctioning throughout the shift, and he is being evaluated for the development of ventilator-associated pneumonia. Today, when returning from lunch, you observed that an experienced nurse was suctioning your patient. His secretions were thick, and you observed that the nurse was instilling saline into the patient’s endotracheal tube as she was suctioning him. The patient turned red and began coughing, and it was obvious he was in distress. You asked the nurse why she was instilling saline into his endotracheal tube. She replied that this was being done to loosen the secretions. You told her this was no longer an acceptable practice. She stated that she had lots of critical care experience and she didn’t care what anyone said, that the only way you could loosen the patient’s secretions would be to instill saline. She also said that would be the last time she would do something for one of your patients while you were at lunch

Questions: 4. What strategies would you use to search for evidence related to best practices for suctioning and whether the instillation of saline while suctioning is an acceptable technique?

6. Identify a source for grading the level of evidence located.

7. What are potential barriers to the utilization of research findings in this setting? a. The research itself b. Clinician c. Organization d. Presentation

8. What are potential resources in your institution to help with the translation of research into practice?

9. Who are potential community partners to assist with addressing this clinical practice problem?

10. Assuming that you located evidence to support the position that instilling saline into an endotracheal tube is ineffective, what would be included in a plan to translate research into practice in the intensive care unit? In the rest of the hospital?

11. What strategies would you use to determine whether indeed nurses and other healthcare professionals are adhering to the recommended practices for endotracheal suctioning?

12. What would you do if you found contradictory evidence regarding the instillation of saline before endotracheal suctioning such as increased dyspnea with saline instillation, but lower rates of ventilator-associated pneumonia?

Answer 1

4. Strategies :-

1) Formulate a clear review question

2) Search the literature for relevant clinical articles and evidence

3) Critically appraise the evidence

4) Implement the evidence

5) Evaluate the impact of the evidence

6. The GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) is a method of assessing the certainty in evidence .

7. The potential barriers to the utilization of research findings in the setting is option C ) organisation .

8. The potential sources required for translation of research to practice are :-

- good supply of resources

- enough working staffs

- provision of incentives

- adopts innovation

- have motivation and interest to change