• Jessica A Schults, Marie Cooke, Debbie Long, and Marion L Mitchell.
• Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, Queensland, Australia; Menzies Health Institute, Griffith University, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Critical Care Research Group, Lady Cilento Children's Hospital, Queensland, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Queensland, Australia. Electronic address: j.schults@griffith.edu.au.
• Aust Crit Care. 2019 Jan 1; 32 (1): 13-19.

BackgroundThe complex nature of the Paediatric Intensive Care Unit (PICU) patient requires the bedside nurse to make rapid, complex decisions regarding endotracheal suction (ETS) interventions. It is not understood what influences nurses' decision making in the context of ETS, however, the actions of the clinician have a direct impact on the efficacy of the ETS event and patient outcomes.ObjectivesTo explore and describe the use of normal saline instillation and lung recruitment with paediatric ETS in a cohort of Australian nurses, and to identify factors that influence normal saline use with ETS.MethodsA descriptive, exploratory study. An evidence-based practice model formed the conceptual basis for the study. Semi-structured interviews were conducted with 12 nurses from an Australian tertiary referral paediatric intensive care unit. Audiotaped interviews were transcribed. Inductive thematic analysis was used to code and analyse the interview data and identify themes.FindingsData analysis revealed three themes: patient's clinical presentation, clinician judgement and unit practice norms.ConclusionsVariability in nurses ETS practice was marked. In the absence of evidence based clinical guidelines, nurses relied on knowledge derived from clinical experience and the local setting to guide NSI and LR intervention decisions. Participants reported uncertainty regarding ETS best practice and perceived the lack of research evidence as a barrier to making informed clinical decisions at the bedside. Rigorous research evaluating the safety and efficacy of NSI and LR with ETS is urgently required for patient care; however PICU nurses rely on multiple sources of evidence to inform ETS practice decision.Copyright © 2018 Australian College of Critical Care Nurses Ltd. All rights reserved.

25 keywords...

hide…