The Development and Evaluation of Clinical Nursing Practice Guidelines for Preventing Unplanned Extubation in Critically Ill Patients

Abstract

This study employed a research and development design to develop and evaluate nursing practice guidelines for the prevention of unplanned extubation (UE). The sample was purposively selected and consisted of 12 registered nurses and 110 intubated patients admitted to the medical intensive care units. The patients were divided into three groups: the pre-intervention group (n=40), the post-intervention group (n=40), and the post-adjustment group (n=30), in which adjustments were made to the practice guidelines regarding the assessment of movement behavior. The research instruments included: the evidence-based nursing practice guideline, a knowledge assessment tool for UE prevention, and a nurse satisfaction questionnaire regarding the practice guidelines, with content validity indices of 0.98, 0.76, and 0.93, respectively. The reliability coefficients demonstrated 0.85 for the knowledge assessment using KR-20 and 0.84 for the satisfaction questionnaire using Cronbach’s alpha. Data were analyzed by descriptive statistics, Fisher’s exact test, and repeated measures ANOVA.

The results showed that the incidence of UE among patients in the post-intervention and the post-adjustment groups was significantly lower than in the pre-intervention group (p = .01). Nurses’ knowledge scores significantly increased (F (2,22) = 16.84, p = .001). Pairwise comparisons indicated that knowledge scores of the post-intervention were significantly higher than the pre-intervention (p = .031), post-adjustment scores were significantly higher than the pre-intervention scores (p = .001), and the post-adjustment scores (p = .021). Nurses’ satisfaction with the practice guideline was at a high level, accounting for 100%.