Assessing Nursing Students Knowledge on Mechanical Ventilation Patient Care: A Cross-Sectional Study

INTRODUCTION

Mechanical ventilation (MV) is a critical intervention for approximately one-third of patients admitted to intensive care units (ICUs) worldwide, assisting in breathing and oxygenation when patients are unable to do so independently due to severe injuries or critical conditions.^[1] While MV can be life-saving, it also presents various side effects and complications.^[2] Nurses play a crucial role in the care of patients reliant on mechanical ventilation, ensuring proper monitoring and adjustment of ventilator settings, recognizing and managing complications, providing emotional support to patients and their families, and coordinating care with a multidisciplinary team.^[3] Their expertise is vital for optimizing patient outcomes and ensuring safe and effective ventilation therapy.^[4] Multiple studies indicate that approximately two to three million ICU patients globally require mechanical ventilation annually, with associated costs ranging from $15 to $27 billion.^[5] These patients are at an increased risk for complications and adverse outcomes, including mortality. Complications such as ventilator-associated infections, acute respiratory distress syndrome, and pulmonary embolism contribute to increased mortality among ventilated patients. These complications often result in prolonged mechanical ventilation duration, extended ICU and hospital stays, escalated healthcare expenses, and heightened risks of disability and death. Mortality rates among mechanically ventilated patients vary, ranging from 24% for individuals aged 15 to 19 years to 60% for those aged over 85 years. Nurses are the first-line caregivers for ventilated patients, and they must recognise and address complications associated with mechanical ventilation.^[6] Research indicates that nurses in ICUs worldwide generally have limited knowledge about mechanical ventilation, even in developed countries with advanced nursing education.^[7] This study aims to gain further insights into the understanding of nursing students regarding the management of mechanically ventilated patients. Patients undergoing mechanical ventilation face a range of risks and complications, including infections like ventilator-associated pneumonia (VAP), which constitutes up to 47% of ICU infections.^[8] VAP extends ICU stays and increases mortality risk in critically ill patients. In India, the incidence of VAP has varied over different periods, with data from the National Nosocomial Infections Surveillance System showing median occurrences ranging from 2.2 to 14.7 cases per 1,000 patient-days of mechanical ventilation in adults.^[9] Mechanically ventilated patients are also at risk for pneumothorax, with prevalence rates up to 38%. A 2013 retrospective cohort study at a tertiary academic centre found that among 20,356 mechanically ventilated patients, 5.6% developed ventilator-associated conditions (VAC), 2.1% experienced infection-related VAC, 0.7% had possible VAP, and 0.6% had probable VAP.^[10] These complications were associated with prolonged intubation, extended hospital stays, and increased mortality risk. In modern medical and nursing practices, the care of critically ill patients is of paramount importance.^[11] Nurses play a crucial role in enhancing the efficiency of mechanical ventilation, mitigating risks, and improving patient outcomes.^[12] A comprehensive understanding among nurses and nursing students regarding the management of mechanically ventilated patients is crucial for optimizing the benefits of ventilator assistance while minimizing potential complications.^[13] Studies suggest that nurses globally lack sufficient understanding of caring for patients on mechanical ventilation, even in regions with advanced nursing education systems. Therefore, this research is significant as it seeks to reveal further insights into the proficiency levels of nursing students in caring for ventilated patients.^[14]

MATERIAL AND METHODS

A descriptive cross-sectional study was conducted at a selected nursing college in Mangaluru, where a total of 226 nursing students were enrolled using the universal sampling technique. Permission was obtained from the institutional ethics committee (NUINS/CON/NU/IEC/2023-24/1706) on May 9, 2023. The study employed a demographic proforma with five items and a 25-item knowledge questionnaire. The questionnaire consisted of 25 multiple-choice questions related to the care of mechanical ventilators. Each correct response was awarded 1 point & incorrect answers or no responses were awarded 0 points. The total score ranged from 0 to 25, with higher scores indicating better knowledge. Based on the total score, students' knowledge levels were classified as follows. Excellent Knowledge Scores between 17 to 25, Average Knowledge Scores between 8 to 16, & Poor Knowledge Scores below 7. Students who had not been exposed to patients on ventilators were excluded from the study.

All the tools, including the demographic proforma and knowledge questionnaire, were validated by five subject experts to establish content validity. A pilot study was conducted with 226 nursing students, and the instruments were found to be reliable, with a Cronbach's alpha value of 0.73. This process helped finalize the tools for the main study.

RESULTS

Analysis involves organizing and synthesizing data to answer the research question and test the hypothesis. It helps address the research question and objectives framed by the researcher. This study employs a quantitative research design. A total of 226 nursing students participated in the study. Demographic characteristics were recorded for each participant, followed by data collection using various tools. The collected data were arranged, analysed, and interpreted using descriptive statistics such as frequency and percentage. The association between demographic variables and knowledge was examined using the chi-square test.

The following represents the frequency and percentage of baseline demographic characteristics. Table 1 illustrates that out of a total of 226 participants, the majority (81%) were female, while only 19% were male. Among all the participants, 39% were from the 4th year of BSc Nursing, 41.6% were from the 5th semester of BSc Nursing, and 19% were from the 3rd year of GNM Nursing. The table depicts that the majority of participants (70.8%) had ICU exposure for more than 9 days, while 13.3% had ICU exposure for 7-9 days, and 15.9% had ICU exposure for 3-6 days. All 226 participants (100%) had some previous knowledge regarding the care of patients on mechanical ventilation. Table 1 also shows that the primary source of knowledge for all participants (100%) was their ICU experiences. In this study, the majority of participants, comprising 81%, were female, while 19% were male. Similarly, a study assessing nurses' knowledge reveals that 71% of the participants were female, while 29% were male. However, a study conducted on “knowledge regarding mechanical ventilation and practices of ventilatory care among nurses working in ICU in selected government hospitals in Addis Ababa” indicates that a majority of the participants, precisely 51.4%, were male. Regarding educational backgrounds, 39.2% of the participants in our study were studying in the 4th year of BSc nursing, 41.6% were in the 5th semester of BSc nursing, and 19% were pursuing GNM nursing and study conducted to evaluate the nursing students ‘understanding regarding patient care during mechanical ventilation and prevention of ventilated associated infection at Selected Nursing College revealed that there is equal distribution of 21 participants from each academic year (2nd year and 3rd year BSc nursing) 31 In the category of previous knowledge 100% of the students has answered yes in our present study but in the study conducted to assess knowledge of 3rd year BSc nursing on MV showed that 62% of student answered ‘no’ and 38% say ‘yes’. Present study showed that maximum (70.8%) participants have exposure to ICU more than 9 day while 13.3% of the participants has ICU exposure of 7-9 days and remaining students (15.9%) has ICU exposure of 3-6 days however study showed that majority (45.2%) of students has 2-4 weeks of ICU experience and only 9.5% had more than 6 weeks of ICU experience. In this study maximum [100%] of the participants have previous knowledge on the care of patients on MV due to ICU exposure, but in study shows that 57.5% of nurses had participated in the training related to MV, and 42.5% have not participated in any training on MV.

The knowledge levels of nursing students, categorized into three levels: poor, average, and excellent. In this study, 53.7% (121) of participants demonstrated excellent knowledge, 42.3% (96) showed average knowledge, and 4% (9) exhibited poor knowledge. Conversely, another study revealed that among 100 pre-test samples, 9% had poor knowledge, 87% had adequate knowledge, and 4% had good knowledge. Similarly, a study evaluating the knowledge of student nurses about the care of patients on mechanical ventilation (MV) and the prevention of ventilator-associated pneumonia (VAP) at a selected nursing college showed that the majority (57.1%) of students had good knowledge, 4.8% had excellent knowledge, 35.7% had average knowledge, and only 2.4% had poor knowledge on VAP prevention.

Table 2 presents the knowledge levels of various nursing student batches. Overall, it indicates that 4th-year BSc nursing students have a greater number of students with excellent knowledge compared to 5th-semester BSc and 3rd-year GNM nursing students. In the 4th-year BSc group, out of 89 participants, 71.9% (64) have excellent knowledge, 27% (24) have average knowledge, and only 1.1% (1) have poor knowledge regarding MV. In the 5th-semester BSc group, among 94 participants, 52.1% (49) have excellent knowledge, 44.7% (42) have average knowledge, and 3.2% (5) have poor knowledge. In the 3rd-year GNM group, only 18.6% (8) of the participants demonstrated excellent knowledge, 69.8% (30) had average knowledge, and 11.6% (5) had poor knowledge.

DISCUSSION

The results of this study provide valuable insights into the knowledge of nursing students regarding the care of patients on MV. The findings indicate that the majority of students possess good to excellent knowledge, with 53.7% of participants scoring in the excellent knowledge range. This finding aligns with previous studies that suggest a correlation between ICU exposure and enhanced knowledge in ventilator care. The significant association between students' course year and their knowledge of MV care may be attributed to the progression of nursing education and clinical exposure. Fourth-year BSc Nursing students demonstrated the highest level of knowledge, which may reflect their more advanced clinical training and exposure to patient care in the ICU setting. Similar findings were observed in studies that report better knowledge among more experienced nursing students or those with more advanced years of study.

The association between ICU exposure and knowledge levels highlights the importance of practical experience in enhancing students' understanding of patient care in critical settings. Students with prolonged ICU exposure (more than 9 days) showed significantly higher knowledge levels compared to those with shorter ICU exposure. This finding is consistent with studies indicating that hands-on experience in critical care environments directly contributes to improved knowledge and skill acquisition related to MV care.

Interestingly, the study revealed no significant association between gender, previous knowledge, and knowledge sources with MV knowledge levels. This suggests that, regardless of demographic characteristics, exposure to ICU settings and academic progression may play a more critical role in shaping students' understanding of MV care. These findings underscore the need for increased exposure to ICU settings, especially for students in the early years of their nursing education. Incorporating more hands-on clinical experiences, particularly in critical care areas, could enhance the knowledge and skills of nursing students in mechanical ventilation care, ultimately improving patient outcomes.

Conclusion

This study emphasizes the importance of mechanical ventilators in supporting critically ill patients and highlights the key role nurses play in ensuring safe and effective ventilator care. Conducted at Nitte Usha Institute of Nursing Sciences, the study assessed the knowledge of 226 nursing students. Results revealed that 53.7% had excellent, 42.3% average, and 4% poor knowledge, with ICU clinical exposure being the main source of learning. Knowledge levels significantly correlated with the year of study, course, and ICU exposure. The findings underline the need for enhanced clinical training to better equip nursing students for ventilator care in real-world healthcare settings.