Development of a Tool for Measuring Ventilator-Associated Pneumonia Prevention Behaviors of Intensive Care Unit Nurses
Abstract
:1. Introduction
Aim
2. Materials and Methods
2.1. Study Design
2.2. Study Procedure
2.2.1. Phase 1: Scale Development Phase
- Step 1. Determine What You Want to Measure Clearly
- (1)
- Theoretical Phase
- (2)
- Fieldwork Phase
- (3)
- Final Analytic Phase
- Step 2. Generate an Item Pool
- Step 3. Determine the Format for Measurement
- Step 4. Have Initial Item Pool Reviewed by Experts
- (1)
- Content Validity
- (2)
- Face Validity
- Step 5. Consider the Inclusion of Validation Items
2.2.2. Phase 2: Scale Validation Phase
- Step 6. Administer Items to a Development Sample
- (1)
- Research Method
- (2)
- Subjects and Data Collection Method
- Step 7. Evaluate the Items
- (1)
- Exploratory Factor Analysis Plan
- (2)
- Criterion Analysis Plan
- (3)
- Reliability Analysis Plan
3. Results
3.1. Exploratory Factor Analysis
3.2. Confirmation Factor Analysis
3.3. Convergent Validity and Discriminant Validity
3.4. Criterion Validity Analysis
3.5. Reliability
- Step 8. Optimize Scale Length
4. Discussion
Limitation and Practical Implications
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. VAP Preventative Behavior Measurement Tool
No | Item | I Never Do It | I Seldom Do It | I Mostly Do It | I Always Do It |
---|---|---|---|---|---|
1 | Except for contraindicated patients, elevate at an angle of 30–45 degrees the head of the bed | ① | ② | ③ | ④ |
2 | Cuff pressure should be maintained at 20–30 cm H2O | ① | ② | ③ | ④ |
3 | Regularly check and control of tracheal cuff pressure using a manual manometer | ① | ② | ③ | ④ |
4 | Regularly check the proper positioning of the nasogastric tube | ① | ② | ③ | ④ |
5 | Oral care is performed with chlorhexidine (0.12% or 2%) | ① | ② | ③ | ④ |
6 | Oral care is performed every 4–8 h | ① | ② | ③ | ④ |
7 | Perform subglottic secretion suction (subglottic secretion: oropharyngeal secretions in the subglottic region above the cuff of the endotracheal tube) | ① | ② | ③ | ④ |
8 | Before deflating the cuff of an endotracheal tube, before moving the tube, or patient position change ensure that secretions are cleared from above the tube cuff | ① | ② | ③ | ④ |
9 | Except for contraindicated patients, Daily Perform spontaneous awakening trials with sedatives turned off | ① | ② | ③ | ④ |
10 | Daily perform spontaneous breathing trials once a day | ① | ② | ③ | ④ |
11 | Change the ventilator circuit when it is visibly soiled or mechanically malfunctioning | ① | ② | ③ | ④ |
12 | Do not flush condensate water from the ventilator circuit into the machine or onto the patient | ① | ② | ③ | ④ |
13 | Use sterile water to fill ventilator humidifiers | ① | ② | ③ | ④ |
14 | In patients using an open suction system, use a sterile disposable suction catheter and sterile water for each suction. | ① | ② | ③ | ④ |
15 | In patients using an closed suction system, a closed suction catheter should be used for each new patient | ① | ② | ③ | ④ |
16 | Observe aseptic technique when managing the tracheostomy site and replacing the tracheostomy tube | ① | ② | ③ | ④ |
17 | Do not use the oxygen tube, mask, and ambu bag used for one patient on another patient. | ① | ② | ③ | ④ |
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Characteristics | Categories | Data Set EFA (n = 180) n (%) or M ± SD | Data Set CFA (n = 272) n (%) or M ± SD |
---|---|---|---|
Gender | Man | 22 (12.2) | 40 (14.7) |
Woman | 158 (87.8) | 232 (85.3) | |
Age (years) | 29.3 ± 4.90 | 28.9 ± 4.80 | |
Level of education | College | 19 (10.6) | 27 (9.9) |
University | 129 (71.7) | 191 (70.2) | |
≥Graduate | 32 (17.8) | 54 (19.8) | |
Current work unit | MICU | 58 (32.2) | 85 (31.3) |
SICU | 68 (37.8) | 78 (28.7) | |
NCU | 16 (8.9) | 33 (12.1) | |
CICU | 3 (1.7) | 8 (2.9) | |
ECU | 32 (17.8) | 66 (24.3) | |
Others | 3 (1.7) | 2 (0.7) | |
Clinical career (years) | ≤1 | 16 (8.9) | 25 (9.2) |
1~<5 | 87 (48.3) | 139 (51.1) | |
5~<10 | 45 (25.0) | 78 (28.7) | |
10~<15 | 26 (14.4) | 22 (8.1) | |
≥15 | 6 (3.3) | 8 (2.9) | |
5.64 ± 4.33 | 5.12 ± 4.04 | ||
Region of hospital | Seoul | 85 (37.2) | 152 (55.9) |
Daejeon | 48 (22.8) | 86 (31.6) | |
Gyeongsang-do | 9 (5.1) | 19 (7.2) | |
Gyeonggi-do | 7 (3.9) | 6 (2.2) | |
Chungcheong-do | 29 (16.1) | 6 (2.2) | |
Jeolla-do | 2 (1.2) | 3 (1.1) | |
Scale of Hospital (beds) | 800~899 | 124 (68.9) | 181 (66.5) |
900~999 | 15 (8.3) | 16 (5.9) | |
≥1000 | 41 (22.8) | 75 (27.6) |
Factors | Item | Item Analysis | Factor Loading | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
M ± SD | ITC | Alpha If Item Deleted | Communality | 1 | 2 | 3 | 4 | 5 | 6 | 7 | ||
1. Prevention of aspiration | Q2 | 3.61 ± 0.55 | 0.42 | 0.84 | 0.71 | 0.76 | 0.10 | 0.03 | 0.22 | 0.21 | −0.11 | −0.02 |
Q1 | 3.74 ± 0.47 | 0.41 | 0.84 | 0.72 | 0.76 | 0.14 | 0.17 | −0.20 | 0.03 | 0.15 | 0.17 | |
Q3 | 3.43 ± 0.81 | 0.53 | 0.83 | 0.73 | 0.65 | 0.09 | −0.14 | 0.37 | 0.20 | 0.06 | 0.28 | |
Q6 | 3.69 ± 0.61 | 0.41 | 0.84 | 0.76 | 0.60 | 0.12 | 0.42 | −0.02 | −0.11 | 0.41 | −0.13 | |
2. Ventilator circuit management | Q18 | 3.60 ± 0.52 | 0.42 | 0.84 | 0.74 | 0.10 | 0.81 | 0.01 | 0.20 | 0.03 | 0.15 | 0.01 |
Q14 | 3.53 ± 0.73 | 0.50 | 0.83 | 0.74 | 0.16 | 0.81 | 0.19 | 0.06 | 0.06 | 0.03 | 0.05 | |
Q15 | 3.63 ± 0.60 | 0.34 | 0.84 | 0.62 | 0.06 | 0.57 | −0.19 | 0.45 | 0.09 | −0.13 | 0.13 | |
3. Spontaneous awakening trials and spontaneous breathing trials | Q10 | 2.42 ± 1.05 | 0.51 | 0.83 | 0.79 | 0.08 | 0.11 | 0.82 | 0.16 | 0.14 | −0.06 | 0.19 |
Q11 | 2.59 ± 0.98 | 0.44 | 0.83 | 0.74 | 0.09 | −0.03 | 0.78 | 0.24 | 0.06 | 0.04 | 0.20 | |
4. Subglottic suction | Q13 | 3.18 ± 0.82 | 0.47 | 0.83 | 0.70 | 0.06 | 0.15 | 0.25 | 0.76 | −0.01 | 0.17 | −0.01 |
Q12 | 3.43 ± 0.77 | 0.43 | 0.83 | 0.61 | 0.07 | 0.25 | 0.26 | 0.67 | 0.01 | 0.10 | −0.01 | |
5. Suction system management | Q22 | 3.87 ± 0.36 | 0.30 | 0.84 | 0.77 | 0.09 | −0.04 | 0.08 | 0.12 | 0.82 | 0.18 | −0.15 |
Q23 | 3.83 ± 0.48 | 0.41 | 0.84 | 0.74 | 0.15 | 0.19 | 0.09 | −0.09 | 0.79 | 0.10 | 0.13 | |
6. Standard precaution | Q28 | 3.90 ± 0.30 | 0.36 | 0.84 | 0.78 | 0.07 | −0.06 | 0.05 | 0.18 | 0.15 | 00.84 | 0.08 |
Q30 | 3.79 ± 0.42 | 0.39 | 0.84 | 0.68 | 0.06 | 0.25 | −0.08 | 0.04 | 0.22 | 0.67 | 0.30 | |
7. Oral care | Q8 | 2.93 ± 0.92 | 0.39 | 0.84 | 0.70 | 0.20 | 0.06 | 0.09 | 0.14 | −0.07 | 0.15 | 0.77 |
Q7 | 3.18 ± 0.82 | 0.31 | 0.84 | 0.63 | −0.02 | 0.04 | 0.27 | −0.10 | 0.04 | 0.09 | 0.73 | |
Eigen value | 2.12 | 1.94 | 1.84 | 1.70 | 1.54 | 1.54 | 1.50 | |||||
Explained variance (%) | 12.5 | 11.4 | 10.8 | 10.0 | 9.1 | 9.0 | 8.8 | |||||
Cumulative variance (%) | 12.5 | 23.9 | 34.7 | 44.8 | 53.9 | 63.0 | 71.8 | |||||
KMO (Kaiser–Meyer–Olkin) | 0.75 | |||||||||||
Bartlett’s Sphere Formation Test | X2 = 840.75, df = 136, p < 0.000 |
Fitness Index | df | GFI | AGFI | NFI | IFI | TLA | CFI | RMSEA | RMR | SRMR | |
---|---|---|---|---|---|---|---|---|---|---|---|
Criteria | ≥0.90 | ≥0.90 | ≥0.90 | ≥0.80 | ≥0.80 | ≥0.95 | ≤0.05 | ≤0.05 | ≤0.05 | ||
VAP prevention | 137.8 | 98 | 0.94 | 0.91 | 0.92 | 0.97 | 0.96 | 0.97 | 0.03 | 0.01 | 0.03 |
Factors | Item (17) | Standardized estimate (β) | Standard error (SE) | Critical ratio (C.R.) | ρ | Error variances | AVE | CR | |||
1. Prevention of aspiration | 1 | 0.74 | 0.10 | 0.51 | 0.81 | ||||||
2 | 0.70 | 0.09 | 10.33 | <0.001 | 0.13 | ||||||
3 | 0.68 | 0.10 | 10.11 | <0.001 | 0.15 | ||||||
6 | 0.75 | 0.09 | 10.99 | <0.001 | 0.11 | ||||||
2. Oral care | 7 | 0.85 | 0.17 | 0.61 | 0.75 | ||||||
8 | 0.70 | 0.13 | 6.28 | <0.001 | 0.35 | ||||||
3. Spontaneous awakening trials and spontaneous | 10 | 0.70 | 0.52 | 0.60 | 0.75 | ||||||
Breathing trials | 11 | 0.84 | 0.13 | 8.47 | <0.001 | 0.26 | |||||
4. Subglottic suction | 12 | 0.71 | 0.25 | 0.55 | 0.75 | ||||||
13 | 0.77 | 0.15 | 8.01 | <0.001 | 0.26 | ||||||
5. Ventilator circuit management | 14 | 0.94 | 0.01 | 0.65 | 0.84 | ||||||
15 | 0.50 | 0.06 | 8.66 | <0.001 | 0.26 | ||||||
18 | 0.85 | 0.05 | 15.89 | <0.001 | 0.07 | ||||||
6. Suction system management | 22 | 0.95 | 0.01 | 0.79 | 0.88 | ||||||
23 | 0.82 | 0.08 | 12.17 | <0.001 | 0.07 | ||||||
7. Standard precaution | 28 | 0.84 | 0.04 | 0.60 | 0.75 | ||||||
30 | 0.71 | 0.09 | 9.37 | <0.001 | 0.08 |
Factors | |||||||
---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | |
1. Prevention of aspiration | 0.72 † | ||||||
2. Oral care | 0.25 | 0.78 † | |||||
3. Spontaneous awakening trials and spontaneous breathing trials | 0.34 | 0.43 | 0.77 † | ||||
4. Subglottic suction | 0.29 | 0.22 | 0.52 | 0.75 † | |||
5. Ventilator management | 0.28 | 0.13 | 0.07 | 0.394 | 0.80 † | ||
6. Suction system management | 0.42 | 0.05 | 0.02 | 0.17 | 0.17 | 0.89 † | |
7. Standard precaution | 0.44 | 0.24 | 0.04 | 0.35 | 0.33 | 0.57 | 0.77 † |
Factor A ↔ Factor B | Φ | SE | Φ − 2 × SE | Φ + 2 × SE | |||
PA ↔ OC | 0.25 | 0.02 | 0.21 | 0.29 | |||
PA ↔ SAT & SBT | 0.34 | 0.02 | 0.29 | 0.39 | |||
PA ↔ SS | 0.29 | 0.02 | 0.25 | 0.33 | |||
PA ↔ VM | 0.28 | 0.01 | 0.26 | 0.30 | |||
PA ↔ SM | 0.42 | 0.01 | 0.40 | 0.45 | |||
PA ↔ SP | 0.44 | 0.01 | 0.42 | 0.46 | |||
OC ↔ SAT & SBT | 0.43 | 0.04 | 0.33 | 0.52 | |||
OC ↔ SS | 0.22 | 0.03 | 0.15 | 0.30 | |||
OC ↔ VM | 0.13 | 0.01 | 0.10 | 0.16 | |||
OC ↔ SM | 0.05 | 0.01 | 0.01 | 0.08 | |||
OC ↔ SP | 0.24 | 0.01 | 0.21 | 0.28 | |||
SAT & SBT ↔ SS | 0.52 | 0.04 | 0.42 | 0.62 | |||
SAT & SBT ↔ VM | 0.07 | 0.01 | 0.03 | 0.10 | |||
SAT & SBT ↔ SM | 0.02 | 0.02 | 0.00 | 0.07 | |||
SAT & SBT ↔ SP | 0.04 | 0.01 | 0.00 | 0.08 | |||
SS ↔ VM | 0.39 | 0.01 | 0.36 | 0.42 | |||
SS ↔ SM | 0.17 | 0.01 | 0.13 | 0.20 | |||
SS ↔ SP | 0.35 | 0.01 | 0.31 | 0.38 | |||
VM ↔ SM | 0.17 | 0.01 | 0.15 | 0.19 | |||
VM ↔ SP | 0.33 | 0.01 | 0.32 | 0.35 | |||
SM ↔ SP | 0.57 | 0.01 | 0.55 | 0.60 | |||
Criteria | whether (Φ ± 2 × SE) includes 1.0 |
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Kwak, S.; Han, S. Development of a Tool for Measuring Ventilator-Associated Pneumonia Prevention Behaviors of Intensive Care Unit Nurses. Int. J. Environ. Res. Public Health 2022, 19, 8822. https://doi.org/10.3390/ijerph19148822
Kwak S, Han S. Development of a Tool for Measuring Ventilator-Associated Pneumonia Prevention Behaviors of Intensive Care Unit Nurses. International Journal of Environmental Research and Public Health. 2022; 19(14):8822. https://doi.org/10.3390/ijerph19148822
Chicago/Turabian StyleKwak, Sungjung, and Sujeong Han. 2022. "Development of a Tool for Measuring Ventilator-Associated Pneumonia Prevention Behaviors of Intensive Care Unit Nurses" International Journal of Environmental Research and Public Health 19, no. 14: 8822. https://doi.org/10.3390/ijerph19148822