Study Design and Setting
This was a cross-sectional descriptive-analytical study investigating ICU registered nurses' perceived barriers towards VAP prevention in hospitals affiliated to Kerman University of Medical Sciences, Kerman, Iran.
Sample Size and Sampling
All nurses in ICUs and Emergency Departments (EDs) of Shafa, Bahonar, and Afzalipour Hospitals formed the study population. According to the information obtained from these hospitals, there were 321 nurses (Shafa = 77, Bahonar = 112, and Afzalipour = 132) at the time of the study. The sample size was estimated based on the pilot study as 242 nurses, by a confidence coefficient of 95% and the power of 80.
Inclusion criteria were a) having B.Sc. or higher degree; b) job experience of six months in ICUs. The participants were excluded if they voluntarily withdrew from the study or avoided sharing their experiences. Eligible nurses were selected by quota sampling method from each unit and shift, according to its specified proportion.
Measures
The data was collected through a 2-part researcher-made questionnaire.
Demographic Characteristics Questionnaire: This questionnaire included age, sex, education, unit name, job experience, experience of working in ICUs, and having training courses on VAP as well as the type of protocols they adhere to (hand hygiene, oral care and suctioning).
Ventilator-Associated Pneumonia Barriers Prevention Questionnaire: This questionnaire contained 18 items with 4-point Likert scales (one = strongly disagree, four = totally agree). It was developed using various sources in the literature (2, 7, 8, 11). The minimum and maximum score of the questionnaire was 18 and 72, respectively. The higher the average score of each item represents that the barrier was perceived more by nurses. The validity of the questionnaire was evaluated between 0.85 to 1 by giving the questionnaire to 10 faculty members of Kerman University of Medical Sciences, and for the reliability, the questionnaire was provided to 30 target populations. Internal consistency was calculated using Cronbach’s alpha (α = 0.95).
Data collection and Analysis
After obtaining necessary permissions, the researcher referred to the research setting and started sampling. The eligible nurses were invited to participate in the study. After giving explanations about the process of the study, written consent was taken. Then, the questionnaires were given to nurses to be completed in the form of self-report. Two hundred forty-two nurses were enrolled in the study starting from January to May 2017, lasting for five months, and there were no dropouts.
Data were analyzed by SPSS version 18 (SPSS Inc., Chicago, IL, USA). Descriptive statistics (frequency, percentage, mean, and standard deviation) were applied to describe the participants’ demographic characteristics. The repeated measure ANOVA and Independent t-test or their nonparametric equivalents Mann-Whitney U test and Kruskal-Wallis test were used to compare the mean scores between nurses’ demographic characteristics and their perceived barriers towards VAP prevention. The significance level of the p-value was considered to be 0.05.
Ethical Consideration
The study protocol was approved by the Ethics Committee of Kerman University of Medical Sciences (IR.KMU.REC.1395.908). The study objectives were presented to all participants before their enrollment, and the written informed consent was taken. All participants were assured that all information was confidential, and their participation was optional, and they could withdraw from the study at any time.