mohammadhasan bigdeli

 The proper decision-making on weaning patients from the ventilator, removing the endotracheal tube, reducing complications, and the way of cooperating between doctor and nurse is always one of the concerns of intensive care unit (ICU) nurses.

 This study aimed to determine the effect of clinical decision-making based on interactive education on the successful extubations of patients in the ICU.

 This quasi-experimental study was conducted on 50 nurses in the ICU of Ganjavian Hospital in Dezful, Iran, within August-December 2021. The nurses were selected based on inclusion criteria and randomly assigned into intervention and control groups. Clinical decision-making training regarding extubation was provided interactively for one month in five sessions in the experimental group. The data were obtained using a demographic information questionnaire, the Clinical Decision-Making Questionnaire by Lauri et al., and extubation checklist and analyzed using SPSS software (version 24) using descriptive and inferential statistics (i.e., chi-square test, covariance, independent t-test, and paired t-test).

 No difference was observed between the two groups in terms of demographic information (P < 0.05). After the intervention, the mean score of nurses’ clinical decisions and the number of successful extubations in the experimental group were higher than in the control group, with a statistically significant difference (P = 0.014).

 Interactive training effectively improves decision-making skills concerning successful extubations. Therefore, it is suggested to use this method in educational programs to improve the clinical decision-making of nurses, students, and nursing managers.

The use of separation tools from the mechanical ventilation device compared to the usual methods implemented in Intensive Care Units (ICUs) can reduce unsuccessful extubation. Therefore, this study was conducted with the aim of determining the impact of using the airway care score on the success rate of extubation in patients hospitalized in neurosurgical and neurologCal ICUs.

In this semi-experimental study, 98 patients with epidural, subdural and intra cerebral hemorrhage were selected based on the inclusion criteria and by convenience sampling method. According to the table of randomization blocks (permutation blocks) and by using the WinPepi software 11.4, they were randomized and assigned to two interventions (49 people) and control (49 people) groups. In the intervention group, extubation of patients was performed using the airway care score tool and in case of obtaining a score of seven or less. In the control group, patients were extubated based on the opinions and experiences of anesthesiologists.

In this study, the number of re-intubation cases in the intervention group was less than the control group, but this difference was not statistically significant (P=0.2). Also, the duration of connection to the mechanical ventilation device (P=0.02) and endotracheal tube (P=0.018) and the duration of hospitalization in the ICU (P<0.001) in the intervention group were significantly less than the control group.

The use of airway care score tool reduces the number of unsuccessful extubations but this difference was not statistically significant. Also, by using this tool, the duration of hospitalization of patients in neurosurgical and neurological ICUs, the duration of intubation and also the duration of connecting patients to mechanical ventilation were reduced. Therefore, due to the lack of awareness of nurses in ICUs about extubation tools and performing the extubation process in a traditional way, it is necessary to make necessary plans by relevant authorities to increase the awareness of nurses in this field.