Sameh Elhabashy

Background: Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in intensive care units (ICUs), particularly in low- and middle-income countries (LMICs). Evidence-based practice (EBP) bundles have shown effectiveness in reducing VAP; however, the implementation in Bangladesh remains limited. This study aimed to evaluate the effectiveness of EBP to reduce the incidence rate of VAP among adult ICU patients in Bangladesh. Methods: A quasi-experimental study with a historical control group was conducted among 347 eligible ICU patients from October 2024 to April 2025. The intervention included nurse training on VAP bundle practices with advanced equipment support. Data on VAP incidence as a primary endpoint and VAP-related patients’ outcomes were analyzed. Results: The clinically suspected VAP incidence was 30.1 and 51.1 per 1000 ventilator-days, and the prevalence decreased significantly in the intervention group compared to the control group (26.9% vs. 46.1%; p < 0.001), respectively. Logistic regression indicated VAP bundle implementation was associated with reduced VAP (Exp(B) = 0.417, 95% CI: 0.262–0.666), while ventilation ≥96 h was a significant risk factor (Exp(B) = 2.6, 95% CI: 1.385–4.881). Early-onset VAP was reduced (25.0% vs. 10.2%), though late-onset predominated in the intervention group (75.0% vs. 89.8%). Conclusion: Implementation of an EBP-based VAP bundle by trained nurses significantly reduced VAP incidence. However, increased overall ICU mortality highlights the need for broader critical care improvements, including advanced comorbidity management and comprehensive ICU services. This study underscores the feasibility and effectiveness of VAP bundle implementation in the ICU of an LMIC.

Aim: To explore the factors affecting the sustainable improvement of nurses' evidence‐based practice (EBP) competency after receiving an EBP training program. Design: A sequential mixed‐methods study. Methods: Thirty‐seven ICU nurses participated from an adult ICU in Egypt. The qualitative phase used a category‐generating approach with focus group interviews and content analysis. The quantitative phase followed a cross‐sectional descriptive design using self‐report questionnaires. The study adhered to the Good Reporting of a Mixed Methods Study (GRAMMS) guidelines and was registered with ClinicalTrials.gov (NCT05941364). Results: Qualitative analysis generated six subcategories, organised into three overarching themes: working environment challenges, job dissatisfaction and organisational obstacles. Quantitative findings revealed low levels of motivation (M = 19.1, SD = 2.2, out of 60), self‐efficacy (M = 18.4, SD = 8.66) and self‐regulation (M = 124.9, SD = 52.6). The highest mean score was observed for the Sustained Implementation Support Scale (M = 94.7, SD = 5.0, out of 140). These variables showed negative correlations with the sustainability gap. Integration of findings through a joint display demonstrated a convergence of results regarding training program burden and low motivation. Conclusions: Sustaining nurses' EBP literacy requires addressing long‐term obstacles such as inadequate job satisfaction, limited workplace support and lack of team cohesion. Sustained organisational support and leadership development are essential for EBP clinical integration. Implications for Nursing: The study highlights key strategies for nurses' development to enhance care quality, including improving self‐efficacy through mentorship and fostering a supportive work environment. Health policies should establish EBP as a core competency, offer flexible schedules, ongoing training, adequate resources, and empower nurse leaders for successful implementation. Impact: This study addresses the critical challenge of sustaining nurses' competency improvements after EBP training. The findings are crucial for healthcare administrators, policymakers and educators aiming to design effective EBP training programs. By addressing these factors, the study has the potential to improve patient outcomes. Patient Contribution: No patient or public contribution.

Background: The COVID-19 pandemic forced higher education institutions globally to transition abruptly from traditional classroom learning (TCL) to online distance learning (ODL). Understanding students’ perception and achievements is crucial for enhancing learning outcomes. Aim: This study aimed to examine the scholarly achievements and learning perceptions of nursing students who learned by online learning with the adoption of the principles of integrated learning theory compared to those who learned through classroom-based learning, as well as assess students’ readiness for the online learning. Methods: A quasi-experimental research design was employed, involving 649 bachelor’s nursing students divided into study and control groups. The study group learned selected courses via ODL, incorporating principles from integrated learning theory, while the control group received TCL for the same courses. Two adopted tools was utilized to measure students' perceptions and students' readiness while scholarly achievement was evaluated through GPA. Results: No significant statistical difference was found in overall student learning perceptions between the study and control groups (p = 0.13) with a small clinical effect size (-.082). While there was no significant difference in GPA for clinical courses (p = 0.099), the study group achieved significantly higher GPAs for theoretical courses (p = 0.008). For the students’ readiness for ODL the study group demonstrated neutral (moderate) level, with an overall weighted mean of 3.36 ± 0.86. Conclusions: Despite the unplanned transition to ODL during COVID-19, TCL and ODL were perceived similarly by the students when incorporating ODL with the principles of integrated learning theory. ODL positively enhance students' GPA in theoretical courses, but had no significant effect on clinical courses. This suggests that ODL cannot fully replace TCL in nursing education, particularly for clinical courses, which require more virtual clinical simulations. Therefore, blended learning may offer a more effective solution.

Background: Hospital-acquired infection is higher among healthcare workers (HCWs) than among other occupational groups, and the COVID-19 pandemic exacerbated its incidence. Aim: To assess the incidence of hospital-acquired infections among HCWs in, Cairo, Egypt, during the COVID-19 pandemic. Methods: This retrospective cohort study collected and evaluated data on hospital-acquired infections (excluding COVID-19) from 1660 nurses, physicians, technicians, and housekeepers in 6 hospitals in Cairo Governorate, Egypt, 1 year before and 1 year during the COVID-19 pandemic. The data were analysed using SPSS version 21.0 and descriptive and inferential statistics were used to test the magnitude and direction of relationships between the variables. Results: The rate of hospital-acquired infections was 3.1% before and 1.3% during the COVID-19 pandemic. There was a significantly lower risk of hospital-acquired infection among the HCWs during the pandemic than before it. Incidence was highest among housekeepers (10.6%), and physicians had the highest relative risk (4.33). Before the pandemic, pneumonia was the most common hospital-acquired infection (20.8%) among HCWs, while hepatitis C was the most common (8.3%) during the pandemic. The most significant predictors of hospital-acquired infection were COVID-19 (before and during the pandemic), working area and profession. Conclusion: There was a significant reduction in hospital-acquired infections among HCWs during the COVID-19 pandemic, attributed to increased adherence to infection prevention and control measures. Housekeepers, nurses and emergency department workers were at higher risk, indicating the need for further investigations among these groups of HCWs to understand the contributing factors and design targeted interventions to lower the risks and incidence.

Introduction: Self-directed learning (SDL) stands as a contemporary approach to learning, offering efficient and sustainable strategies for enhancing knowledge and practices. Given the pivotal role of nurses in ensuring patient safety and care effectiveness, this study aims to assess the impact of the SDL model compared to the traditional learning model (TLM) on elevating nurses’ airway management (AM) competencies and minimizing airway-related incidents. Methodology: The study employed an experimental research design using a posttest-only control group structure within a two-group comparison framework. Seventy-two nurses participated, with 35 in the study group and 37 in the control group at the Obstetrics and Gynecology Hospital affiliated with Cairo University, Egypt. The trial was carried out between February 2020 and July 2021. Following an assessment of SDL readiness for the intervention group, they received SDL model training based on Knowles’ SDL principles, while the control group received TLM. The primary endpoint was a significant elevation in nurses’ airway management competency, with the secondary outcome being a significant decrease in airway-related incidents reported by nurses. Competency assessments occurred immediately after completion of the intervention and again three months later. Results: A statistically significant difference was observed between the control and intervention groups regarding their practice and knowledge scores, with p-values of 0.02 and < 0.01, respectively. Additionally, the clinically relevant difference between control and intervention groups was evidenced by the effect size (ES) Cohen’s d in both practices and knowledge levels (-0.56 and − 1.55, respectively). A significant difference was also noted between the first post-assessment and the paired second post-assessment concerning nurses’ knowledge and practices among control and intervention groups, as indicated by the paired t-test with p < .01. Over three months, the intervention group reported 18 airway incidents, while the control group reported 24, with no statistically significant difference (> 0.05). Conclusion: The SDL model significantly enhanced nurses’ competencies in AM compared to the TLM. However, the efficacy of both learning models diminishes over time. Although nurses who underwent SDL model reported fewer airway incidents compared to those who received TLM approach of learning, no statistically significant difference was detected. Trial registration: The study has been registered with Clinical Trials.gov under the registration number (NCT04244565) on 28/01/2020.

Background: Evidence-Based Practice (EBP) has been recognised worldwide as a standardised approach for enhancing the quality of healthcare and patient outcomes. Nurses play a significant role in integrating EBP, especially in Intensive Care Unit (ICU). Consequently, this study aims to examine the effect of an adapted evidence-based nursing practices training programme on the competency level of nurses caring for mechanically ventilated patients. Methods: A prospective open-label parallel 1:1 randomised controlled trial was conducted on 80 nurses caring for ICU patients at the National Hepatology and Tropical Medicine Research Institute, Egypt. The trial was carried out between November 2022 and February 2023 under the registration number NCT05721664. The enrolled nurses were randomly divided into intervention and control groups. The intervention group received the evidence-based nursing practice training programme (EBNPTP) in accordance with the Johns Hopkins EBP conceptional model, whereas the control group received traditional in-service education. Four assessments (one pre- and three post-assessments) were conducted to evaluate nurses’ competency level over time using the adapted evidence-based nursing competency assessment checklist. The primary endpoint was an increase the competency levels among nurses caring for mechanically ventilated patients. Results: The current study results revealed statistically significant differences between intervention and control groups in relation to their level of competency across the three post-assessments, with (p <.001). The study also demonstrated that the nurses’ competency level continued to decline significantly over time, with (p <.001). Additionally, a significant correlation was found between the nurses’ pre-assessment and educational level, acting as independent variables (predictors), and the third endpoint assessment (p <.01), indicated by multiple linear regression. Conclusion: The EBP training programme demonstrated a significant increase in the nurses’ level of competency compared with traditional in-service education. This suggests that by training the nurses in various settings with the essential skills and knowledge for EBP, their competency level can be enhanced, leading to the delivery of effective care and improving patient outcomes. However, the long-term sustainability of the EBP adoptions was insufficient; further studies are needed to investigate the factors that affect the durability of EBP adoption. Trial registration: The study was registered with Clinical Trials.gov (Registration # NCT05721664) on 10/02/2023.

Aim: Medical Device-Related Pressure Ulcers are skin breakdowns related to certain medical devices that increase morbidity, lengthen hospital stays, and increase the cost of treatment. Approximately one third of reported pressure ulcers are associated with medical devices. The aim of this study is to examine the impact of a suggested nursing intervention protocol on the occurrence of medical device-related pressure ulcers in critically ill patients. Design: A prospective, quasi-experimental research design was used in this study. Methods: 100 patients participated in our study, divided into study and control groups. The researchers selected Endo-tracheal and Nasogastric tubes to examine their association with the development of pressure ulcers. The researchers observed the prevalence of pressure ulcers caused by the selected devices through daily clinical observation. Patients receiving routine care were used as a control group, while the suggested nursing intervention protocol was implemented to the study group of patients. The results of the given protocol on the study subjects were compared to the collected base line data for the control group. Results: The study revealed a highly statistically and clinically significant difference between the study and control groups in relation to incidence of endo-tracheal and nasogastric tube pressure ulcers. The results indicate that the incidence of endo-tracheal tube pressure ulcers decreased from 90% to 32.1% after implementation of the suggested nursing intervention protocol (p = 0.031), whereas the incidence of nasogastric tubes pressure ulcers fell from 77.8% to 13.1% (p = 0.012). Conclusion: the examined evidence based suggested nursing intervention protocol proved highly effective in reducing the occurrence of selected Medical Device-Related Pressure Ulcers in critically ill patients. Keywords: critically ill, medical devices, nursing protocol, pressure ulcer