Quality of Nursing Care of Patients under Mechanical Ventilation in Intensive Care Unit in Taif City, Saudi Arabia in 2024

Tagreed Musaad AlQutami *¹, Nagwa Ibrahim Abbas Ghoneim ², Amira Mohammed Saad Mohammed ³, Asmaa Ghareeb Mohammed ⁴, Jalal Naeem Alharbi ⁵, Sara Eidah Aloufi ⁶, Abdullah Hamdan Alsufyani ⁷, Bandar Raddah Alsufyani⁸

 

2. Lecturer of Critical Care and Emergency Nursing, Faculty of Nursing, Tanta University, Egypt. Assist prof, Nursing Department, Applied Medical Sciences College, UHB, SA.  (0000-0001-6400-4121),

3.  Assistant Professor of Pediatric Nursing, college of applied medical sciences, university of Hafr Al-Batin.

4. Professor of Community Health Nursing, Nursing Department Applied Medical Sciences, College, Hafer Al Batin, Kingdom of Saudi Arabia.

5.  Vice Dean for academic affairs, applied medical sciences college.

6.  Nursing specialist -KFMC-Taif.

7, 8.  Master's Degree in Emergency and Disaster Nursing-KFMC-Taif.

*Correspondence to: Tagreed Musaad AlQutami, Specialist in science of critical care- Taif city-Saudi Arabia.

Copyright
© 2025: Tagreed Musaad AlQutami. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received:  14 February 2025

Published: 28 February 2025

Abstract

Background: Nurses have an important role in intensive care units (ICUs), significantly impacting patient outcomes through the quality of care provided. Enhanced education and training are essential for improving nursing care for mechanically ventilated (MV) patients. Mechanical ventilation, crucial for supporting critically ill patients, requires skilled nursing management to ensure positive outcomes. The aim of this study was to assess the quality of nursing care provided to patients under mechanical ventilation in the ICU in Taif City, focusing on nurses' knowledge, performance, and the impact of demographic factors.

Methods: This cross-sectional, hospital-based descriptive study was conducted at King Abdulaziz Specialist Hospital and King Faisal Specialist Hospital & Research Centre in Taif Governorate. The study included ICU nurses with at least one year of experience, selected through convenience sampling. Data collection involved a questionnaire assessing knowledge of MV care and an observational checklist evaluating nursing practices. Data were analyzed using SPSS version 23.

Results: Among the 102 ICU nurses. The majority (75.5%) were aged 25-35 years, with a mean age of 26.22±2.85 years, 51.0% were female, and 69.6% were non-Saudi. Educational qualifications showed 64.7% held bachelor's degrees, and 64.7% had 1-5 years of experience. Knowledge assessment revealed 51.0% had poor knowledge, 38.2% had average knowledge, and 10.8% had good knowledge (mean score: 23.86±4.73). Practice assessments showed significant variability, with poor practice levels notably high in chest physiotherapy (66.7%) and overall care (68.6%). Significant correlations were found between educational qualifications (p = 0.007) and years of experience (p = 0.028) with knowledge levels.

Conclusion: Nurses' knowledge and practice regarding mechanical ventilators in selected public hospitals were suboptimal. Enhancing educational qualifications and providing targeted training programs are crucial for improving nursing care for MV patients. Implementing evidence-based practices and fostering effective communication within healthcare teams can improve patient outcomes.

The presence of Certified Nurse Specialists (CNS) as ICU head nurses has been linked to better patient outcomes and fewer ventilator-dependent patients, highlighting the importance of specialized nursing leadership.

Keywords: Mechanical ventilation, ICU nursing care, nurse education, patient outcomes, evidence-based practice, Certified Nurse Specialist, critical care, ventilator management, healthcare training, patient safety, nursing interventions, Taif City.

 Introduction

Nurses played a crucial role among healthcare workers, particularly in the intensive care unit (ICU), where the quality of nursing care significantly impacted patient outcomes. Improved education and training for nurses enhanced the quality of care provided to ICU patients. Danielis et al. (2020) highlighted that a well-designed nursing care plan was essential for ICU patients, showing the promotion of education levels among nurses. The ICU, a specialized care area, aimed to provide critical care to improve patients' clinical conditions. The need for intensive care increased, making mechanical ventilation (MV) a vital supportive therapy for patients with compromised respiratory function (Mohammed & Ebrahem, 2022).

Mechanical ventilation was widely used in ICUs to support critically ill patients, with survival rates varying due to differences in patient selection, care standards, and population characteristics (Taha et al., 2019). The indications for MV ranged from postoperative management and drug intoxication to acute respiratory failure caused by various conditions such as COPD and multiple traumas (Hesham, 2016). Nurses were often the first to manage critically ill patients and were responsible for recognizing and addressing issues related to MV settings. Andres and Jorge (2022) showed that nurses' expertise in ventilator management, patient care, and the identification of potential complications was vital for improving patient outcomes.

Quality nursing care in the ICU involved not only the technical management of ventilators but also the holistic care of the patient. Jackson and Cairns (2021) noted that critical care nurses played a key role in enhancing the effectiveness of MV, preventing harm, and optimizing outcomes. Ensuring high-quality care and patient satisfaction was a technical and social imperative in healthcare (Duffy, 2022). Therefore, nurses needed to be knowledgeable about ventilator functions, potential complications, and appropriate patient management (Emel & Ekici, 2020).

The research problem focused on the increasing demand for mechanical ventilation in ICUs, driven by an aging population, advancements in therapy, and increased ICU bed capacity. Effective nursing care was central to managing the complexities of MV and ensuring positive patient outcomes. Despite the critical role of nurses, studies showed that knowledge about MV among ICU nurses globally was often inadequate (HadiAtiyah & Abdul-Wahhab, 2016). Furthermore, recent studies in Saudi Arabia highlighted the need for improved training and education for ICU nurses regarding MV (Aldhahir et al., 2024).

Pulmonary ventilation, the process of air moving in and out of the lungs, was critical for gas exchange and was influenced by mechanical ventilation. Mechanical ventilation altered normal respiratory physiology, impacting lung mechanics and cardiac output (Tobin, 8). Proper management of MV involved understanding key parameters such as tidal volume, airway pressure, and compliance, which were essential for optimizing patient care and preventing complications (Christou et al., 2020). The various modes of ventilation, including assist control, synchronized intermittent mandatory ventilation, and pressure support, each had specific applications and implications for patient management (Carpio & Mora, 2023).

Mechanical ventilation, while life-saving, carried risks such as ventilator-associated lung injury and other complications. Preventing these complications required vigilant nursing care, including proper hand hygiene, monitoring, and management of ventilator settings (Ramirez-Estrada et al., 2023). Additionally, the discontinuation of mechanical ventilation involved systematic steps and assessment to ensure patient safety and successful weaning (Burns et al., 2021).

Nursing care for mechanically ventilated patients included preparation, equipment management, and patient monitoring. Ensuring compliance with protocols and maintaining detailed documentation were crucial for patient safety and quality care (Williams & Sharma, 2023). Family involvement and education were also important aspects of care, helping to alleviate anxiety and improve patient outcomes (Salmani et al., 2022). Continuous education and competency assessments for nurses were necessary to maintain high standards of care and address the complexities of mechanical ventilation (Hassen et al., 2023).

Research by Powers and Dhamoon (2021) on the pulmonary ventilation process showed the importance of the flow of air into and out of the alveoli for effective gas exchange. Changes in the ventilation/perfusion (V/Q) ratio could affect gas exchange and contribute to hypoxemia. Davies and Misra (2014) highlighted that the process of inhalation and exhalation involved complex interactions between muscles and pressure gradients, which were significantly altered by mechanical ventilation.

In terms of mechanical ventilation physiology, Tobin (2018) described how positive pressure ventilation changed normal respiratory mechanics, potentially decreasing venous return and cardiac output. Poor (2018) further discussed how mechanical ventilation reduced the work of breathing, redistributed blood flow, and helped improve acidosis in patients with respiratory failure.

Clinical management of mechanical ventilation required an understanding of lung compliance and pressures, as described by Christou et al. (2020). Pham et al. (2017) stressed the importance of avoiding barotrauma and maintaining appropriate ventilation settings to manage hypercapnia or acidosis. The use of mechanical ventilation extended beyond the ICU, with applications in managing conditions such as ARDS and COPD. Brochard and Lellouche (2013) explained the use of pressure support ventilation (PSV) for ventilator weaning, while Zhou et al. (2017) discussed the benefits of airway pressure release ventilation (APRV) for patients with difficult-to-oxygenate lungs.

Ventilator-associated events (VAE) and ventilator-induced lung injury (VILI) were significant concerns, as highlighted by Hyzy and Slutsky (2020). Strategies to prevent these complications included lung protective strategies, minimizing sedation, and daily spontaneous breathing trials (Ramirez-Estrada et al., 2023). The process of mechanical ventilation discontinuation involved systematic steps to ensure patient safety, as described by Burns et al. (2021).

Overall, the quality of nursing care for mechanically ventilated patients depended on a comprehensive understanding of mechanical ventilation, vigilant monitoring, and adherence to evidence-based protocols. This study aimed to assess the quality of nursing care provided to patients under mechanical ventilation in the ICU in Taif City in 2024, focusing on nurses knowledge, performance, and the impact of demographic factors.

Methods

The study was conducted at King Abdulaziz Specialist Hospital and King Faisal Specialist Hospital & Research Centre in Taif Governorate. King Abdulaziz Specialist Hospital, with its multiple specialties and a bed capacity of 500, aimed to provide high-quality healthcare and educational services. King Faisal Specialist Hospital & Research Centre, with an 800-bed capacity including 300 for maternity and children, aimed to deliver top-tier healthcare within an integrated educational and research setting.

A cross-sectional, hospital-based descriptive study using a quantitative approach was employed. The target population consisted of staff nurses with at least one year of ICU experience, responsible for bedside patient care at the selected hospitals. Nurses available during data collection and willing to participate were included in the study.

Stratified sampling was used, after sample size calculation using the suitable equation based on the total population size (117 ICU nurses in all hospitals of the study area. Then, selecting nurses proportionally to the number of staff in each hospital until the required sample size was met. Data collection involved a questionnaire and an observational checklist. The questionnaire, developed after reviewing relevant literature, assessed nurses' knowledge about nursing care for mechanically ventilated patients, including personal characteristics and 20 knowledge questions. The observational checklist, based on a pediatric nursing procedures manual (Hockenberry, 2023), assessed the quality of nursing care practices.

Knowledge scoring included 20 questions with a total score of 40, categorized as good (75-100%), average (60-74%), and poor (<60%). Practice scoring evaluated procedures as completely done (2), partially done (1), or not done (0). Validity was confirmed by five critical care nursing experts, and reliability was assessed using Cronbach's alpha (0.87). A pilot study with 10% of subjects ensured clarity and tool applicability. Official permission was obtained, and the questionnaire was distributed to nurses at the selected hospitals. Data collection occurred according to a time plan, with interviews and observations conducted during morning shifts. Ethical considerations included Ethics Committee approval, participant consent, anonymity, confidentiality, and conflict of interest avoidance.

Data were analyzed using SPSS version 23. Limitations included sample size, selection bias, measurement bias, time constraints, and resource limitations, potentially impacting the study's generalizability, validity, and reliability.

Results

The study included 102 nurses from King Abdulaziz Specialist Hospital and King Faisal Specialist Hospital & Research Centre. The majority (75.5%) were aged 25-35 years, with a mean age of 26.22±2.85 years. The gender distribution was almost equal, with 51.0% female and 49.0% male. Most participants were married (71.6%) and non-Saudi (69.6%). Regarding educational qualifications, 64.7% held bachelor's degrees, and 53.9% resided in rural areas. The majority (64.7%) had 1-5 years of experience in ICU. Also, 37.3% of them had previous training program in the care of patients under mechanical ventilation in the intensive care unit among the studied nurses as detailed in table 1.

Table (1): Percentage distribution of the studied nurses according to their socio-demographic characteristics (n=102)

Socio-demographic characteristics		N	%
Age	25-35 years	77	75.5
	36-45 years	25	24.5
	Mean ± SD	26.22±2.85
Gender	Male	50	49.0
	Female	52	51.0
Marital Status	Single	22	21.6
	Married	73	71.6
	Divorced	3	2.9
	Widowed	4	3.9
Nationality	Non-Saudi	71	69.6
	Saudi	31	30.4
Educational qualifications	Diploma	28	27.5
	Bachelor	66	64.7
	Master	5	4.9
	Doctoral	3	2.9
Residence	Urban	47	46.1
	Rural	55	53.9
Years of experience	1-5 years	66	64.7
	6-10 years	23	22.5
	11 – 15 years	13	12.7

 

In terms of knowledge, nearly half of the nurses demonstrated a complete understanding of key concepts related to mechanical ventilation, such as indicators of weaning (50.0%), prevention of ventilator-associated pneumonia (49.0%), and how to prevent nosocomial infections (47.1%). However, there were areas with lower comprehension, such as the definition of weaning from mechanical ventilation (8.8%) and sufficient respiratory muscle strength as an indicator for weaning (8.8%). The knowledge assessment, based on 20 questions, revealed that over half of the nurses (51.0%) had poor knowledge, 38.2% had average knowledge, and only 10.8% demonstrated good knowledge. The mean knowledge score was 23.86 with a standard deviation of 4.73, indicating a wide range of knowledge levels among the nurses as reported in table 2.

Regarding practice, many nurses performed critical procedures incompletely. For hand hygiene, steps such as rubbing hands together vigorously for at least 20 seconds and drying hands with a clean towel were incompletely done by 52.0% and 49.0% of nurses, respectively. When measuring axillary temperature, ensuring the patient was in a comfortable position was incompletely done by 56.9%, and cleaning the thermometer probe with an alcohol swab was incompletely done by 51.0%. For endotracheal tube suctioning, while all nurses connected the suction catheter to the suction source correctly, 85.3% incompletely applied intermittent suction while rotating and withdrawing the catheter. In chest physiotherapy, 57.8% incompletely performed percussion, and 52.9% incompletely followed with vibration. Intravenous infusion practices showed that verifying prescribed medication or solution and the rate of infusion was incompletely done by 82.4% of nurses. Mouth care practices revealed that 73.5% of nurses incompletely moistened the toothbrush or swab. Eye care practices showed 73.5% incompletely used a clean, soft cloth or sterile saline-soaked gauze. In positioning, 83.3% incompletely placed patients in a side-lying position. (See annex 1 for the details findings).

The general practice assessments encompassed various critical care procedures, each with a different number of assessment questions. The results highlighted significant variability in practice quality. For hand hygiene, which consisted of six questions, over half of the nurses (55.9%) had poor practice, 29.4% had average practice, and 14.7% had good practice, with a mean score of 6.05±2.25. Measuring axillary temperature, also with six questions, showed that 28.4% of nurses had poor practice, 37.3% had average practice, and 34.3% had good practice, with a mean score of 8.11±2.31.

For endotracheal tube suctioning, which involved ten questions, the majority (54.9%) had poor practice, 32.4% had average practice, and 12.7% had good practice, with a mean score of 11.12±2.78. Chest physiotherapy, with six questions, revealed that 66.7% had poor practice, 31.4% had average practice, and only 2.0% had good practice, with a mean score of 5.34±2.19. Intravenous infusion, assessed with nine questions, showed that 43.1% had poor practice, 37.3% had average practice, and 19.6% had good practice, with a mean score of 10.52±2.66 as reported in table 2.

Mouth care, assessed with eight questions, revealed that 56.9% of nurses had poor practice, 30.4% had average practice, and 12.7% had good practice, with a mean score of 8.21±2.53. Eye care, with six questions, showed that 46.1% had poor practice, 36.3% had average practice, and 17.6% had good practice, with a mean score of 6.85±2.17. Positioning, assessed with nine questions, indicated that 58.8% had poor practice, 38.2% had average practice, and only 2.0% had good practice, with a mean score of 10.48±2.58. Overall care of patients under mechanical ventilation showed that 68.6% of nurses had poor practice, 27.5% had average practice, and only 3.9% had good practice as reported in table 2.

Table (2) the overall knowledge and practice assessment findings toward quality of nursing care of patients under mechanical ventilation in intensive care unit (n = 102)

Category (Number of assessment questions)		Overall assessment level			Mean score ± SD (Range)
		Poor	Average	Good
Knowledge	On mechanical ventilation (20)	52 (51.0%)	39 (38.2%)	11 (10.8%)	23.86±4.73 (1-37)
Practice	Hand hygiene (6)	57 (55.9%)	30 (29.4%)	15 (14.7%)	6.05± 2.25 (2-10)
	Measuring Axillary Temperature (6)	29 (28.4%)	38 (37.3%)	35 (34.3%)	8.11±2.31 (4-12)
	Endotracheal Tube Suctioning (10)	56 (54.9%)	33 (32.4%)	13 (12.7%)	11.12±2.78 (5-11)
	Chest Physiotherapy (6)	68 (66.7%)	32 (31.4%)	2 (2.0%)	5.34 ± 2.19 (2-12)
	Intravenous Infusion (9)	44 (43.1%)	38 (37.3%)	20 (19.6%)	10.52 ± 2.66 (5-17)
	Mouth Care (8)	58 (56.9%)	31 (30.4%)	13 (12.7%)	8.21±2.53 (4-14)
	Eye Care (6)	47 (46.1%)	37 (36.3%)	18 (17.6%)	6.85±2.17 (2-12)
	Positioning (9)	60 (58.8%)	39 (38.2%)	2 (2.0%)	10.48 ±2.58 (6-18)
	Care of patients under MV (overall)	70 (68.6%)	28 (27.5%)	4 (3.9%)	-

The relationship between ICU nurses' demographic and professional characteristics and their knowledge levels was also examined. The study found no significant relationship between knowledge level and age, gender, marital status, or residence. However, a significant relationship was found between educational qualifications and knowledge level (p = 0.007). Nurses with diplomas tended to have better knowledge than those with bachelor's degrees or higher. Additionally, there was a significant relationship between years of experience and knowledge level (p = 0.028). Nurses with 1-5 years of experience had higher knowledge levels compared to those with more experience.

These findings showed that recent graduates or those new to the field may be more current in their knowledge due to recent training and education as reported in table 3.

Table 3: Relationship between ICU nurses demographic / professional characteristics with their knowledge level (n=102)

Variable		Poor	Fair	Good	Chi square (p value)
Age	25-35	38 (49.4%)	32 (41.6%)	7 (9.1%)	1.906 (0.386)
	36-45	14 (56.0%)	7 (28.0%)	4 (16.0%)
Gender	Male	30 (60.0%)	15 (30.0%)	5 (10.0%)	3.361 (0.186)
	Female	22 (42.3%)	24 (46.2%)	6 (11.5%)
Marital Status	Single	6 (27.3%)	12 (54.5%)	4 (18.2%)	10.946 (0.090)
	Married	44 (60.3%)	24 (32.9%)	5 (6.8%)
	Divorced	1 (33.3%)	1 (33.3%)	1 (33.3%)
	Widowed	1 (25.0%)	2 (50.0%)	1 (25.0%)
Educational qualifications	Diploma	25 (37.9%)	32 (48.5%)	9 (13.6%)	17.546 (0 .007) *
	Bachelor	21 (75.0%)	6 (21.4%)	1 (3.6%)
	Master	5 (100.0%)	0 (0.0%)	0 (0.0%)
	Doctoral	1 (33.3%)	1 (33.3%)	1 (33.3%)
Residence	Urban	19 (40.4%)	21 (44.7%)	7 (14.9%)	4.217 (0 .121)
	Rural	33 (60.0%)	18 (32.7%)	4 (7.3%)
Years of experience	1-5 years	27 (40.9%)	32 (48.5%)	7 (10.6%)	10.862 (0.028) *
	6-10 years	18 (78.3%)	3 (13.0%)	2 (8.7%)
	11 – 15 years	7 (53.8%)	4 (30.8%)	2 (15.4%)

* p value was significance at < 0.05

 

Discussion

Nurses play a crucial role in managing patients on mechanical ventilators, requiring in-depth scientific knowledge and evidence-based practice. This study aimed to assess the knowledge and practice levels of ICU nurses in caring for mechanically ventilated patients. The findings highlight the importance of quality nursing care for patients under mechanical ventilation in the Intensive Care Unit in Taif City.

The majority of the studied nurses were aged 25-35 years, predominantly female, married, and non-Saudi. Most had bachelor's degrees and 1-5 years of experience. These demographics are similar to the study by Hassen et al. (2023), where most nurses were aged 20-29 years. However, unlike Hassen et al.'s finding that the majority were male, our study had a nearly equal gender distribution. This difference may be due to the varying cultural and institutional settings. Similarly, Hetland, Heusinkvelt, Krabbenhoft, and Grotts (2018) in Iraq found that a majority of ICU nurses were younger males, which contrasts with our predominantly female cohort.

Regarding training programs, most nurses in our study had not attended any training related to mechanical ventilation, aligning with the study by Dumbre (2019), which also reported low training levels among ICU nurses in Egypt. This lack of training could contribute to the gaps in knowledge and practice observed. Conversely, a study by Anesthesia (2020) in India found that ongoing training programs significantly improved nurses' competency in mechanical ventilation practices.

Knowledge levels among nurses were generally poor, with nearly half scoring poorly on mechanical ventilation knowledge. This finding aligns with the study by Hassen et al. (2023) in Ethiopia, where over half of the nurses had poor knowledge. Similarly, a study in southern India by Anesthesia (2020) found that 53.5% of nurses had poor knowledge of mechanical ventilation. However, Alemayehu et al. (2022) reported higher knowledge levels among nurses in Eastern India, indicating potential regional differences in training and education. Additionally, a study conducted by Hashemian et al. (2018) found that ICU nurses in developed countries had significantly better knowledge and understanding of mechanical ventilation, suggesting that higher resource availability and advanced training programs play a critical role in enhancing knowledge levels.

The practice levels were similarly low, with two-thirds of nurses demonstrating poor practice in caring for mechanically ventilated patients. This is consistent with Hassen et al. (2023) and Anesthesia (2020), who also reported poor practice levels among ICU nurses. However, Addisu (2019) found better practice levels among nurses in Sri Lanka, suggesting variations in training programs and healthcare practices. Furthermore, a study by Taha et al. (2019) in Saudi Arabia found that ICU nurses who received specialized training in mechanical ventilation demonstrated significantly better practice levels compared to those who did not receive such training, highlighting the importance of targeted educational interventions.

A study by Jing, Qian, and Yi (2021) indicated that education significantly improves nurses' competence in managing mechanical ventilation. They found that education interventions increased nurses' knowledge about ventilator-associated complications and improved their competence in using ventilators. This showed the need for continuous education and training programs to enhance nurses' skills and knowledge. Similarly, Sjoding, Gong, Haas, and Iwashyna (2019) in Australia found that structured education programs significantly increased nurses' confidence and autonomy in using lung protective strategies, further supporting the benefits of continuous professional development.

The importance of holistic care was showed by Rak et al. (2020), who noted that critical care staff, particularly nurses, play a central role in providing comfort and security to patients. Integrating psychological and social aspects into care planning is essential for holistic patient care, which includes not only technical skills but also the manner in which care is provided. Andres and Jorge (2022) also highlighted that holistic nursing care, which encompasses emotional and psychological support, is crucial in improving patient outcomes and satisfaction in the ICU.

The role of head nurses and Certified Nurse Specialists (CNS) in managing ward policy, staff, and finances to achieve ward goals is crucial. The presence of a CNS as head nurse was associated with reduced mortality and fewer patients requiring ventilators, highlighting the impact of specialized nursing leadership on patient outcomes. Mohammed and Ebrahem (2022) also found that effective nursing leadership, characterized by strong communication and organizational skills, was instrumental in improving the quality of care in ICUs and reducing patient mortality rates.

In conclusion, the study found significant gaps in the knowledge and practice levels of ICU nurses regarding mechanical ventilation. Continuous education and training programs are essential to improve these aspects. Additionally, incorporating holistic care practices and effective nursing leadership can enhance patient outcomes in ICU settings. This study showed the critical need for targeted educational interventions and the implementation of best practice guidelines to ensure high-quality nursing care for mechanically ventilated patients.

Conclusion

The study showed that knowledge and practice regarding mechanical ventilators among nurses in selected public hospitals were suboptimal. Educational level was significantly associated with both knowledge and practice, indicating that enhancing the educational qualifications of ICU nurses is crucial. Improving education can enhance nursing interventions, promote patient recovery, maintain oropharyngeal hygiene, adjust pH and blood gas levels, and reduce the risk of ventilator-associated pneumonia (VAP) and other complications, ultimately lowering morbidity and mortality rates.

To improve nursing care for mechanically ventilated patients, targeted educational programs addressing specific knowledge gaps, such as ventilator management and infection control, are essential. Implementing evidence-based practices, such as regular patient repositioning, can prevent complications like pressure ulcers and VAP. Enhancing communication and collaboration within the healthcare team through standardized protocols can improve patient outcomes. Continuous quality improvement initiatives, regular monitoring, and feedback incorporation are vital. Additionally, having a Certified Nurse Specialist (CNS) as the ICU head nurse, combining advanced clinical and management skills, has been associated with better patient outcomes and fewer ventilator-dependent patients. Future research should further explore the clinical value of CNS-qualified head nurses and establish standardized non-invasive mechanical ventilation (NIMV) care protocols.

Acknowledgment

We extend our deepest gratitude to the staff and management of King Abdulaziz Specialist Hospital and King Faisal Specialist Hospital & Research Centre for their invaluable support and cooperation during this study. We also thank the nurses who participated in this research for their dedication and contribution. Special thanks to our colleagues and mentors for their insightful feedback and encouragement throughout this project.

Author Contribution

This paper is extracted from the original MSc research conducted by Tagreed Musaad as part of the Master of Nursing in Critical Care program at the University of Hafer Al Batin, College of Applied Medical Sciences. Tagreed Musaad was responsible for the study conception and design, data collection, and initial manuscript drafting. Dr. Salwa Yousif, who served as the supervisor for this research, handled data analysis, interpretation of results, and manuscript revisions. Both authors read and approved the final manuscript.

Conflict of Interest

The authors declare no conflict of interest regarding the publication of this paper. This study was self-funded by the principal authors. All procedures followed were in accordance with ethical standards.

Ethical Consideration

This study was conducted following the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee. Written informed consent was secured from all participants, ensuring anonymity, confidentiality, and the right to withdraw from the study at any time without any consequences.

Data Availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request. All data have been anonymized to protect the privacy of the participants.

 

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