Hospital educators commonly encounter urgent requests from critical care units for enhanced education on the care of Central Venous Access Devices (CVADs). However, despite numerous training sessions, hospital-associated CVAD infections persist. This raises a question – is there a gap in the understanding of the guidelines amongst the nurses, or are there other concealed impediments in their practice? Seeking to answer this and to provide a supportive infrastructure for nursing practice, a 2022 research study was conducted in eight intensive care units (ICUs) within a large hospital system in the U.S. The study aimed to elucidate the barriers that stood in the way of effective care of CVADs.
CVADs, which are often required in the care of critically ill patients, can pose infection risks if not managed correctly. Evidence-backed guidelines have been available since 2011, but adherence to these guidelines seems inconsistent. Seemingly, critical care nurses do not always practice every component of the CLABSI prevention bundle. Adamantly, the research study set out to discover the root causes, focussing on critical aspects such as nurses’ knowledge of the guidelines, their level of experience, and unit culture. The initial strategy of repeated reeducation did not manifest evidently in improved outcomes, highlighting the need for a more individually catered tactic rather than a one-size-fits-all approach.
Underpinning the study was the Theory of Planned Behavior which extends the premise that an individual’s intention to commit to a certain behavior bases on their attitude towards that behavior, the social norms or peer pressure, and their perception of difficulties involved in performing that behavior. Analysis of the nurses’ responses validated this theory, with attitudes, norms, and barriers collectively influencing the adherence to CVAD care guidelines.
However, certain barriers spelled out in the study highlighted some poignant points of examination. These self-reported obstacles revolved around familiar themes such as lack of time, difficulties in prioritization, and dealing with complicated patient conditions. Nurse educators and ICU leaders, using these insights, are now steering their attention to address these barriers rather than solely focussing on reeducating the guidelines. The intention is to build an atmosphere where open discussions are encouraged and where nurses are considered as integral partners in the strategy planning rather than mere end recipients of mandates.
To counter these challenges, few strategies have been proposed. For nurses, a supportive culture that encourages evidence-based practice along with open dialogues helps. Educators should modify their teachings to address these underlying issues and cultivate an attitude of understanding towards impediments in care, simultaneously teaching about guidelines and CVAD care skills. As for leaders, the demonstration of the importance of CVAD care and the fostering of a culture that makes room for recognition of good practice can influence care positively. Collaborative bedside rounds are recommended which could include discussions on barriers to care.
Therefore, it may be time to hit the pause button on repeated, untargeted education programs and mandates. Instead, a more inclusive approach that addresses not only CVAD care knowledge and skills, but also the role of attitudes, unit culture, and barriers in influencing intentions to offer care could potentially eliminate these infections.