Improving Neonatal Nurses Knowledge and Preventive Practices for Unplanned Extubation: Effective of a low-cost Multimodal Educational Intervention in the NICU

Abstract Unplanned Extubation is a frequent adverse event in Neonatal Intensive Care Units (NICUs), that is associated with increased morbidity, prolonged hospitalization and financial costs. Evidence suggests that unplanned extubation (UE) is preventable through the management of its risk factors. Many modifiable UE risk factors are directly related to nursing care, thus empowering nurses through education can improve neonatal safety outcomes. This study aimed to evaluate the effectiveness of a structured educational intervention in improving nurses knowledge and practices related to UE in NICUs. A quasi-experimental pretest-posttest study was conducted in two tertiary hospitals in northern Jordan. One hospital is university-affiliated and one is governmental hospital. Participating Nurses in the selected settings received a four-week multimodal educational intervention related to UE. The intervention comprised of face-face session, WhatsApp-based educational messages, educational videos and placement of a poster in the NICU. Knowledge and practices of 58 nurses were assessed at baseline, post intervention and one month later using a validated questionnaire and direct observation. A baseline rate of UE was also measured in both settings with rate of 5 events per 100 ventilator days in the university-affiliated compared to 32 events per 100 ventilator days in governmental hospital. Repeated-measures and mixed-design ANOVA revealed significant improvements in nurses knowledge in both settings with a large effect size (p{superscript 2} = .60). Also, the observed preventive practices scores also improved significantly and remained elevated at one-month follow-up (p{superscript 2} = .50). Older age was associated with lower baseline knowledge, though this was diminished post study intervention. Whereas no demographic variables were associated with practice scores. The high rates of UE highlight the need for quality improvement. Study findings suggest that UE-focused education is a feasible and cost-effective strategy for strengthening neonate nurses competencies regarding safer care for mechanically ventilated neonates in the NICUs.