Endotracheal Suctioning Practices Among Intensive Care Unit Nurses in Addis Ababa, Ethiopia: A Mixed-Methods Assessment of Knowledge, Barriers, and Facilitators

Endotracheal Suctioning Practices Among Intensive Care Unit Nurses in Addis Ababa, Ethiopia: A Mixed-Methods Assessment of Knowledge, Barriers, and Facilitators | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Endotracheal Suctioning Practices Among Intensive Care Unit Nurses in Addis Ababa, Ethiopia: A Mixed-Methods Assessment of Knowledge, Barriers, and Facilitators Bayisa Gadisa Bultuma1*, Liu Jia2 This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7502697/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Endotracheal suctioning (ETS) is a component of bronchial hygiene therapy and mechanical ventilation and involves the mechanical aspiration of pulmonary secretions from a patient with an artificial airway in place. This study aimed to assess ICU nurses’ adherence to evidence-based practices of endotracheal suctioning,identify knowledge gaps, explore barriers to improving patient care standards. Methods A mixed-method design was employed, consisting of a quantitative study of 152 ICU nurses and qualitative semi-structured interviews with 11 ICU nurses in Addis Ababa, Ethiopia. It was conducted between August 1 2024-30 and August 2024 with nurses working in intensive care in the selected five public hospitals. The quantitative data were analyzed using descriptive and inferential statistics, while qualitative data underwent content analysis to identify barriers and facilitators of ETS practices. The data were analyzed using descriptive statistics (mean, standard deviation, frequency, and percentages) and inferential analysis (t-test, ANOVA and bi variate analysis). The study ethics committee approval, institutional permission, and participant consent were obtained before starting the research. Result The study revealed that ICU nurses’ overall adherence to ETS best practices was 47.2%, while the overall ICU nurses’ knowledge score of 64.6%. ICU nurses’ knowledge of ETS, training in ICU, and work experience in ICU were statistically significantly influenced ETS practice. The significance level of the predictor variables indicated at ( p < 0.05) confidence interval 95% statistically significant. Conclusion The findings revealed a significant gap between established evidence-based practice of ETS and the actual practices of ETS utilized by ICU nurses. Endotracheal suctioning ICU nurses evidence-based practice knowledge barriers facilitators Introduction Endotracheal suctioning (ETS) is the crucial part of the bronchial hygiene procedure for patients on mechanical ventilation. It requires the mechanical aspiration of pulmonary secretions from a patient who has an artificial airway inserted [ 1 ] . The ETS procedure is needed to maintain the patient's airway open, preventing respiratory tract infection, and optimizing ventilation and oxygenation [ 2 ] [ 3 ] . Although endotracheal suctioning is the life-saving procedure for mechanically ventilated patients, yet improper techniques can lead to severe complications [ 4 ] . It is important for Intensive Care Unit (ICU) nurses to have the necessary knowledge and skills based on valid scientific evidence in performing ETS and aspects related to it [ 5 ] . The practice of ETS should be according to the patient’s specific requirements rather than on a routine schedule has been indicated to lead to better outcomes and fewer side effects. Research suggests that well-educated, skilled nurses can considerably lower procedure-related complications by evaluating the patient's condition before suctioning [ 6 ] . This method aligns with evidence-based practices of ETS procedures that show how crucial it is to assess patients before suctioning [ 7 ] . Unsafe endotracheal suction techniques remain an issue globally [ 8 ] [ 9 ] . Numerous studies have shown that the ICU nurses often continue to perform ETS procedures in a conventional or routine way, even though there are established, evidence-based guidelines for ETS. This points to a gap between the scientific knowledge available and the actual practices used in clinical settings [ 10 , 11 ] . Several factors contributed to why nurses are not adopting these recommendations, including limited ICU training, insufficient support from management, resistance to change, difficulty in accessing relevant literature, a lack of time to thoroughly read and understand the existing evidence, ineffective change management processes, and the absence of clear guidelines. Studies have been conducted on the use of endotracheal suctioning (ETS) guidelines, and their research found that many intensive care unit nurses were ignorant of ETS guidelines and lacked basic ETS knowledge, which resulted in practices that ignored evidence-based recommendations [ 12 ] , [ 7 ] , [ 13 ] , [ 14 ] . Compared to untrained nurses, nurses with intensive care unit training (57.3%) showed a significantly higher level of ETS knowledge [ 15 ] . According to a quantitative analysis of the studies, only 36% of the nurses had assessed patients before endotracheal suctioning, and only 46% knew the proper suction machine pressure to use for ETS. It was found that only 62% of nurses wash their hands before suctioning [ 9 ] . In Ethiopia, the practice of ETS for mechanically ventilated patients using the available evidence-based recommendations is low, 51% of nurses had poor knowledge, and almost 80% of nurses’ practices toward ETS was low [ 16 ] . Limited study was conducted on this topic in Ethiopia. This practice gap is caused by a number of factors. First, a major obstacle has been identified as the lack of knowledge among healthcare professionals, particularly intensive care unit nurses, about the proper methods and indications for ETS [ 17 ] . Many nurses restricted to outdated practices due to comfort and familiarity, which deepens the gap in their awareness of ETS [ 18 ] . Additionally, the role of managerial support is often overlooked. Insufficient support from hospital administration often results in a lack of resources and continued education and training on best practices in ETS [ 17 ] . This scarcity of resources challenges nurses' ability to stay informed about the latest recommendations and techniques in ETS, creating a significant barrier to practice improvement [ 19 ] . For patients on mechanical ventilation, these gaps contributed to higher rates of morbidity and mortality, ultimately impacting patient safety [ 7 ] . This study target to improve patient safety and clinical outcomes in patients on mechanical ventilation by evaluating and providing relevant evidence regarding the ETS practices of intensive care unit nurses. Understanding the current state of ETS practices in ICU settings could help healthcare administrators make informed decisions regarding quality improvement in ICU settings, especially in light of the ongoing competency of nursing staff. This study can be used as a benchmark for continuous improvements in nursing care and patients’ standardized care in critical care settings, as well as a starting point for future research on ETS practices. Methods and materials Study Design: This study employed a mixed-method explanatory sequential design from 1 st August to 30 th August 2024. The explanatory sequential design with quantitative data collected in the first phase, followed by qualitative data collected in the second phase. The data from the qualitative phase explained the data from the quantitative phase. An explanatory sequential design (quantitative followed by qualitative) suitable when the quantitative results are surprising (significant serendipitous results). Study Population: The intended population of this study were nurses who are working in intensive care unit and directly responsible for patient care from selected hospital. From the selected hospitals for the study, about 196 nurses were employed. Eligibility Criteria: The inclusion criteria included ICU nurses who provided direct care for patients on mechanical ventilation and who were breathing through tracheostomy or endotracheal tube were eligible for the study. The exclusion Criteria included nurses who were not a part of the ICU staff, and those who didn’t, available during data collection, nurses’ managers and other healthcare professionals were excluded from the study. Sample size determination: The sample size for the study was calculated by using a single population formula. The practice of endotracheal suctioning among ICU nurses from previous studies was 50% [7] . The normal standard deviation of 1.96 corresponds to a 95% confidence interval. P = prevalence rate = 0.50. D = degree of accuracy of the result = 0.07. However, because the study population from five hospitals is relatively small, the modified sample size calculation using Cochran's formula for finite populations (<10,000) was applied. The initial sample size calculated using this approach was also 196. Given that the total ICU nurse population across the five hospitals was only 196, a census approach was adopted to ensure comprehensive representation. This decision ensured that all available ICU nurses were included in the study, thereby maximizing the representatives and reliability of the findings. =196 Sampling technique: The study approached a non-probability convenience sample by inviting all accessible and eligible ICU nurses to participate to provide an image of the current practice and associated factors related to endotracheal suctioning in selected hospitals. The convenience sampling technique is a non-random sampling techniques that allows the researchers to collect information from participants who are easily accessible and available. A purposive sampling technique was employed for the qualitative study. The study participants were recruited and directly face to face interviewed. The repetition of themes, minimal new insights, repetition of responses, diverse perspectives Coverage, and reflective iteration were the indication of data saturation. Eleven ICU nurses were interviewed for the study. Study tools : The data measurement tools were adopted from the previous study, in which the reliability was checked and validated [7] . The reliability of the data measurement tools used for this study was assessed through a test-retest method in a previous study. In the previous study, the data measurement tool was tested by five ICU nurses invited to fill out the questionnaire. The Cronbach’s alpha values for the knowledge section and the practices section were reported as 0.835, and 0.812, respectively, indicating good internal consistency of the questionnaire [7] . The questionnaire consisted of three parts. Part one: demographic data such as age, sex, marital status, training sessions on ETS techniques, educational level, and work experience in the ICU, to assess the knowledge of nurses regarding endotracheal suctioning. Part two: there were 26 yes or no questions in the knowledge section, each with one correct answer. The ‘YES’ answer received one point; it was correct answer, while the ‘NO’ answer was erroneous and received zero points. Part three: There are 34 ‘yes’ or ‘no’ questions in the practice question about nurses’ endotracheal suctioning skills. In the study instruments for the practice of endotracheal suctioning, the (yes) right answer received one point, while ‘NO’ was an erroneous response that received zero points. An interview guide was designed to build on the results of the quantitative study to explore the barriers and facilitators related to ICU nurses’ practice of endotracheal suctioning qualitative study. This semi-structured questions was adapted to ensure a thorough investigation of the barrier and facilitator factors related to ICU nurses’ practice of endotracheal suctioning [12, 20] . A pilot interview was conducted in five ICU nurses by nursing researchers who have experience in qualitative data collection. The pilot test demonstrated that the interview questions were understandable, a ppropriate to ICU nursing experiences, and elicited r ich qualitative data With absolute clarity. Variables: Dependent variables: practice of endotracheal suctioning (ETS) procedure among ICU nurses. Independent Variables: knowledge of endotracheal suctioning (ETS) procedure among ICU nurses , age, sex, marital status, training sessions on ETS , educational level, and work experience in the ICU. Ethical Consideration: Ethical clearance was obtained from Central South University Xiangya School of Nursing after being approved by the institution’s ethical review board (ethical review number: 2024WJ014). Permission to commence the study was also obtained from each hospital, by submitting filled application forms with the proposal to get approval to conduct this study and additional permission was obtained from the nurse in ICU. The respondents were properly informed and guaranteed confidentiality and anonymity throughout the study and informed that the data collection process was done on an individual basis to ensure their privacy. Participation was completely voluntary basis and could withdraw from the study at any time or stage of the study. To keep all the information confidential, numbers were used instead of names to identify participants. Data Collection and Recruitment Procedure: Data was collected for one month from1 August 2024 to 30, August 2024 after obtaining ethical clearance from Central South University Xiangya School of Nursing, and a permission letter to conduct the study in respective hospitals. The principal investigator gave training sessions to five research assistants face to phase on the purpose of the study and the use of the data collection tool. The training was conducted for two days on the general overview of the study including the broad and specific objectives of the study. During the data collection period, research assistants visited the nurses in the ICU of each selected hospital with the permission letter for the approval of commencing the study in the unit. Those nurses who met the criteria were given a participant information sheet about the overall study. After obtaining permission from participants, the structured questionnaires were distributed to the nurses. They were asked to complete the questionnaire during their free time, ensuring it did not interfere with their regular duties. Research assistants collect the completed questionnaires. The semi-structured interviews was conducted by face-to-face to collect new data and explore participants' thoughts and beliefs about barrier and facilitator factors effluence ETS practice. Quality Control and Data Analysis: Completed questionnaires were routinely checked by research assistants daily. The data was checked, organized, coded, and entered into the statistical package for social science (SPSS) for analysis program version 27.0 for analysis. The researcher managed and analyzed these data properly. Descriptive analysis included frequency percentages. An inferential analysis t-test, ANOVA and bi-variate analysis was used to examine the relationship between the influencing factors and ICU nurses’ practice regarding endotracheal suctioning. Variables that statistically significant were undergone multiple linear regression analysis was used to examine the relationship between the variable being studied and other predictor variables. A confidence interval of 95% and p-value ≤ 0.05 was considered statistically significant correlation to the practices of ETS among ICU nurses. The content analysis was used to analyze the qualitative study. In this study, all audio-recorded interviews were transcribed to full verbatim by actively listening. Full verbatim refers to a type of transcription that captures every word and sound exactly as they were spoken. This includes not only the actual words but also filler words( like “um’’ and “uh’’), stutters, false starts, and any grammatical or vocabulary mistakes made by the speaker [21, 22] . In contrast, there is also a style known as “clean verbatim,” which removes unnecessary speech elements to enhance readability while still conveying the original meaning of the dialogue. This style omits filler words and other verbal tics, making the transcript easier to read without altering the essential content. While conducting clean verbatim transcription, false starts, repetition, stutters, filler words, and slang words in the full verbatim were altered [23] . In the qualitative study the trustworthiness data refers to the degree of confidence in the data, method, and interpretation used to ensure the quality of a study [24] . Choosing the study sample carefully and allowing the participants to express their views and opinions freely is the key to ensuring the accuracy of qualitative data collection. A significant contribution to validity criteria has been made by authors [25] , who have established the importance of credibility and authenticity as quality indicators. The rigidity or trustworthiness of a qualitative study is assessed by its credibility, dependability, Confirmability and Transferability [25] . Results Part One Quantitative Result Descriptive analysis of sociodemographic information of Study participants A total of 152 nurses completed the questionnaires leading to a 96.8% response rate of nurses. The majority of the study respondents were females 89(58.6%) as to males 63(41.4). The mean age of the study participants involved was 29.72 ± 3.41, a minimum of 23 to a maximum of 41 years old. The majority of the study groups reported falls between the age group (26–30) years 98 (64.5%), of which (31–35) years 33 (21.7%) fall within the second majority age group, (20–25) years accounted for 12 (7.9%), and (36–40) years accounted for 8 (5.3%). The majority of the respondents were from Saint Paul Millennium Medical College 44 (28.94%) and Saint Peter Specialized Hospital 36 (23.68%), followed by Yekatit 12 Medical College Hospital 29 (19.1%), regarding the number of years working in the critical care units. 85 (55.9%) of the nurses reported between (5–10) years, 40 (26.3%) of the nurses reported between (11–15) years, 23 (15.1%) of the nurses reported less than five years and, only 4 (2.6%) of the nurses reported ≥ 16 years have worked in critical care units. “Table 1 .” Table 1 Sociodemographic characteristics of ICU nurses (N = 152), Addis Ababa, Ethiopia Characteristic Group N (%) Age 20–25 12 (7.9) 26–30 98 (64.5) 31–35 33 (21.7) 36–40 8 (5.3) ≥ 41 1 (0.7) Gender Male 63 (41.4) Female 89 (58.6) Marital status Single 71 (46.7) Married 81 (53.3) Educational level BSc 124 (81.6) MSc 28 (18.4) Work experience in ICU < 5 years 23 (15.1) 5–10 years 85 (55.9) 11–15 years 40 (26.3) ≥ 16 years 4 (2.6) Patients per nurse One patient per nurse 135 (88.8) Two patients per nurse 17 (11.2) Job title of the participant Junior 22 (14.5) Senior 86 (56.6) Chief 30 (19.7) Expert 14 (9.2) Theoretical training Yes 64 (42.1) No 88 (57.9) Practical training Yes 64 (42.1) No 88 (57.9) 3.1.2 Knowledge of ICU nurses regarding endotracheal suctioning Tables 2 show the knowledge scores of intensive care unit nurses (N = 152) about endotracheal suctioning for critically ill patients in Addis Ababa five selected hospitals. One of the objectives of the current study was to assess the intensive care unit nurse’s knowledge about endotracheal tube suctioning for critical patients (Tables 3 and 4 ). The study revealed that the overall knowledge of ICU nurses regarding endotracheal suction was 64.6%. This study revealed that 68.4% of nurses said that suctioning should only be done when the assessment of the patient establishes the indication of endotracheal suctioning. Table 2 knowledge scores of ICU (N = 152) about ETS Addis Ababa, Ethiopia Knowledge questions items (N = 26) Correct Incorrect N (%) N (%) 1. Suctioning should only be done when a thorough assessment of the patient establishes the need. 104 (68.4) 48 (31.6) 2. If patients are able to cough up their own secretions, they should be encouraged to do so. 90 (59.2) 62 (40.8) 3. The suction catheters should be as small as possible, yet large enough to facilitate secretion removal. 101 (66.4) 51 (33.6) 4. The size of the suction catheter should occlude no more than half of the internal diameter of the artificial airway to minimize falls in PaO₂. 98 (64.5) 54 (35.5) 5. I possess the required procedural skill and gentleness when performing ET suctioning due to the potential associated hazards. 104 (68.4) 48 (31.6) 6. The use of a closed suction system is suggested for adults with high FiO₂ or PEEP, or at risk for acute lung injury. 97 (63.8) 55 (36.2) 7. The closed and open suction systems have no difference in terms of oxygen saturation, cardiovascular stability, secretion removal, environmental contamination, and cost. 106 (69.7) 46 (30.3) 8. Aseptic technique should be considered essential for the invasive component of suctioning, including hand washing and glove use, as endotracheal suctioning may lead to lower airway contamination. 93 (61.2) 59 (38.8) 9. Routine use of normal saline instillation before endotracheal suctioning should not be performed. 84 (55.3) 68 (44.7) 10. Ensuring patients are adequately hydrated is a way healthcare providers can facilitate the removal of respiratory secretions. 104(68.4) 48 (31.6) 11. The suction catheter should be inserted to the carina and then retracted 1–2 cm before suctioning is performed, or the length should be estimated by measuring an identical endotracheal tube. 88 (57.9) 64 (42.1) 13. The lowest possible suction pressure should be used during endotracheal suctioning, usually 80–120 mmHg. 92 (60.5) 60 (39.5) 14. The suctioning procedure should last no longer than 15 seconds. 133 (87.5) 19 (12.5) 15. There should not be more than three consecutive suction procedures secretions. 102(67.1) 50(32.9) 16. Perform suctioning at least every 8-hour to reduce risk of partial occlusion of the endotracheal tube and accumulation of secretion 96(63.2) 56(36.8) 17. Using volumes of hyperinflation that is indexed to the size of the patient may assist in minimizing potential difficulties. 99(65.1) 53(34.9) 18.Tidal volumes should no more than900 cc during hyperinflation because patients may feel dyspnea 106(69.7) 46(30.3) 19. If hyperventilation used in the patient before suctioning, caution should be employed because it may be associated with increases in mean arterial blood pressure. 103(67.8) 49(32.2) 20. Combining hyper oxygenation and hyperinflation prior to suctioning can minimize suctioning-induced hypoxemia 92(60.5) 60(39.5) 21. Pre-oxygenation by the delivery of 100% oxygen for at least 30 seconds before sectioning. 113(74.3) 39(25.7) 22. A ventilator should be used rather than a manual resuscitation bag to provide hyperventilation/ hyper-oxygenation prior to suctioning to reduce hemodynamic alterations 100(65.) 52(34.2) 23. Suctioning through an adaptor is preferred to preserve oxygenation in mechanically ventilated patients. 99(65.1) 53(34.9) 24. Post-suctioning hyper oxygenation with 100% of oxygen. 98(64.5) 54(35.5) 25. prior to, during, and after the procedure, oxygen saturation, respiratory rate and pattern, hemodynamic parameters, sputum characteristics, cough characteristics, and intracranial pressure should be monitored 94(61.8) 58(38.2) 26. Endotracheal suctioning, unless managed appropriately, can lead to various adverse events (tracheal trauma, hypoxemia, hypertension, cardiac arrhythmia, and raised intracranial pressure) and increase mortality and morbidity rates. 104(68.) 48(31.6) Total 64.6 (35.4) Items (N = 26), N = frequency, %= percentage, Yes = correct responded Practice Of ICU Nurses In ETS For Mechanically Ventilated Patients Table 3 show practice scores of intensive care unit nurses (n = 152) about endotracheal suctioning for critically ill patients in Addis Ababa five selected hospitals. The objective of the current was to assess intensive care unit nurses’ practice regarding endotracheal suctioning for critical patients. This study revealed that only 47.2% of ICU nurses followed the recommended practices for endotracheal suction. This study revealed that 53.9% of nurses recognized the need for endotracheal suctioning as a routine part of assessing patients' blood pressure, heart rate, oxygen saturation, and breathing sounds, along with evaluating the ventilator system. Table 3 Practices Scores Of Intensive Care Unit Nurses (n = 152) About Endotracheal Suctioning Addis Ababa, Ethiopia No. Practice questions item (N = 34) Correct Incorrect N (%) N (%) 1 Assessed the need for endotracheal suctioning as routine part of the patient’s BP, HR, oxygen saturation, and breathing sound/ventilator system assessment. 82 (53.9) 70 (46.1) 2 Identify indication for suctioning 112 (73.7) 40 (26.3) 3 Prepare equipment for suctioning 107 (70.4) 45 (29.6) 4 If patients able to cough, they should be encouraged to do so. 82 (53.9) 70 (46.1) 5 The size of used suction catheter occlude less than half of the internal diameter of the artificial airway 69 (45.4) 83 (54.6) 6 The use of a closed suction system is suggested for adults with high FIO2 or PEEP, or at risk for acute lung injury 72 (47.6) 80 (52.4) 7 Check the suction machine with the connecting tube, and prepare ambu bag with O2 supplies 79 (52.0) 73 (48.0) 8 Perform Pre-oxygenation by delivering 100% oxygen for at least 30 seconds prior to and after the suction procedure. 83(54.6) 69(45.4 ) 9 Position patient in semi-Fowler position 85(55.6) 67(44.1) 10 I Washed my hands, wore gloves and face mask before endotracheal suctioning. 64(42.1) 88(57.9) 11 Put on sterile gloves, and designate one hand as clean (non-dominant hand). 12(7.9) 140(92.1) 12 Use a sterile hand, sterile towel, and sterile suction catheter during suctioning procedure. 23(15.1) 129(84.9) 13 Gently but quickly insert the catheter into the artificial airway using a sterile technique. 72(47.4) 80(52.6) 14 Apply no suction when inserting 83(54.6 6945.4) 15 Insert the suction catheter to the carina and then retracted 1-2cm before suctioning or measured an identical endotracheal tube to estimate the length of the suction catheter 73(48) 79(52) 16 I did not perform N/saline instillation routinely before ETS. 48(31.6) 104(68.4) 17 Make sure that suction pressure is at 80-120mmHg during suctioning. 84(44.7) 68(68.4) 18 Rotating the suction catheter 360 degrees when withdrawing 80(52.6) 72(47.4) 19 Suction time 10–15 seconds. 115(75.7) 37(24.3) 20 Discontinue if HR is below or above 55(36.2) 97(63.8) 21 Use ventilator instead of a manual resuscitation bag to provide hyperventilation/hyper oxygenation prior to suctioning to reduce hemo dynamic alterations. 83(54.6) 69(45.4) 22 Perform suctioning through an adaptor to preserve oxygenation in mechanically ventilated patients. 82(53.9) 70(46.1) 23 Don’t reinsert the suctioning catheter into the endotracheal tube more than three suction per suctioning. 81(53.3) 71(46.7) 24 I performed suctioning for each patient at least every 8-hours. 82(53.9) 70(46.1) 25 The catheter is detached from the aspirator pipe. 93(61.2) 59(38.8) 26 Hyper oxygenate after suctioning (100% O2). 69(45.4) 83(54.6) 27 Rinse the catheter and connecting tube with the NS. 50(32.9) 102(67.1) 28 Proper way of disposing used suction catheter and gloves post suctioning. 48(31.6) 104(68.4) 29 Wash hand after endotracheal suctioning. 55(36.2) 97(63.8) 30 Assess for secretion clearance. 59(38.8) 93(61.2) 31 Discard used suction catheter 41(27) 111(73) 32 Turn off the suction device 104(68.4) 48(31.6) 33 Monitor breath sounds, respiratory rate and pattern, hemodynamic parameters, and ventilator parameters 66(43.6) 86)56.6) 34 Documentation 59(38.8) 93(61.2) Total average (47.2) 52.8 Items (N = 34), N = frequency, %= percentage, Yes = correct respond Factors associated with practice of endotracheal suctioning procedure The study determined major contributing variables significantly associated with endotracheal suctioning (ETS) practices among nurses. Work experience in the ICU established a strong positive relationship with ETS practices (F = 12.79, p = 0.001) , where nurses with over 15 years of experience manifested the highest practice scores (mean = 0.49 ± 0.13), relative to those with less than five years (mean = 0.41 ± 0.11). This indicates that extended ICU exposure enhances procedural proficiency, likely due to repeated procedural proficiency and increased skill. In addition, job title also significantly affected the practices of ETS (F = 7.11, p = 0.001) , with expert nurses (mean = 0.60 ± 0.08) outperforming junior nurses (mean = 0.39 ± 0.12), demonstrating that clinical seniority and leadership roles relate to stricter compliance to ETS protocols. Also, theoretical training (t = 9.01, p = 0.001) and practical training (t = 7.78, p = 0.001) both significantly influenced the ETS practice. ICU nurses who received theoretical training (mean = 0.56 ± 0.11) and practical training (mean = 0.55 ± 0.12) conducted significantly better than untrained ICU nurses in the necessity of the endotracheal suctioning practices. Additionally, knowledge of ETS indicated a moderate positive relationship with the practice of endotracheal suctioning (r = 0.37, p = 0.001) , inferring that ICU nurses with higher knowledge scores (mean = 0.644 ± 0.12) implemented evidence-based practices more effectively. Table 4 Factors Associated With Endotracheal Suctioning practices Among ICU Nurses in Addis Ababa, Ethiopia Variables Mean ± SD T-Test/Anova p-value Male 0.45 ± 0.14 t = 0.91 0.364 Female 0.47 ± 0.13 20–25 years 0.48 ± 0.15 F = 0.58 0.680 26–30 years 0.46 ± 0.13 31–35 years 0.46 ± 0.15 36–40 years 0.51 ± 0.10 Married 0.47 ± 0.13 t = 0.71 0.479 Single 0.46 ± 0.14 BSc 0.46 ± 0.14 t = 1.10 0.273 MSc 0.49 ± 0.13 < 5 years 0.41 ± 0.11 F = 12.79 15 years 0.59 ± 0.04 1 patient 0.46 ± 0.14 t = 0.23 0.818 2 patients 0.47 ± 0.13 Junior Nurse 0.39 ± 0.12 F = 7.11 0.001 Senior Nurse 0.45 ± 0.13 Chief Nurse 0.49 ± 0.14 Expert Nurse 0.60 ± 0.08 Theoretical (Yes) 0.56 ± 0.11 t = 9.01 0.001 Practical(Yes) 0.55 ± 0.12 t = 7.78 0.001 Knowledge(mean) 0.644 ± 0.12 r = 0.37 0.001 Multiple linear regression analysis of practice of endotracheal among ICU nurses versus associated factors The significance level of the predictor variables indicated at p < 0.05 confidence interval of 95% statistically significant with the dependent variable. The nurses' ICU work experience had a significant positive effect ( B = 0.42, p = 0.001) , revealing that each additional year in the ICU increased ETS practice scores by 0.42 units after controlling for other predictors. This suggests that each year of ICU work contributes meaningfully to the practices of endotracheal suctioning procedures. The theoretical training had a strong positive influence on the ETS practices (B = 0.212, p = 0.001 ), indicating that ICU nurses with theoretical training increased the practice of ETS adherence by 0.212 units after controlling for other predictors. This suggests theoretical learning enhances procedural awareness of the endotracheal suctioning procedure. The practical training had a strong positive influence on ETS practices (B = 0.536, p = 0.006) . indicating that ICU nurses with practical training increased the practice of ETS adherence by 0.536 units after controlling for other predictors. This suggests practical training enhances the practice of ETS competency. ETS Knowledge among ICU nurses had a significant positive influence (B = 0.373, p = 0.042) , indicating that each additional knowledge in the ICU increased ETS practice scores by 0.373 units, after controlling for other predictors. Model Fit and Multicollinearity The constant (intercept) is significant ( p = 0.033 ), suggesting baseline ETS practice is non-zero when all predictors are zero. VIF (Variance Inflation Factor) values are all below 5 (range: 1.010–2.692), indicating no severe multicollinearity among predictors. Practical Implications Training is Critical: Both theoretical and practical training strongly improve ETS practices, highlighting the need for structured educational programs. Experience Matters: ICU experience enhances ETS competency, suggesting mentors practical experience for novice nurses. Knowledge-Practice Link: Higher ETS knowledge correlates with better practice, reinforcing the value of ongoing education. Table 5 The relationship between the ICU Nurses’ practices of endotracheal suctioning and independent variables B Std. Error t P VIF (Constant) 0.834 0.389 2.147 0.033* - Work Experience in ICU 0.419 0.105 3.990 0.001*** 1.230 Job title 0.030 0.012 2.502 0.113 10.516 Theoretical training 0.212 0.057 2.734 0.001 2.256 Practical Training 0.536 0.125 4.288 0.006** 2.692 ETS Knowledge 0.373 0.124 3.008 0.042* 1.019 Notes :R = 0.710, R2 = 0.504 R = 0.710,R2 = 0.504,Adjusted R2 = 0.487, F = 29.876, P < 0.001 R 2 = 0.487, F = 29.876, P < 0.001.VIF values indicate no multicollinearity issues (all < 5 < 5).Significance levels: *P < 0.05 P < 0.05, **P < 0.01 P < 0.01, ***P < 0.001 P < 0.001. Part II Qualitative Results Developing the categorized Coding Schema Steps Content analysis was used to analyzed the data collected from the interviews since it was considered appropriate to meet the objectives of this study. This method allowed for an investigation of the barriers and facilitators of ICU nurses’ knowledge and practice of endotracheal suctioning for mechanically ventilated patients. The content analysis is constructed inductively, based on a thorough reading of the texts and looking for the meaning of the transcript. The structured steps for analyzing interview data using a content analysis approach: 1. read and familiarize: This step resulted in a more holistic understanding of the meaning behind texts [ 26 ] , 2. first-round coding (category): Starting with big picture schema allowed the researcher to move towards the second-round coding without feeling overwhelmed [ 26 ] . 3. Second-round coding (subcategories): This involved a detailed line-by-line analysis of the text. During this process, new codes and subcategories were created under the main theme. 4. Refining the fine-grained subcategories: This stage of analysis involved reviewing, refining and defining major categories and subcategories as part of the production of the refined coding schema. and, 5. Synthesis and interpretation: The final step consisted of examining the merged refined coding schema to determine if there were any connections between the research objectives and each category. Category 1 Nurses’ Barrier in Practice of Endotracheal Suctioning This category reflects the barriers of participants regarding the knowledge and practice of endotracheal suctioning for ventilated patients. The interviewees shared various barriers to following these interviews, which likely influenced their endotracheal suction to disregard professional recommendations. This category consists of a total of four subcategories of associated factors that challenge ICU nurses’ knowledge and practice regarding endotracheal suction. These subcategories are Organizational-related barriers, Individual nurse-related barriers, Healthcare professionals related barriers and Patient-related barriers factors. These subcategories impacted and reflected on the participants’ experiences of endotracheal suctioning, and how these barriers factors can be linked to endotracheal suction practice. Subcategory 1: organization-related barriers of ETS To improve patient outcomes and best nursing practice, ICU nurses must have a thorough grasp of the challenges associated with endotracheal suctioning as a crucial technique in respiratory care. A semi-structured interview and content analysis was conducted on ICU nurses who are directly responsible for patient care. Lack of theoretical training and restricted access to continuous professional development programs on endotracheal suctioning procedures might significantly hinder the ICU nurses’ skills to carry out this vital procedure effectively. The shortage of supplies such as suction catheters, sterile gloves, and suction machines was reported by the participant as a contributing factor to the challenges of endotracheal suctioning. "There is lack of standardized endotracheal suctioning guidelines resulted in the variation of awareness and adherence practices of ETS among ICU nurses."(Participant 1). "In our ICU, we clean and reuse single suction catheter for 12–24 hours as a result of shortage of supply, use of inappropriate size suction catheter, use non-sterile gloves in dominant hand that can increase the risk of infection." (Participant 6). " An inefficient work processes in ICU affect the timely practice of evidence-based recommendation, specifically endotracheal suctioning for patients on mechanical ventilation." (Participant 9). " The majority nurses in our ICU did not get theoretical and practical training that develop procedural skills of endotracheal suctioning." (Participant 4). "In the ICU setting, nurses do not have an ongoing educational and professional development platform to improve evidence-recommendation of the endotracheal suctioning procedure." (Participant 5). Subcategory 2: Individual nurse-related barriers This section focuses on the knowledge and practice barriers that ICU nurses face when performing endotracheal suctioning for mechanically ventilated patients. These barriers considerations in intensive care unit nurses’ indicated lack of awareness in evidence-based recommendation of ETS practice, emotional fatigue and working environment-related stress, and communication barriers among interdisciplinary teams. "The majority of nurses experienced lack of awareness to follow proper techniques of endotracheal suction while other ICU nurses follow the proper endotracheal suctioning practice.” (Participant 9). As the study participant revealed, the discrepancy in adherence to evidence-based recommendations of the endotracheal suctioning practice among ICU nurses may lead to a lack of standardized guidelines for ETS and lacked access to ongoing skills development training. The majority of the study participants had lack of awareness of the availability of ETS guidelines, which led them to personal trend follow during the practices of endotracheal suctioning. " The majority of nurses working in ICU lack training specifically skilled in endotracheal suctioning techniques, which can lead to improper execution of procedures." (Participant 7). " Nurses with more experience in ICU were better at following the evidence-based recommendations of the ETS procedure, and those less experienced in ICU were less in following evidence-based recommendations of ETS." (Participant 11). " Lack of timely endotracheal suctioning while the mechanically ventilated patients with the indication of suctioning resulted in blockage of patients’ airway." (Participant 6) "One of the main issues raised with compromised quality of nursing care in ICU, specifically endotracheal suction, was emotional fatigue and stress of ICU nurses related to the high-pressure working environment of ICU setting." (Participant 3) Subcategory 3 patient-centered barriers of endotracheal suctioning. It is difficult for many patients’ families to provide medications and other treatment supplies. This factor led to underscoring the patient care practice, specifically endotracheal suctioning. Financial constraints imposed by the patient's family may restrict access to necessary medical supplies, including sterile gloves, suction catheters, and other items, posing serious problems for medical staff, especially intensive care unit nurses. In addition to increasing the risk of infection, this healthcare practice highlighted the wider implications of inequality in healthcare. " Not only the nurses’ awareness and practice of endotracheal suctioning, the patients’ financial affordability can affect the practices of endotracheal suctioning among nurses" (participant 8). Subcategory 4: Healthcare Professionals Barriers " Interdisciplinary professional communication among nurses and other professional disciplines is for patient care; however, there is a gap to address evidence-based practices guidelines such as ETS." (Participant 6). "The healthcare professional staff in the ICU followed the variability approach during endotracheal suctioning" (participant 4). Category 2 ICU Nurses’ Facilitator Factors Related to ETS Practice Subcategory 1 organization-related facilitators of ICU nurses’ ETS practice The participants highlighted that hospital leader’s focus on sustaining resource provision based on the demand, which cultivates a culture of safety and excellence and empowers medical staff to give critically ill patients the best care possible, even in situations where resources may be limited. "The hospital leaders perform ongoing monitoring and evaluation of intensive care units and provide supportive leadership." (Participant 10). " The culture of encouraging non-punitive reporting of errors or near misses related to nursing care is important for ongoing improvement quality of care." (Participant 9). Subcategory 2 Individual ICU Nurses’ Related Facilitators of ETS. Participants highlighted that individual nurse-related facilitators of endotracheal suctioning play a crucial role in the practices of evidence-based recommendations to suctioning procedures. A significant number of ICU nurses teach themselves through reading articles, critical care guidelines, and online videos to empower their own knowledge and skills. Moreover, they collaborate with senior staff to share experiences and help nurses stay informed about best practices, specifically regarding endotracheal suctioning. The commitment to continuous professional development not only boosts their confidence but also maximizes their competencies to improve patient care, as they can apply the latest evidence-based techniques in their practice. " Individually, there is the situation of ICU nurses teach themselves by reading articles, critical care guidelines, and online videos to improve their competencies." (Participant 9) " They explored that collaborative knowledge sharing among nursing staff promotes better practices and enhances collective skills in ETS." (Participant 1) Subcategory 3: Healthcare Professionals’ Related Facilitators. The participant highlighted that healthcare professionals’ collaboration can ensure to provision of high-quality care during endotracheal suctioning by fostering an atmosphere of collaboration and continuous education. This coordinated effort ultimately improves patient outcomes by minimizing the risks associated with endotracheal suctioning, such as airway trauma, hypoxia, and ventilator-associated pneumonia. Collaboration among healthcare professionals is another essential facilitator in Knowledge sharing among nursing staff enhanced collective expertise, ensuring that all team members are aligned in their approach to patient care. " In order to maximize comprehensive patient care and resource availability, multidisciplinary teams, including emergency and critical care departments, are useful of collaborate, particularly to enhance the endotracheal suctioning procedure of patients on mechanical ventilators." (Participant 3). Data integration Integration of the Study’s Main Findings This study began with a quantitative investigation and proceeded to a qualitative investigation. After the two sets of data were gathered and examined independently, they were integrated to provide a comprehensive understanding of the phenomenon under study. The outcome of mixing in mixed-methods research can be dramatically enhanced when quantitative and qualitative data are integrated [ 27 ] . Integrating mixed-methods data can offer rich insights into study situations that may not be fully understood by using either method alone. In a mixed-methods study, integration is the explicit connection between the quantitative and qualitative study parts [ 28 ] . Combining the quantitative and qualitative studies for analysis is known as merging. Process of Data Integration Analysis This study integrated the quantitative and qualitative data using the analytical technique, joint display [ 29 ] . The association between the quantitative results and qualitative findings was established based on the statistically significant finding in quantitative data. A joint display technique was used to ensure validity in the design process by aligning findings from each study according to their degree of fit. A visual representation by innovative path diagrams and joint display was developed to generate new insights that go beyond the information derived from the separate quantitative and qualitative analyses [ 29 ] . The integration analysis involved the development of the construct that incorporated findings from both qualitative and quantitative studies to gain a deeper understanding of the factors that influence ICU nurses' practice of endotracheal suctioning. Table 6 Integration of quantitative and qualitative results from the mixed-methods study design, in Addis Ababa Key Theme Qualitative findings Qualitative findings Integration outcomes Knowledge of ETS Overall knowledge of ICU nurses regarding ETS was 64.6%. Specific knowledge gaps were identified in areas such as deep suctioning (35.5% correct) and normal saline use (55.3% correct). "Lack of standardized endotracheal suctioning guidelines resulted in the variation of awareness and adherence practices of ETS among ICU nurses."(Participant 1). confirmed Practice of ETS 15.1% of participants use of a sterile towel and sterile suction catheter during suctioning procedure Only 47.2% of ICU nurses followed recommended ETS practices, properly hand hygiene (42.1% correctly). "In our ICU, we clean and reuse single suction catheter for 12–24 hours as a result of shortage of supply, use of inappropriate size suction catheter, use non-sterile gloves in dominant hand that can increase the risk of infection." (Participant 6). confirmed Work Experience and Training Work experience (p = 0.032) and training (p = 0.001) significantly influenced ETS practices. "The majority of nurses working in ICU lack training specifically skilled in endotracheal suctioning techniques, which can lead to improper execution of procedures." (Participant 7). confirmed Organizational Barriers 57.9% of nurses lacked theoretical and practical training. "Lack of standardized endotracheal suctioning guidelines resulted in the variation of awareness and adherence practices of ETS among ICU nurses."(Participant 1). confirmed Individual Nurse-Related Barriers Only 53.9% of the participants reported practicing assessment for the need for endotracheal suctioning as a routine part of evaluating a patient’s blood pressure, heart rate, oxygen saturation, and breathing sounds, including the ventilator system assessment. "Identified barriers lack of training, emotional fatigue and stress of ICU nurses related to the high-pressure working environment of ICU setting." (participant 7 and 3) confirmed Facilitator factors of ETS Practice Theoretical and practical training significantly improved ETS practices (p = 0.001). "The hospital leaders perform ongoing monitoring and evaluation of intensive care units and give supportive leadership." (Participant 10). confirmed Discussion The present study discussed factors influencing ICU nurses’ ETS practice. Many earlier studies looked at what ICU nurses know and how they perform endotracheal suctioning, revealing differences between what they know and what they actually do. The current study was conducted mixed-method design to explore the barrier and facilitator factors that influence the practices of endotracheal suctioning.and provide a comprehensive understanding of why certain factors influenced the practice of ETS among ICU nurses. This study revealed that 64.6% of ICU nurses have awareness of endotracheal suctioning guidelines. The previous study stated 50–75% awareness of ETS guidelines but identified critical gaps in awareness of suction pressure and saline instillation [ 7 ] . The Similar study findings showed that < 50% of nurses conformed to evidence-based ETS practices [ 30 ] . These discrepancies may derive from organizational factors: in this study, lack of standardized ICU training programs differs markedly from high-income countries’ critical care training. In Ethiopian study documented 51% poor knowledge of ETS [ 16 ] . Globally, adherence to ETS best practices is typically greater in high-resource settings. The research in ICUs stated 60–80% adherence to sterile techniques and suction pressure standards [ 11 ] . The current study was 44.7% adhered to the recommended suction pressure (80–120 mmHg)which is quit higher. Qualitative data stated ICU nurses reused catheters for 12–24 hours due to the shortage of supplies, while quantitative results connected 57.9% lack of practical training of the endotracheal suctioning. In the previous study findings 39.2% of nurses correctly identified the recommended suction pressure of 80–120 mmHg for endotracheal suctioning [ 13 ] . The findings of this study indicate that nurses with 5–10 years of ICU experience (55.9%) demonstrated better adherence to endotracheal suctioning (ETS) guidelines compared to those with less than five years of experience (15.1%), with statistical significance (p = 0.032). Experienced nurses exhibited greater proficiency in key aspects of ETS, such as suction pressure regulation (44.7%) and suction duration control (75.7%), suggesting that accumulated clinical exposure enhances technical competence. These results align with international studies, such as research from Australia The impact of nursing workforce skill-mix on patient outcomes in intensive care units, where ICU nurses with more than five years of experience showed 78% compliance with ETS guidelines [ 31 ] . Research in India, where junior nurses with less than two years of experience struggled with sterile technique only 32% compliance [ 32 ] . The barriers factors identified in qualitative part of this study—including lack of standardized guidelines, resource shortages, and inconsistent training was echoed in both high-income countries and low/middle-income countries, though their manifestations differ starkly. In high-income countries like the US, hospitals with formalized ETS protocols electronic health registration-embedded checklists report 62% adherence to monitoring [ 33 ] , contrasting sharply with 25% adherence in Nigerian ICUs where hierarchical cultures and absent protocols hinder compliance [ 34 ] . Training variability also follows a bifurcated pattern: simulation-based training in German ICUs boosted adherence to 70% [ 35 ] , whereas in overcrowded Indian ICUs, 60% of ETS procedures were delegated to untrained aides due to staff shortages [ 36 ] . This study highlighted that the infection control is deficits as evidenced by the fact that only 7.9% of ICU nurses used sterile gloves during endotracheal suctioning practice. Recent studies highlight that low compliance with sterile glove use during endotracheal suctioning in ICUs. Another study stated only 9.2% of ICU nurses consistently adhered to sterile glove protocols, attributing non-compliance to the perceived convenience of non-sterile gloves [ 37 ] . The clinical consequences demonstrated that ICUs with < 10% sterile glove adherence had a 32% higher incidence of ventilator-associated pneumonia (VAP), directly linking poor aseptic technique to preventable harm [ 38 ] . Together, these studies reveal a global pattern of sub-optimal practice despite established guidelines, emphasizing the urgent need for targeted interventions to bridge the gap between policy and implementation. In this study, only 43.6% of ICU nurses monitor breath sounds, respiratory rate and pattern, hemodynamic parameters, and ventilator parameters before and after endotracheal suctioning. In high-resource ICUs, approximately 50% of staff adhered to comprehensive monitoring of parameters such as breath sounds, respiratory rate, and hemodynamic status after endotracheal suctioning, whereas adherence dropped to 30% in low-resource settings [ 39 ] . This study findings from qualitative evidence confirmed that the leadership plays a crucial role in creating an environment conducive to effective practice similar research finding reveal that hospitals with strong nursing leadership and safety cultures had 30% higher adherence to ETS guidelines, including aseptic techniques and Pre-oxygenation [ 40 ] . [ 41 ] . [ 42 ] . Implication of the study : The findings of this study revealed important deficiencies and potential areas to improve ETS among ICU nurses in Ethiopia, have implications for theory, clinical practices, policy making, and research. The Cognitive-Behavioral Theory (CBT) model explains the influence of nurses' knowledge, practices, and work circumstances on adherence to ETS. However, a theory-practice gap still exists, since only 47.2% of the ICU nurses who obtained a knowledge proficiency of 64.6% followed the ETS guidelines. Theoretical training and practical training: From a clinical perspective, aseptic technique, optimal suction pressure and avoidance of saline instillation should be prioritize in compulsory workshops. The hospital-wide protocol adopt the existing guidelines, with checklists and audits, could help to minimize clinical variation. At the policy level, the Ministry of Health and critical care societies should incorporate ETS best practices in to national ICU guidelines, emphasizing infection prevention, regulatory competency assessments and nurse well-being programs could further enhance adherence and the future research will intervene, self learning, peer mentoring and multi-center studies and evaluate long term policy impact before and after implementation of the endotracheal suctioning protocol. Strengths This study indicates several remarkable strengths that enrich the validity and relevance of its findings. Methodologically, the mixed-methods approach merging quantitative surveys (N = 152) with qualitative interviews (N = 11) allowed comprehensive data integration, enhancing the strengthen of conclusions about endotracheal suctioning (ETS) practices. Theoretically, the study was rooted in Cognitive-Behavioral Theory (CBT), giving a structured framework to evaluate how knowledge, practices and influencing factors collectively influence ETS practices. Furthermore, the implementation of international protocols secures the findings sustain relevance to both national practice needs and global critical care standards. Limitations : Self-reported questionnaires, which may introduce bias due to social desirability or recall errors, were used to collect the quantitative data. The ICU nurses may over-report or under-report the barrier and facilitator factors due to fear of judgement. The focused on the practice of ETS and associated factors, and explore the barrier and facilitator factors among ICU nurses, but the study didn’t direct address the patient outcome such as ventilation-associated pneumonia. The study does not show the impact of training on the improvement of ETS practices. A Longitudinal study will be more appropriate to assess the impact of training on ETS practices. In-depth limitation in the qualitative study: data collection techniques involved semi-structure interview techniques to collect information from the study participant, and the semi-structured interview form may not have addressed the full depth of nurses’ the information related to barrier and facilitator factors that influence the practice of ETS. Conclusion This study described the endotracheal suctioning (ETS) technique used by ICU nurses and highlighted the ongoing differences between evidence-based recommendations and actual clinical practice. Engaging a mixed-methods strategy helped the study to find both statistical trends and personal insights on the obstacles and enablers to implementing ETS. Nurses with more clinical experience and those who received theoretical and practical training were considerably more likely to attend best practices, reinforcing the value of continuous learning and practical experience. Barrier factors such as inconsistent guidelines, resource shortages (sterile equipment), emotional fatigue, inconsistent professional communication and inefficient workflow processes in ICU contributed to unsafe practice of endotracheal suctioning. These study results revealed definite reality, despite the barrier factors hindering the optimal practice ETS, ultimately influencing patient safety. Facilitator’s factors such as supportive leadership, theoretical and practical training, experience share-learning, individual self-learning, and interdisciplinary teamwork commented as key drivers for better practice of endotracheal suctioning. Recommendations : For Nursing Practice: Standardize ETS practice guidelines for ICUs should be clearly adopted in order to follow evidence-based guidelines to eliminate variability in practice. Enhance hands-on training and continues professional development should enhance professional skills, improve quality of care and ensure patients safety. Strengthen Infection Control to Strictly adherence to aseptic practices; hand hygiene, sterile gloves, and single-use catheters must not be compromised. For Hospital Administration & Policymakers: Ensure the availability ICU resource and reliable access infection control personal protective equipment and functioning equipment is fundamental the issue for the quality of care and patients safety during ETS practice. Mandate Ongoing Education: Require continues evaluations ETS practice and take the correction action and keep nurses updated to refresher themselves. Supportive Supervision enable nurses to cultivate a blame-free environment where nurses can report challenges without fear. Optimize nurse-to-patient ratios to reduce workload among ICU nurses and improve the practice of procedure related to ETS. For Future Research: Assess the impact of training programs and guideline implementation on the practice of ETS quality and patients outcome. Explore regional variations in ETS practices to identify context-specific barriers. Investigate the direct impacts of ETS practices on complications like ventilator-associated pneumonia or hypoxia. Declarations Authors’ contribution Bayisa Gadisa Bultuma : conceptualization, design the study, data collection, formal analysis data, validation, visualization, writing the original manuscript, and review and editing. Liu Jia :Supervision, critical revision, Validation, provided the critical feedback, revision and validation of the research. Funding: no funding Availability of the data and materials: The datasets generated and analyzed during the current study are not publicly available due to ethical considerations and privacy concerns, but are available from the author upon reasonable request. Ethics approval and consent to participate: This research study was approved by ethics institutional board of Xiangya school of nursing of central south university, informed consent were received from all participants. The study was conducted in accordance with the general ethical principles of the Declaration of Helsinki. None of the researchers had professional or private relation to the study participants. Consent for publication: Not applicable Competing interests: The authors declared that they have no conflicts of interest. Clinical trial : Not applicabe References BLAKEMAN T C, SCOTT J B, YODER MA et al (2022) AARC clinical practice guidelines: artificial airway suctioning [J]. Respir Care 67(2):258–271 SINGH R, BHALOTRA A R, SHARMA S (2023) Audit on practices of endotracheal suctioning in intensive care unit patients among Health Care Workers (HCWs) [J]. Indian Journal of Critical Care Medicine: Peer-reviewed. Official Publication Indian Soc Crit Care Med 28(1):58 ZEB A, ALI F, HUSSAIN N et al (2017) Knowledge and practice of ICU nurses regarding endotracheal suctioning in tertiary care hospitals, Peshawar [J]. JOJ Nurse Health Care 2(4):555–595 CHALKIAS A, ADAMOS G, MENTZELOPOULOS SD (2023) General Critical Care, Temperature Control, and End-of-Life Decision Making in Patients Resuscitated from Cardiac Arrest [J]. J Clin Med, 12(12) HEIDARI M (2017) Nurses’ awareness about principles of airway suctioning [J]. J Clin Diagn research: JCDR 11(8):LC17 MWAKANYANGA E T, MASIKA G M, TARIMO E A (2018) M. Intensive care nurses' knowledge and practice on endotracheal suctioning of the intubated patient: A quantitative cross-sectional observational study [J]. PLoS ONE 13(8):e0201743 CHEN W, HU S, LIU X et al (2021) Intensive care nurses’ knowledge and practice of evidence-based recommendations for endotracheal suctioning: a multisite cross-sectional study in Changsha, China [J]. BMC Nurs 20:1–12 JANSSON M, M, SYRJÄLÄ H P, OHTONEN P P et al (2017) Longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on endotracheal suctioning knowledge and skills: A randomized controlled trial [J]. Am J Infect Control 45(1):83–85 PINTO HJ, D'SILVA F, SANIL TS (2020) Knowledge and practices of endotracheal suctioning amongst nursing professionals: a systematic review [J]. Indian J Crit Care Medicine: Peer-reviewed Official Publication Indian Soc Crit Care Med 24(1):23 MOHAMED R A, ALHUJAILY M, AHMED F A et al (2024) Nurses' experiences and perspectives regarding evidence-based practice implementation in healthcare context: A qualitative study [J]. Nurs Open, 11(1): e2080 ALACA A, SARı HY, YILMAZ M et al (2024) A scoping review of pain resulting from the endotracheal suctioning of paediatric intensive care patients [J]. Int J Palliat Nurs 30(6):264–273 KANWAL QAISER R, RN BSN M, YASMEEN SAGGU R et al (2020) Endotracheal Suctioning: Effectiveness of Structured Training Program in Enhancing Performance Knowledge of Intensive Care Unit Nurses [J] NTELELE C T (2023) Intensive care nurses’ knowledge about endotracheal suctioning guidelines in one major academic hospitals in Johannesburg [J] PARKE R L GILDERE, JULL A et al (2019) Endotracheal suction in intensive care: A point prevalence study of current practice in New Zealand and Australia [J]. Australian Crit Care 32(2):112–115 MWAKANYANGA E (2017) TARIMO E, MASIKA G. Intensive care nurses' knowledge and practice on endotracheal suctioning of the intubated patient [J] ESAYAS A. Assessment of Knowledge and Practice of Intensive Care Unit Nurses Towards Open Endotracheal Suctioning for Mechanically Ventilated Patient in Four Selected Government Public Hospitals in Addis Ababa, Ethiopia [J]. Ethiopia Addis AbabaUniversity, (2017) ALKUBATI S A, AL-SAYAGHI K M, ALRUBAIEE G G et al (2022) Adherence of critical care nurses to endotracheal suctioning guidelines: a cross-sectional study [J]. BMC Nurs 21(1):312 CHERAGHI R, EBRAHIMI H, KHEIBAR N et al (2023) Reasons for resistance to change in nursing: an integrative review [J]. BMC Nurs 22(1):310 LAM S K K, KWONG E W Y, HUNG M S Y et al (2020) Investigating the Strategies Adopted by Emergency Nurses to Address Uncertainty and Change in the Event of Emerging Infectious Diseases: A Grounded Theory Study [J]. Int J Environ Res Public Health, 17(7) PITSILLIDOU M, NOULA M, ROUPA Z et al (2023) Barriers to the Adoption of Evidence Based Practice in Nursing: a Focus Group Study [J]. Acta Inf Med 31(4):306–311 KRIPPENDORFF K (2018) Content analysis: An introduction to its methodology [M]. Sage WHITNEY C, EVERED J (2024) Whose um voice is it anyway? Leveraging thick transcription to promote inclusion in qualitative research through transcript alignment [J]. Int J Qualitative Methods 23:16094069241256548 FUNDERBURK JS, GASS J C, WRAY JM et al (2023) Prevalence and predictors of team-based care activities between primary care providers and embedded behavioral health providers: A national survey [J]. J Interprof Care 37(1):58–65 ADLER R H (2022) Trustworthiness in qualitative research [J]. J Hum Lactation 38(4):598–602 LIM W M (2024) What is qualitative research? An overview and guidelines [J]. Australasian Mark J, : 14413582241264619 VEARS D F GILLAML (2022) Inductive content analysis: A guide for beginning qualitative researchers [J]. Focus on Health Professional Education: A Multi-Professional Journal, 23(1): 111 – 27 SCHOONENBOOM J (2017) JOHNSON R B. How to construct a mixed methods research design [J]. Kolner Z fur Soziologie und Sozialpsychologie 69(Suppl 2):107 HANDS AS (2022) Integrating quantitative and qualitative data in mixed methods research: An illustration [J]. Can J Inform Libr Sci 45(1):1–20 YOUNAS A, PEDERSEN M (2020) Characteristics of joint displays illustrating data integration in mixed-methods nursing studies [J]. J Adv Nurs 76(2):676–686 ALKUBATI S A, AL-SAYAGHI K M, ALRUBAIEE G G et al (2022) Adherence of critical care nurses to endotracheal suctioning guidelines: a cross-sectional study [J]. BMC Nurs 21(1):312 ROSS P, JASPERS R, WATTERSON J et al (2024) The impact of nursing workforce skill-mix on patient outcomes in intensive care units in Victoria, Australia [J]. Crit Care Resusc 26(2):135–152 PARMINDER K, KAUR M H BHUPINDERK (2019) A Study to Assess the Effectiveness of Child to Child Approach on Knowledge and Practices Regarding Hand Washing among the Primary School Children of a Selected School Faridkot, Punjab [J]. Amarjeet Kaur Sandhu 11(4):461 FERRY A M, DAVIS M J RUMPRECHTE et al (2021) Medical Documentation in Low- and Middle-income Countries: Lessons Learned from Implementing Specialized Charting Software [J]. Plast Reconstr Surg Glob Open 9(6):e3651 OKO C, YUSUF A, TAIB F (2022) Assessment of Hand Hygiene Compliance in the Context of COVID19 Among Paediatric Nurses in a Nigerian Federal University Teaching Hospital [J]. 44:306–311 OPIE C (2021) Training of radiation therapists in Asia-Pacific region low-and middle-income countries [J]. J Med Imaging Radiat Oncol 65(4):445–453 DUCKETT S (2023) Healthcare funding and Christian ethics [M]. Cambridge University Press ZABIN L M, ZAITOUN R S A, SWEITY E M et al (2023) The relationship between job stress and patient safety culture among nurses: a systematic review [J]. BMC Nurs 22(1):39 GUPTA C, JOGDAND D S KUMARM (2022) Reviewing the Impact of Social Media on the Mental Health of Adolescents and Young Adults [J]. Cureus 14(10):e30143 BRUYNEEL A, GALLANI M C, TACK J et al (2021) Impact of COVID-19 on nursing time in intensive care units in Belgium [J]. Intensive Crit Care Nurs 62:102967 ULRICH B, BARDEN C (2019) Critical care nurse work environments 2018: findings and implications [J]. Crit Care Nurse 39(2):67–84 HAKEMI A, BLAMOUN J (2023) LUNDAHL A, A conceptual framework for instructional design of a high acuity and low occurrence event-simulation based education training of residents, medical students, and nurses in anaphylaxis utilizing curated educational theories [J]. Adv Med Educ Pract, : 101–107 SHIOTA N, NOSAKA N, NAWA N et al (2025) Enhancing early mobilization in critically ill patients through multidisciplinary rounds: A process-focused observational study [J]. Anaesth Crit Care Pain Med 44(2):101485 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7502697","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":508131707,"identity":"0fd524a1-ee53-45e8-b9b8-78275ca64990","order_by":0,"name":"Bayisa Gadisa Bultuma1*","email":"data:image/png;base64,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","orcid":"","institution":"Department of Nursing, Saint Peter Specialized Hospital, Ethiopia","correspondingAuthor":true,"prefix":"","firstName":"Bayisa","middleName":"Gadisa","lastName":"Bultuma1*","suffix":""},{"id":508131708,"identity":"cb749cb6-c55d-4f53-be83-933102abee5e","order_by":1,"name":"Liu Jia2","email":"","orcid":"","institution":"Department of Nursing, Third Xiangya Hospital, Central South University, Changsha City, China","correspondingAuthor":false,"prefix":"","firstName":"Liu","middleName":"","lastName":"Jia2","suffix":""}],"badges":[],"createdAt":"2025-08-31 20:28:22","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7502697/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7502697/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90487430,"identity":"217abfc5-ea97-47cb-9fb6-58eb60d88cea","added_by":"auto","created_at":"2025-09-03 09:06:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1541921,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7502697/v1/c79dc45c-9e9d-4b8c-92c7-bc8d557802f3.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eEndotracheal Suctioning Practices Among Intensive Care Unit Nurses in Addis Ababa, Ethiopia: A Mixed-Methods Assessment of Knowledge, Barriers, and Facilitators\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEndotracheal suctioning (ETS) is the crucial part of the bronchial hygiene procedure for patients on mechanical ventilation. It requires the mechanical aspiration of pulmonary secretions from a patient who has an artificial airway inserted\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. The ETS procedure is needed to maintain the patient's airway open, preventing respiratory tract infection, and optimizing ventilation and oxygenation \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Although endotracheal suctioning is the life-saving procedure for mechanically ventilated patients, yet improper techniques can lead to severe complications \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. It is important for Intensive Care Unit (ICU) nurses to have the necessary knowledge and skills based on valid scientific evidence in performing ETS and aspects related to it \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. The practice of ETS should be according to the patient\u0026rsquo;s specific requirements rather than on a routine schedule has been indicated to lead to better outcomes and fewer side effects. Research suggests that well-educated, skilled nurses can considerably lower procedure-related complications by evaluating the patient's condition before suctioning \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. This method aligns with evidence-based practices of ETS procedures that show how crucial it is to assess patients before suctioning \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eUnsafe endotracheal suction techniques remain an issue globally \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Numerous studies have shown that the ICU nurses often continue to perform ETS procedures in a conventional or routine way, even though there are established, evidence-based guidelines for ETS. This points to a gap between the scientific knowledge available and the actual practices used in clinical settings \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Several factors contributed to why nurses are not adopting these recommendations, including limited ICU training, insufficient support from management, resistance to change, difficulty in accessing relevant literature, a lack of time to thoroughly read and understand the existing evidence, ineffective change management processes, and the absence of clear guidelines. Studies have been conducted on the use of endotracheal suctioning (ETS) guidelines, and their research found that many intensive care unit nurses were ignorant of ETS guidelines and lacked basic ETS knowledge, which resulted in practices that ignored evidence-based recommendations \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e,\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Compared to untrained nurses, nurses with intensive care unit training (57.3%) showed a significantly higher level of ETS knowledge \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. According to a quantitative analysis of the studies, only 36% of the nurses had assessed patients before endotracheal suctioning, and only 46% knew the proper suction machine pressure to use for ETS. It was found that only 62% of nurses wash their hands before suctioning \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. In Ethiopia, the practice of ETS for mechanically ventilated patients using the available evidence-based recommendations is low, 51% of nurses had poor knowledge, and almost 80% of nurses\u0026rsquo; practices toward ETS was low \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Limited study was conducted on this topic in Ethiopia.\u003c/p\u003e\u003cp\u003eThis practice gap is caused by a number of factors. First, a major obstacle has been identified as the lack of knowledge among healthcare professionals, particularly intensive care unit nurses, about the proper methods and indications for ETS \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Many nurses restricted to outdated practices due to comfort and familiarity, which deepens the gap in their awareness of ETS \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Additionally, the role of managerial support is often overlooked. Insufficient support from hospital administration often results in a lack of resources and continued education and training on best practices in ETS \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. This scarcity of resources challenges nurses' ability to stay informed about the latest recommendations and techniques in ETS, creating a significant barrier to practice improvement \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. For patients on mechanical ventilation, these gaps contributed to higher rates of morbidity and mortality, ultimately impacting patient safety \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e This study target to improve patient safety and clinical outcomes in patients on mechanical ventilation by evaluating and providing relevant evidence regarding the ETS practices of intensive care unit nurses. Understanding the current state of ETS practices in ICU settings could help healthcare administrators make informed decisions regarding quality improvement in ICU settings, especially in light of the ongoing competency of nursing staff. This study can be used as a benchmark for continuous improvements in nursing care and patients\u0026rsquo; standardized care in critical care settings, as well as a starting point for future research on ETS practices.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cp\u003eStudy Design: This study employed a mixed-method explanatory sequential design from 1\u003csup\u003est\u003c/sup\u003e August to 30\u003csup\u003eth\u003c/sup\u003e August 2024.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe explanatory sequential design with quantitative data collected in the first phase, followed by qualitative data collected in the second phase. The data from the qualitative phase explained the data from the quantitative phase. An explanatory sequential design (quantitative followed by qualitative) suitable when the quantitative results are surprising (significant serendipitous results).\u003c/p\u003e\n\u003cp id=\"_Toc14498\"\u003eStudy Population: The intended population of this study were nurses who are working in intensive care unit and directly responsible for patient care from selected hospital. From the selected hospitals for the study, about 196 nurses were employed. Eligibility Criteria: The inclusion criteria included ICU nurses who provided direct care for patients on mechanical ventilation and who were breathing through tracheostomy or endotracheal tube were eligible for the study. The exclusion Criteria included nurses who were not a part of the ICU staff, and those who didn\u0026rsquo;t, available during data collection, nurses\u0026rsquo; managers and other healthcare professionals were excluded from the study. Sample size determination: The sample size for the study was calculated by using a single population formula. The practice of endotracheal suctioning among ICU nurses from previous studies was 50% \u003csup\u003e[7]\u003c/sup\u003e. The normal standard deviation of 1.96 corresponds to a 95% confidence interval. P = prevalence rate = 0.50. D = degree of accuracy of the result = 0.07. However, because the study population from five hospitals is relatively small, the modified sample size calculation using Cochran\u0026apos;s formula for finite populations (\u0026lt;10,000) was applied. The initial sample size calculated using this approach was also 196. Given that the total ICU nurse population across the five hospitals was only 196, a census approach was adopted to ensure comprehensive representation. This decision ensured that all available ICU nurses were included in the study, thereby maximizing the representatives and reliability of the findings.\u003c/p\u003e\n\u003cp\u003e\u003cimg width=\"87\" height=\"33\" src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1756889089.jpg\" alt=\"image\"\u003e=196\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc32504\"\u003eSampling technique: \u003cspan id=\"_Toc196305496\"\u003eThe study approached a non-probability convenience sample by inviting all accessible and eligible ICU nurses to participate to provide an image of the current practice and associated factors related to endotracheal suctioning in selected hospitals. The convenience sampling technique is a non-random sampling techniques that allows the researchers to collect information from participants who are easily accessible and available. A purposive sampling technique was employed for the qualitative study. The study participants were recruited and directly face to face interviewed. The repetition of themes, minimal new insights, repetition of responses, diverse perspectives Coverage, and reflective iteration were the indication of data saturation. Eleven ICU nurses were interviewed for the study.\u0026nbsp;\u003c/span\u003eStudy tools\u003c/span\u003e: The data measurement tools were adopted from the previous study, in which the reliability was checked and validated \u003csup\u003e[7]\u003c/sup\u003e. The reliability of the data measurement tools used for this study was assessed through a test-retest method in a previous study. In the previous study, the data measurement tool was tested by five ICU nurses invited to fill out the questionnaire. The Cronbach\u0026rsquo;s alpha values for the knowledge section and the practices section were reported as \u003cem\u003e0.835, and\u003c/em\u003e 0.812, respectively, indicating good internal consistency of the questionnaire \u003csup\u003e[7]\u003c/sup\u003e.\u003cem\u003e\u0026nbsp;\u003c/em\u003eThe questionnaire consisted of three parts. Part one: demographic data such as age, sex, marital status, training sessions on ETS techniques, educational level, and work experience in the ICU, to assess the knowledge of nurses regarding endotracheal suctioning. Part two: there were 26 yes or no questions in the knowledge section, each with one correct answer. The \u0026lsquo;YES\u0026rsquo; answer received one point; it was correct answer, while the \u0026lsquo;NO\u0026rsquo; answer was erroneous and received zero points. Part three: There are 34 \u0026lsquo;yes\u0026rsquo; or \u0026lsquo;no\u0026rsquo; questions in the practice question about nurses\u0026rsquo; endotracheal suctioning skills. In the study instruments for the practice of endotracheal suctioning, the (yes) right answer received one point, while \u0026lsquo;NO\u0026rsquo; was an erroneous response that received zero points. An interview guide was designed to build on the results of the quantitative study to explore the barriers and facilitators related to ICU nurses\u0026rsquo; practice of endotracheal suctioning qualitative study. This semi-structured questions was adapted to ensure a thorough investigation of the barrier and facilitator factors related to ICU nurses\u0026rsquo; practice of endotracheal suctioning \u003csup\u003e[12, 20]\u003c/sup\u003e. A pilot interview was conducted in five ICU nurses by nursing researchers who have experience in qualitative data collection. \u003cem\u003eThe pilot test demonstrated that the interview questions were understandable, a\u003c/em\u003eppropriate\u003cem\u003e\u0026nbsp;to ICU nursing experiences, and elicited r\u003c/em\u003eich qualitative data With absolute clarity.\u003c/p\u003e\n\u003cp id=\"_Toc10847\"\u003eVariables: Dependent variables: practice of endotracheal suctioning (ETS) procedure among ICU nurses. Independent Variables: knowledge of endotracheal suctioning (ETS) procedure among ICU nurses\u003cspan id=\"_Toc196305498\"\u003e, age, sex, marital status, training sessions on ETS , educational level, and work experience in the ICU.\u0026nbsp;\u003c/span\u003eEthical Consideration: Ethical clearance was obtained from Central South University Xiangya School of Nursing after being approved by the institution\u0026rsquo;s ethical review board (ethical review number: 2024WJ014). Permission to commence the study was also obtained from each hospital, by submitting filled application forms with the proposal to get approval to conduct this study and additional permission was obtained from the nurse in ICU. The respondents were properly informed and guaranteed confidentiality and anonymity throughout the study and informed that the data collection process was done on an individual basis to ensure their privacy. Participation was completely voluntary basis and could withdraw from the study at any time or stage of the study. To keep all the information confidential, numbers were used instead of names to identify participants.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc11847\"\u003eData Collection and Recruitment Procedure: \u003cspan id=\"_Toc196305500\"\u003eData was collected for one month from1 August 2024 to 30, August 2024 after obtaining ethical clearance from Central South University Xiangya School of Nursing, and a permission letter to conduct the study in respective hospitals. The principal investigator gave training sessions to five research assistants face to phase on the purpose of the study and the use of the data collection tool. The training was conducted for two days on the general overview of the study including the broad and specific objectives of the study. During the data collection period, research assistants visited the nurses in the ICU of each selected hospital with the permission letter for the approval of commencing the study in the unit. Those nurses who met the criteria were given a participant information sheet about the overall study. After obtaining permission from participants, the structured questionnaires were distributed to the nurses. They were asked to complete the questionnaire during their free time, ensuring it did not interfere with their regular duties. Research assistants collect the completed questionnaires. The semi-structured interviews was conducted by face-to-face to collect new data and explore participants\u0026apos; thoughts and beliefs about barrier and facilitator factors effluence ETS practice.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eQuality Control and Data Analysis: Completed questionnaires were routinely checked by research assistants daily. The data was checked, organized, coded, and entered into the statistical package for social science (SPSS) for analysis program version 27.0 for analysis. The researcher managed and analyzed these data properly. Descriptive analysis included frequency percentages. An inferential analysis t-test, ANOVA and bi-variate analysis was used to examine the relationship between the influencing factors and ICU nurses\u0026rsquo; practice regarding endotracheal suctioning. Variables that statistically significant were undergone multiple linear regression analysis was used to examine the relationship between the variable being studied and other predictor variables. A confidence interval of 95% and p-value \u0026le; 0.05 was considered statistically significant correlation to the practices of ETS among ICU nurses.\u003c/p\u003e\n\u003cp\u003eThe content analysis was used to analyze the qualitative study. In this study, all audio-recorded interviews were transcribed to full verbatim by actively listening. Full verbatim refers to a type of transcription that captures every word and sound exactly as they were spoken. This includes not only the actual words but also filler words( like \u0026ldquo;um\u0026rsquo;\u0026rsquo; and \u0026ldquo;uh\u0026rsquo;\u0026rsquo;), stutters, false starts, and any grammatical or vocabulary mistakes made by the speaker \u003csup\u003e[21, 22]\u003c/sup\u003e. In contrast, there is also a style known as \u0026ldquo;clean verbatim,\u0026rdquo; which removes unnecessary speech elements to enhance readability while still conveying the original meaning of the dialogue. This style omits filler words and other verbal tics, making the transcript easier to read without altering the essential content. While conducting clean verbatim transcription, false starts, repetition, stutters, filler words, and slang words in the full verbatim were altered\u003csup\u003e[23]\u003c/sup\u003e. In the qualitative study the trustworthiness data refers to the degree of confidence in the data, method, and interpretation used to ensure the quality of a study \u003csup\u003e[24]\u003c/sup\u003e. Choosing the study sample carefully and allowing the participants to express their views and opinions freely is the key to ensuring the accuracy of qualitative data collection. A significant contribution to validity criteria has been made by authors\u003csup\u003e[25]\u003c/sup\u003e, who have established the importance of credibility and authenticity as quality indicators. The rigidity or trustworthiness of a qualitative study is assessed by its credibility, dependability, Confirmability and Transferability\u003csup\u003e[25]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003ePart One Quantitative Result\u003c/h2\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003eDescriptive analysis of sociodemographic information of Study participants\u003c/h2\u003e\u003cp\u003eA total of 152 nurses completed the questionnaires leading to a 96.8% response rate of nurses. The majority of the study respondents were females 89(58.6%) as to males 63(41.4). The mean age of the study participants involved was 29.72\u0026thinsp;\u0026plusmn;\u0026thinsp;3.41, a minimum of 23 to a maximum of 41 years old. The majority of the study groups reported falls between the age group (26\u0026ndash;30) years 98 (64.5%), of which (31\u0026ndash;35) years 33 (21.7%) fall within the second majority age group, (20\u0026ndash;25) years accounted for 12 (7.9%), and (36\u0026ndash;40) years accounted for 8 (5.3%). The majority of the respondents were from Saint Paul Millennium Medical College 44 (28.94%) and Saint Peter Specialized Hospital 36 (23.68%), followed by Yekatit 12 Medical College Hospital 29 (19.1%), regarding the number of years working in the critical care units. 85 (55.9%) of the nurses reported between (5\u0026ndash;10) years, 40 (26.3%) of the nurses reported between (11\u0026ndash;15) years, 23 (15.1%) of the nurses reported less than five years and, only 4 (2.6%) of the nurses reported\u0026thinsp;\u0026ge;\u0026thinsp;16 years have worked in critical care units. \u0026ldquo;Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic characteristics of ICU nurses (N\u0026thinsp;=\u0026thinsp;152), Addis Ababa, Ethiopia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12 (7.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98 (64.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33 (21.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (5.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e63 (41.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89 (58.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e71 (46.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81 (53.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBSc\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e124 (81.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMSc\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28 (18.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork experience in ICU\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23 (15.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85 (55.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u0026ndash;15 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40 (26.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;16 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (2.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatients per nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOne patient per nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e135 (88.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwo patients per nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17 (11.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJob title of the participant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJunior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22 (14.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSenior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e86 (56.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChief\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30 (19.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExpert\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14 (9.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheoretical training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64 (42.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e88 (57.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePractical training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64 (42.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e88 (57.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.1.2 Knowledge of ICU nurses regarding endotracheal suctioning\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e show the knowledge scores of intensive care unit nurses (N\u0026thinsp;=\u0026thinsp;152) about endotracheal suctioning for critically ill patients in Addis Ababa five selected hospitals. One of the objectives of the current study was to assess the intensive care unit nurse\u0026rsquo;s knowledge about endotracheal tube suctioning for critical patients (Tables \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The study revealed that the overall knowledge of ICU nurses regarding endotracheal suction was 64.6%. This study revealed that 68.4% of nurses said that suctioning should only be done when the assessment of the patient establishes the indication of endotracheal suctioning.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eknowledge scores of ICU (N\u0026thinsp;=\u0026thinsp;152) about ETS Addis Ababa, Ethiopia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eKnowledge questions items (N\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCorrect\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIncorrect\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Suctioning should only be done when a thorough assessment of the patient establishes the need.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e104 (68.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48 (31.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. If patients are able to cough up their own secretions, they should be encouraged to do so.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e90 (59.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62 (40.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. The suction catheters should be as small as possible, yet large enough to facilitate secretion removal.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e101 (66.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51 (33.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. The size of the suction catheter should occlude no more than half of the internal diameter of the artificial airway to minimize falls in PaO₂.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e98 (64.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54 (35.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. I possess the required procedural skill and gentleness when performing ET suctioning due to the potential associated hazards.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e104 (68.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48 (31.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. The use of a closed suction system is suggested for adults with high FiO₂ or PEEP, or at risk for acute lung injury.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e97 (63.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55 (36.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. The closed and open suction systems have no difference in terms of oxygen saturation, cardiovascular stability, secretion removal, environmental contamination, and cost.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e106 (69.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46 (30.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8. Aseptic technique should be considered essential for the invasive component of suctioning, including hand washing and glove use, as endotracheal suctioning may lead to lower airway contamination.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e93 (61.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59 (38.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9. Routine use of normal saline instillation before endotracheal suctioning should not be performed.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e84 (55.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68 (44.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10. Ensuring patients are adequately hydrated is a way healthcare providers can facilitate the removal of respiratory secretions.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e104(68.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48 (31.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11. The suction catheter should be inserted to the carina and then retracted 1\u0026ndash;2 cm before suctioning is performed, or the length should be estimated by measuring an identical endotracheal tube.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e88 (57.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64 (42.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13. The lowest possible suction pressure should be used during endotracheal suctioning, usually 80\u0026ndash;120 mmHg.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e92 (60.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60 (39.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14. The suctioning procedure should last no longer than 15 seconds.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e133 (87.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19 (12.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15. There should not be more than three consecutive suction procedures secretions.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e102(67.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50(32.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16. Perform suctioning at least every 8-hour to reduce risk of partial occlusion of the endotracheal tube and accumulation of secretion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e96(63.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56(36.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17. Using volumes of hyperinflation that is indexed to the size of the patient may assist in minimizing potential difficulties.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e99(65.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53(34.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18.Tidal volumes should no more than900 cc during hyperinflation because patients may feel dyspnea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e106(69.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46(30.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19. If hyperventilation used in the patient before suctioning, caution should be employed because it may be associated with increases in mean arterial blood pressure.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e103(67.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49(32.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20. Combining hyper oxygenation and hyperinflation prior to suctioning can minimize suctioning-induced hypoxemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e92(60.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60(39.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21. Pre-oxygenation by the delivery of 100% oxygen for at least 30 seconds before sectioning.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e113(74.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39(25.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e22. A ventilator should be used rather than a manual resuscitation bag to provide hyperventilation/ hyper-oxygenation prior to suctioning to reduce hemodynamic alterations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e100(65.)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52(34.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e23. Suctioning through an adaptor is preferred to preserve oxygenation in mechanically ventilated patients.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e99(65.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53(34.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24. Post-suctioning hyper oxygenation with 100% of oxygen.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e98(64.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54(35.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25. prior to, during, and after the procedure, oxygen saturation, respiratory rate and pattern, hemodynamic parameters, sputum characteristics, cough characteristics, and intracranial pressure should be monitored\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e94(61.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58(38.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26. Endotracheal suctioning, unless managed appropriately, can lead to various adverse events (tracheal trauma, hypoxemia, hypertension, cardiac arrhythmia, and raised intracranial pressure) and increase mortality and morbidity rates.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e104(68.)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48(31.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(35.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eItems (N\u0026thinsp;=\u0026thinsp;26), N\u0026thinsp;=\u0026thinsp;frequency, %= percentage, Yes\u0026thinsp;=\u0026thinsp;correct responded\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003ePractice Of ICU Nurses In ETS For Mechanically Ventilated Patients\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e show practice scores of intensive care unit nurses (n\u0026thinsp;=\u0026thinsp;152) about endotracheal suctioning for critically ill patients in Addis Ababa five selected hospitals. The objective of the current was to assess intensive care unit nurses\u0026rsquo; practice regarding endotracheal suctioning for critical patients. This study revealed that only 47.2% of ICU nurses followed the recommended practices for endotracheal suction. This study revealed that 53.9% of nurses recognized the need for endotracheal suctioning as a routine part of assessing patients' blood pressure, heart rate, oxygen saturation, and breathing sounds, along with evaluating the ventilator system.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePractices Scores Of Intensive Care Unit Nurses (n\u0026thinsp;=\u0026thinsp;152) About Endotracheal Suctioning Addis Ababa, Ethiopia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNo.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePractice questions item (N\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCorrect\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIncorrect\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAssessed the need for endotracheal suctioning as routine part of the patient\u0026rsquo;s BP, HR, oxygen saturation, and breathing sound/ventilator system assessment.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82 (53.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70 (46.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIdentify indication for suctioning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e112 (73.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40 (26.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrepare equipment for suctioning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107 (70.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45 (29.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIf patients able to cough, they should be encouraged to do so.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82 (53.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70 (46.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe size of used suction catheter occlude less than half of the internal diameter of the artificial airway\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69 (45.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83 (54.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe use of a closed suction system is suggested for adults with high FIO2 or PEEP, or at risk for acute lung injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72 (47.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80 (52.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCheck the suction machine with the connecting tube, and prepare ambu bag with O2 supplies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79 (52.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73 (48.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerform Pre-oxygenation by delivering 100% oxygen for at least 30 seconds prior to and after the suction procedure.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83(54.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69(45.4 )\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePosition patient in semi-Fowler position\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85(55.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67(44.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI Washed my hands, wore gloves and face mask before endotracheal suctioning.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64(42.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e88(57.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePut on sterile gloves, and designate one hand as clean (non-dominant hand).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(7.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e140(92.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUse a sterile hand, sterile towel, and sterile suction catheter during suctioning procedure.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23(15.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e129(84.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGently but quickly insert the catheter into the artificial airway using a sterile technique.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72(47.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80(52.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eApply no suction when inserting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83(54.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6945.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInsert the suction catheter to the carina and then retracted 1-2cm before suctioning or measured an identical endotracheal tube to estimate the length of the suction catheter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73(48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79(52)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI did not perform N/saline instillation routinely before ETS.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48(31.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e104(68.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMake sure that suction pressure is at 80-120mmHg during suctioning.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84(44.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68(68.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRotating the suction catheter 360 degrees when withdrawing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80(52.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72(47.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSuction time 10\u0026ndash;15 seconds.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e115(75.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37(24.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiscontinue if HR is below or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55(36.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97(63.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUse ventilator instead of a manual resuscitation bag to provide hyperventilation/hyper oxygenation prior to suctioning to reduce hemo dynamic alterations.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83(54.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69(45.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerform suctioning through an adaptor to preserve oxygenation in mechanically ventilated patients.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82(53.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70(46.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDon\u0026rsquo;t reinsert the suctioning catheter into the endotracheal tube more than three suction per suctioning.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81(53.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71(46.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI performed suctioning for each patient at least every 8-hours.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82(53.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70(46.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe catheter is detached from the aspirator pipe.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93(61.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59(38.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHyper oxygenate after suctioning (100% O2).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69(45.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83(54.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRinse the catheter and connecting tube with the NS.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50(32.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e102(67.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProper way of disposing used suction catheter and gloves post suctioning.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48(31.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e104(68.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWash hand after endotracheal suctioning.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55(36.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97(63.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAssess for secretion clearance.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59(38.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93(61.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiscard used suction catheter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41(27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e111(73)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTurn off the suction device\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e104(68.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48(31.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMonitor breath sounds, respiratory rate and pattern, hemodynamic parameters, and ventilator parameters\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66(43.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86)56.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDocumentation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59(38.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93(61.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal average\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(47.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eItems (N\u0026thinsp;=\u0026thinsp;34), N\u0026thinsp;=\u0026thinsp;frequency, %= percentage, Yes\u0026thinsp;=\u0026thinsp;correct respond\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eFactors associated with practice of endotracheal suctioning procedure\u003c/h3\u003e\n\u003cp\u003eThe study determined major contributing variables significantly associated with endotracheal suctioning (ETS) practices among nurses. Work experience in the ICU established a strong positive relationship with ETS practices \u003cem\u003e(F\u0026thinsp;=\u0026thinsp;12.79, p\u0026thinsp;=\u0026thinsp;0.001)\u003c/em\u003e, where nurses with over 15 years of experience manifested the highest practice scores (mean\u0026thinsp;=\u0026thinsp;0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13), relative to those with less than five years (mean\u0026thinsp;=\u0026thinsp;0.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11). This indicates that extended ICU exposure enhances procedural proficiency, likely due to repeated procedural proficiency and increased skill. In addition, job title also significantly affected the practices of ETS \u003cem\u003e(F\u0026thinsp;=\u0026thinsp;7.11, p\u0026thinsp;=\u0026thinsp;0.001)\u003c/em\u003e, with expert nurses (mean\u0026thinsp;=\u0026thinsp;0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08) outperforming junior nurses (mean\u0026thinsp;=\u0026thinsp;0.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12), demonstrating that clinical seniority and leadership roles relate to stricter compliance to ETS protocols. Also, theoretical training \u003cem\u003e(t\u0026thinsp;=\u0026thinsp;9.01, p\u0026thinsp;=\u0026thinsp;0.001)\u003c/em\u003e and practical training \u003cem\u003e(t\u0026thinsp;=\u0026thinsp;7.78, p\u0026thinsp;=\u0026thinsp;0.001)\u003c/em\u003e both significantly influenced the ETS practice. ICU nurses who received theoretical training (mean\u0026thinsp;=\u0026thinsp;0.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11) and practical training (mean\u0026thinsp;=\u0026thinsp;0.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12) conducted significantly better than untrained ICU nurses in the necessity of the endotracheal suctioning practices. Additionally, knowledge of ETS indicated a moderate positive relationship with the practice of endotracheal suctioning \u003cem\u003e(r\u0026thinsp;=\u0026thinsp;0.37, p\u0026thinsp;=\u0026thinsp;0.001)\u003c/em\u003e, inferring that ICU nurses with higher knowledge scores (mean\u0026thinsp;=\u0026thinsp;0.644\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12) implemented evidence-based practices more effectively.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFactors Associated With Endotracheal Suctioning practices Among ICU Nurses in Addis Ababa, Ethiopia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eT-Test/Anova\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.364\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;25 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.680\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26\u0026ndash;30 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;35 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u0026ndash;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.479\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBSc\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;1.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.273\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMSc\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;12.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;15 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;15 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 patient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.818\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;7.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSenior Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChief Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExpert Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheoretical (Yes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;9.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePractical(Yes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;7.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnowledge(mean)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.644\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003er\u0026thinsp;=\u0026thinsp;0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eMultiple linear regression analysis of practice of endotracheal among ICU nurses versus associated factors\u003c/h2\u003e\u003cp\u003eThe significance level of the predictor variables indicated at \u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e confidence interval of 95% statistically significant with the dependent variable. The nurses' ICU work experience had a significant positive effect (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.42, \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.001)\u003c/em\u003e, revealing that each additional year in the ICU increased ETS practice scores by 0.42 units after controlling for other predictors. This suggests that each year of ICU work contributes meaningfully to the practices of endotracheal suctioning procedures. The theoretical training had a strong positive influence on the ETS practices (B\u0026thinsp;=\u0026thinsp;0.212, \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/em\u003e), indicating that ICU nurses with theoretical training increased the practice of ETS adherence by 0.212 units after controlling for other predictors. This suggests theoretical learning enhances procedural awareness of the endotracheal suctioning procedure. The practical training had a strong positive influence on ETS practices \u003cem\u003e(B\u0026thinsp;=\u0026thinsp;0.536, p\u0026thinsp;=\u0026thinsp;0.006)\u003c/em\u003e. indicating that ICU nurses with practical training increased the practice of ETS adherence by 0.536 units after controlling for other predictors. This suggests practical training enhances the practice of ETS competency. ETS Knowledge among ICU nurses had a significant positive influence \u003cem\u003e(B\u0026thinsp;=\u0026thinsp;0.373, p\u0026thinsp;=\u0026thinsp;0.042)\u003c/em\u003e, indicating that each additional knowledge in the ICU increased ETS practice scores by 0.373 units, after controlling for other predictors.\u003c/p\u003e\u003cp\u003eModel Fit and Multicollinearity\u003c/p\u003e\u003cp\u003eThe constant (intercept) is significant (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.033\u003c/em\u003e), suggesting baseline ETS practice is non-zero when all predictors are zero. VIF (Variance Inflation Factor) values are all below 5 (range: 1.010\u0026ndash;2.692), indicating no severe multicollinearity among predictors. Practical Implications Training is Critical: Both theoretical and practical training strongly improve ETS practices, highlighting the need for structured educational programs. Experience Matters: ICU experience enhances ETS competency, suggesting mentors practical experience for novice nurses. Knowledge-Practice Link: Higher ETS knowledge correlates with better practice, reinforcing the value of ongoing education.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe relationship between the ICU Nurses\u0026rsquo; practices of endotracheal suctioning and independent variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStd. Error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eVIF\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Constant)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.834\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.389\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.033*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork Experience in ICU\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.419\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.990\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.230\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJob title\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.502\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10.516\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheoretical training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.057\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.734\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.256\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePractical Training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.536\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.006**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.692\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eETS Knowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.373\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.042*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNotes\u003c/b\u003e:R\u0026thinsp;=\u0026thinsp;0.710, R2\u0026thinsp;=\u0026thinsp;0.504\u003cem\u003eR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.710,R2\u0026thinsp;=\u0026thinsp;0.504,Adjusted R2\u0026thinsp;=\u0026thinsp;0.487, F\u0026thinsp;=\u0026thinsp;29.876, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003cem\u003eR\u003c/em\u003e2\u0026thinsp;=\u0026thinsp;0.487, \u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;29.876, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.VIF values indicate no multicollinearity issues (all \u0026lt;\u0026thinsp;5\u0026thinsp;\u0026lt;\u0026thinsp;5).Significance levels: *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **P\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***P\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePart II Qualitative Results\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eDeveloping the categorized Coding Schema Steps\u003c/h2\u003e\u003cp\u003eContent analysis was used to analyzed the data collected from the interviews since it was considered appropriate to meet the objectives of this study. This method allowed for an investigation of the barriers and facilitators of ICU nurses\u0026rsquo; knowledge and practice of endotracheal suctioning for mechanically ventilated patients. The content analysis is constructed inductively, based on a thorough reading of the texts and looking for the meaning of the transcript. The structured steps for analyzing interview data using a content analysis approach: 1. read and familiarize: This step resulted in a more holistic understanding of the meaning behind texts \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e, 2. first-round coding (category): Starting with big picture schema allowed the researcher to move towards the second-round coding without feeling overwhelmed\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. 3. Second-round coding (subcategories): This involved a detailed line-by-line analysis of the text. During this process, new codes and subcategories were created under the main theme. 4. Refining the fine-grained subcategories: This stage of analysis involved reviewing, refining and defining major categories and subcategories as part of the production of the refined coding schema. and, 5. Synthesis and interpretation: The final step consisted of examining the merged refined coding schema to determine if there were any connections between the research objectives and each category.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eCategory 1 Nurses\u0026rsquo; Barrier in Practice of Endotracheal Suctioning\u003c/h2\u003e\u003cp\u003eThis category reflects the barriers of participants regarding the knowledge and practice of endotracheal suctioning for ventilated patients. The interviewees shared various barriers to following these interviews, which likely influenced their endotracheal suction to disregard professional recommendations. This category consists of a total of four subcategories of associated factors that challenge ICU nurses\u0026rsquo; knowledge and practice regarding endotracheal suction. These subcategories are Organizational-related barriers, Individual nurse-related barriers, Healthcare professionals related barriers and Patient-related barriers factors. These subcategories impacted and reflected on the participants\u0026rsquo; experiences of endotracheal suctioning, and how these barriers factors can be linked to endotracheal suction practice.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eSubcategory 1: organization-related barriers of ETS\u003c/h2\u003e\u003cp\u003eTo improve patient outcomes and best nursing practice, ICU nurses must have a thorough grasp of the challenges associated with endotracheal suctioning as a crucial technique in respiratory care. A semi-structured interview and content analysis was conducted on ICU nurses who are directly responsible for patient care. Lack of theoretical training and restricted access to continuous professional development programs on endotracheal suctioning procedures might significantly hinder the ICU nurses\u0026rsquo; skills to carry out this vital procedure effectively. The shortage of supplies such as suction catheters, sterile gloves, and suction machines was reported by the participant as a contributing factor to the challenges of endotracheal suctioning.\u003c/p\u003e\u003cp\u003e \"There is lack of standardized endotracheal suctioning guidelines resulted in the variation of awareness and adherence practices of ETS among ICU nurses.\"(Participant 1).\u003c/p\u003e\u003cp\u003e\"In our ICU, we clean and reuse single suction catheter for 12\u0026ndash;24 hours as a result of shortage of supply, use of inappropriate size suction catheter, use non-sterile gloves in dominant hand that can increase the risk of infection.\" (Participant 6).\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"\u003c/em\u003eAn inefficient work processes in ICU affect the timely practice of evidence-based recommendation, specifically endotracheal suctioning for patients on mechanical ventilation.\" (Participant 9).\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"\u003c/em\u003eThe majority nurses in our ICU did not get theoretical and practical training that develop procedural skills of endotracheal suctioning.\" (Participant 4).\u003c/p\u003e\u003cp\u003e\"In the ICU setting, nurses do not have an ongoing educational and professional development platform to improve evidence-recommendation of the endotracheal suctioning procedure.\" (Participant 5).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSubcategory 2: Individual nurse-related barriers\u003c/h2\u003e\u003cp\u003eThis section focuses on the knowledge and practice barriers that ICU nurses face when performing endotracheal suctioning for mechanically ventilated patients. These barriers considerations in intensive care unit nurses\u0026rsquo; indicated lack of awareness in evidence-based recommendation of ETS practice, emotional fatigue and working environment-related stress, and communication barriers among interdisciplinary teams.\u003c/p\u003e\u003cp\u003e\"The majority of nurses experienced lack of awareness to follow proper techniques of endotracheal suction while other ICU nurses follow the proper endotracheal suctioning practice.\u0026rdquo; (Participant 9).\u003c/p\u003e\u003cp\u003e As the study participant revealed, the discrepancy in adherence to evidence-based recommendations of the endotracheal suctioning practice among ICU nurses may lead to a lack of standardized guidelines for ETS and lacked access to ongoing skills development training. The majority of the study participants had lack of awareness of the availability of ETS guidelines, which led them to personal trend follow during the practices of endotracheal suctioning.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"\u003c/em\u003eThe majority of nurses working in ICU lack training specifically skilled in endotracheal suctioning techniques, which can lead to improper execution of procedures.\" (Participant 7).\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"\u003c/em\u003eNurses with more experience in ICU were better at following the evidence-based recommendations of the ETS procedure, and those less experienced in ICU were less in following evidence-based recommendations of ETS.\" (Participant 11).\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"\u003c/em\u003eLack of timely endotracheal suctioning while the mechanically ventilated patients with the indication of suctioning resulted in blockage of patients\u0026rsquo; airway.\" (Participant 6)\u003c/p\u003e\u003cp\u003e\"One of the main issues raised with compromised quality of nursing care in ICU, specifically endotracheal suction, was emotional fatigue and stress of ICU nurses related to the high-pressure working environment of ICU setting.\" (Participant 3)\u003c/p\u003e\u003cp\u003e\u003cb\u003eSubcategory 3 patient-centered barriers of endotracheal suctioning.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIt is difficult for many patients\u0026rsquo; families to provide medications and other treatment supplies. This factor led to underscoring the patient care practice, specifically endotracheal suctioning. Financial constraints imposed by the patient's family may restrict access to necessary medical supplies, including sterile gloves, suction catheters, and other items, posing serious problems for medical staff, especially intensive care unit nurses. In addition to increasing the risk of infection, this healthcare practice highlighted the wider implications of inequality in healthcare.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"\u003c/em\u003eNot only the nurses\u0026rsquo; awareness and practice of endotracheal suctioning, the patients\u0026rsquo; financial affordability can affect the practices of endotracheal suctioning among nurses\" (participant 8).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eSubcategory 4: Healthcare Professionals Barriers\u003c/h2\u003e\u003cp\u003e\u003cem\u003e\"\u003c/em\u003eInterdisciplinary professional communication among nurses and other professional disciplines is for patient care; however, there is a gap to address evidence-based practices guidelines such as ETS.\" (Participant 6).\u003c/p\u003e\u003cp\u003e\"The healthcare professional staff in the ICU followed the variability approach during endotracheal suctioning\" (participant 4).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eCategory 2 ICU Nurses\u0026rsquo; Facilitator Factors Related to ETS Practice\u003c/h2\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003eSubcategory 1 organization-related facilitators of ICU nurses\u0026rsquo; ETS practice\u003c/h2\u003e\u003cp\u003eThe participants highlighted that hospital leader\u0026rsquo;s focus on sustaining resource provision based on the demand, which cultivates a culture of safety and excellence and empowers medical staff to give critically ill patients the best care possible, even in situations where resources may be limited.\u003c/p\u003e\u003cp\u003e\"The hospital leaders perform ongoing monitoring and evaluation of intensive care units and provide supportive leadership.\" (Participant 10).\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"\u003c/em\u003eThe culture of encouraging non-punitive reporting of errors or near misses related to nursing care is important for ongoing improvement quality of care.\" (Participant 9).\u003c/p\u003e\u003cp\u003e\u003cb\u003eSubcategory 2 Individual ICU Nurses\u0026rsquo; Related Facilitators of ETS.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants highlighted that individual nurse-related facilitators of endotracheal suctioning play a crucial role in the practices of evidence-based recommendations to suctioning procedures. A significant number of ICU nurses teach themselves through reading articles, critical care guidelines, and online videos to empower their own knowledge and skills. Moreover, they collaborate with senior staff to share experiences and help nurses stay informed about best practices, specifically regarding endotracheal suctioning. The commitment to continuous professional development not only boosts their confidence but also maximizes their competencies to improve patient care, as they can apply the latest evidence-based techniques in their practice.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"\u003c/em\u003eIndividually, there is the situation of ICU nurses teach themselves by reading articles, critical care guidelines, and online videos to improve their competencies.\" (Participant 9)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"\u003c/em\u003eThey explored that collaborative knowledge sharing among nursing staff promotes better practices and enhances collective skills in ETS.\" (Participant 1)\u003c/p\u003e\u003cp\u003e\u003cb\u003eSubcategory 3: Healthcare Professionals\u0026rsquo; Related Facilitators.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe participant highlighted that healthcare professionals\u0026rsquo; collaboration can ensure to provision of high-quality care during endotracheal suctioning by fostering an atmosphere of collaboration and continuous education. This coordinated effort ultimately improves patient outcomes by minimizing the risks associated with endotracheal suctioning, such as airway trauma, hypoxia, and ventilator-associated pneumonia. Collaboration among healthcare professionals is another essential facilitator in Knowledge sharing among nursing staff enhanced collective expertise, ensuring that all team members are aligned in their approach to patient care.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"\u003c/em\u003eIn order to maximize comprehensive patient care and resource availability, multidisciplinary teams, including emergency and critical care departments, are useful of collaborate, particularly to enhance the endotracheal suctioning procedure of patients on mechanical ventilators.\" (Participant 3).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eData integration\u003c/h2\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003eIntegration of the Study\u0026rsquo;s Main Findings\u003c/h2\u003e\u003cp\u003eThis study began with a quantitative investigation and proceeded to a qualitative investigation. After the two sets of data were gathered and examined independently, they were integrated to provide a comprehensive understanding of the phenomenon under study. The outcome of mixing in mixed-methods research can be dramatically enhanced when quantitative and qualitative data are integrated \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Integrating mixed-methods data can offer rich insights into study situations that may not be fully understood by using either method alone. In a mixed-methods study, integration is the explicit connection between the quantitative and qualitative study parts \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Combining the quantitative and qualitative studies for analysis is known as merging.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eProcess of Data Integration Analysis\u003c/h2\u003e\u003cp\u003eThis study integrated the quantitative and qualitative data using the analytical technique, joint display \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. The association between the quantitative results and qualitative findings was established based on the statistically significant finding in quantitative data. A joint display technique was used to ensure validity in the design process by aligning findings from each study according to their degree of fit. A visual representation by innovative path diagrams and joint display was developed to generate new insights that go beyond the information derived from the separate quantitative and qualitative analyses \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. The integration analysis involved the development of the construct that incorporated findings from both qualitative and quantitative studies to gain a deeper understanding of the factors that influence ICU nurses' practice of endotracheal suctioning.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIntegration of quantitative and qualitative results from the mixed-methods study design, in Addis Ababa\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKey Theme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQualitative findings\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQualitative findings\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIntegration outcomes\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnowledge\u003c/p\u003e\u003cp\u003eof ETS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall knowledge of ICU nurses regarding ETS was 64.6%. Specific knowledge gaps were identified in areas such as deep suctioning (35.5% correct) and normal saline use (55.3% correct).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"Lack of standardized endotracheal suctioning guidelines resulted in the variation of awareness and adherence practices of ETS among ICU nurses.\"(Participant 1).\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003econfirmed\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePractice\u003c/p\u003e\u003cp\u003eof ETS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.1% of participants use of a sterile towel and sterile suction catheter during suctioning procedure\u003c/p\u003e\u003cp\u003eOnly 47.2% of ICU nurses followed recommended ETS practices, properly hand hygiene (42.1% correctly).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"In our ICU, we clean and reuse single suction catheter for 12\u0026ndash;24 hours as a result of shortage of supply, use of inappropriate size suction catheter, use non-sterile gloves in dominant hand that can increase the risk of infection.\" (Participant 6).\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003econfirmed\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork Experience\u003c/p\u003e\u003cp\u003eand Training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWork experience (p\u0026thinsp;=\u0026thinsp;0.032) and training (p\u0026thinsp;=\u0026thinsp;0.001) significantly influenced ETS practices.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"The majority of nurses working in ICU lack training specifically skilled in endotracheal suctioning techniques, which can lead to improper execution of procedures.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e(Participant 7).\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003econfirmed\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOrganizational Barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57.9% of nurses lacked theoretical and practical training.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"Lack of standardized endotracheal suctioning guidelines resulted in the variation of awareness and adherence practices of ETS among ICU nurses.\"(Participant 1).\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003econfirmed\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndividual Nurse-Related Barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOnly 53.9% of the participants reported practicing assessment for the need for endotracheal suctioning as a routine part of evaluating a patient\u0026rsquo;s blood pressure, heart rate, oxygen saturation, and breathing sounds, including the ventilator system assessment.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"Identified barriers lack of training, emotional fatigue and stress of ICU nurses related to the high-pressure working environment of ICU setting.\" (participant 7 and 3)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003econfirmed\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFacilitator factors of ETS Practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTheoretical and practical training significantly improved ETS practices (p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"The hospital leaders perform ongoing monitoring and evaluation of intensive care units and give supportive leadership.\" (Participant 10).\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003econfirmed\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study discussed factors influencing ICU nurses\u0026rsquo; ETS practice. Many earlier studies looked at what ICU nurses know and how they perform endotracheal suctioning, revealing differences between what they know and what they actually do. The current study was conducted mixed-method design to explore the barrier and facilitator factors that influence the practices of endotracheal suctioning.and provide a comprehensive understanding of why certain factors influenced the practice of ETS among ICU nurses. This study revealed that 64.6% of ICU nurses have awareness of endotracheal suctioning guidelines. The previous study stated 50\u0026ndash;75% awareness of ETS guidelines but identified critical gaps in awareness of suction pressure and saline instillation\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. The Similar study findings showed that \u0026lt;\u0026thinsp;50% of nurses conformed to evidence-based ETS practices \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. These discrepancies may derive from organizational factors: in this study, lack of standardized ICU training programs differs markedly from high-income countries\u0026rsquo; critical care training. In Ethiopian study documented 51% poor knowledge of ETS \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Globally, adherence to ETS best practices is typically greater in high-resource settings. The research in ICUs stated 60\u0026ndash;80% adherence to sterile techniques and suction pressure standards\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. The current study was 44.7% adhered to the recommended suction pressure (80\u0026ndash;120 mmHg)which is quit higher. Qualitative data stated ICU nurses reused catheters for 12\u0026ndash;24 hours due to the shortage of supplies, while quantitative results connected 57.9% lack of practical training of the endotracheal suctioning. In the previous study findings 39.2% of nurses correctly identified the recommended suction pressure of 80\u0026ndash;120 mmHg for endotracheal suctioning\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e The findings of this study indicate that nurses with 5\u0026ndash;10 years of ICU experience (55.9%) demonstrated better adherence to endotracheal suctioning (ETS) guidelines compared to those with less than five years of experience (15.1%), with statistical significance (p\u0026thinsp;=\u0026thinsp;0.032). Experienced nurses exhibited greater proficiency in key aspects of ETS, such as suction pressure regulation (44.7%) and suction duration control (75.7%), suggesting that accumulated clinical exposure enhances technical competence. These results align with international studies, such as research from Australia The impact of nursing workforce skill-mix on patient outcomes in intensive care units, where ICU nurses with more than five years of experience showed 78% compliance with ETS guidelines\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. Research in India, where junior nurses with less than two years of experience struggled with sterile technique only 32% compliance\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e The barriers factors identified in qualitative part of this study\u0026mdash;including lack of standardized guidelines, resource shortages, and inconsistent training was echoed in both high-income countries and low/middle-income countries, though their manifestations differ starkly. In high-income countries like the US, hospitals with formalized ETS protocols electronic health registration-embedded checklists report 62% adherence to monitoring\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e, contrasting sharply with 25% adherence in Nigerian ICUs where hierarchical cultures and absent protocols hinder compliance \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. Training variability also follows a bifurcated pattern: simulation-based training in German ICUs boosted adherence to 70% \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e, whereas in overcrowded Indian ICUs, 60% of ETS procedures were delegated to untrained aides due to staff shortages \u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. This study highlighted that the infection control is deficits as evidenced by the fact that only 7.9% of ICU nurses used sterile gloves during endotracheal suctioning practice. Recent studies highlight that low compliance with sterile glove use during endotracheal suctioning in ICUs. Another study stated only 9.2% of ICU nurses consistently adhered to sterile glove protocols, attributing non-compliance to the perceived convenience of non-sterile gloves\u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e. The clinical consequences demonstrated that ICUs with \u0026lt;\u0026thinsp;10% sterile glove adherence had a 32% higher incidence of ventilator-associated pneumonia (VAP), directly linking poor aseptic technique to preventable harm\u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e. Together, these studies reveal a global pattern of sub-optimal practice despite established guidelines, emphasizing the urgent need for targeted interventions to bridge the gap between policy and implementation. In this study, only 43.6% of ICU nurses monitor breath sounds, respiratory rate and pattern, hemodynamic parameters, and ventilator parameters before and after endotracheal suctioning. In high-resource ICUs, approximately 50% of staff adhered to comprehensive monitoring of parameters such as breath sounds, respiratory rate, and hemodynamic status after endotracheal suctioning, whereas adherence dropped to 30% in low-resource settings \u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis study findings from qualitative evidence confirmed that the leadership plays a crucial role in creating an environment conducive to effective practice similar research finding reveal that hospitals with strong nursing leadership and safety cultures had 30% higher adherence to ETS guidelines, including aseptic techniques and Pre-oxygenation\u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e. \u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e. \u003csup\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplication of the study\u003c/b\u003e: The findings of this study revealed important deficiencies and potential areas to improve ETS among ICU nurses in Ethiopia, have implications for theory, clinical practices,\u0026ensp;policy making, and research. The Cognitive-Behavioral Theory (CBT) model explains the influence of nurses' knowledge, practices, and work circumstances on\u0026ensp;adherence to ETS. However, a theory-practice gap still exists, since only 47.2% of the ICU nurses\u0026ensp;who obtained a knowledge proficiency of 64.6% followed the ETS guidelines. Theoretical training and practical training: From\u0026ensp;a clinical perspective, aseptic technique, optimal suction pressure and avoidance of saline instillation should be prioritize in compulsory workshops. The hospital-wide protocol adopt the existing guidelines, with checklists and audits, could\u0026ensp;help to minimize clinical variation. At the policy level, the Ministry of Health and critical care societies should incorporate ETS best practices in to national ICU guidelines, emphasizing infection prevention, regulatory competency assessments and nurse well-being programs could further enhance adherence and the future research will intervene, self learning, peer mentoring and multi-center studies and evaluate long term policy impact before and after implementation of the endotracheal suctioning protocol.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eStrengths\u003c/strong\u003e\u003cp\u003eThis study indicates several remarkable strengths that enrich the validity and relevance of its findings. Methodologically, the mixed-methods approach merging quantitative surveys (N\u0026thinsp;=\u0026thinsp;152) with qualitative interviews (N\u0026thinsp;=\u0026thinsp;11) allowed comprehensive data integration, enhancing the strengthen of conclusions about endotracheal suctioning (ETS) practices. Theoretically, the study was rooted in Cognitive-Behavioral Theory (CBT), giving a structured framework to evaluate how knowledge, practices and influencing factors collectively influence ETS practices. Furthermore, the implementation of international protocols secures the findings sustain relevance to both national practice needs and global critical care standards.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e: Self-reported questionnaires, which may introduce bias due to social desirability or recall errors, were used to collect the quantitative data. The ICU nurses may over-report or under-report the barrier and facilitator factors due to fear of judgement. The focused on the practice of ETS and associated factors, and explore the barrier and facilitator factors among ICU nurses, but the study didn\u0026rsquo;t direct address the patient outcome such as ventilation-associated pneumonia. The study does not show the impact of training on the improvement of ETS practices. A Longitudinal study will be more appropriate to assess the impact of training on ETS practices. In-depth limitation in the qualitative study: data collection techniques involved semi-structure interview techniques to collect information from the study participant, and the semi-structured interview form may not have addressed the full depth of nurses\u0026rsquo; the information related to barrier and facilitator factors that influence the practice of ETS.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study described the endotracheal suctioning (ETS) technique used by ICU nurses and highlighted the ongoing differences between evidence-based recommendations and actual clinical practice. Engaging a mixed-methods strategy helped the study to find both statistical trends and personal insights on the obstacles and enablers to implementing ETS. Nurses with more clinical experience and those who received theoretical and practical training were considerably more likely to attend best practices, reinforcing the value of continuous learning and practical experience. Barrier factors such as inconsistent guidelines, resource shortages (sterile equipment), emotional fatigue, inconsistent professional communication and inefficient workflow processes in ICU contributed to unsafe practice of endotracheal suctioning. These study results revealed definite reality, despite the barrier factors hindering the optimal practice ETS, ultimately influencing patient safety. Facilitator\u0026rsquo;s factors such as supportive leadership, theoretical and practical training, experience share-learning, individual self-learning, and interdisciplinary teamwork commented as key drivers for better practice of endotracheal suctioning.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRecommendations\u003c/b\u003e: For Nursing Practice: Standardize ETS practice guidelines for ICUs should be clearly adopted in order to follow evidence-based guidelines to eliminate variability in practice. Enhance hands-on training and continues professional development should enhance professional skills, improve quality of care and ensure patients safety. Strengthen Infection Control to Strictly adherence to aseptic practices; hand hygiene, sterile gloves, and single-use catheters must not be compromised. For Hospital Administration \u0026amp; Policymakers: Ensure the availability ICU resource and reliable access infection control personal protective equipment and functioning equipment is fundamental the issue for the quality of care and patients safety during ETS practice. Mandate Ongoing Education: Require continues evaluations ETS practice and take the correction action and keep nurses updated to refresher themselves. Supportive Supervision enable nurses to cultivate a blame-free environment where nurses can report challenges without fear. Optimize nurse-to-patient ratios to reduce workload among ICU nurses and improve the practice of procedure related to ETS. For Future Research: Assess the impact of training programs and guideline implementation on the practice of ETS quality and patients outcome. Explore regional variations in ETS practices to identify context-specific barriers. Investigate the direct impacts of ETS practices on complications like ventilator-associated pneumonia or hypoxia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBayisa Gadisa Bultuma\u003c/strong\u003e: conceptualization, design the study, data collection, formal analysis data, validation, visualization, writing the original manuscript, and review and editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLiu Jia\u003c/strong\u003e:Supervision, critical revision, Validation, provided the critical feedback, revision and validation of the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e no funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of the data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets generated and analyzed during the current study are not publicly available due to ethical considerations and privacy concerns, but are available from the author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research study was approved by ethics institutional board of Xiangya school of nursing of central south university, informed consent were received from all participants. The study was conducted in accordance with the general ethical principles of the Declaration of Helsinki. None of the researchers had professional or private relation to the study participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declared that they have no conflicts of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial\u003c/strong\u003e: Not applicabe\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBLAKEMAN T C, SCOTT J B, YODER MA et al (2022) AARC clinical practice guidelines: artificial airway suctioning [J]. Respir Care 67(2):258\u0026ndash;271\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSINGH R, BHALOTRA A R, SHARMA S (2023) Audit on practices of endotracheal suctioning in intensive care unit patients among Health Care Workers (HCWs) [J]. Indian Journal of Critical Care Medicine: Peer-reviewed. Official Publication Indian Soc Crit Care Med 28(1):58\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZEB A, ALI F, HUSSAIN N et al (2017) Knowledge and practice of ICU nurses regarding endotracheal suctioning in tertiary care hospitals, Peshawar [J]. JOJ Nurse Health Care 2(4):555\u0026ndash;595\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCHALKIAS A, ADAMOS G, MENTZELOPOULOS SD (2023) General Critical Care, Temperature Control, and End-of-Life Decision Making in Patients Resuscitated from Cardiac Arrest [J]. J Clin Med, 12(12)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHEIDARI M (2017) Nurses\u0026rsquo; awareness about principles of airway suctioning [J]. J Clin Diagn research: JCDR 11(8):LC17\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMWAKANYANGA E T, MASIKA G M, TARIMO E A (2018) M. Intensive care nurses' knowledge and practice on endotracheal suctioning of the intubated patient: A quantitative cross-sectional observational study [J]. PLoS ONE 13(8):e0201743\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCHEN W, HU S, LIU X et al (2021) Intensive care nurses\u0026rsquo; knowledge and practice of evidence-based recommendations for endotracheal suctioning: a multisite cross-sectional study in Changsha, China [J]. BMC Nurs 20:1\u0026ndash;12\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJANSSON M, M, SYRJ\u0026Auml;L\u0026Auml; H P, OHTONEN P P et al (2017) Longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on endotracheal suctioning knowledge and skills: A randomized controlled trial [J]. Am J Infect Control 45(1):83\u0026ndash;85\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePINTO HJ, D'SILVA F, SANIL TS (2020) Knowledge and practices of endotracheal suctioning amongst nursing professionals: a systematic review [J]. Indian J Crit Care Medicine: Peer-reviewed Official Publication Indian Soc Crit Care Med 24(1):23\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMOHAMED R A, ALHUJAILY M, AHMED F A et al (2024) Nurses' experiences and perspectives regarding evidence-based practice implementation in healthcare context: A qualitative study [J]. Nurs Open, 11(1): e2080\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eALACA A, SARı HY, YILMAZ M et al (2024) A scoping review of pain resulting from the endotracheal suctioning of paediatric intensive care patients [J]. Int J Palliat Nurs 30(6):264\u0026ndash;273\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKANWAL QAISER R, RN BSN M, YASMEEN SAGGU R et al (2020) Endotracheal Suctioning: Effectiveness of Structured Training Program in Enhancing Performance Knowledge of Intensive Care Unit Nurses [J]\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNTELELE C T (2023) Intensive care nurses\u0026rsquo; knowledge about endotracheal suctioning guidelines in one major academic hospitals in Johannesburg [J]\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePARKE R L GILDERE, JULL A et al (2019) Endotracheal suction in intensive care: A point prevalence study of current practice in New Zealand and Australia [J]. Australian Crit Care 32(2):112\u0026ndash;115\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMWAKANYANGA E (2017) TARIMO E, MASIKA G. Intensive care nurses' knowledge and practice on endotracheal suctioning of the intubated patient [J]\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eESAYAS A. Assessment of Knowledge and Practice of Intensive Care Unit Nurses Towards Open Endotracheal Suctioning for Mechanically Ventilated Patient in Four Selected Government Public Hospitals in Addis Ababa, Ethiopia [J]. Ethiopia Addis AbabaUniversity, (2017)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eALKUBATI S A, AL-SAYAGHI K M, ALRUBAIEE G G et al (2022) Adherence of critical care nurses to endotracheal suctioning guidelines: a cross-sectional study [J]. BMC Nurs 21(1):312\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCHERAGHI R, EBRAHIMI H, KHEIBAR N et al (2023) Reasons for resistance to change in nursing: an integrative review [J]. BMC Nurs 22(1):310\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLAM S K K, KWONG E W Y, HUNG M S Y et al (2020) Investigating the Strategies Adopted by Emergency Nurses to Address Uncertainty and Change in the Event of Emerging Infectious Diseases: A Grounded Theory Study [J]. Int J Environ Res Public Health, 17(7)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePITSILLIDOU M, NOULA M, ROUPA Z et al (2023) Barriers to the Adoption of Evidence Based Practice in Nursing: a Focus Group Study [J]. Acta Inf Med 31(4):306\u0026ndash;311\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKRIPPENDORFF K (2018) Content analysis: An introduction to its methodology [M]. Sage\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHITNEY C, EVERED J (2024) Whose um voice is it anyway? Leveraging thick transcription to promote inclusion in qualitative research through transcript alignment [J]. Int J Qualitative Methods 23:16094069241256548\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFUNDERBURK JS, GASS J C, WRAY JM et al (2023) Prevalence and predictors of team-based care activities between primary care providers and embedded behavioral health providers: A national survey [J]. J Interprof Care 37(1):58\u0026ndash;65\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eADLER R H (2022) Trustworthiness in qualitative research [J]. J Hum Lactation 38(4):598\u0026ndash;602\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLIM W M (2024) What is qualitative research? An overview and guidelines [J]. Australasian Mark J, : 14413582241264619\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVEARS D F GILLAML (2022) Inductive content analysis: A guide for beginning qualitative researchers [J]. Focus on Health Professional Education: A Multi-Professional Journal, 23(1): 111\u0026thinsp;\u0026ndash;\u0026thinsp;27\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSCHOONENBOOM J (2017) JOHNSON R B. How to construct a mixed methods research design [J]. Kolner Z fur Soziologie und Sozialpsychologie 69(Suppl 2):107\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHANDS AS (2022) Integrating quantitative and qualitative data in mixed methods research: An illustration [J]. Can J Inform Libr Sci 45(1):1\u0026ndash;20\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYOUNAS A, PEDERSEN M (2020) Characteristics of joint displays illustrating data integration in mixed-methods nursing studies [J]. J Adv Nurs 76(2):676\u0026ndash;686\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eALKUBATI S A, AL-SAYAGHI K M, ALRUBAIEE G G et al (2022) Adherence of critical care nurses to endotracheal suctioning guidelines: a cross-sectional study [J]. BMC Nurs 21(1):312\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eROSS P, JASPERS R, WATTERSON J et al (2024) The impact of nursing workforce skill-mix on patient outcomes in intensive care units in Victoria, Australia [J]. Crit Care Resusc 26(2):135\u0026ndash;152\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePARMINDER K, KAUR M H BHUPINDERK (2019) A Study to Assess the Effectiveness of Child to Child Approach on Knowledge and Practices Regarding Hand Washing among the Primary School Children of a Selected School Faridkot, Punjab [J]. Amarjeet Kaur Sandhu 11(4):461\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFERRY A M, DAVIS M J RUMPRECHTE et al (2021) Medical Documentation in Low- and Middle-income Countries: Lessons Learned from Implementing Specialized Charting Software [J]. Plast Reconstr Surg Glob Open 9(6):e3651\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOKO C, YUSUF A, TAIB F (2022) Assessment of Hand Hygiene Compliance in the Context of COVID19 Among Paediatric Nurses in a Nigerian Federal University Teaching Hospital [J]. 44:306\u0026ndash;311\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOPIE C (2021) Training of radiation therapists in Asia-Pacific region low-and middle-income countries [J]. J Med Imaging Radiat Oncol 65(4):445\u0026ndash;453\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDUCKETT S (2023) Healthcare funding and Christian ethics [M]. Cambridge University Press\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZABIN L M, ZAITOUN R S A, SWEITY E M et al (2023) The relationship between job stress and patient safety culture among nurses: a systematic review [J]. BMC Nurs 22(1):39\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGUPTA C, JOGDAND D S KUMARM (2022) Reviewing the Impact of Social Media on the Mental Health of Adolescents and Young Adults [J]. Cureus 14(10):e30143\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBRUYNEEL A, GALLANI M C, TACK J et al (2021) Impact of COVID-19 on nursing time in intensive care units in Belgium [J]. Intensive Crit Care Nurs 62:102967\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eULRICH B, BARDEN C (2019) Critical care nurse work environments 2018: findings and implications [J]. Crit Care Nurse 39(2):67\u0026ndash;84\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHAKEMI A, BLAMOUN J (2023) LUNDAHL A, A conceptual framework for instructional design of a high acuity and low occurrence event-simulation based education training of residents, medical students, and nurses in anaphylaxis utilizing curated educational theories [J]. Adv Med Educ Pract, : 101\u0026ndash;107\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSHIOTA N, NOSAKA N, NAWA N et al (2025) Enhancing early mobilization in critically ill patients through multidisciplinary rounds: A process-focused observational study [J]. Anaesth Crit Care Pain Med 44(2):101485\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endotracheal suctioning, ICU nurses, evidence-based practice, knowledge, barriers, facilitators","lastPublishedDoi":"10.21203/rs.3.rs-7502697/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7502697/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eEndotracheal suctioning (ETS) is a component of bronchial hygiene therapy and mechanical ventilation and involves the mechanical aspiration of pulmonary secretions from a patient with an artificial airway in place. This study aimed to assess ICU nurses\u0026rsquo; adherence to evidence-based practices of endotracheal suctioning,identify knowledge gaps, explore barriers to improving patient care standards.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA mixed-method design was employed, consisting of a quantitative study of 152 ICU nurses and qualitative semi-structured interviews with 11 ICU nurses in Addis Ababa, Ethiopia. It was conducted between August 1 2024-30 and August 2024 with nurses working in intensive care in the selected five public hospitals. The quantitative data were analyzed using descriptive and inferential statistics, while qualitative data underwent content analysis to identify barriers and facilitators of ETS practices. The data were analyzed using descriptive statistics (mean, standard deviation, frequency, and percentages) and inferential analysis (t-test, ANOVA and bi variate analysis). The study ethics committee approval, institutional permission, and participant consent were obtained before starting the research.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e\u003cp\u003eThe study revealed that ICU nurses\u0026rsquo; overall adherence to ETS best practices was 47.2%, while the overall ICU nurses\u0026rsquo; knowledge score of 64.6%. ICU nurses\u0026rsquo; knowledge of ETS, training in ICU, and work experience in ICU were statistically significantly influenced ETS practice. The significance level of the predictor variables indicated at (\u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/em\u003e confidence interval 95% statistically significant.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe findings revealed a significant gap between established evidence-based practice of ETS and the actual practices of ETS utilized by ICU nurses.\u003c/p\u003e","manuscriptTitle":"Endotracheal Suctioning Practices Among Intensive Care Unit Nurses in Addis Ababa, Ethiopia: A Mixed-Methods Assessment of Knowledge, Barriers, and Facilitators","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-03 08:49:57","doi":"10.21203/rs.3.rs-7502697/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"96adf5a6-6188-4265-9dbe-47910677d305","owner":[],"postedDate":"September 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-03T15:59:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-03 08:49:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7502697","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7502697","identity":"rs-7502697","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}