Effect of Structured Training on ICU Nurses' Knowledge-Based Competence in Ventilator-Associated Pneumonia Prevention in a Resource-Limited Setting: An Explanatory Sequential Mixed-Methods Study.

AIM: To evaluate the effect of a structured training intervention on ICU nurses' knowledge-based competence in VAP prevention in a resource-limited setting and identify personal, environmental and organisational barriers to implementation.

DESIGN

An explanatory sequential mixed-methods design was employed, integrating a single-group quasi-experimental pre-test-post-test quantitative strand with a qualitative interview strand. Because participant responses were not linked across assessment points, findings represent group-level improvements rather than within-individual change.

METHODS

ICU nurses completed pre-test (n = 57) and post-test (n = 56) assessments using an adapted eight-item VAP prevention knowledge questionnaire. A structured 3-h workshop on VAP prevention bundles, infection control and airway management was delivered between tests; the post-test occurred within 2 weeks. Group differences were analysed using an independent-samples t-test and chi-square tests. Qualitative interview data (n = 8) were analysed thematically to explain and contextualise the quantitative findings.

RESULTS

Mean knowledge scores increased from 3.63 (SD 1.57) to 5.29 (SD 1.57) out of 8 (t(111) = -5.61, p < 0.001; d = 1.06). Because participant responses were not linked across assessment points, findings represent group-level improvements rather than within-individual change. The proportion classified as high knowledge-based competence increased from 24.6% to 64.3% (χ2(2) = 22.43, p < 0.001). Experience variables did not predict post-test scores. Qualitative findings showed that shortages of supplies/equipment, unreliable power, absent protocols, limited supervision and high workload restricted consistent implementation. These findings highlight that improvements in knowledge may not translate into consistent bedside practice without system-level support in resource-limited ICUs.

CONCLUSIONS

A brief, context-specific training workshop significantly improved ICU nurses' knowledge-based competence in VAP prevention. However, systemic barriers-equipment shortages, absent protocols, limited supervision and workload pressures-constrain the translation of knowledge gains into consistent bedside practice. Sustainable improvement requires embedding education within broader quality improvement efforts.

NO PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.