Document Type : Original Article


1 Departments of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences

2 Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran


INTRODUCTION: Majority of critical care nurses do not have desirable skills in performing
endotracheal tube suctioning (ETS) despite related training taught in the curricula. This study aimed
to investigate and compare the effect of education through video and performance feedback (PF)
on nurses’ skills in performing ETS.
METHODS: This was a quasi‑experimental study. The sample size comprised of all nurses (n = 49)
working in the intensive care unit of one of the educational hospital located in one of the western
cities of Iran. Nurses were assigned to either one of educational video (EV) and PF groups. Data
were collected using a 25‑item structured best practices information sheet. Data were analyzed using
SPSS software version 20 (SPSS Inc., Chicago, IL, USA).
RESULTS: After the interventions, no significant difference was found in the total mean score of
nurses’ practice in ETS between those who received education through EV and those who received
through PF (16.3 vs. 15.1) (P > 0.05). Before and after the intervention, a significant improvement
was observed in the total mean score and other dimensions of nurses’ practice in endotracheal
suctioning (P < 0.0001).
CONCLUSIONS: The results showed that both of methods through feedback and EV are useful
in improving nurses’ ETS practice. However, further studies are required to examine the effects of
such interventions in the long term.


1. Rezaee HH, Sabzevari S, SharafkhaniR, GolzariZ. Study of nurses
performance on standardized endotracheal and tracheostomy
tube suctioning in intensive care unit in Kerman hospitals
2013‑2014. J Iran Soc Anaesthesiol Intensive Care 2015;37:11‑9.
2. Meijiao L, Qiao Z, Xiaohua W. CT findings of pulmonary
infection in patients with endotracheal intubation and mechanical
ventilation. Radiol Infect Dis 2017;4:1‑6.
3. Pedersen C, Rosendahl‑Nielsen M, Hjermind J, Egerod I.
Endotracheal suctioning of the adult intubated patient‑‑what is
the evidence? Intensive Crit Care Nurs 2009;25:21‑30.
4. Mazaheri A, Jawadi MS, Mohammadi R, Swadopour M,
KazemzadehR. Nursing staff performance in chest care in patients
undergoing mechanical ventilation. J Health Care 2013;13:51‑6.
5. Mohammadi N, Parviz S, Pairavi H. The effect of tracheal
tube suction retraining on changes in blood oxygen saturation
and heart rate in patients admitted to the intensive care unit.
J Cardiovasc Nurs 2013;1:232‑45.
6. Day T, Iles N, Griffiths P. Effect of performance feedback on tracheal suctioning knowledge and skills: Randomized controlled
trial. J Adv Nurs 2009;65:1423‑31.
7. Li G, Cook DJ, Thabane L, Friedrich JO, Crozier TM, Muscedere J,
et al. Risk factors for mortality in patients admitted to intensive
care units with pneumonia. Respir Res 2016;17:80.
8. Amirzade N, KHorsandi F, Feizi A, Baghaei R. Evaluating the
application of safe suction criteria by nurses working in intensive
care unit in Urmia. J Urmia Nurs Midwifery Fac 2015;11:98‑112.
9. Ghorbanpoor A, Jouybari L, Vakili MA, Sanagoo A, Kavosi A.
Knowledge and practices of nurses in intensive care units on
endotracheal suctioning. J Nurs Edu 2018;7:9‑17.
10. Frota O, Loureiro MD, Ferreira AM. Open system endotracheal
suctioning: Practices of intensive care nursing professionals. Esc
Anna Nery 2014;18:296‑302.
11. Mwakanyanga ET, Masika GM, Tarimo EA. Intensive care
nurses’ knowledge and practice on endotracheal suctioning of
the intubated patient: A quantitative cross‑sectional observational
study. PLoS One 2018;13:e0201743.
12. Ziarat MH, Hashemi M, Fakharzadeh L, Nasagi AN, Khazni S.
Assessment of efficacy of oral feedback on trainee’s satisfaction
in nursing education. J Nurs Edu 2019;7:11‑20.
13. Barzoki EK, Bakhshandeh H, Nikpajouh A, Elahi E, Haghjoo M.
Comparison of the effect of education through lecture and
multimedia methods on knowledge, attitude, and performance
of cardiac care. J Cardiovasc Nurs J 2016;4:6‑13.
14. Kaye A, Okanlawon O, Urman R. Clinical performance feedback
and quality improvement opportunities for perioperative
physicians. Adv Med Educ Pract 2014;5:115‑23.
15. Kaphle S, Matheke‑Fischer M, Lesh N. Effect of performance
feedback on community health workers’ motivation and
performance in Madhya Pradesh, India: A randomized controlled
trial. JMIR Public Health Surveill 2016;2:e169.
16. Brame CJ. Effective educational videos: Principles and guidelines
for maximizing student learning from video content. CBE Life Sci
Educ Wint 2016;15:1‑6.
17. Islami Vaghar M. The impact of an educational program on blood
and blood products transfusion on nurses’ level of knowledge
and performance. J Med Life 2018;11:238‑42.
18. Jansson M, Ala‑Kokko T, Ylipalosaari P, Kyngäs H. Evaluation
of endotracheal‑suctioning practices of critical‑care nurses an
observational correlation study. J Nurs Edu Pract 2013;3:99‑105.
19. Abu‑Hanna A, Eslami S, Schultz MJ, de Jonge E, de Keizer NF.
Analyzing effects of providing performance feedback at ward
rounds on guideline adherence the importance of feedback usage
analysis and statistical control charts. Stud Health Technol Inform
20. Keulers BJ, Welters CF, Spauwen PH, Houpt P. Can face‑to‑face
patient education be replaced by computer‑based patient
education? A randomised trial. Patient Educ Couns 2007;67:176‑82.
21. Varaei S, Mamashli L, Ghiyasvandian, SH, Bahrani N. The Effect
of multimedia education program on knowledge and practice of
nurses about safe injection. Iran J Nurs 2016;29:68‑77.
22. Gilder E, Parke RL, Jull A, Australian and New Zealand Intensive
Care Society Clinical Trials Group and The George Institute for
Global Health. Endotracheal suction in intensive care: A point
prevalence study of current practice in New Zealand and
Australia. Aust Crit Care 2019;32:112‑5.
23. Kim J, Gu MO, Chang H. Effects of an evidence‑based
practice education program using multifaceted interventions:
A quasi‑experimental stud with undergraduate nursing students.
BMC Med Edu 2019;19:1‑10.
24. Tang B, Coret A, Qureshi A, Barron H, Ayala AP, Law M. Online
lectures in undergraduate medical education: Scoping review.
JMIR Med Educ 2018;4:e11.