Consent Form

Title of the Study:

You are invited to participate in an evidence-based project conducted by 4th-
year BSN nursing students. This project aims to assess the knowledge,
attitudes, and practices of critical care nurses regarding compliance with the
ventilator care bundle (VCB) for preventing ventilator-associated pneumonia
(VAP). Your participation will contribute to improving nursing practices
related to VCB compliance, ultimately enhancing patient outcomes.

Your participation is entirely voluntary, and you may withdraw from the study at any time
without any negative consequences. The information collected will be reported in aggregate
form, ensuring your anonymity and confidentiality. By signing below, you acknowledge that you
have read and understood the information provided, and you voluntarily agree to participate in
the study.

Participant Name: _____________________

Signature: ___________________________
Date: _______________________________

Researcher Name: ____________________

Signature: ___________________________
Date: _______________________________

Questionnaire for Assessing ICU Nurses’ Knowledge, Attitude and Practices of VCB for
Preventing Ventilator-Associated Pneumonia.

Part A: Demographic Information

1. Age:
☐ 20-30 years

☐ 31-40 years

☐ 41-50 years

☐ Above 50 years
2. Professional Qualification:
☐ Nursing Diploma

☐ Generic BSN

☐ post-RN BSN

☐ Other (Specify): __________

3. Clinical Experience:
☐ 1-5 years

☐ 6-10 years

☐ 11-15 years

☐ Above 15 years

Part B: ICU Nurses’ Knowledge of Ventilator Care Bundle (VCB)

1. VCB is:
☐ A checklist used as a protocol of care for mechanically ventilated patients.

☐ Guidelines used to reduce the risk of atelectasis.

☐ Interventions to treat malignancies of lungs.

☐ I do not know.

2. Non-compliance to VCB is associated with:

☐ Decreased risk of VAP.

☐ High mortality in mechanically ventilated patients.

☐ Reduced morbidity in mechanically ventilated patients.

☐ I don’t know.

3. Which component is not included in the VCB for the prevention of VAP?
☐ Oral care.

☐ Head of bed elevation.

☐ Daily sedation vacation.

☐ Administration of antibiotics.
4. VAP is likely to occur in patients who have received mechanical ventilation for:
☐ 6 hours.

☐ 12 hours.

☐ 24 hours.

☐ 48 hours.

5. What is the recommended position for a ventilated patient to prevent VAP?

☐ Supine position.

☐ Semi-recumbent position.

☐ Prone position.

☐ Side-lying position.

6. Head of the bed elevation should be:

☐ 0-15 degrees.

☐ 15-30 degrees.

☐ 30-45 degrees.

☐ I do not know.

7. What is the effect of kinetic beds in the prevention of VAP?

☐ Increases the risk for VAP.

☐ Reduces the risk for VAP.

☐ No effect.

☐ I don’t know.

8. Which route is best recommended when intubating a patient?

☐ Oral intubation.

☐ Nasal intubation.

☐ Both routes are recommended.

☐ I do not know.

9. Evidence-based guidelines recommend changing ventilator circuits how frequently?

☐ Every 48 hours.
 ☐ Every 72 hours.

☐ Every week.

☐ Every new patient.

10. A nurse caring for a ventilated patient should wash hands:

☐ Before oral and ETT suctioning.

☐ After oral and ETT suctioning.

☐ Before and after oral / ETT suctioning.

☐ I don’t know.

11. Oral care with a swab moistened with Chlorhexidine 1% should be performed:
☐ Once per shift.

☐ Every 4 to 6 hours and whenever necessary.

☐ Twice daily.

☐ I do not know.

12. One of the components of VCB is:

☐ Chest physiotherapy.

☐ Sedation interruption.

☐ Daily ventilator circuit changes.

☐ I don’t know.

13. Early weaning:

☐ Reduces the risk for VAP.

☐ Increases the risk for VAP.

☐ Does not influence the risk for VAP.

☐ I don’t know.

14. What is your opinion regarding respiratory physiotherapy in preventing VAP?

☐ Highly recommended.

☐ Can be recommended.

☐ No evidence of efficacy.
 ☐ I don’t know.

15. Contraindications for DVT prophylaxis include:

☐ Thrombocytopenia (HIT).

☐ Active bleeding (GI bleed).

☐ Presumed or confirmed clot in lower extremity.

☐ All of the above.

Part C: Observational Checklist for VCB Practices

Checklist items in practice of individual bundle items
A. Elevation of the Head of Bed
1. Does the nurse elevate the head of the bed to 30-45°?
o ☐ Yes

o ☐ No

2. Does the nurse consider contraindications for elevating the head of bed?
o ☐ Yes

o ☐ No

B. Oral Care with 1% Chlorhexidine

1. Does the nurse position the patient in a semi-recumbent position?
o ☐ Yes

o ☐ No

2. Does the nurse wash hands before oral care?

o ☐ Yes

o ☐ No

3. Does the nurse apply clean gloves and rinse the mouth with a clean swab?
o ☐ Yes

o ☐ No

4. Does the nurse provide oral care with 1% Chlorhexidine according to hospital policy?
 o ☐ Yes

o ☐ No

5. Does the nurse clean and return the equipment properly?

o ☐ Yes

o ☐ No

C. Sedation Interruption Protocol

1. Is the nurse implementing daily sedation vacations based on hospital policy?
o ☐ Yes

o ☐ No

2. Does the nurse provide spontaneous breathing trials as ordered by the doctor?
o ☐ Yes

o ☐ No

D. Peptic Ulcer Prophylaxis

1. Does the nurse provide peptic ulcer prophylaxis as ordered by the doctor?
o ☐ Yes

o ☐ No

E. Deep Vein Thrombosis (DVT) Prophylaxis

1. Does the nurse provide DVT prophylaxis as ordered by the doctor?
o ☐ Yes

o ☐ No

2. Does the nurse consider contraindications for DVT prophylaxis?

o ☐ Yes

o ☐ No

Observational Checklist for Individual VAP Bundle Component Practices

A. Elevation of the Head of Bed
1. Does the nurse elevate the head of the bed to 30-45° for mechanically ventilated patients?
o ☐ Yes
 o ☐ No

2. Does the nurse consider contraindications to elevating the head of the bed to 30-45°?
o ☐ Yes

o ☐ No

B. Oral Care with 1% Chlorhexidine

1. Does the nurse position the patient in a semi-recumbent position for oral care?
o ☐ Yes

o ☐ No

2. Does the nurse wash hands before providing oral care?

o ☐ Yes

o ☐ No

3. Does the nurse apply clean gloves before providing oral care?
o ☐ Yes

o ☐ No

4. Does the nurse provide oral care using a swab moistened with 1% Chlorhexidine,
according to hospital policy?
o ☐ Yes

o ☐ No

5. Does the nurse clean and return the equipment to its proper place after oral care?
o ☐ Yes

o ☐ No

C. Sedation Interruption Protocol

1. Does the nurse implement daily sedation vacations based on the hospital’s policy?
o ☐ Yes

o ☐ No

2. Does the nurse provide spontaneous breathing trials to mechanically ventilated patients as
ordered by the doctor?
 o ☐ Yes

o ☐ No

D. Peptic Ulcer Prophylaxis

1. Does the nurse provide peptic ulcer prophylaxis as ordered by the doctor?
o ☐ Yes

o ☐ No

2. Is the implementation of peptic ulcer prophylaxis based on the hospital’s policy?

o ☐ Yes

o ☐ No

E. Deep Vein Thrombosis (DVT) Prophylaxis

1. Does the nurse provide DVT prophylaxis as ordered by the doctor?
o ☐ Yes

o ☐ No

2. Does the nurse consider contraindications to DVT prophylaxis for mechanically

ventilated patients?
o ☐ Yes

o ☐ No

Part A consisted of nurse’s demographic data, e.g., age, professional qualification and clinical
experience.
Part B included fifteen multiple choice questions (MCQs) to assess knowledge. Each question
had four options, out of which one option was correct and given one mark, whereas the rest of
three options were incorrect and marked zero (0). Based upon the scoring system utilized and
overall mean score earned, the knowledge level was categorized into four categories (Box 1).
Part C included a check list to physically assess nurses’ practices of VCB. The observational
checklist was further divided into two sections; one was used to assess overall VAP bundle
practices and the second was used to assess individual component practices of VAP bundle.
Reference:
Aziz, Z., Kausar, S., Zahid, S., Farooqi, S., Aziz, Z., & Ahmad, R. A. (2020). Knowledge and
practice of ventilator care bundle for preventing ventilator associated pneumonia by ICU
 nurses of tertiary care hospitals of Lahore. Anaesthesia Pain & Intensive Care, 24(4).
https://doi.org/10.35975/apic.v24i4.1315

Part D: ICU Nurses’ Attitudes Toward Ventilator Care Bundle (VCB)

1. I believe the VCB is effective in reducing the incidence of VAP.
☐ Strongly Agree

☐ Agree

☐ Neutral

☐ Disagree

☐ Strongly Disagree

2. I feel confident in implementing the VCB protocols in my daily practice.

☐ Strongly Agree

☐ Agree

☐ Neutral

☐ Disagree

☐ Strongly Disagree

3. I believe non-compliance with the VCB can significantly increase the risk of VAP.
☐ Strongly Agree

☐ Agree

☐ Neutral

☐ Disagree

☐ Strongly Disagree

4. I find it challenging to follow all the VCB components due to time constraints.
☐ Strongly Agree

☐ Agree
 ☐ Neutral

☐ Disagree

☐ Strongly Disagree

5. I feel adequately supported by the hospital in implementing the VCB guidelines.

☐ Strongly Agree

☐ Agree

☐ Neutral

☐ Disagree

☐ Strongly Disagree

6. I believe continuous education and training on VCB are necessary for all ICU staff.
☐ Strongly Agree

☐ Agree

☐ Neutral

☐ Disagree

☐ Strongly Disagree

7. I prioritize VCB practices over other nursing tasks while caring for mechanically ventilated
patients.
☐ Strongly Agree

☐ Agree

☐ Neutral

☐ Disagree

☐ Strongly Disagree

Part A consisted of nurse’s demographic data, e.g., age, professional qualification and clinical
experience.
Part B included fifteen multiple choice questions (MCQs) to assess knowledge. Each question
 had four options, out of which one option was correct and given one mark, whereas the rest of
three options were incorrect and marked zero (0). Based upon the scoring system utilized and
overall mean score earned, the knowledge level was categorized into four categories (Box 1).
Part C included a check list to physically assess nurses’ practices of VCB. The observational
checklist was further divided into two sections; one was used to assess overall VAP bundle
practices and the second was used to assess individual component practices of VAP bundle.
Reference:
Aziz, Z., Kausar, S., Zahid, S., Farooqi, S., Aziz, Z., & Ahmad, R. A. (2020). Knowledge and
practice of ventilator care bundle for preventing ventilator associated pneumonia by ICU
nurses of tertiary care hospitals of Lahore. Anaesthesia Pain & Intensive Care, 24(4).
https://doi.org/10.35975/apic.v24i4.1315

Part D Evaluation of Attitudes

 Strongly Agree = 5
 Agree = 4
 Neutral = 3
 Disagree = 2
 Strongly Disagree = 1
Based on the scores:
 Positive Attitude: High mean score (e.g., 4-5)
 Neutral Attitude: Moderate mean score (e.g., 3)
 Negative Attitude: Low mean score (e.g., 1-2)

 Face validity:
Sign:
Comment:

Sign:
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