Impact of Nurses' Behavior Change and Evidence-Based Practice Implementation on Quality Indicators in Intensive Care Units in Low- and Middle-Income Countries

Summary

Study title:

Impact of nurses' behavior change and implementing evidence-based practice to improve quality indicators in intensive care units in low-and middle-income countries

Background and Rationale:

Quality care is crucial for preventing adverse events and improving patient survival rates in healthcare settings, especially in the intensive care units (ICU). To improve patient outcomes, complying with evidence-based practice (EBP) and continuous monitoring of quality indicators by Plan-Do-Check- Act (PDCA) cycle is effective; in which "P: decide and plan target actions", "D: implement the plans", "C: measure and evaluate the indicators", and "A: discuss the next step for improvement". Regarding quality indicators at ICU, Japan has achieved the highest global survival rate with the fewest adverse events.

In a scoping review, when EBPs were implemented, 90% of the studies showed improved patient outcomes, and 94% found a positive return on investment. In ICU, EBP is essential for providing high-quality care, reducing errors, educating healthcare professionals, ensuring the efficacy of treatments, and fostering trust and good patient care relationships.

In Egypt, as a one of the low-and middle-income countries (LMICs), 59.9% of ICU patients had poor outcomes, with a 14.9% mortality rate. The incidence rate of total device- associated infections was 35.3/1000 device-days. The incidence of VAP is 38.4%, and it has reached 75% in some Egyptian hospitals; contrarily, in Japan, where Bundle care (evidence-based guideline) is strictly followed by nurses, the incidence of VAP is only 5.7%. EBP is hindered in LMICs by a lack of research infrastructure, a knowledge gap, poor nursing management, and limitation of resources. However, promoting this change will require increased advocacy of nurses, technical advancements, and integration into curricula and continuing education programs. Moreover, global collaboration is imperative for comprehensive development.

Objectives:

Primary Objective: Improve the quality of care in the ICU through implementation of EBP (indicated by selected quality indicators which assessed as routine work monthly in the selected ICU).

Secondary Objective: To enhance ICU nurses' professional competency in applying EBP.

The level of compatibility between the research proposal and the department's research goals.

There is a high level of compatibility between the research proposal and the department's research goals, particularly in terms of enhancing the competency of ICU staff through targeted training, improving the quality of care, and ultimately contributing to better patient outcomes.

The level of compatibility between the research proposal and the NCI 's research Plan.

The research proposal demonstrates a high level of compatibility with the NCI's research plan through the implementation of the latest evidence-based practices (EBP), standardized care protocols, and up-to-date clinical guidelines. It also aims to reduce contributing factors associated with increased morbidity and complication rates, thereby aligning with the institute's goals to advance patient safety and care quality.

\- Study Design: An open- label, prospective, parallel-group (1:1), non-randomized controlled trial, with a pre- and post-design.

Conditions

• Ventilator-Associated Pneumonia (VAP)
• Central Line-Associated Bloodstream Infection
• Pressure Ulcers (Hospital-acquired Pressure Injuries)
• Prolonged Intensive Care Unit Length of Stay
• ICU Mortality (Survival Rate)

Interventions

PROCEDURE

Evidence based practices bundles of care

Participants in this arm will receive a structured evidence-based practice (EBP) education and behavior change program. The intervention includes theoretical training on EBP principles, simulation-based skills training, and supervised implementation of evidence-based ICU care bundles guided by the Plan-Do-Check-Act (PDCA) cycle. The program aims to improve nurses' competency, motivation, and adherence to evidence-based practices to reduce ICU-acquired complications.

Sponsors & Collaborators

• Cairo University

  lead OTHER

Principal Investigators

• Michiko Moriyama, professor · Hiroshima University

Study Design

Allocation

NON_RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Model

PARALLEL

Eligibility

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2026-03-01

Primary Completion

2026-08-01

Completion

2026-08-01

Countries

• Egypt

Study Locations