Background of study
The healthcare industry for a long time has faced challenges in the efforts to reduce pneumonia acquired at the hospital. Ventilator-associated pneumonia (VAP) is a condition caused by pulmonary inflammation usually after intubation. Patients face the risk of 6 to 21 times when they receive mechanical ventilation and normally encountered in high-tech areas such as the Intensive Care Unit (ICU). VAP has been associated with increased patient morbidity, mortality, length of stay, and increased hospital and patient costs. Patients diagnosed with this disease spend approximately $ 40,000 more compared to the normal average healthcare costs incurred by patients in the ICU without this disease (Zurmehly, 2013). The high costs have been linked to increased stay and ventilator days. In the United States, approximately $6.5 billion is used by the federal government to treat this disease. Majority of the patients having VAP are admitted to the ICU while already having harmful bacteria running in their system. The researchers note that educational interventions for the ICU staff and registered nurses can extensively reduce the VAP occurrence. Nevertheless, while interventions such as oral care education have been associated with a reduction in the VAP incidence rate, there lacks consistency in practice. Implementation of lessons from the interventions associated with VAP remains a challenge. For instance, while within a hospital setting there can be oral care policies, the practice patterns often have discrepancies. A strategy which can help to achieve this is using technology-enhanced instruction. For example, the benefits of using online learning modules include cost efficiency, flexible deliver, and savings in time (Zurmehly, 2013).
Thus, the objective of the study was evaluating the effectiveness of a nursing quality education improvement program on a care practice administered orally in the reduction of VAP incidence within the ICU. The focus of the study was staff education, oral care, and ongoing surveillance on the patients. The significance of this study to the nursing practice is critical because it contributes to provision of quality healthcare to the patients. The study seeks to have ICU staff and registered nurses increase their skills and knowledge in dealing with VAP. Reducing the incidence rates will lead to less mortality and low medical costs incurred by individual patients and the government.
Discussion of method of study
In this study, the researchers used a quasi-experiment design in investigating an evidence based practice education program while including a nursing intervention of oral care. The effect of the intervention program was measured through a pretestposttest design using a convenience sample. In particular, the researchers implemented a VAP prevention education program for the 60 nurses who provided care to an ICU with a capacity of 12 beds. A convenience sample was used in the selection of 44 nurses where their performance and awareness in prevention of VAP was measured. The researchers also calculated the VAP’s occurrence rate for 180 mechanically ventilated patients in the ICU. The inclusion criteria of the nurses was having a work experience of 3 months in the ICU. The patients included in the study were those who had been used a mechanical ventilator for 48 hours and more but at the time of admission to the ICU they did not have VAP. The exclusion criteria left out nurses who were transferred occasionally from the ICU and patients who had been admitted to the ICU after connection to a mechanical ventilator. The review board determined there was no need of having a full review from the institutional review board because the nurses included in the study volunteered. The program was administered from October to December. The education initiative focused on a 10- item questionnaire and self-study program. The data collected was analysed using SPSS (Statistical Package for the Social Sciences, version 16.0). The theoretical framework that the researchers in this study adopted was the lowa model of evidence based practice to achieve quality care. The significance of choosing this model was because of the ability to promote integration of evidence into practice with the aim of improving the outcomes of the patient while providing an opportunity for nurses to make effective contribution to delivery of quality care (Zurmehly, 2013).
Results of study
The results showed that majority of the nurses working in the ICU were female having an average of 44 years. Many of the respondents had an associate degree while others had a bachelor of science degree with a average 8 years hospital experience. Before the program was administered, the mean of the oral care was 8.45 out of 10. However, after implementing the program the mean increased to 9.84. The changes in score as shown by the post-test analysis depicted that the 30 minute education module directly contributed to the increase in nurses knowledge of oral care and VAP with 0.12% CHG. In practice pattern changes, the study results revealed that oral care’s frequency significantly increased. Moreover, the findings revealed that after the program the ventilator days decreased. In addition, the VAP rates were decreased by 62.5% after administering the education intervention (Zurmehly, 2013).
The implication of these findings is that the use of education intervention can help in reducing VAP incidence rates. The knowledge that nurses have when administering care increases and as a result there is a high levels of compliance. The study results have further implications for educating ICU nurses in that providing them with knowledge to improve their competencies increases quality outcomes. Thus, training new nurses on performing appropriate oral care on patients with VAP helps to address the condition. Additionally, it is important to ensure that VAP policies within hospitals match the normal practice administered by the nurses. Suitable oral guidelines should be developed to help nurses provide quality care to the patients. Thus, the education program should be implemented as a preventive measure and there should be regular assessment if it is properly administered (Zurmehly, 2013).
Ethical considerations
Conducting a nursing research requires the researchers to adhere to certain ethical considerations. First is the need to have the responses of the participants stay confidential. The responses should not be revealed to an employer. Moreover, the names and distinctions of the respondents should remain private. The privacy of the personal information should be respected where names of the respondents should not be disclosed to any person without the necessary consent. Additionally, before conducting the research, consent from the respondents should be sought. The participation to a nursing research should also be voluntary. The researcher should inform respondents of the purpose and objective of the study as well as their right of withdrawal.
Conclusion
Preventing VAP has been identified as a significant priority for achieving improvement in healthcare quality and outcomes, consequently reducing the number of deaths. There is evidence that educational interventions reduce VAP effectively resulting in reduction of the medical costs and promoting the quality of care delivered.

Reference
Zurmehly, J. (2013). Oral care education in the prevention of ventilator-associated pneumonia: quality patient outcomes in the intensive care unit. The Journal of Continuing Education in Nursing, 44(2), 67-75.