Background: Mechanical ventilation is a highly technical nursing intervention that is an important part of intensive care units (ICUs) and requires the knowledge and skill of the nurse to ensure patient safety and to provide optimal outcomes. Inadequate ventilator usage can result in complications, morbidity, and mortality for the critically ill.
Aim: The purpose of the study was to evaluate the knowledge and practices of the nurses working in the ICU of tertiary care hospitals in Peshawar regarding the management of ventilators.
Methodology: The study design was a descriptive cross-section of the nurses working in the ICU for two hospitals (public and private). Convenience sampling was employed for 147 nurses from a population of 330 nurses. Structured questionnaires were used to collect data on demographic characteristics, knowledge, and practices. Descriptive statistics were used to analyze data in SPSS version 22.
Results: The results showed that 89.1% of the nurses had poor knowledge and 10.9% had good knowledge about the management of ventilators. Practices: 82.3% had poor practices and 17.7% had good practices. Ventilator settings, oxygenation parameters, and alarm interpretation were identified as areas of knowledge gap. Compliance was poor in documentation, infection control, and ventilator care practice but was relatively good in head elevation practice (90.5%).
Conclusion: The poor practices and lack of knowledge of ICU nurses on ventilator management were demonstrated. The need of the hour is to establish structured training programs, continuous education, and standardized critical care protocols to enhance patient safety and critical care outcomes.

Mechanical ventilation, Intensive care unit, Critical care nursing, Ventilator management, Nursing practices.

An ICU is a hospital-recognized area that provides intensive or high levels of care to patients with serious illnesses who need life support treatment. Ventilator management describes the clinical practice of operating, adjusting, and monitoring mechanical ventilators to ensure adequate ventilation and oxygenation of patients with respiratory failure. The registered health care specialist who cares for patients in the ICU is a nurse who monitors ventilators, cares for airways, and is trained for emergency response. Knowledge is defined as understanding ventilator modes, settings, ventilator alarms, and ventilator complications. Practices are defined as the use of evidence-based ventilator care such as suctioning, infection prevention, and patient positioning. Tertiary care hospitals are the high-end hospitals that provide specialized critical care services in Peshawar.[1,2]

Mechanical ventilation is one of the fundamental interventions in intensive care units all over the world. Many critically ill patients have to receive ventilatory assistance because of respiratory failure, sepsis, trauma, and neurological diseases. Estimates in the world suggest that mechanical ventilation is used in almost 40%–50% of all patients admitted to an ICU.[1] Ventilator-associated complications are associated with increased morbidity, length of stay in the ICU, and mortality rates. In critical care settings, the competence of the nurse in managing ventilators has a direct impact on the care and outcomes of patients requiring ventilator support.[3]

In Pakistan, ICU services are becoming more in demand as the number of respiratory infections, cardiac conditions, and trauma cases are on the rise. Nevertheless, differences in critical care nursing education exist among healthcare institutions. Nurses in ICUs have suboptimal competency levels as a result of limited access to structured training programs in ventilators. Research studies have documented lack of knowledge of ventilators and inconsistencies in ventilator management practices in tertiary hospitals throughout the country. [3] Low levels of training and limited opportunities for ongoing professional development threaten patient safety.[4]

Many patients with severe illnesses and the need for mechanical ventilation are managed at tertiary care hospitals in Peshawar. ICU nurses are working with a high workload and less staff support. There is some variation in ventilator management practice as a result of experience, training exposure, and resource availability. Difficulties with adherence to standard ventilator care practices have an impact on critical care quality of care in these hospitals.[5]

Accurate monitoring of respiratory data such as tidal volume, airway pressure, oxygen saturation, and alarm systems is all important for ventilator management. ICU nurses are key to early recognition of complications associated with the use of a ventilator, including ventilator-associated pneumonia, barotrauma, and hypoxia. Nursing care interventions at the right time shorten the length of mechanical ventilation and save lives. Ventilator care is a component of the care of critically ill patients in intensive care units, which helps to stabilize patients.[6]

Variations in education and clinical experience explain some of the variations among ICU nurses regarding ventilator-related knowledge. Hands-on training contributes to a lack of skills in responding to ventilator alarms and respiratory emergencies. With a lack of standardized competency-based training programmers, this decreases the uniformity of clinical practice. Ventilator management is improved when nurses have high-level skills in this area.[7,8]

To identify gaps in critical care delivery, assessment of the knowledge and practice of the ICU nurses in tertiary care hospitals of Peshawar is necessary. The findings will help to inform targeted training programs and policy interventions for enhancing the competency of ventilator care. Nursing knowledge and clinical practice enhancement are associated with better patient safety and minimizing complications in the ICU.

For this purpose, the knowledge and practices of ICU nurses concerning the management of the ventilator in tertiary care hospitals were evaluated using a cross-sectional study design. To include a wider spectrum of critical care nursing practice, the study was conducted in two tertiary care hospitals, one private and one government, which were selected. The target population comprised nurses in intensive care units of both hospitals. All willing and actively working nurses in the ICU were included in the study. Nurses on leave, those who did not want to participate, and those who were rotating to other units during the data collection were excluded from the study. The convenience sampling technique was applied for the selection of participants. The structured questionnaire was adapted from previously validated instruments used in a similar study. Content validity was established by a panel of five experts comprising three critical care nursing educators and two intensive care unit consultants. The panel reviewed the questionnaire for relevance, clarity, and comprehensiveness. The content validity index (CVI) was calculated as 0.89. For reliability, the questionnaire was pilot-tested on 15 ICU nurses (not included in the main study), and internal consistency was assessed using Cronbach’s alpha, which yielded values of 0.84 for the knowledge section and 0.81 for the practice section, indicating acceptable reliability. The number of all ICU nurses in both hospitals was 330, and the sample size obtained from the Raosoft sample size calculator at a 0.5% margin of error and 95% confidence interval (CI) was 147.

Data collection procedure: A structured and adapted questionnaire was used to collect data. The tool was divided into two parts. The first part contained demographic data like age, gender, qualifications, clinical experience, etc. The second part evaluated the knowledge about ventilator management such as ventilator settings, monitoring, complications, and nursing interventions. The hospital administrations were contacted first for the collection of the data. The aim of the study was explained to the participants, and informed consent was obtained from all the respondents. The questionnaires were handed out to the nurses in the ICU during their duty hours and were retrieved at the same duty hour or next duty hour to maximize the response rate and accuracy of the data.

Data analysis procedure: Data analysis was done using the statistical package for social sciences (SPSS) version 22. Data were summarized with descriptive statistics. Categorical variables (gender, qualification, and knowledge levels) were given frequencies and percentages. Means and standard deviation were calculated for continuous variables. The results were presented in tabular and graphical form for easy interpretation. Data analysis was used to identify patterns in the level of knowledge and practice of the ICU nurses in the management of ventilators in tertiary care hospital settings.

Demographic characteristics of participants: The demographic profile of ICU nurses is seen in Table 1. The majority of the participants were male (64.6%), and 35.4% were female. Marital distribution was fairly balanced, with almost half of the respondents being married (49.7%) and nearly half (50.3%) unmarried. As for academic qualifications, most nurses were Bachelor of Science in Nursing (BSN) (61.9%), Post Registered Nurse (RN) (30.6%), or Diploma (5.4%), and there was a small percentage who possessed Master of Science in Nursing (MSN) qualifications (2%). The highest distribution rate for workplaces was found for Surgical ICU (37.4%), followed by medical ICU (33.3%), pediatric ICU (15%), and coronary care unit (CCU) (14.3%). The average age of participants was 29.00 ± 4.54 years, suggesting that most of the nurses were young adults, with most of them having relatively short critical care experience.

Table 1: Demographic characteristics of participants

As shown in Table 2, the knowledge of ICU nurses was found to be overall limited in mechanical ventilator management. Less than half of the participants (45.6%) had received formal training on mechanical ventilators. There was a moderate number of correct responses for oxygen titration goals (61.2%) and positive end-expiratory pressure (PEEP)-related knowledge (51.7%) and a very low number of correct responses for key clinical concepts: initiation criteria based on pH (24.5%), use of non-invasive ventilation (NIV) in ventilation initiation (22.4%), and understanding of fraction of inspired oxygen (FiO₂) management (18.4%). Likewise, there were gaps in knowledge about ventilator parameters, including tidal volume (29.3%) and alarm interpretation. In summary, the results show that the theory knowledge of the ICU nurses about the ventilator setting and management is insufficient, and it is recommended that structured training programs be conducted.

Table 2: Knowledge of participants regarding mechanical ventilator management

Table 3 shows that overall, the level of clinical practices among the ICU nurses was found to be fairly inadequate in relation to the care of ventilated patients. Only 7.5% reported endotracheal tube position and 14.3% reported cuff pressure monitoring being incorporated in protocols. Infection prevention and eye care practices were also poor, with low levels of eye care technique adherence (27.2%-32.0%) and oral care technique adherence (38.8%). Better compliance was noted with respect to the patient’s anxiety (91%) and head elevation (90.5%) practice, suggesting awareness of some interventions needed in critical care. The results indicate that overall, there is a large gap between evidence-based ventilator care and some awareness of the protective measures to take, with a lack of uniformity in how ventilator care is carried out in ICUs.

Table 3: Practices of participants in care of mechanically ventilated patients

The present study evaluated the knowledge and practices of ICU nurses regarding the management of ventilators in tertiary care hospitals of Peshawar, Pakistan, and the findings revealed that a significant proportion of the nurses were found to have inadequate knowledge and poor practices. The overall result indicated that 89.1% of the respondents had a poor knowledge level and 10.9% had good knowledge. Likewise, poor practices were observed in 82.3% of nurses, while good practice was observed in 17.7% for the care of mechanically ventilated patients.[9] The results suggest that there are large deficits in critical care competence and that training and clinical use of ventilators in ICUs are not sufficient. In developing countries, similar studies have also found inadequate knowledge and suboptimal nursing practices in mechanical ventilation care associated with the lack of ongoing education and limited practical experience in critical care units.[10,11]

The participants’ demographic data showed that most of them were young nurses whose mean age was 29.00 ± 4.54 years. The majority of participants were male (64.6%) and had a BSN qualification (61.9%), with a smaller proportion having a postgraduate qualification. It indicates that the workforce in the ICUs is predominantly low- and middle-skilled early-career nurses. The results of the current study are like those of previous studies, which revealed that younger nurses with less clinical experience had less competency in advanced critical care skills, such as ventilator management.[12]

Results of a knowledge assessment showed that there were gaps in concepts about mechanical ventilators. Only half of the participants had had formal training in ventilator management (45.6%). Answers to the basic concepts (oxygen titration, PEEP effects) were relatively high, whereas weak answers were noted in more critical topics such as criteria for initiating ventilation, management of FiO₂, and interpretation of tidal volume.[13] These findings are linked to poor theoretical preparation and the absence of structured training programs for the ICU, having a direct impact on the ability to appropriately manage complex ventilator settings by the nurses.[14]

Evidence-based ventilator care was found to be extremely deficient in practice. Compliance for documentation of endotracheal tube position (7.5%) and cuff pressure monitoring (14.3%) and eye care practices (27.2%-32.0%) was very low. Oral hygiene, another indicator of poor implementation of ventilator-associated infection prevention strategies (VAIPs), was also poor (38.8%).[15] But there were a few important interventions for which there was awareness—better practices were seen in head elevation (90.5%) and the recognition of patient anxiety (91%). The discrepancies indicate a lack of uniformity in the care provided in the ICUs and inadequate oversight in clinical care.[16]

The study identifies a significant knowledge-practice gap in relation to the practice of the ICU nurse that suggests that theoretical knowledge is not well implemented. This may be due to lack of training in tertiary hospitals, high workload, and few resources in these hospitals. Continuous training of staff, structured ventilator care protocols, and adequate staffing of the ICU are key to patient safety and better outcomes in mechanically ventilated patients.

The study results suggest that hospital administration in tertiary care hospitals of Peshawar should conduct in-service training for the nurses in the ICU on a regular and systematic basis to train them on mechanical ventilator management. There should be continuous professional development courses, simulation-based learning, and competence-based workshops to enhance both theoretical knowledge and practical skills. Implementing a standard ventilator care protocol, as well as endotracheal tube care, cuff pressure monitoring, infection control protocols, and alarm management, should be developed and strictly followed to strengthen ICU policies.

Increasing the nurse-to-patient ratio in ICUs to decrease workload and improve patient monitoring and care quality is also recommended. Management in the hospital should ensure that the basic equipment and supplies related to ventilators are available to make nursing work safe. ICU nurses who are posted should be oriented to the use of ventilators, critical care procedures, etc. Comprehensive instruction in the use of ventilators, critical care procedures, etc. should be provided during orientation programs for newly posted ICU nurses.

Supervision and regular clinical audits should take place to review compliance with the guidelines for caring for the ventilator and to determine where improvement is required. It is also recommended that modules for the management of ventilators be an integral part of the undergraduate and postgraduate nursing syllabus to reinforce basic knowledge. Interventional studies should be done in the future to assess the effectiveness of training programs on improving the performance of nurses in the ICU and patient outcomes.

From the present study, it was concluded that the knowledge of the ICU nurses regarding the management of ventilators was inadequate, and their clinical practices were also poor in the tertiary care hospitals located in Peshawar. Significant gaps were found, as 89.1% of participants exhibited poor knowledge, and 82.3% exhibited unsatisfactory practices, thus showing poor competencies in critical care. Nurses knew some of the basic concepts of ventilators and demonstrated good compliance for a few practices, including elevation of the head and an awareness of patient anxiety, but overall performance was not adequate for safe and effective ventilator care. The results also showed that inadequate formal training, a a lack of formal education programs, and a lack of clinical experience are important factors in these shortcomings. The study highlights the need for ongoing professional development, competency training, and standardized ventilator care protocols in the ICU environment. Increased knowledge acquisition and clinical practice of nurses will lead to better patient safety, decrease the frequency of complications associated with the use of a ventilator, and improve the outcome for the severely unwell patient in tertiary care settings.

The authors would like to express their sincere gratitude to Dr. Shah Hussain, Principal/Associate Professor, Janbar College of Nursing, Swat, for his invaluable supervision, guidance, and support throughout the course of this study.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Corresponding Author:
Farooq Ahmad
Department of Nursing
Ghandhara University, Peshawar, Pakistan
Email: [email protected]

Co-Authors:
Gul Nazar
Department of Nursing
Khyber Medical University, Peshawar, Pakistan

Muhammad Hussain
Department of Nursing
Khyber Medical University, IHS Kurram

Abdul Waqar Shah
Department of Nursing
Institute of Health Sciences, Peshawar, Pakistan

Adnan Khan, Muhammad Awais
Department of Nursing
Farkhanda Institute of Nursing and Public Health, Peshawar, Pakistan

Farooq Ahmad and Gul Nazar contributed to data collection and data analysis. Muhammad Hussain and Abdul Waqar Shah were involved in data collection and literature review. Adnan Khan and Muhammad Awais contributed to data collection, data organization, and interpretation.

Ethical Approval was obtained from the Saidu Teaching Hospital, Swat, Ref No KTH/IRB/2026/30.

The authors declare that there is no conflict of interest regarding the publication of this paper.

Farooq Ahmad is the guarantor of this study and takes full responsibility for the integrity of the data and the accuracy of the data analysis.

https://doi.org/10.63096/medtigo3092324

Ahmad F, Nazar G, Hussain M, Shah AW, Khan A, Awais M. Knowledge of Intensive Care Units Nurses Related Ventilator Management and Practices in Tertiary Care Hospitals in Peshawar. medtigo J Emerg Med. 2026;3(2):e3092324. doi:10.63096/medtigo3092324 Crossref