Theory-Based Educational Program for VAP Prevention and Nursing Care in Intensive Care Units

This study is a national, multicenter, two-arm, parallel-group cluster-randomized controlled trial evaluating a theory-based structured educational program for nurses working in adult intensive care units (ICUs) affiliated with the Ministry of Health in Jordan. Cluster randomization is conducted at the ICU level to reduce contamination among nurses working within the same clinical environment.

The educational program is theoretically grounded in Schön's Reflective Practice Theory and was developed to support the integration of evidence-based VAP prevention knowledge with clinical reasoning and reflective nursing practice. The program consists of four weekly educational sessions, each lasting approximately three hours, for a total of approximately 12 contact hours. Educational strategies include interactive lectures, case-based learning, group discussion, clinical scenarios, demonstration, simulation-based learning, reflective exercises, structured debriefing, and practice-improvement planning.

The first session focuses on VAP prevention knowledge and clinical decision-making, including VAP risk factors, mechanisms contributing to VAP development, evidence-based preventive practices, oral care, positioning, airway and secretion management, aspiration prevention, hand hygiene, and relevant ventilator-care bundle components. The second session addresses nursing care of mechanically ventilated patients and the integration of reflective practice into routine ICU care. The third session uses simulation-based clinical scenarios involving mechanically ventilated patients and is followed by structured reflective debriefing. The fourth session integrates the major concepts, addresses barriers to implementation, and supports the development of individualized practice-improvement plans.

Participants in the control group receive usual institutional care and education. Routine institutional education and patient-safety procedures are not withheld. The study-specific structured educational program is not provided to control ICUs during the active intervention period.

Study outcomes are assessed at three prespecified time points: baseline (T0), immediately after completion of the educational program (T1), and six months after intervention completion (T2). The primary outcome is VAP prevention knowledge. Secondary nurse-level outcomes include reflective nursing practice related to invasive mechanical ventilation and quality of nursing care. Family satisfaction with ICU care is evaluated as a family-level secondary outcome using the FS-ICU 24R. Family respondents are recruited independently of participating nurses and are linked to the relevant ICU and assessment period rather than to individual nurses.

The primary treatment effect is evaluated by examining the difference in change between intervention and control groups over time, with particular emphasis on the group-by-time interaction from baseline to the immediate post-intervention assessment. The six-month assessment evaluates retention and sustainability of intervention effects. Longitudinal analyses account for the clustered nature of the trial and repeated measurements.

The study was conducted among attending nurses working in intensive care units affiliated with the Ministry of Health (MOH), Jordan, during the period from August 2025 to February 2026.

Inclusion criteria

• Registered nurses employed by a participating Ministry of Health hospital in Jordan.
• Nurses assigned to a participating adult intensive care unit (ICU).
• Nurses providing direct patient care to mechanically ventilated or critically ill patients.
• Nurses with sufficient clinical experience to participate in the study procedures.

Willingness to participate voluntarily and provide written informed consent.

Exclusion criteria

• Administrative nurses without direct bedside responsibilities.
• Nurses on extended leave during the intervention period.
• Nurses expected to leave the participating ICU before completion of the immediate post-intervention assessment.