Design and implementation of intensive care unit
protocols for critical care
nurses in River Nile State Government Hospitals -Sudan
Mahadi Abdelrahman Fadulelseid
1*2 Dr Higazi Mohammed Ahmed Abdallah
1st Khartoum University, medical- surgical nursing
Sudan, MSC of medical surgical nursing (PhD candidate karary university) mahadyabdo8@gmail.com .
2 Associate professor of medical - surgical nursing, -Fezzan
university.Libya.higazi124@yahoo.com
*Corresponding
Author: Mahadi Abdelrahman Fadulelseid
Khartoum University, medical- surgical nursing Sudan,
MSC of medical surgical nursing (PhD candidate karary university) , mahadyabdo8@gmail.com
Abstract
Background:
The utilization of protocols in the Intensive care
unit can potentially improve the care of the critically ill patient. Because of
the complexities of caring for the critically ill patient, the use of protocols
in the intensive care unit has become increasingly common. We will review the
definition of a protocol, discuss their advantages, and highlight some of the limitations
and potential for harm with their use
Objectives: This study
IMES To design and implement of intensive care
unit protocol for critical care nurses in River Nile State Government Hospitals
Method
QUASI-EXPERIMENTAL STUDY
Total coverage sampling method was adopted to select70 nurses working in icu
governmental hospitals - in River Nile State Self-administered structured questionnaire and check
list was used for data collection and analysed using IBM SPSS Version 20.
Descriptive and inferential statistics such as frequency, percentage, mean,
Chi-square test was used to analyse the data.
Result:
Comparative Analysis – Pre‑Study vs. Post‑Study Results
The
comparison between the pre‑study (before “ICU” training) and post‑study (after
“ICU” training) analyses reveal clear improvements in both confidence and
practice among participants.
1.
Infection Control Practices
•
Pre‑study: Responses showed variability, with some nurses focusing only on
single measures such as hand hygiene or PPE. Smaller proportion consistently
applied the full package of infection control practices.
•
Post‑study: The majority (62.9%) reported consistently following all measures
together — hand hygiene, PPE use, equipment disinfection, and isolation
protocols.
•
Difference: Training reinforced the idea that infection control is a system of
interconnected safeguards, leading to a shift from fragmented habits to
comprehensive application.
2.
Confidence in Infection Control Measures
•
Pre‑study: Confidence levels were mixed, with some participants reporting only
slight or moderate confidence.
•
Post‑study: More than 90% described themselves as confident or very confident
in applying infection control measures.
•
Difference: The study clearly boosted self‑assurance, showing that structured
learning translates into stronger readiness and reliability in practice.
3.
Familiarity with Documentation Protocols
•
Pre‑study: A notable portion of nurses were only somewhat familiar with
documentation standards.
•
Post‑study: Nearly 70% reported being very familiar, reflecting improved
clarity and consistency in record‑keeping and incident reporting.
•
Difference: Training helped close gaps in documentation knowledge, reducing
risks of inconsistency.
4.
Daily Nursing Roles and Effectiveness
•
Pre‑study: Some nurses expressed neutral or negative views about the
effectiveness of daily responsibilities.
•
Post‑study: More than 90% rated responsibilities as effective or very
effective.
•
Difference: The study appears to have aligned tasks more closely with patient
needs, improving perceptions of role effectiveness.
5.
Familiarity and a Confidence with “ICU” Equipment
•
Pre‑study: Familiarity and troubleshooting confidence varied, with some nurses
reporting limited experience.
•
Post‑study: Around 80% described themselves as very or extremely familiar with
equipment, and more than 80% felt very or extremely confident in
troubleshooting.
•
Difference: Training provided hands‑on exposure, transforming uncertainty into
technical resilience.
6.
Equipment Maintenance and Impact on Patient Care
•
Pre‑study: Perceptions of maintenance effectiveness and equipment impact were
moderate, with some nurses unsure of its role.
•
Post‑study: Nearly three‑quarters rated maintenance as effective or very
effective, and more than 75% believed equipment has a significant or great
impact on patient outcomes.
•
Difference: The study strengthened for awareness of how reliable equipment
directly supports workflow and patient safety.
7.
Continuous Improvement and Training Frequency
•
Pre‑study: Participation in refresher training was inconsistent, with some
nurses rarely attending.
•
Post‑study: More than half reported always attending refresher sessions, and
another 12.9% said often.
•
Difference: The study fostered a culture of continuous learning, embedding
regular training into professional practice.
Conclusion: the study concluded
that there was satisfactory level of knowledge @practics among nurses at
selected hospitals River Nile state. Nurses’ knowledge of intensive care unit protocols
Recommendations:
improve the quality of nursing knowledge should focus more studies to be
conducted to improve nurses’ level of Knowledge@practics regarding of intensive
care unit protocols for critical care nurses.
1.INTRODUCTION
A hospital's
intensive care unit is a specially staffed and equipped area devoted to the
care of patients who have life-threatening diseases, accidents, or
complications. evolved from
postoperative treatment rooms and respiratory units in the 1920s, 1930s, and
1940s, when it became apparent that grouping the sickest patients together was
advantageous. Positive energy that comes and goes.
With studies into the
pathophysiological pathways, treatment regimens, and outcomes of the critically
ill, as well as the establishment of specialty journals, educational programs,
and credentials dedicated to intensive care,
The
intensive care unit should be close to specific acute locations, such as
operating rooms, emergency rooms, Cardiac care units, labor wards, and acute
wards, as well as investigational units (e.g. radiology department, cardiac
catheterization laboratory). A large number of lifts, along with doors and
corridors, should be available to safely move critically ill patients to and
from the intensive care unit (1,).
Intensive care unit is highly specified and
sophisticated area of a hospital which is specifically designed, staffed,
located, furnished and equipped, dedicated to management of critically sick
patient, injuries or complications. It is a department with dedicated medical,
nursing and allied staff. It operates with defined policies; protocols and
procedures should have its own quality control, education, training and
research programmers. It is emerging as a separate specialty and can no longer
be regarded purely as part of anesthesia, Medicine, surgery or any other
specialty. It has to have its own separate team in terms of doctors, nursing
personnel and other staff who are tuned to the requirement of the specialty (2).
Care of the
critically ill patient is often punctuated with physiologic changes that
require immediate attention. Given the frequency of emergent interventions,
clinicians may be distracted from important, less urgent tasks that are still
essential for optimal patient care. For this and other reasons, the utilization
of protocols in the Intensive care unit can potentially improve the care of the
critically ill patient. Because of the complexities of caring for the
critically ill patient, the use of protocols in the intensive care unit has become
increasingly common. We will review the definition of a protocol, discuss their
advantages, and highlight some of
their
limitations and potential for harm with their use (3) .
High standard of intensive care medicine is
influenced by good design and adequate space.
Whenever renovations or new structures are
being planned there are certain features which must be considered. The total
area of the ICU should be 2.5-3 times the patient care area. Patient area – in
adult ICUs at least 20m2 of floor area is required for each beds pace in an
open area exclusive of service areas and circulation space.
Single
rooms should be at least 25 m2. Pediatric ICUs may use less than 20m2 when
using cots rather than beds.
There must be adequate access to the head of
each bed. Working area – the working area must include adequate space for staff
to work in comfort while maintaining visual contact with the patient
Adequate space must be allowed for patient
monitoring, resuscitation equipment and medical storage areas (including a
refrigerator).
The
unit needs space for a mobile x-ray machine, and associated equipment. The x-ray viewing facilities must enable
simultaneous viewing of multiple x-rays.
There should be adequate room for telephones and other communication
systems, computers and data collection equipment and storage of
stationery. Adequate space for a
receptionist and/or ward clerk must be available. Environment – the unit should
have appropriate air conditioning which allows control of temperature, humidity
and air change. Pharmacy/drug preparation area – for clean and rapid drug and
fluid preparation Equipment storage area
e.g. for monitors, ventilators, infusion pumps, dialysis equipment,
disposables, fluids, drip stands, trolleys, blood warmers, suction apparatus,
linen, large items of special equipment.
Dirty
utility area for cleaning appliances,
urine testing, emptying and cleaning bed pans and urine bottles. Unit design should provide appropriate
movement pathways for contaminated equipment. Staff facilities – should be
sited close to the patient area and have adequate communication with it. They
should allow for relaxation and debriefing during breaks Relatives area – a
separate waiting area must be available (with drinks dispenser, radio,
television and comfortable seating
desirable). A separate interview room
and a separate area for distressed relatives must be available and overnight
rooms for relatives should also be considered. (4)
There are multiple
definitions for protocols as 'sets of explicit, algorithmic rules, which direct
clinical management or research (5)
Protocols as 'precise and detailed plans for
the study of a medical or biomedical problem and/or for a regimen of therapy',
which should be differentiated from guidelines (6)
3.1 General objective:
To design and implement
intensive care unit protocol for critical care nurses in Khartoum state public
hospitals
3.2 Specific objectives:
To assess critical
care nurse’s knowledge regarding routine care pre post program
To assess critical
care nurse’s practice regarding routine care and unit adjustment pre post
program.
To identify the impact of protocol on intensive care unit nurse’s knowledge and
performance.
2. Materials and Methods:
2.1 Study design
Quasi experimental study River Nile hospital -based study
was conducted during the period (September 2024 – march 2025).
2. 2 STUDY AREA River Nile,
including Shandi Teaching Hospital 13 nurses, almak Nimr university Hospital 18
nurses, Atbara locality which includes
Atbara Teaching Hospital 26 nurses DamarLocality,
Aldamar Teaching Hospital 13nurse
2.3 Study Population
The study targeted all
nurses working in critical care units in the study area according to criteria
of selection.
2.3.1 Inclusion
criteria:
The nurses recruited
in the study included those who:
· Nurses who are working
for more than 6 months.
· Willing to participate
in the Study.
· Nurses with diploma
and above.
2.3.2 Exclusion
Criteria:
Nurses who were
excluded from the study included those:
· Nurses in an
internship period
· Non-permanent
contract.
2.4 Sample size and
Sample technique.
2.4.1 Sample size:
The researcher was
selecting the sample for all nurses how fulfil the above criteria in critical
care unit at governmental hospitals in River
Nile State.
2.4.2 Sample technique
The study was total
enumeration research hence there was total coverage purposive size.
2.5 Study Variables
Available is
achactrisics or quality that take one different value for example it varies
from one person or object to another.
2.5.1 Independent Variable:
The independent
variable includes (age, gender, education
, experience.).
2.5.2 Dependent
Variable
Dependent Variable
means the variable hypothesized to depen on or be caused by another variable
(the independent variable) in this study. the dependent Variables Knowledge of
the nurses regarding ethical issues in critical care unit.
2.6 Data Collection
instrument
The date collection
instrument consists of two sections as follow:
2.6.1 section one
The first part of the
tool related to demographic characteristics of the nurses such as age, gender, education,
experience.
2.6.2 section two
Close end knowledge
questionnaire, Consist of 15 questions with 4 correct answers in each question.
The mean score of all questions were calculated for each nurse.
2.6.2.1 Scoring
Interpretation of Knowledge by using overall mean scale scoring.
The scoring of the nurse’s knowledge based on
response of a 3 -point Likert scale scoring that ranged from one to four (3-4
=Adequate knowledge
2- 3 = Moderate knowledge 1-2 = Inadequate knowledge).
2.8 Validity of the
Questionnaire
The Questionnaire for data collection was
designed from literature review and presented to the supervisor and other
experts in the field of research and ethics that ensured the face, some modifications
have been made, content and construct validity before it was used for the
study.
2.9 Reliability of Tool
A Pilot study was conducted to assess study
tools clarity and applicability. It has also served in estimating the time
needed for fulfilling the study tools. The revised questionnaires were piloted
to investigate the feasibility of data collection tools. Collecting pilot study
data lasts for one week. No modification had occurred in the pilot study, so it
was included in the main study subject.
2.10 Ethical
consideration
Approval
from the Karari university faculty of graduate studies & scientific
research is done. involved official parties like state ministry of health.
Research
committee and administration of the hospitals will be informed about data
collection and the aims of the research. Verbal informed consent will be
requested from all respondents to participate in the study after fully
explaining the research purpose and objectives in the simple words. Names of
the respondents will not be used in the report. the questionnaire will be
filled out during their rest time.
confidentiality
of the information gathered will be assured. respondents have a right to
withdraw at any time during the research, however, their right to refuse to
participate in the study will be respected and they will not lose the right to
any benefits from the research. all necessary precautions and precautionary
measures for covid -19 in the hospitals will be followed.
result
Section
1: Demographic and Professional
Information
|
Std. d |
Mean |
Missing |
Valid |
Item |
|||
|
75 |
50 |
25 |
|||||
|
2.26 |
1.64 |
1.12 |
0.562 |
1.66 |
0 |
70 |
age |
|
1.84 |
1.34 |
|
0.478 |
1.34 |
0 |
70 |
Gender |
|
1.84 |
1.24 |
|
0.765 |
1.37 |
0 |
70 |
Educational Level |
|
|
3.48 |
2.84 |
0.750 |
3.40 |
0 |
70 |
Total Years of Nursing Experience |
|
3.97 |
2.91 |
1.83 |
1.271 |
2.91 |
0 |
70 |
Years of Experience in the “ICU” |
|
|
1.77 |
1.27 |
0.423 |
1.77 |
0 |
70 |
Employment Status |
|
3.29 |
2.16 |
1.23 |
1.151 |
2.26 |
0 |
70 |
Hospital/Locality |
Section
2: Knowledge Assessment on ICU Protocols and Design
|
Percentiles |
S.D |
mean |
valid |
Item |
||||||
|
75 |
50 |
25 |
|
|
|
|
||||
|
4.67 |
3.88 |
3.00b |
1.169 |
3.71 |
70 |
How familiar are you with the current “ICU”
protocols at your hospital? |
||||
|
7.17 |
2.81 |
1.76b |
3.689 |
4.57 |
70 |
Key Elements of “ICU” Protocols: |
||||
|
|
4.49 |
3.90b |
0.806 |
4.40 |
70 |
Importance of “ICU” Design: |
||||
|
4.89 |
4.23 |
3.32b |
0.983 |
4.07 |
70 |
Understanding of Clinical Protocols: |
||||
Section
3: Practice Assessment
Routine
Use of Protocols@ Essential Elements for “ICU” Admission:
|
Percentiles |
S.D |
mean |
valid |
item |
|||||||
|
75 |
50 |
25 |
|
|||||||||
|
|
4.59 |
3.95b |
1.013 |
4.40 |
70 |
In your daily
practice, how often do you follow the established “ICU” protocols? |
|
|||||
|
4.98 |
4.43 |
3.77b |
0.762 |
4.36 |
70 |
Consistency
in Routine Care Procedures: |
|
|||||
|
4.97 |
4.39 |
3.69b |
0.870 |
4.29 |
70 |
Comfort with
Critical Care Procedures: |
|
|||||
|
|
4.52 |
3.92b |
0.935 |
4.37 |
70 |
Please
indicate your level of agreement with the statement: |
|
|||||
|
2.46 |
1.58 |
.b,c |
1.098 |
1.80 |
70 |
Essential
Elements for “ICU” Admission: |
|
|||||
Section
4:
ISBAR
Handover Protocol@ Infection Control Measures
@
Daily Nursing Roles and Unit Adjustment
|
Percentiles |
S.D |
mean |
valid |
|
||
|
75 |
50 |
25 |
||||
|
|
4.59 |
4.05b |
4.59a |
4.49 |
70 |
5.2 Infection Control Measures |
|
5.48 |
4.74 |
3.75b |
4.74a |
4.36 |
70 |
Which of the
following infection control practices do you consistently follow? (Select all
that apply) |
|
2.50 |
1.45 |
. b,c |
1.45a |
1.80 |
70 |
5.3 ISBAR Handover Protocol How
frequently do you use the ISBAR method during patient handover? |
|
|
2.69 |
2.19b |
2.69a |
2.69 |
70 |
5.4
Documentation and Reporting |
|
4.91 |
4.36 |
3.68b |
4.36a |
4.26 |
70 |
5.5 Daily
Nursing Roles and Unit Adjustment |
Section
5: Use of Devices and Equipment in the ICU
item
|
Percentiles |
S.D |
mean |
valid |
|
|
|||||||
|
75 |
50 |
25 |
|||||||||
|
4.86 |
|||||||||||
|
4.23 |
3.39 |
4.23 |
4.4 |
70 |
6.1 Familiarity and Training |
|||||||
|
4.90 |
4.29 |
3.50 |
4.29 |
4.17 |
70 |
6.2 Confidence and
Troubleshooting |
|||||
|
4.90 |
4.23 |
3.38 |
4.29 |
4.13 |
70 |
Effectiveness of Equipment Maintenance: |
|||||
|
|
4.43 |
3.54 |
4.43 |
4.19 |
70 |
6.3
Impact on Patient Care and Workflow |
|||||
Discussion
The comparative analysis
between pre‑study and post‑study results underscores the profound impact of the
“ICU” training program on both technical competence and professional confidence
among nurses. Prior to the intervention,,, participants demonstrated only
moderate familiarity with infection control protocols,,, documentation
standards,,, and equipment use. Confidence levels varied considerably,,, with
some nurses relying on fragmented practices such as hand hygiene alone or
occasional documentation,,, rather than adopting a comprehensive,,,
system‑oriented approach. This variability reflected gaps in training and
highlighted the need for structured educational reinforcement.
Following the training,,,
however,,, the results shifted dramatically. The majority of nurses reported
consistently applying all infection control measures—hand hygiene,,, PPE use,,,
equipment disinfection,,, and isolation protocols—together as an integrated
system. Confidence in documentation protocols rose sharply,,, with most
participants describing themselves as “very familiar,,,” thereby reducing risks
of inconsistency in patient records and incident reporting. Technical
proficiency also improved: nearly 80% of nurses reported being “very” or
“extremely familiar” with “ICU” equipment,,, and more than 80% expressed strong
confidence in troubleshooting alarms and errors. These findings illustrate how
structured training transforms uncertainty into resilience,,, enabling nurses
to respond effectively to the complex demands of critical care.
The program’s influence
extended beyond individual skills to broader workflow and patient outcomes.
Nurses overwhelmingly recognized that equipment functionality and availability
have a “great” or “significant” impact on patient care,,, reflecting heightened
awareness of the link between technology reliability and clinical safety.
Similarly,,, perceptions of daily nursing responsibilities shifted toward
effectiveness,,, with more than 90% rating their roles as “effective” or “very
effective” post‑study. This suggests that the training not only improved
technical knowledge but also clarified role expectations,,, strengthened
teamwork,,, and enhanced confidence in daily routines.
Another notable outcome was
the increased participation in refresher training and simulation sessions. More
than half of the respondents reported “always” attending such sessions,,,
compared to inconsistent participation before the study. This shift indicates
that the program fostered a culture of continuous learning,,, embedding regular
practice and reinforcement into professional identity. Sustained engagement in
training is critical in high‑acuity environments,,, where rapid technological
changes and evolving infection control challenges demand ongoing adaptation.
Taken together,,, these
findings highlight the effectiveness of structured “ICU” training in embedding
best practices,,, strengthening confidence,,, and promoting a culture of safety
and continuous improvement. They also align with previous studies that emphasize
the value of competency‑based education and simulation in critical care nursing
(Pandian et al.,,, 2024; Hill & Lamichhane,,, 2024; Rebmann,,, 2025). The
convergence between our results and prior literature reinforces the conclusion
that targeted training programs are essential for bridging gaps in practice,,,
standardizing protocols,,, and ultimately improving patient outcomes.
At the same time,,, the
presence of small groups reporting lower confidence or familiarity reminds us
that variability persists even after training. Addressing these gaps requires
ongoing mentorship,,, peer support,,, and institutional commitment to continuous
education. Future programs should therefore integrate regular evaluation,,,
individualized feedback,,, and adaptive learning strategies to ensure that all
nurses achieve and sustain high levels of competence.
In summary,,, the “ICU”
training program proved transformative,,, shifting nurses from fragmented
practices to comprehensive,,, system‑oriented approaches,,, strengthening
confidence in documentation and equipment use,,, and embedding continuous
learning into daily routines. These changes not only enhance patient safety and
workflow efficiency but also contribute to the professional growth and
resilience of “ICU” nurses.
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