Effectiveness of an Evidence-Based Respiratory and Renal Care Training With Case-Based Discussion on Nurses' Clinical Reasoning, Knowledge & Practice, Nurse-Physician Collaboration and Mechanically Ventilated Patient Outcomes in a Tertiary-Level ICU in Bangladesh

This study will evaluate the effectiveness of an evidence-based respiratory and renal care training program combined with case-based discussion on nurses' clinical reasoning, knowledge \& practice, nurse-physician collaboration, as well as selected clinical outcomes among mechanically ventilated patients in a tertiary-level ICU in Bangladesh. The intervention will provide structured education and practical training to ICU nurses on evidence-based respiratory and renal care for mechanically ventilated patients. Case-based discussions will be conducted to promote clinical reasoning, evidence-based decision-making, and nurse-physician collaboration during daily ICU rounds. Nurses' outcomes will be assessed before and after the intervention, focusing on clinical reasoning, knowledge, practice, and nurse-physician collaboration. Patient outcomes will be assessed using historical pre-intervention data and post-intervention data among eligible mechanically ventilated ICU patients, focusing on ventilator-associated events (VAE), ventilator-associated pneumonia (VAP), Acute Kidney Injury (AKI), duration of mechanical ventilation, ICU length of stay, and ICU mortality. The study is intended to determine whether evidence-based respiratory and renal care training with case-based discussion can improve ICU nurses' clinical reasoning, knowledge, practice, nurse-physician collaboration and contribute to improved outcomes among mechanically ventilated patients.

Inclusion Criteria: For nurses: * Registered nurses employed in the ICU at the time of enrollment * Involved in direct patient care * Willing to participate and provide informed written consent For Patients: * Age ≥18 years * Patients receive mechanical ventilation for at least ≥ 48 hours * Legal guardian of the patients who will provide informed written consent Exclusion Criteria: For nurses: * Nurses on long-term leave and study leave during the intervention period * Nurses working exclusively in administrative or managerial roles * Nurses who did not complete the pre-test assessment For Patients: * Patients mechanically ventilated for less than 48 hours. * Patients who have already developed VAE or VAP at ICU admission * Patients with end-stage renal disease on chronic dialysis prior to ICU admission * Readmissions to ICU during the same hospital stay