Holistic Ventilation Training Boosts NICU Nurses’ Confidence in Pilot Study

A seven-hour training program that teaches neonatal nurses not just how to manage ventilators, but how to care for the whole ventilated infant, produced measurable gains in nurses’ self-reported knowledge, perceived competence, and awareness of evidence-based practice, according to a pilot study published in BMC Pediatrics. The research, conducted by Didem Yayla Karakurt of Biruni University in Istanbul, Türkiye, offers an early signal that a more holistic approach to neonatal mechanical ventilation education may fill gaps left by traditional, narrowly focused training.

Mechanical ventilation is one of the most technically demanding responsibilities in a neonatal intensive care unit. Premature and critically ill newborns who cannot breathe adequately on their own depend on ventilators that deliver carefully calibrated pressures, volumes, and oxygen concentrations, and the nurses at the bedside must interpret arterial blood gas results, adjust to changing ventilator settings, recognize signs of deterioration, and prevent complications such as ventilator-associated pneumonia. Yet the study’s author notes that conventional training in this area tends to concentrate almost exclusively on weaning parameters—the numbers that tell clinicians when a baby might be ready to come off the machine. What is often missing, the paper argues, is the supportive care that surrounds the technology: chest physiotherapy to keep airways clear, and kangaroo care, the practice of skin-to-skin contact between parent and infant that has documented benefits for physiological stability, temperature regulation, and bonding.

To test whether a broader curriculum could move the needle, Karakurt designed a prospective, quasi-experimental, single-group pre-test/post-test pilot study involving 28 neonatal intensive care nurses. The participants attended a seven-hour educational program covering three intertwined domains: the principles of mechanical ventilation, physiotherapy for ventilated neonates, and kangaroo care. Because the study included no control group, all participants completed the same self-report instrument before and immediately after the training, allowing the researcher to compare each nurse’s baseline scores with their post-intervention scores.

The measurement tool itself was a 23-item questionnaire using a five-point Likert scale, and its development received considerable attention. A panel of seven neonatologists reviewed the items for content validity, yielding a Content Validity Index of 0.92, a figure well above commonly accepted thresholds. The instrument also demonstrated strong internal consistency, with a Cronbach’s alpha of 0.928, meaning the items appeared to reliably measure the same underlying constructs. The questionnaire captured three domains: self-reported clinical knowledge, perceived competence, and awareness of evidence-based practice.

The results showed statistically significant improvement across the board. Overall self-reported scores rose from 4.44 plus or minus 0.38 before the training to 4.78 plus or minus 0.23 afterward, a difference that was highly significant with a P value below 0.001 and a large effect size, Cohen’s d of 0.96. Breaking the results down by domain revealed an interesting pattern. The largest gain appeared in perceived competence, which improved with a P value below 0.001 and an effect size of 1.38. Awareness of evidence-based practice also improved significantly, with a P value of 0.008 and an effect size of 0.87. Clinical knowledge showed a smaller but still statistically significant gain, with a P value of 0.034 and an effect size of 0.59.

One of the most instructive aspects of the study lies in what the numbers did not show. Baseline scores were already high, ranging from 4.30 to 4.55 on the five-point scale, which raises the possibility of a ceiling effect. When participants begin near the top of a measurement scale, there is simply little room left for improvement to be detected, and the true impact of an intervention may be underestimated. The author explicitly flags this limitation, noting that the high starting point may have constrained how much improvement could appear in the post-test scores. This is a recurring challenge in educational research involving experienced clinicians, who may legitimately rate their knowledge highly even before targeted training.

The study also explored whether junior and senior nurses responded differently to the curriculum. Twenty of the 28 participants were junior nurses and eight were senior nurses, and in this exploratory comparison the junior group showed a numerically larger gain, an increase of 0.39 points compared with 0.23 points for the senior group. However, the difference was not statistically significant, with a P value of 0.294. The author is careful to caution against overinterpreting this result: given the small and unequal subgroup sizes, the analysis was underpowered, and a Type II error—a failure to detect a real difference—cannot be excluded. In other words, the data cannot support the claim that both groups benefited equally, nor can it confirm that junior nurses truly gained more.

The methodological constraints of the pilot deserve emphasis. With no control group, it is impossible to rule out confounding influences such as test-retest familiarity, the natural enthusiasm that follows any intensive workshop, or concurrent learning from other sources. The outcomes are entirely self-reported, capturing what nurses believe they know and how competent they feel rather than objectively measured performance at the bedside. The author states plainly that the findings should be regarded as preliminary and self-reported, not as evidence of demonstrated clinical competence or of any benefit to patient safety. Self-efficacy is a meaningful construct in nursing education research, and perceived competence can influence clinical behavior, but the gap between confidence and capability is precisely the kind of gap that only objective assessment can close.

The ethical framing of the study is also noteworthy. The research evaluated voluntary, anonymous self-assessment questionnaires administered to healthcare professionals attending a specialized training workshop held during an academic medical conference. Because it involved no clinical interventions, no patient involvement, no access to patient records, and no biological sampling, the investigators classified it as an educational course evaluation and professional development audit, overseen academically by Biruni University, and it was not submitted for prior review to the university’s Scientific Research Ethics Committee. The study was conducted in accordance with the Declaration of Helsinki, and written informed consent was obtained from all participating nurses before the questionnaires were administered. The author declares no competing interests, and the study received no specific funding from any public, commercial, or not-for-profit agency.

So where does this leave the idea of holistic ventilation education? The pilot provides proof of concept that a curriculum pairing technical ventilation content with physiotherapy and kangaroo care can be delivered in a single day and is associated with immediate, statistically significant gains across three self-report domains, with the strongest effect on perceived competence. It also demonstrates a validated measurement instrument that future researchers can adapt. What it does not yet provide is the evidence needed to recommend the program for widespread adoption. The author calls for larger, controlled, multicenter trials with objective performance measures and longer follow-up before such a program could be recommended for wider use. Those trials would need to test whether self-reported gains translate into demonstrable skills, whether the effects persist beyond the immediate post-test period, and, ultimately, whether better-trained nurses contribute to safer ventilation practices and improved outcomes for the smallest and most vulnerable patients in the intensive care unit. Until then, the study stands as a careful, honestly reported first step toward an educational model that treats the ventilated newborn not as a set of numbers on a monitor, but as a whole patient whose respiratory support and developmental care belong in the same lesson.

Subject of Research: A holistic educational program for neonatal mechanical ventilation and its effect on NICU nurses' self-reported knowledge and perceived competence

Article Title: A holistic educational program and its association with self-reported knowledge and perceived competence in neonatal mechanical ventilation: a prospective, single-group pre–post pilot study

Article References: Karakurt, D. Y. (2026). A holistic educational program and its association with self-reported knowledge and perceived competence in neonatal mechanical ventilation: a prospective, single-group pre–post pilot study. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07818-y

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07818-y

Keywords: neonatal mechanical ventilation, NICU nursing, nursing education, kangaroo care, physiotherapy, perceived competence, evidence-based practice, pilot study, pre-post design, self-efficacy, neonatal intensive care, holistic education