ABSTRACT
Background
Artificial airway suctioning is one of the most widespread nursing procedures in clinical practice. Although artificial airway suctioning is frequently applied procedure, it is not easy to perform. It is most important to follow the correct technique to prevent possible complications.
Methods
This study aims to assess the content, reliability, and quality of training videos on endotracheal aspiration for nurses. The descriptive and retrospective study was conducted in September 2023 and the videos available on the YouTube platform for artificial airway suctioning training of nurses were evaluated in terms of content, reliability and quality.
Results
In total, 36 videos were analyzed. The analysis was conducted by two independent researchers. Video Information Form and Endotracheal or Tracheostomy Tube Aspiration Checklist created in line with the literature were used to evaluate the application steps of the videos. The short form of the DISCERN questionnaire was utilized to assess the reliability of the videos, while the 5‐point Global Quality Scale (GQS) was employed to evaluate their quality. The mean DISCERN score for the videos was 2.958 ± 1.513, the mean GQS score was 3.430 ± 1.083, and the mean total score for the Implementation Checklist was 47.166 ± 10.338. A strong agreement was observed between the assessments made by the first and second researchers using the DISCERN, GQS, and Checklist. The videos included in the study were found to be of medium quality. Additionally, it was determined that all videos exhibited deficiencies in the Checklist steps. In addition, there were significant deficiencies in application principles such as compliance with sterile technique, sequence of application stages and recording.
Conclusions
These deficiencies are thought to pose a great risk in terms of patient safety. It is recommended that artificial airway suctioning videos available on YouTube be used in nursing education after being checked for content and by experts.
Keywords: artificial airway suctioning, clinical skills, video, YouTube
1. Background
Artificial airway suctioning is a commonly performed nursing procedure in clinical settings [1]. Although endotracheal aspiration is a frequently applied procedure, it is not easy to perform. It is most important to follow the correct technique to prevent possible complications (bleeding, pain, infection, atelectasis, hypoxaemia, increased intracranial pressure, trauma to the airway mucosa, cardiac arrest, and respiratory arrest). Therefore, nurses should be aware of the risks and have sufficient knowledge to perform the procedure based on evidence‐based practices [2].
The literature suggests that nurses should use artificial airway suctioning clinical guidelines and standards to prevent or reduce aspiration‐related complications [3]. Observational studies in which nurses' practice of the evidence‐based artificial airway suctioning procedure was examined reported that various errors were made in the steps of the procedure. The study by Talbert [3] reported that although more secretion was aspirated at high pressure, it deepened oxygen desaturation and caused severe mucosal damage. Shamali [4] reported that the number and rates of complications levels were higher in patients who underwent routine aspiration compared to those who were aspirated only when necessary. The study conducted by Ozsaban [5] reported that aspiration procedures in patients admitted to the intensive care unit led to an increase in pain scores, which were recognized as a critical risk factor for patient safety.
Several training methods, such as oral training, written materials and brochures, simulation, and multimedia‐based training, are used in artificial airway suctioning training. In recent years, training methods that make use of technology have become more and more widespread. Video‐assisted training and audio‐visual materials among these methods are frequently preferred due to the ease of learning for individuals in clinical learning settings [6, 7]. As technology has advanced, the internet has become an essential source of access to health information [8]. Nursing practices and skills are broadcast audio‐visually, especially on websites such as YouTube, and thousands of people watch them in a short time [7]. YouTube users constitute 95% of all internet users [9, 10]. YouTube is one of the most visited websites. It offers training videos to more than one billion monthly viewers [10]. Also, YouTube has a great potential to provide easy access to health‐related information, but the accuracy and usefulness of this information have not been fully recognised [11, 12].
Although studies have reported that YouTube videos are educational for patients and healthcare professionals, a study by Esen [7] reported a lack of quality in training videos upon a review of breast self‐examination and mammography training videos. Küçükakkaş and Ince [13] found that training videos were insufficient and incomplete after examining YouTube videos of lymphedema rehabilitation practices.
The studies have shown that while the Internet provides easy and unlimited access to health‐related videos, it often delivers unreliable or inadequate information to users. YouTube videos on injection practice training, pelvic floor muscle exercise training, intermittent urethral catheter insertion training, mammography training, breast self‐examination, rheumatoid arthritis, and lymphedema rehabilitation training have been reviewed, but no study has been found to evaluate artificial airway suctioning training videos. This study aims to assess YouTube videos in terms of accuracy, reliability and quality and adequacy.
2. Methods
2.1. Type of Study
This descriptive and retrospective study was conducted to assess the content, reliability, and quality of training videos on endotracheal aspiration and artificial airway suctioning for nurses.
2.2. Search Strategy and Procedure
To identify videos that demonstrate the steps involved in endotracheal aspiration, YouTube videos were searched using the search phrase ‘artificial airway suctioning’ and ‘endotracheal aspiration.’ When selecting the English search entries, trending terms on Google were utilized. The first two terms that appear when ‘artificial airway suctioning’ and ‘endotracheal aspiration’ is typed into the Google Search Engine are ‘endotracheal aspiration procedure’ and ‘endotracheal aspiration technique.’ These two terms were compared using Google Trends, revealing that ‘artificial airway suctioning’ and ‘endotracheal aspiration’ experienced higher search popularity in 2023 [10].
Two researchers (SK and DY) searched the videos were viewed on a single computer between October and December 2023. Researchers searched through YouTube [14] without logging in as a user. All videos were listed with the following statement: Researchers watched and analysed ‘artificial airway suctioning’ and ‘endotracheal aspiration’ until repetitive and irrelevant videos appeared. While selecting the videos to be included in the study among the analysed videos, researchers paid attention to examining the first 30 s of the videos and ensuring that the title of the video was appropriate for the purpose of the study. The study included the videos that passed the first evaluation [7, 15]. The inclusion criteria of the videos were determined as follows: (i) artificial airway suctioning procedure steps are shown as the main theme; (ii) endotracheal aspiration procedure is shown on a model/simulator or a person; (iii) videos with more than one section contain sections showing the artificial airway suctioning procedure; and (iv) the language is English (speech or subtitles).
The title, theme, upload source, video type, number of views and likes, video length, upload date, and the number of days the video had been on YouTube were recorded for the videos that met the inclusion criteria. After gathering these details, two researchers (SK and DY) independently assessed the videos for content, reliability, and quality. Two researchers (SK and DY) discussed and evaluated the inconsistencies between them, and reached a consensus. The researchers were instructors teaching endotracheal aspiration procedure in the nursing department, with a PhD (DY), master's degree (SK), and clinical experience in nursing (SK, DY).
After the data capture, the contents of the videos were examined by 2 independent people (SK and DY) and divided into informative and misleading. Videos classified as informative were scientifically accurate practice steps and information according to guidelines from major public health agencies (e.g., World Health Organization, American Respiratory Care Association) at the time the video was published. Videos classified as misleading contained one or more incorrect or missing information and/or implementation steps, according to these agencies. Videos included in the analysis are available at this link: https://youtube.com/playlist?list=PLosh8ihGWSLDjudNYN2wQfk0dZNCEOP1L&si=RAwz1m4z2cDqhC9n.
2.3. Data Collection Tools
The data were collected using the following tools: the Video Information Form, the Endotracheal or Tracheostomy Tube Aspiration Checklist, the modified DISCERN instrument, and the Global Quality Scale (GQS).
Video Information Form: This form, developed by the researchers, contains eight questions designed to capture essential details about the videos. These include the title, length, visual quality, and upload date of the videos, as well as the total number of views, daily views, and number of likes and dislikes.
Endotracheal or Tracheostomy Tube Aspiration Checklist: The checklist included in the nursing fundamentals practice guide developed by Kaya [15] is used to evaluate the artificial airway suctioning practice stages. Permission for use of the checklist was obtained from Kaya via e‐mail. The checklist was translated into English by the researchers. The English version was checked by an expert assessor. It was additionally checked by a native English speaker. During the evaluation of the videos, the sections of informing the patient about the aspiration procedure, preparing before the procedure, performing the aspiration procedure, practices after aspiration, and taking infection control measures during and after the procedure were used, and a total of 21 items were evaluated. Each item is rated as excellent (3 points), adequate (2 points), or should be improved (1 point). A high score indicates that artificial airway suctioning is performed correctly.
DISCERN Instrument: The instrument was designed to help individuals who benefit from health services and Information providers assess the quality of written materials regarding treatment options for various health condition. The instrument was developed by Charnock and Shepperd [16] A modified DISCERN instrument, consisting of five questions, was used to evaluate the visual media and associated information. A modified DISCERN instrument, questions included; (1) Is the video clear, short and easy to comprehend?, (2) Is it obtained from relevant sources (relevant studies, expert)?, (3) Is the information presented balanced and unbiased?, (4) Are additional references of information for the patient/viewer indicated?, (5) Does the video consider controversial or ambiguous issues? Each ‘yes’ response to any item on the instrument is assigned 1 point, with total scores ranging from 0 to 5. The reliability of the videos was categorized as follows: scores above 3 points indicated that the video contained good and useful information for viewers; a score of three points suggested that the video provided average information and required additional sources; and scores below three points indicated poor reliability. All videos were assessed for the reliability and completeness of the information they contained using the modified DISCERN instrument [14].
Global Quality Scale (GQS): The GQS, developed by Bernard [17], is designed to assess the overall quality of video content, including the usefulness of the information, ease of understanding, and video streaming quality. The scale assigns scores ranging from 1 to 5, with 1–2 points indicating low video quality, three points representing medium quality, and 4–5 points signifying high quality. This scale helps to evaluate the comprehensiveness and technical quality of the video [17].
2.4. Ethical Considerations
This study was conducted following ethical guidelines and standards. Approval (No: 2023/123, Date: 18.10.2023) was obtained from the Istanbul Aydın University Ethics Committee before its initiation. Participants were fully informed about the purpose of the study and assured that their participation was entirely voluntary. They were also informed that they could withdraw from the study at any time without providing any explanation or facing any consequences. Informed consent was obtained from all participants before data collection began. The study adhered to the ethical principles set forth in the Declaration of Helsinki, ensuring respect for participants' rights, privacy, and well‐being throughout the research process.
2.5. Data Analysis
The data were analyzed using the SPSS (Statistical Package for the Social Sciences) version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistical methods, including frequency (number), percentage, mean, median, and standard deviation, were used to summarize the data. To test for differences between groups, the t‐test was applied for data with normal distribution, while the Mann–Whitney U test was used for non‐normally distributed data. The Kolmogorov‐Smirnov test was performed to assess the normality of the data distribution. For group comparisons, the independent sample t‐test, Mann–Whitney U test, Chi‐square test, and ANOVA were utilized as appropriate. Spearman's correlation analysis was conducted to explore potential correlations between the total content score and the DISCERN score, GQS score, Endotracheal or Tracheostomy Tube Aspiration Checklist score, and various video characteristics. The Kappa coefficient was used to assess inter‐rater agreement, with the following interpretation: values of 0.20 or below indicated poor agreement, 0.21–0.40 indicated fair agreement, 0.41–0.60 indicated moderate agreement, 0.61–0.80 indicated substantial agreement, and values above 0.80 indicated near‐perfect agreement [18]. The results were considered statistically significant at a 95% confidence interval and a significance level of p < 0.05.
3. Results
When the metrics of the 36 videos included in the study were analysed, it was observed that the mean length of the videos was longer than 4 min (Min = 1 munite, Max = 20 min), the videos were viewed more than 133 thousand times (Min = 15, Max = 895.555), and they were liked more than 1.160 times (Min = 0, Max = 15,000) (Table 1). There are also no dislikes on the videos. The mean total scores on DISCERN, GQS, and Practice Checklist of the videos were 2.958 ± 1.513, 3.430 ± 1.083, and 47.166 ± 10.338, respectively. The results indicated that the videos included in the study were of medium quality (see Table 1). Moreover, there was no statistically significant difference between the total GQS scores according to the source from which the videos were uploaded (Kruskal–Wallis test value = 2.606, p = 0.457).
Table 1.
Analysis of the video characteristics.
| Characteristics | Mean ± SD | Min‐Max. | |
|---|---|---|---|
| Video length/minute | 4.77 ± 3.803 | 1‐20 | |
| Number of Views | 133.007.3056 ± 216.951.727 | 15–895.555 | |
| Number of likes | 1160.527 ± 2687.901 | 0–15,000 | |
| DISCERN | 2.958 ± 1.513 | 1–5 | |
| GQS (Global Quality Scale) | 3.430 ± 1.083 | 1–5 | |
| Checklist | 47.166 ± 10.338 | 27–62 | |
| Video length/minute | Number of Views | Number of Likes | |||
|---|---|---|---|---|---|
| Uploaded Source | n | % | Mean ± SD | Mean ± SD | Mean ± SD |
| Health institution | 16 | 44.4 | 4.56 ± 4.64 | 130.573.8750 ± 207,442 | 1449.9375 ± 3700 |
| TV channel | 12 | 33.3 | 4.33 ± 2.70 | 179.139.4167 ± 284,488 | 1081.666 ± 1905 |
| Website | 2 | 5.6 | 3.00 ± 1.414 | 25,998 ± 18,253 | 158.00 ± 48.083 |
| Healthcare professional | 6 | 16.7 | 6.83 ± 3.600 | 82,902 ± 97,668 | 880.666 ± 851 |
| Total | 36 | 100 | — | — | — |
Table 2 shows interobserver reliability for GQS, DISCERN, and Checklist mean scores. The GQS, DISCERN, and Checklist scores of the first and second researchers were 3.527 ± 1.133 versus 3.333 ± 1.121, 3.055 ± 1.548 versus 2.861 ± 1.514, 47.333 ± 10.427 versus 47.001 ± 10.265, respectively.
Table 2.
Interobserver reliability for the mean scores on the DISCERN, GQS (Global Quality Scale), and Checklist.
| DISCERN1 | DISCERN2 | |||||
|---|---|---|---|---|---|---|
| Mean ± SD | Median | Mean ± SD | Median | rs | p | ICC |
| 3.055 ± 1.548 | 3.00 | 2.861 ± 1.514 | 3.00 | 0.938 | < 0.001 | 0.795 |
| GQS1 | GQS2 | |||||
|---|---|---|---|---|---|---|
| Mean ± SD | Median | Mean ± SD | Median | |||
| 3.527 ± 1.133 | 4.00 | 3.333 ± 1.121 | 3.50 | 0.823 | < 0.001 | 0.851 |
| Checklist1 | Checklist2 | |||||
|---|---|---|---|---|---|---|
| Mean ± SD | Median | Mean ± SD | Median | |||
| 47.333 ± 10.427 | 51.00 | 47.001 ± 10.265 | 49.500 | 0.997 | < 0.001 | 0.678 |
Note: p < 0.05 written in bold. DISCERN1 First observer's assessment, DISCERN2 Second observer's assessment.
Abbreviations: ICC, Intraclass Correlation; rs, Spearman Correlation.
Therefore, there was good agreement between the two researchers regarding the DISCERN, GQS, and Checklist mean scores, with intraclass correlation coefficients (ICC) of 0.795, 0.851, and 0.678, respectively. A strong correlation was observed between the evaluations of the first and second observers using the DISCERN, GQS, and Checklist tools, with Spearman's rank correlation coefficients (rs) of 0.938 (p < 0.001), 0.823 (p < 0.001), and 0.997 (p < 0.001), respectively.
When the distribution of the videos according to the Endotracheal or Tracheostomy Tube Aspiration Checklist items was examined, it was seen that at least (2.8%, n = 1) received points that needed improvement from the ‘Preparing the aspiration catheter’ item. It was determined that at least 22.2% (n = 8) of the items ‘Remove the towel and give the individual a comfortable position and Record procedure and patient responses in Official note’ were evaluated as sufficient (Table 3).
Table 3.
Endotracheal or Tracheostomy Tube Aspiration Checklist (n = 36).
| Should be improved (1) | Adequate (2) | Excellent (3) | ||
|---|---|---|---|---|
| Contents of the items | n (%) | n (%) | n (%) | |
| 1. | Washing hands and wearing a mask, | 12 (33.3) | 1 (2.8) | 23 (63.9) |
| 2. | Keeping the individual's head in hyperextension, | 15 (41.7) | 2 (5.6) | 19 (52.8) |
| 3. | Placing a towel over the individual's chest, | 25 (69.4) | 4 (11.1) | 7 (19.4) |
| 4. | Connecting the suction tube to the aspirator, adjusting the vacuum to the appropriate pressure, | 6 (16.7) | 3 (8.3) | 27 (75.0) |
| 5. | Preparing the aspiration catheter, | 1 (2.8) | 3 (8.3) | 32 (88.9) |
| 6. | Don't wear sterile gloves, | 8 (22.2) | 4 (11.1) | 24 (66.7) |
| 7. | Connecting the catheter with the tube, | 2 (5.6) | 2 (5.6) | 32 (88.9) |
| 8. | Checking the function of the equipment, | 3 (8.3) | 2 (5.6) | 31 (86.1) |
| 9. | Lubrication of the catheter tip with a water‐soluble substance, | 18 (50.0) | 2 (5.6) | 16 (44.4) |
| 10. | Removing the ring adapter, | 5 (13.9) | 6 (16.7) | 25 (69.4) |
| 11. | Careful insertion of the catheter, withdrawal of 1 cm when resistance is encountered, | 2 (5.6) | 3 (8.3) | 31 (86.1) |
| 12. | Practice intermittent aspiration, encouraging the individual to cough as much as possible, | 11 (30.6) | 5 (13.9) | 20 (55.6) |
| 13. | Closing the ring adapter and applying oxygen therapy, encouraging the individual to deep breathing, | 12 (33.3) | 4 (11.1) | 20 (55.6) |
| 14. | Washing the catheter and connecting tube with saline, | 11 (30.6) | 2 (5.6) | 23 (63.9) |
| 15. | Evaluate cardiopulmonary status, repeat the procedure if necessary, | 12 (33.3) | 7 (19.4) | 17 (47.2) |
| 16. | Removing the catheter correctly, | 5 (13.9) | 1 (2.8) | 30 (83.3) |
| 17. | Keep the gloves on, | 11 (30.6) | 6 (16.7) | 19 (52.8) |
| 18. | Remove the towel and give the individual a comfortable position, | 25 (69.4) | 3 (8.3) | 8 (22.2) |
| 19. | Removing the mask, washing hands, | 23 (63.9) | 2 (5.6) | 11 (30.6) |
| 20. | Placing a ready‐made aspiration set at the bedside. | 21 (58.3) | 2 (5.6) | 13 (36.1) |
| 21. | Record procedure and patient responses in Official note. | 25 (69.4) | 3 (8.3) | 8 (22.2) |
The comparison of the DISCERN, GQS, and Checklist scores based on various characteristics of the videos is presented in Table 4. 75.0% (n = 27) of the videos were considered informative and 25.0% (n = 9) were considered misleading. According to the type of videos, DISCERN, GQS, and CheckList average scores were determined to be statistically significantly higher in informative videos compared to misleading videos (p < 0.05).
Table 4.
Comparison of the DISCERN, GQS (Global Quality Scale) and CheckList scores according to the some characteristics of the videos (n = 36).
| DISCERN | GQS | CheckList | ||
|---|---|---|---|---|
| Characteristics | n (%) | Mean ± SD | Mean ± SD | Mean ± SD |
| Video type | ||||
| Informative video | 27 (75.0) | 3.666 ± 1.208 | 3.925 ± 0.828 | 46.407 ± 8.797 |
| Misleading video | 9 (25.0) | 1.222 ± 0.833 | 2.333 ± 1.118 | 37.000 ± 7.053 |
| z | −3.918 | −3.312 | −2.510 | |
| p | < 0.001 | 0.001 | 0.012 |
| Uploaded Source | n (%) | Mean ± SD | Mean ± SD | Mean ± SD |
|---|---|---|---|---|
| Health institution | 16 (44.4) | 3.200 ± 1.475 | 3.500 ± 1.080 | 42.200 ± 8.257 |
| TV channel | 12 (33.3) | 2.916 ± 1.729 | 3.5210 ± 1.243 | 48.083 ± 8.764 |
| Website | 2 (5.6) | 2.500 ± 2.121 | 3.511 ± 0.707 | 41.500 ± 17.677 |
| Healthcare professional | 6 (16.7) | 3.666 ± 0.816 | 4.001 ± 0.894 | 50.500 ± 7.064 |
| χ 2 | 0.924 | 0.933 | 4.533 | |
| p | 0.820 | 0.818 | 0.209 |
Note: p < 0.05 written in bold.
Abbreviations: χ2, Kruskal–Wallis test; Z, Mann–Whitney U test.
However, depending on the source from which the videos were uploaded, it was observed that there was no statistically significant difference in the DISCERN, GQS, and Checklist mean scores (p > 0.05) (see Table 4).
The relationship analyses between the number of views and likes of the videos and their accuracy are given in Table 5. It was determined that there was a statistically significant positive correlation between the DISCERN score of the videos and the number of views (r = 0.501, p = 0.002). Also, It was determined that there was a statistically significant positive correlation between the DISCERN score of the videos and the number of likes (r = 0.554, p < 0.001). Additionally, it was determined that there was a statistically significant positive correlation between the GQS score of the videos and the number of likes (r = 0.434, p = 0.008), (Table 5).
Table 5.
The relationship between the number of views and likes of videos and their accuracy (n = 36).
| 1 | 2 | 3 | 4 | ||
|---|---|---|---|---|---|
| 1. Number of Views | r | 1 | |||
| p | — | ||||
| 2. Number of Likes | r | 0.922 | 1 | ||
| p | 0.000 | — | |||
| 3. GQS | r | 0.214 | 0.434 | 1 | |
| p | 0.210 | 0.008 | — | ||
| 4. CheckList | r | 0.099 | 0.179 | 0.602 | 1 |
| p | 0.565 | 0.296 | 0.000 | — | |
| 5. DISCERN | r | 0.501 | 0.554 | 0.668 | 0.639 |
| p | 0.002 | 0.000 | 0.000 | 0.000 |
Note: p < 0.05 written in bold., Spearman correlation test.
4. Discussion
Video‐based training is essential in nursing education, with YouTube being a key platform [16, 19]. However, many health education videos lack evidence‐based information [20, 21]. Despite the significance of artificial airway suctioning in nursing, no study has assessed related YouTube videos for quality [18]. This study analyzes the reliability and educational effectiveness of YouTube videos on artificial airway suctioning.
It Analysis of the 36 videos revealed that the average video length exceeded 4 min (Min = 1, Max = 20 min), with over 133,000 views on average (Min = 15, Max = 895,555) and more than 1160 likes (Min = 0, Max = 15,000) (Table 1). The mean DISCERN, GQS, and Practice Checklist scores were 2.958 ± 1.513, 3.430 ± 1.083, and 47.166 ± 10.338, respectively, indicating medium‐quality content. No statistically significant difference was found in GQS scores based on the video source (Kruskal–Wallis test = 2.606, p = 0.457). Interobserver reliability, shown in Table 2, demonstrated consistent scoring between the two researchers for GQS (3.527 ± 1.133 vs. 3.333 ± 1.121), DISCERN (3.055 ± 1.548 vs. 2.861 ± 1.514), and Checklist (47.333 ± 10.427 vs. 47.001 ± 10.265).
In their study, Ozsaban [22] found that the videos were viewed more than 129 thousand times (129.164.858 ± 242.017.858) and liked more than 270 times (270.08 ± 426.681). In their study, Culha [23] found that the videos were viewed more than 31 thousand times (31.867,93 ± 90.926,32) and liked more than 44 times (44.61 ± 102.51). In this context, it was observed that while the video viewing rates in the present study were similar to those in the literature, there were differences in the liking rates. This difference is considered to be caused by the differences in the content and video quality of the videos on the YouTube platform [9, 23].
The 36 videos included in the study were assessed by two researchers. Upon comparing the scores assigned by the first and second researchers using the DISCERN, GQS, and Checklist tools, it was found that the videos exhibited an overall medium quality (see Table 2). When we reviewed the studies conducted by Lim [24], Culha [25] and Leong [26] it was determined that most of the videos were of low quality (88.13%, 63.4%, and 55.7%, respectively). However, the study conducted by Ozsaban [22] reported that most of the videos (80.8%) were useful. When we review the literature, it is very important to note that there are videos that are not reliable in terms of content in all studies even though it is different from the findings of the present study.
In this study, all the videos were analysed for content using the Checklist tool. The content analysis covered the steps of the Artificial airway suctioning procedure. According to the results obtained from the first and second researchers' Checklist scores, the content validity scores of the videos with good quality were compatible with the literature [8, 12, 20, 21, 23, 27, 28, 29, 30, 31]. However, it was observed that there were deficiencies in the Checklist steps in all of the videos. In this context, it is considered that errors made during the Artificial airway suctioning procedure would pose a great risk to patient safety. Besides artificial airway suctioning skills, it was found that there were significant deficiencies in practice principles such as compliance with sterile technique, sequence of practice stages, and recording. In addition to the injection skills, significant deficiencies were observed in the principles of practice, such as maintaining the individual's head in hyperextension, placing a towel on the individual's chest, lubricating the catheter tip with a water‐soluble substance, removing the towel, ensuring the individual is in a comfortable position, and documenting the procedure and the patient's responses in a formal note. However, these principles are essential, involving ethics and patient safety, and must be followed for every patient [21, 23, 27, 28, 29, 30, 31]. It may be advisable to review videos for any deficiencies or errors related to these critical topics.
Videos were broadcast as a source to health institutions (44.4%), TV channels (33.3%), websites (5.6%), and healthcare professionals (16.7%) (Table 1). Moreover, there was no statistically A significant difference was observed in the total GQS scores based on the source from which the videos were uploaded (Kruskal–Wallis test value = 2.606, p: 0.457). In their studies, Esen [7], Tolu [8], Culha [25], Kandemir [27], Elangovan [30] examined the content of YouTube videos used in health education and found that the reliability scores of individually uploaded videos were statistically significantly lower than the reliability scores of videos uploaded by health institutions. This different result in the present study was due to the similarities between the number of videos uploaded by health institutions and health personnel and the number of individual videos. It has been determined that there is a statistically significant relationship between the source of upload and the popularity and engagement indices of YouTube videos. As the quality and reliability of the videos increase, the number of likes and views also rises. Based on the data obtained, it can be concluded that the popularity and engagement indices of videos are influenced by content, reliability, and quality levels.
4.1. Limitations of the Study
Since YouTube features dynamic content, search results may fluctuate depending on factors such as the time of the search, the IP history of the reviewing computer, and the geographical location of the researchers. This variability can be considered a limitation of the study. Another limitation is that the videos were screened and analyzed exclusively in English. However, a notable strength of the study is that it represents the first evaluation of YouTube videos related to artificial airway suctioning practice, specifically in terms of content analysis, reliability, and quality.
5. Conclusion
Although the number of views of YouTube videos on artificial airway suctioning was high, the content quality of some videos was low, and the information was not reliable. YouTube videos are an easily accessible source of information for people who want to get information about in artificial airway suctioning. Educational videos should convey scientifically accurate information and comply with the current guidelines of professional organisations. Unfortunately, not all YouTube videos meet these criteria. Studies to increase the number of reliable and useful videos that will provide knowledge and skills for both nurses and patient relatives in the practice of Artificial airway suctioning can be recommended by public institutions affiliated with the Ministry of Health, university hospitals, professional associations, and healthcare professionals to produce up‐to‐date and evidence‐based videos. Suggestions for Nurses to Access High Quality Educational Videos and Avoid Low Quality Videos: Use of Safe and Reliable Platforms; Nurses should be directed to evidence‐based and reliable platforms for educational materials. For example, education portals of internationally recognised nursing associations (such as American Nurses Association, European Federation of Critical Care Nursing Associations) or online libraries of universities should be preferred. Reference Control of Videos; When watching a video, nurses should consider whether the content is obtained from a reliable reference (e.g., academic research, expert opinion). In addition, the information used in the video should be described with supporting references and should be verifiable. Use of Quality Assessment Instruments; Nurses can use a specific quality assessment framework to evaluate the quality of the videos they watch. For example, quality assessment tools such as DISCERN, checklists developed by experts, can be used to examine the content reliability, objectivity and clarity of videos. These approaches can increase nurses' access to quality educational materials and thus contribute to the prevention of malpractices that may be caused by low‐quality videos. In this process, both individual awareness and the support of institutions are critical.
Author Contributions
Dilek Yıldırım and Sercan Kara made substantial contributions to the conceptualization of the study, the development of the analysis plan, and the drafting of the manuscript. Both Dilek Yıldırım and Sercan Kara were responsible for leading the data analysis, drafting the manuscript, and conducting the literature review. Additionally, they contributed to the preparation and acquisition of data. All authors reviewed the work for intellectual content, read and revised the manuscript, and approved it for submission.
Conflicts of Interest
The authors declare no conflicts of interest.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.