Nursing care of the mechanically ventilated patient: what does the evidence say? Part one

Nursing strategies for the mechanically ventilated patient

The goal of this manuscript is to provide a comprehensive and multi-disciplinary review of the best nursing practices of caring for mechanically ventilated patients. By reviewing human medicine literature, the authors will extrapolate procedures that have been found to be most effective in reducing the risk of mechanical ventilation (MV) complications. Paired with review of the current standards in veterinary medicine, the authors will compile the best practice information on mechanically ventilated patient care, which will serve as a detailed resource for the veterinary nursing staff. Written from a nursing standpoint, this manuscript aims to consolidate the nursing assessment of a mechanically ventilated patient, addressing both systemic and physical changes that may be encountered during hospitalization. The goal of this review article is to present information that encourages a proactive approach to nursing care by focusing on understanding the effects of polypharmacy, hemodynamic changes associated with MV, complications of recumbent patient care, and sources of hospital acquired infections. When applied in conjunction with the more technical aspects of MV, this manuscript will allow veterinary technicians involved in these cases to understand the dynamic challenges that mechanically ventilated patients present, provide guidance to mitigate risk, address issues quickly and effectively, and create an up-to date standard of practice that can be implemented.

Critical care nurses' perception of care coordination competency for management of mechanically ventilated patients

AIMS AND OBJECTIVES

To evaluate nurses' care coordination competency for mechanically ventilated patients in intensive care units (ICUs) of Saudi Arabia (SA).

BACKGROUND

ICUs are increasingly using multidisciplinary approach to provide critical care. Functionality gaps remain within these teams preventing optimum performance, including a lack of adequate care coordination in the management of mechanically ventilated (MV) patients.

DESIGN

A cross-sectional survey of ICU nurses working across 20 hospitals in SA.

METHODS

The Nurses' Care Coordination Competency Scale (NCCCS) survey for MV patients was administered to all the nurses to assess their care coordination competence. The data were analysed using Student's t test, ANOVA and linear regression. Reporting of this research follows STROBE guidelines.

RESULTS

A total of 254 nurses participated in the survey. The overall NCCCS mean score was 3.94 (±0.69) out of a 5-point scale. Also, the "promoting team cohesion factor (Factor 1)" had a mean score of 3.90 (±0.77), the "understanding care coordination needs factor (Factor II)" had a mean score of 4.00 (±0.77), the "aggregating and disseminating information factor (Factor III)" had a mean score of 4.05 (±0.76), and the "devising and clearly articulating the care vision factor (Factor IV)" had a mean score of 3.78 (±0.87). The mean overall NCCCS score was 4.10 among Indians, 3.98 among Filipinos and 3.81 among Saudi nationals.

CONCLUSION

There were a high overall score and subscale scores of nurses' care coordination competence for mechanically ventilated patients, but few gaps were identified in some of the items.

RELEVANCE TO CLINICAL PRACTICE

The results provide information on the status and gaps in ICU nurses' care coordination competencies to address the needs of mechanically ventilated critically ill patients. The NCCCS can be utilised as an educational tool for nurses who are new to the ICU work environment.

Identifying Nursing Diagnosis Patterns in Three Intensive Care Units Using Network Analysis

PURPOSE

This study aimed to analyze the patterns of nursing diagnoses used in three different types of intensive care units (ICUs) using network analysis.

METHODS

A secondary analysis was conducted using clinical datasets of 582 patients. Frequency, degree/betweenness centrality, and subgroup analysis were performed.

FINDINGS AND CONCLUSIONS

The findings illuminated core nursing diagnoses with high centrality as well as high frequency. The centrality analysis identified the differences between and unique characteristics of each ICU. The subgroup analysis revealed the nursing problem groups related to the specific nursing care delivered to ICU patients.

IMPLICATIONS FOR NURSING PRACTICE

Theses results provide a knowledge base to aid ICU nurses' prompt decision making regarding nursing diagnoses.

Holistic Care for Patients During Weaning from Mechanical Ventilation: A Qualitative Study

BACKGROUND

Weaning patients from mechanical ventilation is a complex and highly challenging process. It requires continuity of care, the overall assessment of patients, and a focus on all aspects of patients' needs by critical care nurses.

OBJECTIVES

The aim of the present study was to explore holistic care while patients are being weaned from mechanical ventilation from the perspective of the critical care nurses.

METHODS

The study was carried out in the intensive care units (ICUs) of six hospitals in Ahvaz, Iran, from 2014 to 2015. In this qualitative study, 25 ICU staff including nurses, nurse managers, and nurse educators were selected by means of purposive sampling. Semi-structured interviews were used for data collection. The interview transcripts were then analyzed using qualitative content analysis.

RESULTS

The four main themes that emerged to explain nurses' experiences of holistic care when weaning patients from mechanical ventilation include continuous care, a holistic overview of the patient, promoting human dignity, and the overall development of well-being.

CONCLUSIONS

It was found that avoiding routine pivotal expertise, increasing consciousness of the nonphysical aspects of patients while providing treatment and presenting exclusive care, utilizing experienced ICU nurses, and placing more emphasis on effective communication with patients in order to honor them as human beings can all enhance the holistic quality of care.

Optimizing Oxygenation in the Mechanically Ventilated Patient: Nursing Practice Implications

Critical care nurses constitute front-line care provision for patients in the intensive care unit (ICU). Hypoxemic respiratory compromise/failure is a primary reason that patients require ICU admission and mechanical ventilation. Critical care nurses must possess advanced knowledge, skill, and judgment when caring for these patients to ensure that interventions aimed at optimizing oxygenation are both effective and safe. This article discusses fundamental aspects of respiratory physiology and clinical indices used to describe oxygenation status. Key nursing interventions including patient assessment, positioning, pharmacology, and managing hemodynamic parameters are discussed, emphasizing their effects toward mitigating ventilation-perfusion mismatch and optimizing oxygenation.

Continuous care and patients' basic needs during weaning from mechanical ventilation: A qualitative study

BACKGROUND

Mechanical ventilation is associated with a number of risks and complications. Thus, rapid and safe weaning from mechanical ventilation is of great importance. Weaning is a complex and challenging process, requiring continuous care and knowledge of the patient.

AIMS

The aim of the present study was to describe the continuous care process during weaning as well as to analyse the facilitators and obstacles to the weaning process from start to finish from the perspective of intensive care unit (ICU) staff, particularly nurses.

RESEARCH DESIGN

Twenty-two ICU staff members, including nurses and physicians, and three patients hospitalised in the ICU were enrolled in this qualitative study. Semi-structured interviews were used for data collection and the transcripts were analysed using qualitative content analysis.

FINDINGS

'Continuous care' was found to be the patients' basic need during weaning from mechanical ventilation. Uninterrupted, stable, comprehensive and dynamic care and monitoring with immediate response to all physiological and psychological changes were features of continuous care. The three main themes identified by this study were time spent with the patient, comprehensive supervision and maintenance of the quality of care during shifts.

CONCLUSION

Continuous and constant care should be provided during the weaning process. Such care will help to provide health care staff with a deeper understanding of the patient and his or her continuous changes, leading to a timely and favourable response during weaning. To achieve this goal, skill, communication and organisational changes are essential.

Nursing diagnoses and interventions for a child after cardiac surgery in an intensive care unit

Objetivo: descrever o julgamento clínico de enfermagem para identificar diagnósticos NANDA e desenvolver um plano de tratamento NIC para uma criança em pós-operatório de cirurgia cardíaca em terapia intensiva. Método: estudo de caso com coleta de dados retrospectiva no prontuário. Resultados: três enfermeiras identificaram diagnósticos NANDA e intervenções NIC. Criança de 6 meses, submetida a cirurgia cardíaca, necessitou oxigenação extracorpórea por membrana no pós-operatório. Foram identificados quatro principais diagnósticos, aos quais foram direcionadas dez intervenções. A proposta de intervenções para responder às necessidades humanas prioritárias da criança foi otimizada pelo uso das terminologias padronizadas. Todos os diagnósticos foram sustentados por indicadores diagnósticos; todas as intervenções foram cientificamente sustentadas. Conclusão: espera-se que os enfermeiros abordem não somente as respostas fisiológicas, mas também aquelas dos domínios psicossociais.

Weaning from mechanical ventilation: factors that influence intensive care nurses' decision-making

AIM

The aim of the study was to describe the factors that influence intensive care nurses' decision-making when weaning patients from mechanical ventilation.

BACKGROUND

Patients with failing vital function may require respiratory support. Weaning from mechanical ventilation is a process in which the intensive care nurse participates in both planning and implementation.

DESIGN AND METHOD

A qualitative approach was used. The data were collected by means of semi-structured interviews with 22 intensive care nurses. The interviews were transcribed and analysed using qualitative content analysis.

FINDINGS

One theme emerged: 'A complex nursing situation where the patient receives attention and which is influenced by the current care culture'. There was consensus that the overall assessment of the patient made by the intensive care nurse was the main factor that influenced the decision-making process. This assessment was a continuous process consisting of three factors: the patient's perspective as well as her/his physical and mental state. On the other hand, there was a lack of consensus about what other factors influenced the decision-making process. These factors included the care culture constituted by the characteristics of the team, the intensive care nurses' professional skills, personalities and ability to be present.

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

The individual overall assessment of the patient enabled nursing care from a holistic perspective. Furthermore, the weaning process can be more effective and potential suffering reduced by creating awareness of the care culture's impact on the decision-making process.

[Methods for endotracheal tube fixation. Results of a survey of intensive care nurses]

There are a wide variety of strategies and methods used in securing and managing the oral endotracheal tube and mouth and oral care in German clinical intensive care nursing for mechanically ventilated patients. There are no nationally recognized guidelines or recommendations on this topic. A survey among intensive care nurses identified the most widely used nursing strategies and methods. Regarding the results of the survey and international literature findings, the commonly used strategies and methods are discussed. Following these discussions, there are recommendations for improving nursing care of orally intubated patients in intensive care, including the aspects of evidence identified, currently used methods and patient needs. Also included are aspects of patient safety, potential complications and quality-orientated nursing care within a system having limited overall nursing care resources.

Competence and certification of registered nurses and safety of patients in intensive care units

BACKGROUND

Adverse events that place patients at risk for harm are common in intensive care units. Clinicians' level of knowledge and judgment appear to play a role in the prevention, mitigation, and creation of adverse advents. Research suggests a possible association between nurses' specialty certification and clinical expertise. The relationship between specialty certification and clinical competence of registered nurses and safety of patients is a relatively new area of inquiry in nursing.

OBJECTIVE

To explore the relationship between the proportion of certified staff nurses in a unit and risk of harm to patients.

METHODS

Hierarchical linear modeling was used in a secondary data analysis of 48 intensive care units from a random sample of 29 hospitals to examine the relationships between unit certification rates, organizational nursing characteristics (magnet status, staffing, education, and experience), and rates of medication administration errors, falls, skin breakdown, and 3 types of nosocomial infections. Medicare case mix index was used to adjust for patient risk.

RESULTS

Unit proportion of certified staff registered nurses was inversely related to rate of falls, and total hours of nursing care was positively related to medication administration errors. The mean number of years of experience of registered nurses in the unit was inversely related to frequency of urinary tract infections; however, the small sample size requires that caution be exercised when interpreting results.

CONCLUSIONS

Specialty certification and competence of registered nurses are related to patients' safety. Further research on this relationship is needed.