mechanical ventilation; emergency department; role; education
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background: Little data describes the role of emergency department (ED) nurses in caring for ventilated patients yet these patients may remain in ED for prolonged durations due to unavailability of intensive care beds.
Objectives: To examine: exposure of ED nurses to patients requiring invasive ventilation; responsibilities for ventilated patients; and education on ventilation received.
Methods: Cross sectional mailed survey sent to members of the National Emergency Nursing Association in Canada. Domains and items were refined from a survey of ventilation roles and responsibilities in intensive care. Pilot testing comprised ED nurse and respiratory therapist (RT) expert feedback on face and content validity and test-retest reliability.
Results: Response rate was 247/526 (47%); 39% provided care to ≤ 10 ventilated patients every 2 weeks, 32% ≤ 5 patients monthly and 27% ≤ 5 patients every 6 months. A 1:1 nurse: patient ratio for ventilated patients in ED was reported by 38% of respondents; 45% managed 1 or 2 additional patients; 15% ≥ 3 additional patients. Most respondents (54%) reported RTs remained in ED until patients stabilized; 28% RT was available on call, 11% RT remained until patient transfer, and 7% reported no RT available. Few nurses reported being primarily responsible for initial ventilator setting selection (7%), and titration of ventilation (6%); nurse responsibility for these tasks was influenced by RT availability (P<0.001). Primary responsibility for monitoring patient response to ventilation, alarm troubleshooting, and management of oxygenation was reported by 44%, 36%, and 30% respectively. Education was received by 51% of respondents prior to caring for ventilated patients; most (57%) indicated competency in caring for ventilated patients was never assessed. Institutional guidelines for ventilation were reported available by 39% of respondents.
Conclusion: ED nurses have variable exposure to ventilated patients and responsibility for management of ventilation is influenced by RT availability.