Challenges of administering effective patient care for mechanically ventilated patients

Holistic Nursing Care of the Patient with Mechanical Ventilation

One of the most critical and challenging aspects of care for many nurses in essential environments of care is administering effective patient care towards improving healthcare outcomes for mechanically ventilated patients. Baid, (2016) provides that the process of mechanical ventilation is a necessary therapeutic intervention in nursing for many patients, it is associated with potential or actual complications which present further challenges for critically ill patients. As a result, many of the patients admitted into the various healthcare facility intensive care unit require airway maintenance and as well as mechanical ventilation support. This is because nursing management of the mechanically ventilated patients is very challenging on many levels and these patients, therefore, nursing care and control of the critically ill mechanically ventilated patients has increasingly become so demanding and necessitates the development of a patient-focused approach towards achieving improved health care outcomes. It is therefore paramount that all qualified nurses working in any critical care environment to understand the indication for the use of mechanical ventilation, the most common associated complications with patients as well as the modes of ventilation delivery (Barton, Vanderspank-Wright & Shea, 2016). Although the mechanically ventilated patient is a lifesaving process, it is also important to note that it can cause both physiological and psychological complications for the patient and hence the need for the development of a patient-centered care approaches.

The purpose of this research paper is, therefore, to develop a project proposal on the topic addressing the holistic nursing care of patients with mechanical ventilation. This will be achieved through the analysis and evaluation of various literature materials to provide more understanding on the topic and why it is critical for any nursing student to be equipped with knowledge and skills towards addressing the challenges facing the mechanically ventilated patients to improve their healthcare outcomes.

The clinical project will seek to achieve various goals in line with improving the healthcare outcomes for the patients who are mechanically ventilated in the different critical care environments or intensive care units. These include;

Primary Objective

To explore the nature of holistic care received by mechanically ventilated patients from the perspectives of the critical care nurses.

• To establish the various methods and techniques which can be used to promote the development of continuous care for the patients
• To explore in a holistic view the patient care towards fostering human dignity as well as the overall development of patients well being
• To identify the various issues facing mechanically ventilated patients in different critical care environments and their implications to the patients
• To establish the multiple problems facing the mechanically ventilated patients and their relevance to students practice through a holistic and comprehensive manner.

Given the nature of care for the mechanically ventilated patients and the likely challenges or complications to the patient’s different scholars have developed various studies which are critical in understanding how nurses can develop holistic care for the patients with a mechanical ventilator. Schmidt (2017) argues that it is essential to realize that as much as technological advancements have played a critical role towards improving the nature of patient care in critical care environments, nurses operating in such situations have a responsibility of developing a patient-focused or centered approach towards enhancing the patients’ healthcare outcomes. This is because even though mechanical ventilation provides therapeutic intervention to the patients, it is associated with an increased likelihood of further complications which may later present severe impact for the critically ill patient. It is, therefore, the role of every nurse to develop effective strategies for patients care to reduce possibilities of developing these complications and promote the development of positive health outcomes for the patients (Yoshida, Fujino, Amato & Kavanagh, 2017). Therefore most of the literature developed by various scholars have focused on patient health review and the different management strategies for patient indicators such as pain, stressors and sedation. These management strategies play a critical role in relieving the patients from pain when weaning them from mechanical ventilation and reduce further complications associated with the process.

Importance of understanding the indication for the use of mechanical ventilation for nurses

Mechanically ventilated patients are at risk of both physiological and psychological complications which necessitate the development of a patient-centered approach to care at the critical care environments (Prime et al., 2016). The effective management of these complications has become very challenging to the nurses and especially because, weaning patients has become a complex process of mechanical ventilation and hence it is highly challenging process for nurses requiring an overall patient assessment, continuity of care and increased patient centered or focus in all aspects of patients’ needs by the critical care nurses.

The care of the patients with mechanical ventilation is at the core of a nurse clinical practice in an ICU or intensive care unit, and therefore it is very critical to the development of comprehensive care for the patients (Hodgson & Tipping, 2017). To reduce the array of complication or challenges resulting from mechanical ventilation, most scholars have argued that evidence based nursing care is pivotal to delivery of quality health outcomes for the mechanically ventilated patients. To achieve nursing care based on evidence it is critical for the nurses working in the intensive care unit (ICU) to develop an understanding of the various indicators which will necessitate the use of mechanical ventilation, the various modes of ventilation delivery to patients and the most common patient associated complications (Brochard, Slutsky & Pesenti, 2017). It is the mechanical ventilators which play a critical role in assisting the movement of gases or air into and out of the patient’s lungs while minimizing the effect of breathing for the patients. The indicators for the use of mechanical ventilation which every nurse should take note of include; cardiorespiratory arrest and central nervous system depression among patients, the management of type 1 and two respiratory failures, the removal of CO2 and the control of oxygenation. All these indicators play a critical role to the development of nursing care based on evidence which results to improved patients outcomes as well as increased healthcare efficiency in the various essential units of care or environments (Quraishi, McCarthy, Blum, Cobb & Camargo, 2016). This is therefore relevant for any nursing student as it prepares them to understand the various issues which may result from mechanical ventilation and thus help in developing the necessary actions or steps towards planning for effective care.

 The comfort needs for the patients receiving mechanical ventilation is very critical to their recovery or healing process (Rustam, Kongsuwan & Kitrungrote, 2017). In most case the patients can be disturbed for many reasons and hence contributing to negative impacts because of the unmet comfort needs. According to the theory of comfort by Kolcabas, patients comfort may be enhanced  if their comfort needs of support can be met in the four centers of support including; the physical comfort center, environmental, psychospiritual and sociocultural comfort centers. There is, therefore, an increased need for the nurse to develop a quality comfort care for the patients dependent on mechanical ventilation by identifying the causative factors that may disturb their comfort during mechanical ventilation process and develop appropriate the interventions to promote comfort for the patients. Based on the theory of comfort by Kolcabas, physical comfort are the outcomes of patient reaction to an illness which could be through a stimulus or not (Minton & Batten, 2016).

Most common patient associated complications of mechanical ventilation

The psychospiritual comfort, on the other hand, relates to the internal patient awareness such as self-esteem, sexuality, life meaning, identity as well as an individual relationship to a higher being or order. This are essential comfort needs which may not be easy for the nurses to identity in a patient and hence possible to subject them to harm without their knowledge and hence the reason why nurses are required to have knowledge on these psychospiritual patient’s needs. Environmental comfort is associated with the various external surrounding and conditions of the patients who are likely to affect their wellbeing and include things like light, heat, noise as well as their safety. Lastly, sociocultural comfort refers to things like interpersonal, family and societal relationships (Faria, Pontífice-Sousa & Gomes, 2018). These patients are critical to the patients and comfort is an inherent component of basic human needs and an outcome in nursing care.

Developing quality comfort care in nursing care is a critical part of the healing process and an essential element of holistic care and culture care. Like any other person patients require a special type of comfort that is critical for their healing process more so because of the critical nature of their critical health conditions. Therefore it is necessary for nurses to review and synthesize the knowledge of their care from existing evidence regarding comfort needs and interventions to promote comfort in patients with mechanical ventilation (Jakimowicz & Perry, 2015). Most important it is critical to note that patients comfort may increase if their comfort needs are met by appropriate interventions. These intervention strategies can be divided into; pharmacological interventions, nursing care interventions as well as complementary and alternative interventions. The most likely pharmacological interventions include methods such as the use of analgesics and sedative therapy to relieve patients of discomfort as well as improve their ability to endure the challenges and effects of mechanical ventilation in a humane manner.  

Nursing care interventions which can be implemented by nurse include patients’ proposer positioning, mouth case as well as the management of various stress factors such as sleep disturbance, isolation and ineffective communication (Delgado, 2017). Nurses can achieve this by using relevant nursing and medical technologies as well as psychosocial care measures. There are various technologies which have been developed to help the nurses offer exceptional services to patients with mechanical ventilation. The technologies are used to detect any changes and record the various response behavior to treatment and therefore is it necessary for nurses to have or equip themselves with the necessary technological skills and knowledge.  Lastly, the complementary and alternative measures include patient’s relaxation massage, music therapy, therapeutic touch and emphatic physical patient contacts. Adherence or developing strategies to understand patient comfort needs and develop appropriate intervention strategies is an essential element of holistic nursing care towards patients with mechanical ventilation.

The need for developing a patient-centered care approach for mechanically ventilated patients

Another critical issue of nursing care is weaning patients from mechanical ventilation. Some of the complications occur to patients after they are taken out of the mechanical ventilator. In most case, the length at which the patients spent on the mechanical ventilator varies from other patients (Laerkner, Egerod & Hansen, 2015). Therefore nurse in critical care units should take note of this differences and ensure that weaning should occur without delay to improve patient’s response to healing and recovery and reduce the risk of complications such as increased risk of pneumonia and airway trauma and their associated costs. For instance, the health status of racial and ethnic minority grouping which includes refugees is weaker than that of their own country. When it comes to whiteness, it usually symbolizes nurses or nursing as a profession. Whiteness in nursing is widespread in today’s modern society, mainly because people believe that being white one possesses superior skills and brilliant minds. Much statistical data shows how whiteness has affected power dynamics in nursing. According to Cottingham, Johnson & Erickson (2017), women of color in the nursing industry experience overworking.

It is appropriate that patients should be formally assessed to determine their readiness for discontinuation of mechanical ventilation. This is because most damage is done during the process of discontinuation of the process where nurses may take long and therefore exposing the patient into possible risks. It is, therefore, the responsibility of the nurses in critical care environments to ensure that the appropriate assessments are conducted daily to check evidence that could be the underlying cause of respiratory failure to ensure that it has been reversed (Rustam, Kongsuwan & Kitrungrote, 2018). Nurses, therefore, play a critical role in the transitional stages of the patients from the moment they are transferred from the mechanical ventilator which is very critical because of risk exposure. They must develop appropriate strategies to monitor the patients closely and identify any changes in the physical conditions and support them psychologically during this period which is often very difficult and challenging for them.

The project provides a useful framework for gaining the required skills and understanding of the components and the various issues associated with mechanical ventilation. By the completion of the with week project I will have achieved my goal of developing holistic nursing care for patients with mechanical ventilation. This care is centered towards the understanding of the risk conditions likely to be experienced by the patients during after mechanical ventilation and the appropriate health care precautions or strategies to minimize the impact and reduce further damage. The project will also provide a useful framework to analyze the various stress factors and indicators in providing holistic nursing care that will be patient-focused and will help improve health outcomes. In the end of the project I would therefore be equipped with necessary skills to improve my services towards a holistic nursing healthcare. It is however necessary to understand that it is my responsibility as a nurse to ensure that I’m acquainted with every skill and knowledge that would be critical to helping patients with mechanical ventilation to achieve the desirable healthcare outcomes.

Goals of the clinical project to improve healthcare outcomes for mechanically ventilated patients

The different journal reflections and books, as well as reviews, provide deep insights on the nature of mechanical ventilation and the most critical aspects of care for patients with mechanical ventilation. Most importantly it provides an outlook of the current measures taken and their implication to nursing care. However, most of the literature review provides various intervention strategies by nurses who are considered to be critical in improving healthcare outcomes for patients with mechanical ventilation. These interventions include both the physical interventions to complex technological and medical interventions and therefore it is the responsibility of the nurses to understand and equip themselves with the adequate knowledge and skills on how best to handle different signs and symptoms as they reveal during and after the mechanical ventilation process. By finishing the project, I will acquaint myself with these interventions strategies and therefore be in a position to offer exceptional and holistic healthcare towards improving healthcare outcomes for patients. I believe these skills and knowledge from the project will be critical for my career growth and development.

Conclusion

From the above literature review, it is worth noting that the management of patients with mechanical ventilator is very challenging for nurses and hence the need to develop holistic nursing care towards improving their healthcare outcomes. One of the most critical issues is to understand the various indicators that can be used for mechanical ventilation as well as understanding the technical issues which can help in developing a patient-focused approach. Understanding the importance of patient comfort needs is a critical element of holistic nursing care and very essential to the patients healing process as well as helping them during the weaning process from mechanical ventilation. The understanding of the critical nursing intervention strategies towards patient centered care approach is critical to enhancement and provision of quality healthcare as well as improve the healthcare outcomes of the patients. It is therefore the responsibility of nurses to acquire the necessary skills and knowledge that will aid to the development of effective intervention strategies. Developing nursing care strategies towards these initiatives will contribute positively to the development of holistic nursing care and help improve the health outcomes of patients with a mechanical ventilator.

References

Baid, H. (2016). Patient safety: Identifying and managing complications of mechanical ventilation. Critical Care Nursing Clinics, 28(4), 451-462.

Barton, G., Vanderspank-Wright, B., & Shea, J. (2016). Optimizing oxygenation in the mechanically ventilated patient: nursing practice implications. Critical Care Nursing Clinics, 28(4), 425-435.

Exploring the nature of holistic care received by mechanically ventilated patients

Brochard, L., Slutsky, A., & Pesenti, A. (2017). Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. American journal of respiratory and critical care medicine, 195(4), 438-442.

Delgado, S. (2017). Manual of Critical Care Nursing: Nursing Interventions and Collaborative Management.

Faria, J. M. S., Pontífice-Sousa, P., & Gomes, M. J. P. (2018). Comfort care of the patient in intensive care–an integrative review. Enfermería Global, (50), 503.

Hodgson, C. L., & Tipping, C. J. (2017). Physiotherapy management of intensive care unit-acquired weakness. Journal of physiotherapy, 63(1), 4-10.

Hurlock-Chorostecki, C. (2016). Management of pain during weaning from mechanical ventilation: the nature of nurse decision-making. Canadian Journal of Nursing Research Archive, 34(3).

Jakimowicz, S., & Perry, L. (2015). A concept analysis of patient?centred nursing in the intensive care unit. Journal of advanced nursing, 71(7), 1499-1517.

Laerkner, E., Egerod, I., & Hansen, H. P. (2015). Nurses’ experiences of caring for critically ill, non-sedated, mechanically ventilated patients in the intensive care unit: A qualitative study. Intensive and Critical Care Nursing, 31(4), 196-204.

Minton, C., & Batten, L. (2016). Rethinking the intensive care environment: considering nature in nursing practice. Journal of clinical nursing, 25(1-2), 269-277.

Prime, D., Arkless, P., Fine, J., Winter, S., Wakefield, D. B., & Scatena, R. (2016). Patient experiences during awake mechanical ventilation. Journal of community hospital internal medicine perspectives, 6(1), 30426.

Quraishi, S. A., McCarthy, C., Blum, L., Cobb, J. P., & Camargo Jr, C. A. (2016). Plasma 25-hydroxyvitamin D levels at initiation of care and duration of mechanical ventilation in critically ill surgical patients. Journal of Parenteral and Enteral Nutrition, 40(2), 273-278.

Rustam, J. S., Kongsuwan, W., & Kitrungrote, L. (2018). Comfort in Patients Receiving Mechanical Ventilation: A Literature. Crit Care, 11(2), e64159.

Rustam, J., Kongsuwan, W., & Kitrungrote, L. (2017). Effect of Comfort Care Integrated with the Holy Qur’an Recitation on Comfort of Muslim Patients under Mechanical Ventilation: A Pilot Study. Medical-Surgical Nursing Journal, 6(1), 34-40.

Schmidt, G. A., Girard, T. D., Kress, J. P., Morris, P. E., Ouellette, D. R., Alhazzani, W., … & Ferrer, M. (2017). Official executive summary of an American Thoracic Society/American College of Chest Physicians clinical practice guideline: liberation from mechanical ventilation in critically ill adults. American journal of respiratory and critical care medicine, 195(1), 115-119.

Yoshida, T., Fujino, Y., Amato, M. B., & Kavanagh, B. P. (2017). Fifty years of research in ARDS. Spontaneous breathing during mechanical ventilation. Risks, mechanisms, and management. American journal of respiratory and critical care medicine, 195(8), 985-992.