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The Experience of Acute Mechanical Ventilation From the Patient's Perspective

Roberts, Melanie, DNP, RN-BC, CNS, CCNS, CCRN; Bortolotto, Shannon Johnson, MS, RN, APRN, CCNS; Weyant, Ruth A., MSN, RN, CCRN-CMC; Jock, Leighann, MSN, RN, CCNS; LaLonde, Trent, PhD; Henderson, Ann, PhD, APRN, CNS

Dimensions of Critical Care Nursing: July/August 2019 - Volume 38 - Issue 4 - p 201–212
doi: 10.1097/DCC.0000000000000361
Research DIMENSION
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Background The Pain, Agitation, and Delirium guidelines influenced practice to support targeted, light sedation for the mechanically ventilated patient. This practice is associated with improved clinical outcomes, but it remains unclear how it impacts the patient experience.

Objective The objective was to determine the pervasive patient experience components and how the experience may have been influenced by targeted, light sedation practices.

Methods A prospective observational study using mixed methodology and a convenience sample was conducted after institutional review board approval was obtained. Inclusion criteria were the following: acute mechanical ventilation of less than 14 days, 18 years or older and able to provide consent, English speaking, and delirium-free. Exclusion criteria were the presence of delirium or intravenous opioids/sedatives within 24 hours prior to the interview. The quantitative component included simple yes or no questions and identification of quantitative adjectives describing the mechanical ventilation experience. Every 10th patient was invited to participate in an expanded qualitative interview.

Results Data were collected for 12 months with a total sample size of 130 patients participating in the quantitative component and a subset of 15 patients also participating in the qualitative interview. Sixty percent of the total sample consisted of cardiothoracic surgery patients, and 40% were mixed intensive care unit patient populations. Descriptive statistics include the following averaged values: Richmond Agitation Sedation Scale scores −1.7 throughout mechanical ventilation, aged 59.9 years, days mechanically ventilated 1.4, intensive care unit length of stay 4.6 days, and Acute Physiology and Chronic Health Evaluation II score 16.1. The most significant finding was that 56.2% of patients who could not communicate reported feeling afraid, whereas 32.5% of those who could communicate reported feeling afraid (P < .027). The themes identified in the qualitative component of the study reinforced these quantitative findings; 10 of the 15 patients interviewed reported experiencing fear, and all of the patients reported issues with communication.

Discussion The clinical implications of this research study primarily affect critical care nursing. Changes in nursing practice can address these findings to improve and more effectively acknowledge the patient experience.

Melanie Roberts, DNP, RN-BC, CNS, CCNS, CCRN, is currently the clinical nurse specialist at University of Colorado Health, Medical Center of the Rockies and Poudre Valley Hospital. She holds dual certification, CCNS and CCRN. Dr Roberts earned her doctor of nursing practice degree from the University of Northern Colorado in 2016 and her master of science degree in 1996. She has practiced in critical care for 35 years and as a clinical nurse specialist in critical care for 23 years.

Shannon Johnson Bortolotto, MS, RN, APRN, CCNS, University of Colorado Health: University of Colorado Hospital, Aurora.

Ruth A. Weyant, MSN, RN, CCRN-CMC, University of Colorado Health: Medical Center of the Rockies, Loveland.

Leighann Jock, MSN, RN, CCNS, has a master of science degree in nursing and is a certified clinical nurse specialist. She has 23 years of adult critical care experience, working with all types of populations. She is currently working as the clinical nurse specialist for the Sepsis Program at UCHealth, Memorial Hospital.

Trent LaLonde, PhD, is currently an associate professor and chair for the Department of Applied Statistics and Research Methods at the University of Northern Colorado. Dr Lalonde earned his doctor of philosophy degree from Arizona State University in 2009, with a research focus on quasi-likelihood estimation for joint generalized linear mixed models. He finds applications of his research in longitudinal data analysis, intensive longitudinal data, marginal estimation in the presence of time-dependent covariates, and the joint modeling of multiple outcome properties. Dr Lalonde has contributed to longitudinal studies as a coinvestigator on projects funded by the National Science Foundation, National Institutes of Health, and Institute of Education Sciences, among others.

Ann Henderson, PhD, APRN, CNS, started her career in Finance and Economics and worked in the financial field for more than 20 years. She dedicated herself to helping others through nursing beginning in 1993 with a BSN from Regis University. Dr Henderson taught at the University of Northern Colorado School of Nursing for a number of years before moving to the University of Colorado Health System. There she worked in Clinical Education developing the Nurse Residency Program for a newly certified Magnet Hospital. Dr Henderson has published numerous articles and presented at various conferences throughout her career.

The study was conducted at the University of Colorado Health.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Address correspondence and reprint requests to: Melanie Roberts, DNP, RN-BC, CNS, CCNS, CCRN, University of Colorado Health: Medical Center of the Rockies, 2500 Rocky Mountain Ave, Loveland, CO 80538 (melanie.roberts@uchealth.org).

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