A profile of european ICU nursing

Depasse, B.; Pauwels, Didier; Somers, Yvan; Vincent, Jean‐Louis

doi:10.1007/s001340050693

Cited by 40 publications

(40 citation statements)

References 14 publications

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“…To the best of our knowledge, this is the largest survey describing interprofessional role responsibility for mechanical ventilation across Europe. Our findings suggest greater involvement of nurses in ventilator adjustment compared to a previous survey of physicians profiling ICU nursing in Western Europe conducted over a decade ago [14] but congruence in some countries with interprofessional responsibility for ventilation decisions in Australia and New Zealand [5] and participation in weaning practices reported in a pilot study of European nurses [19]. Physicians are generally present during initiation of ventilation as it coincides with intubation or arrival in ICU and represents an acute deterioration in respiratory status.…”

Section: Discussionmentioning

confidence: 47%

“…Interprofessional roles and responsibilities are influenced by differences in unit structure, staffing and skill-mix, patient case-mix, and medical and nursing leadership models [14]. The primary objective of our study was to describe the professional group with responsibility for determining key ventilation and weaning decisions including: selection of initial ventilator settings, titration of ventilator settings, weaning readiness, weaning method, extubation readiness, and weaning failure.…”

Section: Introductionmentioning

confidence: 99%

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Decisional responsibility for mechanical ventilation and weaning: an international survey

Rose

Blackwood²,

Egerod

et al. 2011

Crit Care

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IntroductionOptimal management of mechanical ventilation and weaning requires dynamic and collaborative decision making to minimize complications and avoid delays in the transition to extubation. In the absence of collaboration, ventilation decision making may be fragmented, inconsistent, and delayed. Our objective was to describe the professional group with responsibility for key ventilation and weaning decisions and to examine organizational characteristics associated with nurse involvement.MethodsA multi-center, cross-sectional, self-administered survey was sent to nurse managers of adult intensive care units (ICUs) in Denmark, Germany, Greece, Italy, Norway, Switzerland, Netherlands and United Kingdom (UK). We summarized data as proportions (95% confidence intervals (CIs)) and calculated odds ratios (OR) to examine ICU organizational variables associated with collaborative decision making.ResultsResponse rates ranged from 39% (UK) to 92% (Switzerland), providing surveys from 586 ICUs. Interprofessional collaboration (nurses and physicians) was the most common approach to initial selection of ventilator settings (63% (95% CI 59 to 66)), determination of extubation readiness (71% (67 to 75)), weaning method (73% (69 to 76)), recognition of weaning failure (84% (81 to 87)) and weaning readiness (85% (82 to 87)), and titration of ventilator settings (88% (86 to 91)). A nurse-to-patient ratio other than 1:1 was associated with decreased interprofessional collaboration during titration of ventilator settings (OR 0.2, 95% CI 0.1 to 0.6), weaning method (0.4 (0.2 to 0.9)), determination of extubation readiness (0.5 (0.2 to 0.9)) and weaning failure (0.4 (0.1 to 1.0)). Use of a weaning protocol was associated with increased collaborative decision making for determining weaning (1.8 (1.0 to 3.3)) and extubation readiness (1.9 (1.2 to 3.0)), and weaning method (1.8 (1.1 to 3.0). Country of ICU location influenced the profile of responsibility for all decisions. Automated weaning modes were used in 55% of ICUs.ConclusionsCollaborative decision making for ventilation and weaning was employed in most ICUs in all countries although this was influenced by nurse-to-patient ratio, presence of a protocol, and varied across countries. Potential clinical implications of a lack of collaboration include delayed adaptation of ventilation to changing physiological parameters, and delayed recognition of weaning and extubation readiness resulting in unnecessary prolongation of ventilation.

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Section: Discussionmentioning

confidence: 47%

Section: Introductionmentioning

confidence: 99%

Decisional responsibility for mechanical ventilation and weaning: an international survey

Rose

Blackwood²,

Egerod

et al. 2011

Crit Care

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“…Intensivists in these ICUs included internists, anesthesiologists, and surgeons. The size of the participating ICUs is comparable with most of those in the United States and Europe (9,15).…”

Section: What This Study Adds To the Fieldmentioning

confidence: 99%

Twenty-four–Hour Intensivist Presence

Garland

Roberts

Graff

2012

Am J Respir Crit Care Med

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Shiftwork staffing was better for intensivists and most were receptive once they had experienced it. Although there were no evident negative outcomes for patients or families, further evaluation is needed to clarify how around-the-clock intensivist staffing influences the various stakeholders in ICU care, given power considerations in this study. Clinical trial registered with www.clinicaltrials.gov (NCT 01146691).

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“…Current nursing provision in China is low, with a nurse:bed ratio of 1.37-2.02:1. This compares unfavourably with Western Europe, where 65% of ICUs surveyed in 1996 reported higher ratios [2]. Moreover, critical care training of both nurses and doctors is limited.…”

mentioning

confidence: 90%