Patientsʼ perceptions of uncertainty and stress during weaning from mechanical ventilation

Wunderlich, Rita J.; Perry, Anne Griffin; Lavin, Mary Ann; Katz, Barry P.

doi:10.1097/00003465-199901000-00001

Cited by 39 publications

(23 citation statements)

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“…Most reviews of weaning from mechanical ventilation have examined only quantitative data [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Range of health care professionals [25][26][27][28][29][30][31][32][33][34][35] Patients only [36][37][38][39][40][41][42][43][44][45] Physicians only (intensivists or anesthetists working in intensive care units) [46][47][48][49] Patients' family members 50,51 Patients and nurses Participant interviews and observation 12,13,27,28,[31][32][33]40<...>…”

Section: Discussionmentioning

confidence: 99%

Weaning From Mechanical Ventilation: A Scoping Review of Qualitative Studies

Rose

Dainty

Jordan

et al. 2014

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. List 3 key factors that influence ventilator weaning. 2. Define a scoping review. 3. Describe the steps in conducting a scoping review.To read this article and take the CNE test online, visit www.ajcconline.org and click "CNE Articles in This Issue." No CNE test fee for AACN members.By Louise Rose, PhD, Katie N. Dainty, PhD, Joanne Jordan, PhD, and Bronagh Blackwood, PhDBackground Weaning from mechanical ventilation is influenced by patient, clinician, and organizational factors.Objective To identify factors that may influence weaning and adoption of weaning strategies and tools, clinicians' perceptions of weaning strategies, and weaning experiences of patients and patients' families. Method A scoping review of indexed and nonindexed publications was done. Qualitative studies of health care providers, patients, and patients' families involved in weaning were included. Two investigators independently screened 8350 publications and extracted data from 43 studies. Study themes were content analyzed to identify common categories and themes within the categories. Results The study sample consisted of nurses in 15 studies, nurses and patients in 1 study, various health care providers in 11, patients in 10, and physicians in 4. Categories identified were as follows: for nurses, role or scope of practice, informing decision making, and influence on weaning outcome; for health care providers, factors influencing weaning decisions or use of protocols, role or scope of practice related to weaning, and organizational structure or practice environment; for patients, experience of mechanical ventilation and weaning, experience of the intensive care environment, psychological phenomena, and enabling success in weaning; and for physicians, tools or factors to facilitate weaning decisions and perceptions of nurses' role and scope of practice. However, even for these easy-to-wean patients, organizational and clinician factors such as staffing levels, skill mix, experience, and decision-making hierarchy influence the weaning process and can delay weaning and extubation. Such delays may result in prolonged duration of mechanical ventilation and stay in the intensive care unit (ICU) and increased costs.3 Approximately 30% of patients treated with mechanical ventilation experience difficult or prolonged weaning. 4 For these patients, similar organizational and clinician factors influence the duration and success of weaning. Because of the risk of further prolongation of mechanical ventilation, reintubation, and increased mortality, 5,6 identification of potentially modifiable factors that cause delays in weaning, unsuccessful weaning trials, and unsuccessful attempts in extubation is needed.An important step in ascertaining patient, clinician, and organizational factors that influence weaning is obtaining the views and perceptions of clinicians, patients, and patients' families who experience the process. Using...

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Section: Discussionmentioning

confidence: 99%

Weaning From Mechanical Ventilation: A Scoping Review of Qualitative Studies

Rose

Dainty

Jordan

et al. 2014

American Journal of Critical Care

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“…In the last 5 years, studies have confirmed the patient's perception of mechanical ventilation and weaning as stressful experiences (Granberg et al 1996;Wunderlich et al 1999;Russel 1999). In the weaning phase, it is a great help if the patient is feeling secure with the situation and has confidence in the clinical staff.…”

Section: Psychological Factorsmentioning

confidence: 99%

“…The use of such scales in intensive care could be of interest. Reducing perceptions of uncertainty and stress during weaning will help the patient to feel secure (Wunderlich et al 1999). Though the nurses frequently document their actions, it seems that scientific results are not always used.…”

Section: Psychological Factorsmentioning

confidence: 99%

“…The environment, nursing interventions, as well as clinical activities can be disturbing for the patient. This situation is a stressful experience for the patient leading to feelings of anxiety (Wunderlich et al 1999). Most intensive care units (ICUs) try to give the patient a good rest by allowing for periods without disturbing activities during the day.…”

Section: Introductionmentioning

confidence: 99%

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Factors influencing the patient during weaning from mechanical ventilation: a national survey

Mårtensson

Fridlund²

2002

Intensive and Critical Care Nursing

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“…Although patients treated with PPV remember little of the time during which they were sedated, 19 once weaning from ventilatory support is started they begin to experience feelings of uncertainty and stress that may prevent successful weaning. 20,21 In summary, ICU patients with cardiac ailments and respiratory or other problems can experience anxiety and its consequences, particularly if they require mechanical ventilation. It may be that less research on anxiety has been done in patients receiving mechanical ventilation-and possibly sedatives-than in other patients because other patients find it easier to complete the measurement instruments used, normally pencil and paper.…”

mentioning

confidence: 99%

Scales for Evaluating Self-Perceived Anxiety Levels in Patients Admitted to Intensive Care Units: A Review

Perpiñá‐Galvañ

Richart‐Martínez

2009

American Journal of Critical Care

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Objective To review studies of anxiety in critically ill patients admitted to an intensive care unit to describe the level of anxiety and synthesize the psychometric properties of the instruments used to measure anxiety. Methods The CUIDEN, IME, ISOC, CINAHL, MEDLINE, and PSYCINFO databases for 1995 to 2005 were searched. The search focused on 3 concepts: anxiety, intensive care, and mechanical ventilation for the English-language databases and ansiedad, cuidados intensivos, and ventilación mecánica for the Spanish-language databases. Information was extracted from 18 selected articles on the level of anxiety experienced by patients and the psychometric properties of the instruments used to measure anxiety. Results Moderate levels of anxiety were reported. Levels were higher in women than in men, and higher in patients undergoing positive pressure ventilation regardless of sex. Most multi-item instruments had high coefficients of internal consistency. The reliability of instruments with only a single item was not demonstrated, even though the instruments had moderate-to-high correlations with other measurements. Conclusion Midlength scales, such the anxiety subscale of the Brief Symptom Inventory or the shortened state version of the State-Trait Anxiety Inventory are best for measuring anxiety in critical care patients.

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Patientsʼ perceptions of uncertainty and stress during weaning from mechanical ventilation

Cited by 39 publications

References 0 publications

Weaning From Mechanical Ventilation: A Scoping Review of Qualitative Studies

Weaning From Mechanical Ventilation: A Scoping Review of Qualitative Studies

Factors influencing the patient during weaning from mechanical ventilation: a national survey

Scales for Evaluating Self-Perceived Anxiety Levels in Patients Admitted to Intensive Care Units: A Review

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