Perception of other healthcare professionals about the nurses' role and competencies in veno‐venous extracorporeal membrane oxygenation care: A qualitative study

Alshammari, Muna; Vellolikalam, Chitra; Alfeeli, Sadiq

doi:10.1002/nop2.1137

Cited by 10 publications

(8 citation statements)

References 30 publications

(58 reference statements)

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“…Similar feelings of disrespect among nurses and the need for greater appreciation of their role in ECMO care have been reported by previous studies. 47,48 It has further been shown that such episodes of perceived injustice and credibility deficit might increase moral distress. 44 The final factor contributing to experiences of moral distress was the perceived lack of team situational awareness.…”

Section: Discussionmentioning

confidence: 99%

Between hope and disillusionment: ECMO seen through the lens of nurses working in a neonatal and paediatric intensive care unit

Jucker,

Cannizzaro,

Kirsch

et al. 2024

Nursing in Critical Care

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BackgroundUsing extracorporeal membrane oxygenation (ECMO) in paediatric and neonatal intensive care units (PICU/NICU) creates ethical challenges and carries a high risk for moral distress, burn out and team conflicts.AimThe study aimed to gain a more comprehensive understanding of the underlying factors affecting moral distress when using ECMO for infants and children by examining the attitudes of ECMO nurses.MethodsFour focus groups discussions were conducted with 21 critical care nurses working in a Swiss University Children's Hospital. Purposive sampling was adopted to identify research participants. The data were analysed using reflexive thematic analysis.ResultsUnlike “miracle machine” stories in online media reports, specialized nurses working in PICU/NICU expressed both their hopes and fears towards this technology. Their accounts also contained references to events and factors that triggered experiences of moral distress: the unspeakable nature of the death of a child or infant; the seemingly lack of honest and transparent communication with parents; the apparent loss of situational awareness among doctors; the perceived lack of recognition for the role of nurses and the variability in end‐of‐life decision‐making; the length of time it takes doctors to take important treatment decisions; and the resource intensity of an ECMO treatment.ConclusionThe creation of a multidisciplinary moral community with transparent information among all involved health care professionals and the definition of clear treatment goals as well as the implementation of paediatric palliative care for all paediatric ECMO patients should become a priority if we want to alleviate situations of moral distress.Relevance for Clinical PracticeThe creation of a multidisciplinary moral community, clear treatment goals and the implementation of palliative care for all paediatric ECMO patients are crucial to alleviate situations of moral distress for nurses, and thus to improve provider well‐being and the quality of patient care in PICU/NICU.

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Section: Discussionmentioning

confidence: 99%

Between hope and disillusionment: ECMO seen through the lens of nurses working in a neonatal and paediatric intensive care unit

Jucker,

Cannizzaro,

Kirsch

et al. 2024

Nursing in Critical Care

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“…Regular monitoring and evaluation of patients' response to ventilation, including factors such as oxygenation levels, lung compliance, and other relevant parameters, should be conducted 41 , 42 . Moreover, interdisciplinary collaboration among healthcare teams involving respiratory therapists, critical care specialists, and other knowledgeable professionals is crucial, especially considering the shortage of experienced staff and experts in transport ventilators 41 , 43 . By implementing these measures, clinicians can increase the optimal use of ventilators, ultimately leading to improved patient survival rates.…”

Section: Discussionmentioning

confidence: 99%

1-year survival rate of SARS-CoV-2 infected patients with acute respiratory distress syndrome based on ventilator types: a multi-center study

Mahmoodpoor

Gohari-Moghadam

Rahimi–Bashar

et al. 2023

Sci Rep

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The aim of this study was to evaluate the association between types of ventilator and the one-year survival rate of patients with acute respiratory distress syndrome (ARDS) due to SARS‑CoV-2 infection. This multi-center, retrospective observational study was conducted on 1078 adult patients admitted to five university-affiliated hospitals in Iran who underwent mechanical ventilator (MV) due to ARDS. Of the 1078 patients, 781 (72.4%) were managed with ICU ventilators and 297 (27.6%) with transport ventilators. Overall mortality was significantly higher in patients supported with transport ventilator compared to patients supported with ICU ventilator (16.5% vs. 9.3% P = 0.001). Regression analysis revealed that the expected hazard overall increased with age (HR: 1.525, 95% CI 1.112–1.938, P = 0.001), opacity score (HR: 1.448, 95% CI 1.122–2.074, P = 0.001) and transport ventilator versus ICU ventilator (HR: 1.511, 95% CI 1.143–2.187, P = 0.029). The Kaplan–Meier curves of survival analysis showed that patients supported with ICU ventilator had a significantly higher 1-year survival rate (P = 0.001). In MV patients with ARDS due to COVID-19, management with non-ICU sophisticated ventilators was associated with a higher mortality rate compared to standard ICU ventilators. However, more studies are needed to determine the exact effect of ventilator types on the outcome of critically ill patients.

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“…L'outcome degli assistiti in trattamento, in termini di sopravvivenza, è legato anche alla gestione assistenziale; in base a questi dati risulta fondamentale una formazione specifica degli infermieri, oltre a quella post-base, mediante corsi specifici come master specialistici, l'aggiornamento continuo anche mediante l'utilizzo della simulazione, al fine di migliorare le competenze del professionista e che gli permetta di specializzarsi nella gestione dei pazienti sottoposti ad ECMO. 6,15,16,20,25,26,27,35 La prevenzione e la rilevazione precoce delle complicanze, sono gli elementi chiave per un'assistenza infermieristica efficace, basata su un attento monitoraggio a 360°.…”

Section: Discussioneunclassified

“…16,18,40 Conclusioni I risultati dello studio rappresentano la letteratura esistente individuando la formazione specifica e la prevenzione delle complicanze come la chiave del successo nei pazienti sottoposti ad ECMO. 6,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Come si è visto, le procedure assistenziali giornaliere sono fondamentali nei pazienti critici poiché migliorano l'igiene, prevengono le infezioni iatrogene ed aiutano a mantenere l'integrità cutanea. L'assistenza infermieristica diventa quindi un elemento di fondamentale importanza, rispetto a questo processo, in particolar modo perché l'infermiere è la figura professionale che si relaziona per più tempo, con gli assistiti.…”

Section: Discussioneunclassified

La gestione infermieristica dell’assistito sottoposto ad ECMO: competenze ed esiti del trattamento. Una revisione della letteratura

D’Arrigo,

Furcieri,

Roberti

et al. 2023

Scenario

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Introduzione: L’ossigenazione extracorporea a membrana (ECMO) è un dispositivo esterno che si avvale dell’uso di tecnica invasiva per il trattamento di pazienti critici, utilizzando un supporto meccanico alla funzione respiratoria e cardiocircolatoria, quando tutti gli altri trattamenti convenzionali risultano inefficaci. La gestione di questi assistiti si avvale di un team multidisciplinare e multispecialistico, al quale appartiene anche l’infermiere, e i cui membri devono essere in possesso di competenze specifiche, sostenute da un programma di formazione ed un aggiornamento continuo. Scopo: Compendiare la letteratura per analizzare, in maniera approfondita, come primo obiettivo quali debbano essere le competenze infermieristiche nella gestione dell’assistito sottoposto alle varie tipologie di ECMO oggi disponibili e, come secondo obiettivo, delineare gli esiti del trattamento in questi pazienti ad alta complessità assistenziale. Metodi: Revisione della letteratura consultando le principali banche biomediche: PubMed, CINAHL, Cochrane Library ed Embase, oltre alle Linee Guida ELSO (Extracorporeal Life Support Organization). Sono stati applicati criteri di inclusione rispetto alla lingua inglese ed italiana, età uguale o superiore a 18 anni. Risultati: Dall’analisi dei 17 studi inclusi in questa revisione narrativa della letteratura è emerso come l’attività assistenziale svolta dall’infermiere ricopre un ruolo fondamentale nella gestione di questi pazienti ad alta criticità, mediante la capacità di gestire tutti gli aspetti dell’assistenza. Le competenze del professionista infermiere riguardano la somministrazione di farmaci, il possesso delle conoscenze tecniche specifiche per l’utilizzo sicuro del circuito ECMO, ed un background di perfusione per la gestione della macchina. La prevenzione e la rilevazione precoce delle complicanze degli assistiti sono gli elementi chiave per un’assistenza infermieristica, di successo, basata su un attento monitoraggio a 360°. L’aderenza alle linee guida esistenti e la standardizzazione delle procedure messe in atto dall’infermiere sono elementi fondamentali, che riducono la mortalità e migliorano gli outcomes del paziente. Conclusioni: Per poter assistere i pazienti sottoposti ad ECMO, il professionista infermiere dovrebbe essere adeguatamente formato e specializzato. L’aggiornamento continuo delle conoscenze e il consolidamento delle competenze accrescono il valore dell’infermiere, che potrà erogare all’assistito un’assistenza attenta, precisa e consapevole, con lo scopo di migliorare gli outcomes.

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Perception of other healthcare professionals about the nurses' role and competencies in veno‐venous extracorporeal membrane oxygenation care: A qualitative study

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 10 publications

References 30 publications

Between hope and disillusionment: ECMO seen through the lens of nurses working in a neonatal and paediatric intensive care unit

Between hope and disillusionment: ECMO seen through the lens of nurses working in a neonatal and paediatric intensive care unit

1-year survival rate of SARS-CoV-2 infected patients with acute respiratory distress syndrome based on ventilator types: a multi-center study

La gestione infermieristica dell’assistito sottoposto ad ECMO: competenze ed esiti del trattamento. Una revisione della letteratura

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