Assess The Learning Needs Of Nurses Working In ICU Regarding Mechanical Ventilators. 

 Assess The Learning Needs Of Nurses Working In ICU Regarding Mechanical Ventilators.

ABSTRACT

Ongoing education for ICU nurses on obtrusive mechanical ventilation is key to the securing and support of knowledge and capacities to streamline patient results.

I am targeting at assessing how ICU nurses perceive current training delivered on mechanical ventilation, including a self-coordinated learning pack and a competency program. Recognize other significant subjects and types of practice; and decide factors related to the consummation of instructive projects on intrusive mechanical ventilators.

A descriptive two-stage configuration will be used for the investigation. Stage one includes the advancement and approval of three clinical vignettes to decide the degree of skill of nurses working in ICUs on mechanical ventilation. An adjusted Delphi procedure utilizing purposively examined specialists from clinical innovation and nursing foundations will be used to approve the three clinical vignettes. Content legitimacy will be fortified by processing CVI of the instrument. In Phase two, continuous scrutiny will be utilized, and data assortment involved members (n) finishing three approved medical vignettes in the ICU “s of two tertiary health institutions in the selected areas. All nurses with interest in the investigation completed a similar three clinical scenarios and segment information. Nurse’s observations regarding their degree of ability concerning mechanical ventilation are measured and contrasted and original scores attained in the medical vignettes.

Registered nurses initiating their ICU involvement in an inadequate understanding of obtrusive MV along these lines, the training is given inside the ICU work environment becomes fundamental to protect and influential practice. The view of enduring with training by nurses from this exploration is sure in any case of the level of ICU experience. It may impact the continued improvement of intrusive MV delivered to ICU nurture later on, not just in the ICU associated with this investigation, however different units globally.

CHAPTER ONE: OVERVIEW OF THE STUDY

Introduction

ICU gives life-sparing consideration to the patients who are fundamentally sick; however, they are related to enormous intricacies, for example, complexities related to the mechanical ventilators. Mechanical ventilation is a fundamental, life-sparing treatment for patients with underlying sickness in concentrated Nearly, 37% got mechanical ventilation (MV) also, vasopressors or inotropes, separately (Mody et al., 2005).

The medical attendants(nurses) assumes a significant role being taken care of by patients on a mechanical ventilator like the customer’s reaction to a ventilator mediates to keep up oxygenation, ventilation, and guarantees that the patient’s unpredictable needs are met and so on. In this way, all together to give quality consideration in a savvy way to the patient on a mechanical ventilator and to lessen the instances of necessary inconveniences. It is required that the medical caretaker must have detailed scientific knowledge and perform proof-based ability to the mechanically ventilated patients.

As mechanical ventilation is essential to keep up air circulation and oxygenation yet patients on mechanical ventilators are subjected to the development of difficulties, for example, liquid and electrolyte imbalance, alveolar hyperventilation, Ventilator-Associated Pneumonia (VAP), Pneumothorax and so on. Research has revealed that ventilator-related complexities delay the time of remaining in the ICU and elevates the fatality in serious cases ailments.

In the ICU, there is a high intricacy of care, which, together with quick modifications in the wellbeing care framework and innovation. Implies that CE is necessary for medical caretakers to keep their comprehension and expertise up to date, and to guarantee they don’t work past the restrictions of their competency. The staff advancement stratagems through effecting a patient safety instructive program can limit clinical blunders and improve patient results in hospitals.

PROBLEM STATEMENT

As of now, globally, in ICU, the MV patient is most likely to be in the hands of a non-ICU qualified medical attendant (Scribante & Bhagwanjee 2007). hence putting the patient in danger of intricacies that may not be accurately evaluated by the NICU skilled medical attendant. The differing levels of training and experience found among medical caretakers in ICU “s on the planet may prompt differing levels of skill among medical attendants assigned to take care of MV patients. An all-encompassing study revealed that constrained examinations either locally or globally as to the ability of medical attendants in ICU concerning mechanical ventilation. The hole in the writing, together with the researchers” possess the understanding of changing degrees of capability among medical attendants concerning mechanical ventilation in concentrated consideration units, incited the analyst to additionally examine the degree of nurses'” skill in mechanical ventilation in ICU “s all-inclusive.

PURPOSE OF THE STUDY

The objective of this investigation is to conclude and portray the degree of nurses” fitness in mechanical ventilation in ICU of two tertiary human services organizations.

STUDY OBJECTIVES

To meet the objectives, the examination the exploration will advance through two stages, and the following destinations are set to:

Phase one objectives

• Create three medical vignettes to evaluate the skill of ICU medical attendants concerning MV in grown-up ICU in two tertiary health institutions.
• Approve three clinical vignettes

Phase two objectives

• Resolve and portray the fitness of medical caretakers concerning mechanical ventilation of the adult ICUs of two tertiary medicinal services establishments, utilizing three medical scenarios created and approved in stage one
• Illustrate any distinctions in levels of capability in MV among medical attendants working in adult ICU.
• Look at nurses’ view of their degree of fitness concerning mechanical ventilation with real scores acquired from the concluded vignettes.

Research methods

Phase one

The advancement of three medical vignettes will be founded on broad modern writing the survey, utilizing books, articles, diaries, the World Wide Web, and web search tools. The researchers” possess information, together with ICU specialist experts,” report and official contextual investigations found in the ICU “s will likewise be utilized in the advancement of the clinical vignettes. Non-likelihood purposive inspecting is used, and information the assortment is attempted utilizing an adjusted Delphi Technique. Approval of the clinical scenarios is attempted utilizing a specialist bunch comprising of master medical caretakers (n) master clinical architects (n) and master specialists (n) everyone of whom meets the incorporation criteria examined in section three. The content legitimacy of the instrument will be reinforced by figuring the substance legitimacy file (CVI), as portrayed by Lynn (1986) and altered by ( Polit et al., 2007). incorporate Item CVI (I-CVI) and Scale CVI (S-CVI) Engaging measurements were utilized to prompt the demographic outline of the illustration and content rationality of three medical vignettes.

Phase Two

The available populace in stage two will comprise of attendants in ICU in two tertiary health establishments for adult MV patients in ICU irrespective of training background and years of experience.

Non-likelihood, sequential inspecting will be utilized and involves the utilization of every accessible individual as study members (Polit et al., 2001). This strategy is used to choose the extensive variability partakers that are representative of the populace under examination.

Data gathering will be carried out employing three medical vignettes, and member scores attained in the vignettes are determined and converted to proportion. The rates reviewed by an evaluating scale, to advise the level regarding the competency of the member concerning mechanical ventilation. Participants'” claim view of their fitness of mechanical ventilation will be converted to percentages and contrasted and actual rates accomplished for the clinical vignettes. Information gathered in stage two is examined utilizing unmistakable,  inferential insights to incorporate and sort out the information got.

A pilot study will also be incorporated to reinforce the legitimacy and unwavering quality, by guaranteeing clearness and comprehension of the instrument, as quantifiable investigation utilizing elucidating and inferential measurements. The steadiness of conditions for members is ensured.

Literature review

The past few decades have seen exponential development in the medical field, more so about mechanical ventilation technology in the intensive care unit (ICU). This has significantly advanced the care given to patients with lung complications. With the advancement so far observed in this field, there is a critical need for improvement of knowledge of the nurses offering these services in the ICU. Therefore it is essential for the nurses taking care of mechanically ventilated patients to have up to date knowledge of the clinical and technological aspects of the mechanical ventilator.  If not well operated, mechanical ventilators can easily damage a patient’s lungs or even cause death. ICU nurses should, therefore, not only equip themselves not only with basic knowledge but be highly advanced to take care of critically ill patients with the latest technology available (Nurses for healthier tomorrow, 2006).

The modern ventilator is computerized with smart control to graphically show the effect of the ventilator breaths on the lungs. Ventilator settings must continuously be optimized by the medical attendant so that they correspond with the lung pathology of the particular patient. Therefore the aftereffects of the conveyed breaths should be checked, deciphered, controlled, and remedied appropriately. A mechanical ventilator gives oxygen and CO2 to and from the lungs by manipulating the airwave pressures. The rate of delivery of breath to the lungs depends on the settings of the ventilator. The nurse, therefore, should always optimize the respirator to ensure appropriate breath is delivered to the lungs by the specific lung pathology of a patient to prevent damaging the lungs.

Generally, three things need to be optimized when a nurse is operating a mechanical ventilator. These include breath types, modes, and settings. For breath type variation, the airflow or pressure can be adjusted. Only one variable can be controlled at a go, i.e., either strain of the flow, not both.  The mode sets the interaction of the patient with the mandatory breaths from the ventilator. It regulates the sequence of ventilator breaths and patient breaths. There exist three ways that can be set, and they include: control mandatory ventilation, spontaneous, and synchronized intermittent necessary ventilation. For settings, the following need to be adjusted appropriately in the mechanical ventilator. This includes oxygen percentage (FiO2), tidal volume (Vt), frequency, peak flow, positive end-expiratory pressure (PEEP), pressure support, trigger sensitivity, inspiratory time (Ti), pressure control setting, inspiratory to the respiratory ratio (IE ratio), biphasic positive airways pressure (BiPAP), and ventilator graphics.

It is, therefore, crucial for nurses taking care of patients using mechanical ventilation in the ICU to be equipped with specialized knowledge concerning the working of the ventilators. They should be in a position to understand the theoretical, practical, and technological functioning of this equipment. They should possess excellent decision skills so that they can judge the appropriate strategies and setting to apply for different patients with varying lung conditions. Globally limited studies are showing the level of competency of ICU nurses regarding taking care of patients using mechanical ventilators. This proposal is aimed at carrying research on the skill of ICU nurses when giving care using mechanical ventilators.

Research Design and Methodology

Introduction

This chapter presents the methods that will be used for data collection, sampling criteria, data validation processes, as well as the general study setting. This study aims to determine the level of competency amongst ICU nurses when giving care to patients using mechanical ventilators.

Research Design

A non-experimental descriptive research design will be used to determine the level of expertise in the usage of mechanical ventilators among ICU nurses in different health facilities. The non-experimental approach will be used because the study just aims to determine the level of competency of the nurses; therefore, it doesn’t require any experiments being carried out. The descriptive study approach will be used since it is ideal for such kind of study, which seeks to build on already existing data to designate the different levels of competency among the nurses.

Research Method

The study methodology will progress through two stages. Stage one will entail the development and validation of three clinical vignettes, while phase two will involve data collection. In step one there will be;

• Development of clinical scenarios Study population
• Sampling and sample
• Data collection
• Validation of three medical vignettes
• Content validity
• Quantification of medical vignettes

For clearness, each stage will be described thoroughly to show the whole process of carrying out the study.

Instrument

An examination instrument is a method for social occasion information about an idea of intrigue, for example, trust torment caring information. “The gadget that an analyst uses to gather information for example polls and so on” (Polit et al., 2001)

With the end goal of the investigation, medical vignettes will be picked to gather data with the end goal of portraying the fitness concerning fundamental mechanical ventilation among attendants working in adult ICUs in two tertiary medicinal services organizations

Data analysis

Data investigation was directed to lessen, sort out, and offer to mean to the information gathered (Burns and Grove, 2003). Statistical information will be stacked into an Excel spreadsheet; descriptive data will be utilized for investigations of phase one while elucidating and analytical study will be used in stage two.

Ethical Considerations

The conduct of nursing study call for mastery and determination as well as trustworthiness and honesty (Burns and Grove 2003). Ethical studies are necessary to create sound knowledge for practice while simultaneously securing the privileges of human subjects. Moral survey and leeway are essential to guarantee harmony among dangers and advantages of an examination and forestall inquire about unfortunate behavior. The accompanying advances were taken to ensure morally stable research.

References

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Polit, D.F., Beck, CT, & Hungler, B.P. 2001. Essentials of nursing research; Methods,appraisal, and utilization. 5th Edition. Pp.236. Lippincott. Philadelphia

Polit, D.F. & Beck, C. 2006. “The Content Validity Index: Are you sure you know what’s being
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Scribante, J & Bhagwangee, S. 2007a. National audit of critical care resources in South Africa nursing profile. South African Medical Journal 97(12):1315-1318