Nurses’ role in mechanical ventilation management in neonatal intensive care units in academic tertiary care

Abstract

Background: Despite the key role nurses play in mechanical ventilation management process and coordinating care of their patients in intensive care units alongside doctors, little remains known about the role of NICU nurses in mechanical ventilation. The lack of literature in South African NICU settings, demonstrate evidence that the role of NICU nurses in mechanical ventilation management remains unclearly defined. Therefore, there is a need to gather current evidence to facilitate clarity on this role. Purpose: The purpose of the study was to describe the role of neonatal nurses in the mechanical ventilation management process in neonatal intensive care units of two tertiary academic hospitals Methods: A quantitative, descriptive and cross sectional survey design was used to meet the objectives of the study to describe the NICU nurses role in ventilation management. The final sample comprised 90 (out of 108) respondents, which yielded a response rate of 83.3% for the study. Results: Of the 108 surveys distributed, 90 were returned (response rate 83.3%). Ninetyseven percent stated that a 1:2 ratio was used for patients receiving mechanical ventilation. Only about 17% percent reported ventilation education for nurses was provided during ICU orientation, and indicated that NICUs had not provided opportunities for on-going ventilation education. Thirty-six percent stated that weaning protocols and protocols for weaning failure were present in ICUs, respectively. This study showed a small percentage of nursing autonomous input made in key ventilator decisions. The majority (66%) nurses in this study agreed that responsibility for ventilation decisions lies at the level of senior registrars and above, and in their absence, all NICU nurses (51%) were perceived to be responsible for key ventilator decisions.Regarding independent titrations of ventilator settings, without medical consultation, findings showed that nurses in this study reported a frequency of >50% of the time for titration of fraction of inspired oxygen. Nurses with higher levels of autonomy, influence in decision making and years of experience scores, frequently (>50% of the time) made independent changes to ventilation settings (p<0.05), with contrast, nurses with fewer years of experience scores, infrequently (<50% of the time) made independent changes to ventilation settings without first checking with the doctor. The study concludes that nurses should strengthen their input in collaboration of key ventilator decisions and the multidisciplinary team could help nurses to re-evaluate their role in ventilation management. Recommendations are made for clinical practice and education of nurses.