NURS 8201 Starting the Research Process
NURS 8201 Starting the Research Process
Research problem statement:
The efficacy and safety of pairing spontaneous awakening trial and breathing trials as successful weaning modes within the ICU setting.
Working in the critical care setting for about two years now, I can clearly imagine how it feels to be in the shoes of family members who are watching or taking care of their critically ill families; ones that are mechanically ventilated, sedated, and on vasoactive medications. Whenever, I start my shift as an ICU nurse, I always make it a habit to plan how I am going to achieve my patient care goals; which is how to accomplish the most care within a 12 hour shift. Since most of the patients that are admitted in the ICU are critically ill that requires them to be intubated and sedated, I try my best as a nurse to ease their discomfort by promoting plans of care that would help decrease their days of being intubated and sedated. I plan to accomplish these goals through working alongside with other interdisciplinary healthcare team members that play a role in the patient’s daily care.
Moving forward, my colleagues and I who have been working in the ICU for a significant amount of time should be
comfortable in handling mechanically intubated and provide plan of care in decreasing the patient length of stay and length of intubation. In the past few months, we are slowly hiring new nurses from different units that want to take up the challenge of becoming an ICU nurse. With this in mind, our nursing educator has brought it to the attention of the nursing management that the new nurses must be comfortable assessing the parameters that verify that a patient is ready to be extubated. This week, our nursing educator has set up educational information about the importance of pairing up spontaneous breathing trials (SBT) with spontaneous awakening trials (SAT) among ventilated patients in the ICU.
One of the most recent research EBP measures that our nurse education has presented to us is to learn the importance of incorporating spontaneous breathing trails partnered up interruption of sedation holidays. The rationale behind this to prevent ventilation assisted pneumonia development, which would further increase their length of stay as well as morbidity and mortality rates. According to AHRQ (2017), SATs and SBTs are associated with reduced length of mechanical ventilations, thereby reducing the ventilator assisted pneumonia, resulting in faster extubating time and earlier discharge date. Protocols for weaning from sedation and ventilation should be done in a timely manner to optimize outcomes.
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The ICU setting is driven by sedation and analgesia as most patients experience pain and stress within their stay. It is also required to ease the discomfort and adaptation of mechanical ventilation. According to Shinotsuka (2013), prolonged sedation with intubation increases delirium rates, longer ICU stays, and increased mortality rate (p.186). Because of this, the evidence practice gap must be addressed because analgesia based goal is commonly a nurse driven protocol; therefore, educational efforts must be addressed to everyone working in the ICU.
With the current situation of the Covid-19 pandemic, healthcare personnel are now becoming more resilient and accepting to new protocols and education towards combating this new pandemic as well as teaching the community. As the burden of critical care services and its down streaming effects of sedation strategies, according to the Massachusetts General Hospital (2020), targeting less sedation overall is associated with improved outcomes in the critically ill mechanically vented patients including morality and overall stays in the ICU. These principles also apply with the management of Covid-19. Also, with the significant rise in the number of patients suffering from Covid-19 and medication shortages; sedation and analgesia should be saved for supporting care among critically ill patients who are reaching moderate to severe acute respiratory distress syndrome to facilitate comfort and ventilator tolerance. Therefore, research of current literature must be implemented in the ICU educational setting determining the risk of sedation balanced with need for lung protection. As a result, daily evaluation of sedation use should be visited among interdisciplinary healthcare teams and pay careful attention to pain and prevention of ICU delirium.
AHRQ (2017). Spontaneous awakening trials and spontaneous breathing trial literature review.
AHRQ Safety Program for Mechanically Ventilated Patient Article.16 (17). 18-19. Retrieved from https://www.ahrq.gov/hai/tools/mvp/modules/technical/sat-sbt-lit-review.html
Massachusetts General Hospital (2020). Update in sedation and analgesia management in Covid-
19 ARDS. The General Hospital Article.. Retrieved from https://advances.massgeneral.org/pulmonary/article.aspx?id=1393
Shinotsuka, C. (2013). Implementing sedation protocols: Closing the evidence-practice gap.
Scielo Journal. 25(3). 186-187. Retrieved from https://www.scielo.br/j/rbti/a/hrpnjPwKdvz6kMQ966J5zVD/?lang=en&format=pdf
This is insightful , ICUs often present complex environments that require great attention to detail. Most healthcare institutions usually try to find innovative ways of dealing with problems that may lead to adverse patient outcomes (Morandi et al., 2017). The practices within the critical care units ought to be pegged into evidence-based practices and research processes to ensure the delivery of quality care (Diaz, 2020). Going with the above factors, your problem of research has professional significance, particularly when it comes to the delivery of quality care to patients in critical care units. The main objective of formulating research problems is to solve a particular problem in the healthcare system and society at large (Caldwell, 2021). In this case, the problem statement has potential or actual significance for society in terms of quality of treatment and the reduction of unnecessary costs that come with longer hospital stays. Finally, your research problem, given the challenges it seeks to address, has the potential to build or refine evidence-based practice.
Caldwell, J. (2021). Evaluation of a Spontaneous Breathing Trial Extubation Protocol on Patient Outcomes. https://uknowledge.uky.edu/dnp_etds/351
Diaz, L. B. (2020). Paired Spontaneous Awakening Trial and Spontaneous Breathing Trial Protocol Implementation. https://archive.hshsl.umaryland.edu/handle/10713/12945
Morandi, A., Piva, S., Ely, E. W., Myatra, S. N., Salluh, J. I., Amare, D., … & Latronico, N. (2017). Worldwide ABCDEF (Assessing pain, both spontaneous awakening and breathing trials, choice of drugs, delirium monitoring/management, early exercise/mobility, and family empowerment) survey. Critical care medicine, 45(11), e1111. 10.1097/CCM.0000000000002640
Thank you for posting your problem statement! Your proposed research problem, “The efficacy and safety of pairing spontaneous awakening trial and breathing trials as successful weaning modes within the ICU setting” is professionally significant. Weaning from mechanical ventilation is an essential element of critically ill patients. It liberates the patient from mechanical support and helps in sustaining spontaneous support (AHRQ, 2017). Combining spontaneous awakening trials and breathing trials can significantly ensure faster weaning hence the quality of care is improved. Pairing them will improve gaseous exchange; reduce incidences of trauma and maintenance of patient airway. Society will benefit from the successful implementation of the proposed ICU practice of change. It will ensure faster weaning implying that more patients will be attended to, the rate of re-hospitalization and mortality will be reduced (Khalafi et al., 2020). The problem can be advanced and used to create evidence-based practices of weaning critically ill patients in the ICU setting. The average time of weaning from the ventilator for critically ill patients ranges from 16 to 37 days after incubation for respiratory failure. The proposed problem can be improved and play a critical role in fastening weaning (Hetland et al., 2018). Thank you for sharing your post!
AHRQ (2017). Spontaneous awakening trials and spontaneous breathing trial literature review. AHRQ Safety Program for Mechanically Ventilated Patient Article.16 (17). 18-19. https://www.ahrq.gov/hai/tools/mvp/modules/technical/sat-sbt-lit-review.html
Hetland, B., Heusinkvelt, J., Krabbenhoft, L., & Grotts, E. (2018). Mechanical ventilation weaning: An evidence-based review. Nursing2020 Critical Care, 13(6), 5-16.
Khalafi, A., Adarvishi, S., & Soltani, F. (2020). Communication with Chronic Patients Weaning from Mechanical Ventilation: A Qualitative Study on Iranian ICU Caregivers. Preventive Care in Nursing & Midwifery Journal, 10(3), 52-58.