Experience of Novice Nurses with NIV in General Wards

Experience of novice nurses caring patients with non-invasive ventilation in general wards.

Non invasive ventilation (NIV) is used to provide respiratory pressure support to upper airway by using external masks without the insertion of endotracheal tube. It is mostly used for the early management of acute respiratory failure (ARF) (Rose and Gerdtz, 2009) and chronic obstructive pulmonary diseases (COPD) ( Penuelas, Frutos-Vivar & Esteban, 2007). NIV is considering less intensive than mechanical ventilation, therefore some clinicians manage these patients outside the intensive care unit (ICU), particularly in hospitals where ICU beds are unavailable (Farha et al., 2006, Hill, 2009). One audit report revealed that inappropriate use of NIV outside the ICU is associated with higher mortality (Sumner and Yadegafar, 2011). Its increasingly usage outside the ICU, lead less experienced nurses to care for these patients’ results in quality care compromised. Previous studies have identified the following factors that contribute towards treatment failure with NIV is lack of knowledge and experience about the regulation of NIV (Kallet, 2009, Lopez et al., 2006, Lopez-Campos et al., 2006, Elliott et al., 2011), inappropriate guideline (Sinuff et al., 2007), patient-ventilator asynchrony, poor judgment about the appropriate mask selection, patient intolerance (Hess, 2011) and delay in patient care at ward level (Elliott et al., 2011).

Safe delivery of NIV can be assured when the patient received care from experienced, educated and well trained staff (Rose and Gerdtz, 2009). Previous studies had explored the experiences of experienced nurses worked in ICU and identified that experienced nurses are using their practical knowledge to select the appropriate mask to patient face. They are using their communication skills to gain control on patient breathing and using their clinical experiences to solve the problems and avoiding delays in adjusting the ventilation (Sorensen et al., 2013) and providing reassurance to immobilized patients and protect them from errors (Acebedo-Urdiales et al., 2014). There is another study that covers the perspectives of general ward nurses about the NIV, is not generalizable study because it was conducted only in one hospital. However, data revealed that 67% nurses didn’t get involved in the decision making process and were inadequately informed. Even they did not received adequate consultation from physicians and medical emergency team and mostly, all nurses in medical wards state that training was inadequate about the NIV (Cabrini et al., 2009). Most of the studies have viewed the experiences of competent nurses in ICU or general ward; however no study has explored the experiences of novice nurses caring the patient with NIV in general ward.

Therefore, the purpose of my study is to explore the experiences of novice nurses caring the patient with NIV in medical ward. The one of the reason for selecting this topic is my own area of practice and my experience of being a novice nurse in medical ward in Pakistan. I remembered that when I was assigned with NIV patient, I really felt very anxious and worried. Because, I didn’t have any idea about the BIPAP machine like how it is operated, what assessment I need to do in patient condition to monitor the effectiveness of treatment. Sometime, I felt hesitate to consult with physician about the patient’s condition, because of my lack of knowledge, skills and training about the NIV. Therefore, some time I had a fear of harming to patient. My colleagues also had shared the same experiences and feeling with me.

For literature search, I have used these electronic databases: CINAHL (15), PubMed (45), Embase (32) and Scopus (35). I have developed the keywords from Medical Subject Headings (MeSH) from each database. I have used these keywords for literature search: work experience; job experience; experience; experiential learning; nursing knowledge; nursing role; nurse-patient relations; job satisfaction, nursing practice; critical care nursing; education, nursing; staff nurses; nurse attitudes; decision making; nurse-physician relations evaluation; new graduates nurse; staff development, nursing care; nurses; novice nurses; respiration, artificial; noninvasive ventilation; noninvasive ventilation; non-invasive ventilation. Reference lists of relevant papers were also checked to identify other potentially relevant literature and take the assistance from nursing librarian. The inclusion criteria for each database were paper published in the English and between the periods of 1 January 2005 to 31 March 2015. I have also used the Boolean operators to limit my search results. The reason for such limitation is to get the relevant literature about my area of interest. Total number of paper which I get from each database is 127 documents. Once, I done with literature search, I started to read the abstract of each article and select the relevant and near relevant article to my research purpose and eliminate those which I found irrelevant. Out of 127, 26 articles were selected, review critically and develop themes like factors for NIV failure, lack of knowledge and skills etc .The difficulty which I faced during literature search was I cannot be able to remove the duplicate articles from each databases.

As, no study has viewed the experience of novice nurses, therefore I would like to conduct the research build on this research question that “what are the experiences of novice nurses, while caring the NIV patients in general wards?” This study will explore the experiences of novice nurses and uncover the challenges which novice nurses are facing at intrapersonal, interpersonal or organizational level while caring the patient with NIV. Moreover, this study will highlight the need for staff training. Because, through proper training of staff, it’s eliminates those factors which contributed towards NIV failure in ARF patients and provides quality patient care. In these studies, novice nurse is defined as “nurses who are new graduates or have limited experience in nursing care particularly with NIV patients” (CINAHL). The reason for selecting the general wards setting is as my area of specialty in medical ward and most of the time, general wards staffs are less experienced and untrained comparatively to ICU staff.

References:

ACEBEDO-URDIALES, M. S., MEDINA-NOYA, J. L. & FERRE-GRAU, C. 2014. Practical knowledge of experienced nurses in critical care: a qualitative study of their narratives. BMC Med Educ, 14, 173.

CABRINI, L., MONTI, G., VILLA, M., PISCHEDDA, A., MASINI, L., DEDOLA, E., WHELAN, L., MARAZZI, M. & COLOMBO, S. 2009. Non-invasive ventilation outside the Intensive Care Unit for acute respiratory failure: the perspective of the general ward nurses. Minerva Anestesiol, 75, 427-33.

ELLIOTT, M., CROOKES, P., WORRALL-CARTER, L. & PAGE, K. 2011. Readmission to intensive care: a qualitative analysis of nurses’ perceptions and experiences. Heart Lung, 40, 299-309.

FARHA, S., GHAMRA, Z. W., HOISINGTON, E. R., BUTLER, R. S. & STOLLER, J. K. 2006. Use of Noninvasive Positive-Pressure Ventilation on the Regular Hospital Ward: Experience and Correlates of Success. Respiratory Care, 51, 1237-1243.

HESS, D. R. 2011. Patient-ventilator interaction during noninvasive ventilation. Respir Care, 56, 153-65; discussion 165-7.

HILL, N. S. 2009. Where should noninvasive ventilation be delivered? Respir Care, 54, 62-70.

KALLET, R. H. 2009. Noninvasive ventilation in acute care: controversies and emerging concepts. Respir Care, 54, 259-63.

LOPEZ-CAMPOS, J. L., GARCIA POLO, C., LEON JIMENEZ, A., ARNEDILLO, A., GONZALEZ-MOYA, E. & FENANDEZ BERNI, J. J. 2006. Staff training influence on non-invasive ventilation outcome for acute hypercapnic respiratory failure. Monaldi Arch Chest Dis, 65, 145-51.

LOPEZ, A. D., SHIBUYA, K., RAO, C., MATHERS, C. D., HANSELL, A. L., HELD, L. S., SCHMID, V. & BUIST, S. 2006. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J, 27, 397-412.

PENUELAS, O., FRUTOS-VIVAR, F. & ESTEBAN, A. 2007. Noninvasive positive-pressure ventilation in acute respiratory failure. Canadian Medical Association Journal,177 , 1211–1218.

ROSE, L. & GERDTZ, M. F. 2009. Review of non-invasive ventilation in the emergency department: clinical considerations and management priorities. Journal of Clinical Nursing, 18, 3216-3224.

SINUFF, T., KAHNAMOUI, K., COOK, D. J. & GIACOMINI, M. 2007. Practice guidelines as multipurpose tools: a qualitative study of noninvasive ventilation. Crit Care Med, 35, 776-82.

SORENSEN, D., FREDERIKSEN, K., GROFTE, T. & LOMBORG, K. 2013. Practical wisdom: A qualitative study of the care and management of non-invasive ventilation patients by experienced intensive care nurses. Intensive and Critical Care Nursing, 29, 174-181.

SUMNER, K. & YADEGAFAR, G. 2011. The utility and futility of non-invasive ventilation in non-designated areas: Can critical care outreach nurses influence practice? Intensive and Critical Care Nursing, 27, 211-217.