Exploring the scope of nursing practices in the care of ECMO supported patients in Israel

ABSTRACT

Objectives: The growing implementation of extracorporeal membrane oxygenation (ECMO) for patients with COVID19 has led to increased involvement of nurses in treating ECMO-supported patients (ECMO-SP). In June 2021, the Israeli Ministry of Health;s Nursing Administration published the first director;s circular in the world to detail the nursing scope of practice in caring for ECMO-SP. This study aimed to examine how often nurses perform various activities while caring for adult ECMO-SP. Method(s) A cross-sectional study. A convenience sample consisted of 76 registered ICU nurses (mean age 41.3+/-8.7 years;71% female). A 20-item Nursing Activities in the Care of ECMO-SP instrument was developed based on the Israeli Ministry of Health;s procedure on Nursing Practice in the Care of ECMO-SP and a literature review. The instrument examined how often nurses perform various activities on a Likert scale ranging from 1 (Never) to 5 (Always). Exploratory and confirmatory factor analyses (EFA and CFA), as well as descriptive statistics and Pierson;s correlations were performed. Result(s) When examined in EFA and CFA, the instrument yielded acceptable fit indices. The instrument contains four subscales with the following mean +/- SD scores Factor 1. Nursing care of ECMO-SP not related to the ECMO device (7 items, a=0.90), M+/-SD=4.66+/-0.61;Factor 2. Activities on the ECMO device during emergencies (5 items, a=0.82), M+/-SD=2.1+/-0.91;Factor 3. ECMO device calibrating and monitoring (4 items, a=0.72), M+/-SD=3.26+/-1.0;and Factor 4. Medication and blood administration through the ECMO device (4 items, a=0.73), M+/-SD=1.52+/-0.60. Of the 20 nursing activities, 10 (50%) were reported as "never" or "rarely" performed. Nine out of 20 items (45%) were reported as "very often" or "always" performed. Conclusion(s) Ten out of 20 (50%) activities while caring for ECMO-SP listed in the scope of practice as permissible for nurses to perform were reported as not performed at all or performed rarely. Policymakers need to act so that the activities listed in the nursing scope of practice are carried out by nurses in practice.