Achieving quality patient-ventilator management: advancing evidence-based nursing care.

This article presents suggestions for nurses to gain skill, competence, and comfort in caring for critically ill patients receiving mechanical ventilatory support, with a specific focus on education strategies and building communication skills with these challenging nonverbal patients. Engaging in evidence-based practice projects at the unit level and participating in or leading research studies are key ways nurses can contribute to improving outcomes for patients receiving mechanical ventilation. Suggestions are offered for evidence-based practice projects and possible research studies to improve outcomes and advance the science in an effort to achieve quality patient-ventilator management in intensive care units.

Overview of mechanical ventilatory support and management of patient- and ventilator-related responses.

Nurses must be knowledgeable about the function and limitations of ventilator modes, causes of respiratory distress and dyssynchrony with the ventilator, and appropriate management in order to provide high-quality patient-centered care. Prompt recognition of problems and action by the nurse may resolve acute respiratory distress, dyspnea, and increased work of breathing and prevent adverse events. This article presents an overview of mechanical ventilation modes and the assessment and management of dyspnea and patient-ventilator dyssynchrony. Strategies to manage patients' responses to mechanical ventilatory support and recommendations for staff education also are presented.

Promoting effective communication for patients receiving mechanical ventilation.

Communicating effectively with ventilator-dependent patients is essential so that various basic physiological and psychological needs can be conveyed and decisions, wishes, and desires about the plan of care and end-of-life decision making can be expressed. Numerous methods can be used to communicate, including gestures, head nods, mouthing of words, writing, use of letter/picture boards and common words or phrases tailored to meet individualized patients' needs. High-tech alternative communication devices are available for more complex cases. Various options for patients with a tracheostomy tube include partial or total cuff deflation and use of a speaking valve. It is important for nurses to assess communication needs; identify appropriate alternative communication strategies; create a customized care plan with the patient, the patient's family, and other team members; ensure that the care plan is visible and accessible to all staff interacting with the patient; and continue to collaborate with colleagues from all disciplines to promote effective communication with nonvocal patients.