Adaptation in families with a member requiring mechanical ventilation at home

Article Abstract:

The cost of hospital care is increasing rapidly, especially for patients who require special treatments. When conditions permit, many of these patients can be discharged home. In addition to reduced costs, home care has the added advantages of decreasing patient exposure to nosocomial (hospital-acquired) infections, and improving patient mobility and nutritional status. The adult ventilation-dependent patient can be cared for in a home setting. However, the cost savings, and several other advantages related to home care, have primarily been enjoyed by the hospitals. The costs to the patients' families, financially and emotionally, attendant to home care have not been adequately researched. This study was designed to determine how family members adapted to the care of a ventilation-dependent patient. Adaptation was identified as maintaining the patient at home for at least two months. Twenty families of patients requiring various amounts of ventilation assistance were interviewed. They also received instructions in the use, care and maintenance of ventilation equipment. The family responses and performances were graded using the Family Coping Scale (F-COPES), a measurement of the use of coping instruments, internal mechanisms, and religious beliefs. Higher scores indicated greater coping capacities. The Family APGAR, a clinically tested instrument used to measure an individuals' satisfaction with their family function, was also employed. According to the F-COPES and APGAR scores, care givers expressed satisfaction with family function and their abilities to manage their patients' needs. Specific positive themes expressed included satisfaction with home care decision, confidence in their performance, and an overall improvement in family quality of life. Negative themes expressed included the burden of providing care, resentment and hopelessness feelings about a satisfactory outcome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Usage, Caregivers, Family life surveys, Home care, Ventilators, Ventilators (Medical equipment)

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Weaning from mechanical ventilation: current controversies

Article Abstract:

Patients who have experienced an episode of acute respiratory failure (ARF) receive mechanical ventilation (breathing assistance) until such time as they are able to resume spontaneous ventilation (breathing). The process of resuming unsupported ventilation, referred to as weaning, is of special concern in the patient with pre-existing lung disease. The time period involved can be extensive, especially in patients who can not readily resume normal breathing function. The role of the critical care nurse, in terms of the three phases of this process (preweaning, weaning, and extubation), is reviewed. In the preweaning phase, the patient's physiologic and psychologic readiness for the transition from mechanical ventilation are evaluated. Physiologic readiness requires the absence of the predisposing causes of ARF and the presence of clinical stability. Psychologic readiness refers to the patient's state of mind and emotional preparedness for the removal of the support system. A communication system between the patient and the nurse must be established. The weaning phase involves the use of four possible alternative techniques: Intermittent mandatory ventilation (IMV), T-piece, positive support ventilation (PSV), and continuous positive airway pressure (CPAP). The efficiency of each method is described and compared with the others. The technique that is most appropriate to the patient's need is selected. The T-piece and the IMV are the most commonly used weaning techniques. The extubation step requires evaluation of the pulmonary, cardiovascular, and central nervous system indicators of independent breathing ability. Each phase must be completed satisfactorily before progressing to the next phase. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Physiological aspects, Acute respiratory distress syndrome, Adult respiratory distress syndrome, Ventilator weaning

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