RESUMO
Management of patients difficult to wean from the ventilator is a practical challenge in which professional nurses are deeply involved.The clinical research applied over the last years has tried to describe the characteristics of weaning phenomenon and the associated factors, to find predictive outcomes to guide clinical decisions, to search new strategies to conduct the protocols and to identify the most effective modes of weaning. In this paper a critical review of the current knowledge from a nursing perspective is done. The weaning conceptual model proposed by the American Association of Critical Care Nurses (AACN) group has been used as a theoretical framework.
Assuntos
Pesquisa em Enfermagem , Desmame do Respirador/enfermagem , Humanos , Respiração Artificial/efeitos adversos , Respiração Artificial/enfermagem , Desmame do Respirador/métodosRESUMO
El cuidado de los pacientes con dificultad para el destete del ventilador continúa siendo un reto en el que los profesionales enfermeros están muy involucrados. La investigación clínica desarrollada durante estos últimos años ha intentado explicar las características del fenómeno del destete y los factores asociados, encontrar indicadores de predicción de resultados para orientar las decisiones clínicas, buscar estrategias alternativas para dirigir el procedimiento e identificar los modos de destete más eficaces. En este trabajo se hace una revisión crítica del conocimiento actual del fenómeno de dificultad para el destete del ventilador desde una perspectiva enfermera y se utiliza el modelo conceptual del destete propuesto por la Asociación Americana de Enfermeras de Cuidados Críticos (American Association of Critical Care Nurses, AACN), como marco teórico de referencia (AU)
Assuntos
Humanos , Pesquisa em Enfermagem , Desmame do Respirador , Respiração ArtificialRESUMO
In this article we present the study financed by the Sanitary Investigations Fund (FIS), with the objectives to prove that the Nursing Diagnosis of "Dysfunctional Ventilatory Response at Weaning" (DWRU) incorporated to the taxonomy of the North American Nursing Diagnosis Association (NANDA), is valid in Spain; as well as identify the items which configure its definition. A descriptive observational study was performed in nine Intensive Care Units belonging to six autonomous communities, including as study subjects 89 male and female nurses who are experts in yhe care of critically ill patients with mechanical ventilation. The model of validation proposed by Fehring and the Delphi Technique were used. The data were analysed calculating the average of the weights of each defining feature; percentage and average calculus; opinion percentages about the related factors; variability calculus; and factorial analysis of the result. The results make us conclude that Spanish nurses who have experience in taking care of critically ill patients, identify DWRU as a phenomenon which patients in our environment present and which can be treated by them. Besides, the identification of levels of DWRU into Severe, Moderate and Slight which the NANDA suggests, is better applied using an association of factors than defining higher and lower features.