Validation of a structured questionnaire to assess the perception and satisfaction of respiratory therapy students toward career prospects and learning resources.

Background: Respiratory therapy is an emerging profession that has existed in India since 1995. Respiratory therapy students will play a significant role in strengthening various aspects of healthcare in the future. There are no validated instruments to evaluate students' perceptions of their careers and satisfaction with the learning resources. The primary objective of the current study is to develop and validate a structured questionnaire (SQ) for respiratory therapy students in India, encompassing all the components of their career development and satisfaction. Methods: Based on the literature review and content validity from respiratory therapy experts through multiple focused group discussions, a reliable SQ was generated with 40 items based on the Likert scale. After getting institutional ethics clearance and informed consent, the SQ was administered to 904 respiratory therapy students across the country. We performed principal component analysis (PCA), structural equation modeling, and confirmatory factor analysis (CFA) for the global fit. Cronbach's alpha was performed to estimate the internal consistency. Results: The PCA generated a 4-factor model, and internal consistency for the total scale exceeded the standard criterion of >0.70. Satisfactory goodness of fit data were yielded from CFA. Average variances extracted were higher than the correlation coefficients of the factors, which show sufficient discriminant validity. Conclusion: This study shows a clinically acceptable model, it fits and suggests the possibility of applying a SQ to a respiratory therapy student with relatively good construct validity and internal consistency, based on the results of CFA.

Burnout among respiratory therapists during COVID-19 pandemic.

Background: Respiratory therapists (RTs) faced many unpredicted challenges and higher stress levels while managing critically ill patients with the coronavirus disease (COVID-19). This study's primary objective was to evaluate the compassion satisfaction and compassion fatigue among RTs in the United States during the COVID-19 pandemic. Methods: This cross-sectional, descriptive, survey-based study conducted from July 2020 to August 2020 was administered to all active members of the American Association of Respiratory Care via AARConnect. RTs' characteristics including personal, job-specific, and organizational factors were collected. Professional Quality of Life Scale (ProQOL, version 5) was used to measure compassion satisfaction and fatigue. Results: A total of 218 participants fully completed the survey, 143 (65.6%) were female, 107 (49.1%) were between 35 and 54 years of age and 72 (33%) were above 55 years of age. Compassion satisfaction was moderate in 123 (56.4%) and high in 93 (42.7%) RTs. Higher compassion satisfaction was found in RTs who have a higher salary (P = 0.003), work overtime (P = 0.01), hold leadership positions (P < 0.001), work in research/education (P < 0.001) and work for departments that provide help in managing burnout and stress (P = 0.007) and that promote a positive work environment (P < 0.001). Burnout score was low in 90 (41.3%) and moderate in 127 (58.3%) RTs. Higher burnout was found among younger RTs (P = 0.019), those with fewer years of experience (P = 0.013) and those with less than a year at their current job (P = 0.045). Secondary traumatic stress (STS) was low in 106 (48.6%) and moderate in 112 (51.4%) RTs. Higher STS levels were noted among younger RTs (P = 0.02) and RTs with lower education levels (P = 0.016). Conclusion: This survey study identified various personal, job and organizational related factors associated with increased compassion satisfaction as well as compassion fatigue among RTs.

The relationship between physical activity and burnout among respiratory therapists in Jeddah City, Saudi Arabia.

Background/objective: Burnout is a condition in which a person feels physically fatigued and mentally drained. It occurs after a long period of work-related stress and may lead to mental disorders, such as depression and anxiety. Therefore, healthcare providers especially require early intervention. Regular physical activity has been reported to benefit individuals with mental illness, suggesting that a relationship between physical activity and burnout might exist. Hence, this study's objective was to analyze the relationship between physical activity and burnout among respiratory therapists and student interns in Jeddah City, Saudi Arabia. Methods: A cross-sectional descriptive study with respiratory therapists and interns working in public and private hospitals was conducted from November 2, 2020, to November 27, 2020. Participants responded to an electronic survey consisting of the Maslach Burnout Inventory - Human Services Survey for Medical Personnel, which measures the burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment. They also completed the International Physical Activity Questionnaire - Long Form and a demographic questionnaire. Results: Among the 250 eligible respiratory therapists and interns, data from the 152 respondents who completed the electronic survey were analyzed. Although no association between physical activity and burnout was found, a significant effect of the novel coronavirus disease 2019 (COVID-19) on physical activity and significant associations of high burnout (emotional exhaustion) with nationality and smoking were found. Conclusion: No association was found between burnout level and physical activity. Confounding factors, such as the COVID-19 pandemic during the study's data collection and analyses, likely contributed to the study's findings.

[COVID-19 pandemic: structured expansion of ventilation capacities using home respirators]. / COVID-19-Pandemie: strukturierte Erweiterung von Beatmungskapazitäten mithilfe von Heimrespiratoren.

Due to the current COVID-19 pandemic there is a need for a rapid increase in intensive care and ventilation capacities. Delivery times for additional intensive care respirators are currently not foreseeable. An option to increase ventilation capacities not only for COVID-19, but for all patients requiring mechanical ventilation is to use home respirators. Home respirators are turbine respirators, so they can usually be operated without high-pressure oxygen connections and can therefore also be used in areas outside the classical intensive care medical infrastructure. Due to their limited technical features, home respirators are not suitable for the treatment of severely affected patients but can be used for weaning after respiratory improvement, which means that intensive care respirators are available again more quickly. Respiratory therapists are specially trained nurses or therapists in the field of out of hospital ventilation and can independently use home ventilation respirators, for example for weaning in the intensive care unit. Thus, they relieve intensive care nursing staff in the pandemic. Due to the COVID-19 pandemic medical students from the Oldenburg University are currently being trained in operating home respirators to provide basic support in the hospital if necessary.

Supraglottic airway device placement by respiratory therapists.

OBJECTIVE: Respiratory Therapists (RTs) are some of the first staff to arrive at in-hospital incidents where cardiopulmonary resuscitation (CPR) is needed, yet at some facilities, their ability to intubate is limited by hospital scope of practice. During the intubation process, CPR is often interrupted which could potentially increase the likelihood of adverse patient outcomes. Training RTs to secure the airway using non-intubation methods may reduce or eliminate time for CPR interruptions and allow for earlier continuous/uninterrupted chest compressions. DESIGN: A pilot study was developed to assess the effectiveness of a new policy for RT scope of practice. METHODS: RTs were trained for supraglottic airway device placement prior to procedure initiation. After each device insertion event, RTs completed a written survey. Time between cardiac arrest and device insertion, number of insertion attempts, ease of placement, technical specifications of the device, complications, and survival were compiled and compared between supraglottic airway device and endotracheal tube (ETT) placement. RESULTS: Procedural information from 23 patients who received a supraglottic airway device during the trial was compared to retrospective data of CPR events requiring intubation from the previous year. Time between initiation of cardiac arrest and advanced airway placement decreased significantly (p < 0.0001) when RTs placed the supraglottic airway device (4.7 min) versus ETT at CPR events the previous year (8.6 min). Device-associated complications were minimal and patient mortality was the same regardless of device. CONCLUSION: We propose that more RTs should be trained to insert supraglottic airway devices during inpatient CPR events.

Psychometric properties and development of a structured questionnaire to assess the perception, attitude, and job satisfaction among respiratory therapists.

Background: Over the past ten years, significant transformations have occurred in the healthcare landscape, presenting respiratory therapists (RTs) with a mix of challenges and opportunities. Hence, their perceptions about career progression and job satisfaction will be critical factor in determining the recruitment and retention of RTs. However, there are no studies in the literature that comprehensively assessed these aspects using a reliable and valid measure specific to RTs. Our objective was to develop and psychometrically test a Standardized Questionnaire (SQ) for evaluating RT's overall job satisfaction. Methods: Following consultations with experts and interviews conducted with RTs, a preliminary questionnaire was devised for the purpose of exploratory factor analysis (EFA). The 49 items of the Structured Questionnaire (SQ) were used for verification of the theorized factor structure and content validity using a confirmatory factor analysis (CFA). Principal Component Analysis (PCA), Structural Equation Modeling (SEM), and Confirmatory Factor Analysis (CFA) for the global fit were done. Cronbach's alpha was performed to estimate the internal consistency. The samples of RTs were collected from India between August 2021 and January 2022. Results: A convenience sample comprising 409 respiratory therapists (RTs) employed in India participated in the survey conducted from June 2021 to January 2022. The exploratory factor analysis revealed three factors that explained 61.2 % of the total variance. The confirmatory factor analysis yielded a 3-factor structure (X2/df = 4.4, p < 0.02, standardized root-mean-square residual = 0.05, goodness of fit index = 0.94, comparative fit index = 0.98). The Cronbach's alpha was 0.94 for the total scale. Conclusions: Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) are becoming more prevalent, especially in the development and psychometric evaluation of instruments. This Structured Questionnaire is a reliable and valid tool that has utility for assessing perceptions, satisfaction, and attitude among Respiratory Therapists and for making comparisons of similar psychometric measures.

Quality indicators in respiratory therapy.

Quality indicators in healthcare refer to measurable and quantifiable parameters used to assess and monitor the performance, effectiveness, and safety of healthcare services. These indicators provide a systematic way to evaluate the quality of care offered, and thereby to identify areas for improvement and to ensure that patient care meets established standards and best practices. Respiratory therapists play a vital role in areas of clinical administration such as infection control practices and quality improvement initiatives. Quality indicators serve as essential metrics for respiratory therapy departments to assess and enhance the overall quality of care. By systematically tracking and analyzing indicators related to infection control, treatment effectiveness, and adherence to protocols, respiratory care practitioners can identify areas to improve and implement evidence-based changes. This article reviewed how to identify, implement, and monitor quality indicators specific to the respiratory therapy departments to set benchmarks and enhance patient outcomes.

Critical Care Experience Shapes Respiratory Therapists' Attitudes toward Death: A Survey Study.

Respiratory therapists (RTs) frequently encounter death in their work with critically ill patients. Healthcare providers' attitudes toward death significantly affect their approach to caring for dying patients; however, there is a lack of knowledge on RTs' attitudes toward death. This study examines how the work environment and personal characteristics of RTs influence their attitudes toward death. Utilizing the Death Attitude Profile-Revised-Chinese questionnaire, a cross-sectional survey compared non-critical care RTs (non-CCRTs, N = 86) to critical care RTs (CCRTs, N = 85). Non-CCRTs displayed significantly lower scores in overall acceptance of death compared to CCRTs (p = 0.015) and a tendency to actively avoid thoughts about death (p = 0.005). CCRTs scored higher in "neutral acceptance" (p = 0.015), and non-CCRTs exhibited higher scores on items reflecting a negative attitude toward death. RTs with shorter professional tenures showed heightened fear of death and avoidance tendencies. Perception of life and death education correlated with higher "fear of death" and "death avoidance" scores (p = 0.001). The findings indicate that CCRTs demonstrate a more neutral acceptance of death. Additionally, experience, sex, mental health status, and life-death education exposure significantly influence RTs' attitudes toward death.

The prevalence of burnout among pulmonologists or respiratory therapists pre- and post-COVID-19: a systematic review and meta-analysis.

OBJECTIVES: The coronavirus disease-19 (COVID-19) increased the already heavy workload in the pulmonary and respiratory departments, which therefore possibly increased the prevalence of burnout among pulmonologists or respiratory therapists. We aimed to compare the differences in burnout among pulmonologists or respiratory therapists pre- and post-COVID-19 by doing a systematic review with meta-analysis. METHODS: We searched pulmonologist, or pulmonary, or respiratory, and burnout up to 29 January 2023 in six databases. We included studies investigating pulmonologists or respiratory therapists and reporting the prevalence of burnout among them. The risk of bias was assessed by a tool for prevalence studies. The overall prevalence of burnout was pooled. RESULTS: A total of 2859 records were identified and 16 studies were included in the final analysis. The included studies reported 3610 responding individuals and 2336 burnouts. The pooled prevalence of burnout was 61.7% (95% confidence interval (CI), 48.6-73.2%; I2 = 96.3%). The pooled prevalence of burnout during COVID-19 was significantly higher than it was prior to the outbreak (68.4% vs. 41.6%, p = .01). The result of the meta-regression revealed that COVID-19 coverage was significantly associated with the prevalence of burnout (p = .04). CONCLUSIONS: Burnout was widely prevalent among pulmonologists or respiratory therapists and increasingly perceived during COVID-19. Therefore, interventions were needed to reduce burnout in this specialty.KEY MESSASGESThe coronavirus disease-19 increased the already heavy workload in the pulmonary and respiratory departments.Burnout was widely prevalent among pulmonologists or respiratory therapists and increasingly perceived during COVID-19.

Integrating Tobacco Dependence Treatment into Hospital Practice Using the Rochester Model.

Purpose: Delivering evidence-based tobacco dependence treatments to hospital patients in real-world settings continues to be a challenge. To achieve long-term abstinence, a program should provide both bedside counseling and post-discharge contacts. These program features are necessary but difficult to implement due to lack of training, time and low administrative support. The Rochester Model is a tobacco treatment program using existing staff and medical students to reduce the barriers for treating hospitalized smokers. Patients and Methods: Any smoking patient admitted to a participating hospital unit can participate. Staff nurses, mid-level providers and physicians deliver the counseling steps during the admission. Nurses hold two bedside counseling sessions, while providers give quitting advice and encourage pharmacotherapy. Nurses also contribute as unit champions and post-discharge call counselors. New York State quit line counselors combined with a University of Rochester call team fulfill the post-discharge calls. The latter call team is composed of staff nurses, respiratory therapists and medical students. Results: The number of smoking patients screened was 2610 while 385 enrolled after a proof-of-concept period. The 7-day point prevalence quit rates using the as treated (patients contacted) analysis is 50% at 4 weeks, 42% at 3 months and 38% at 6 months. The 7-day point prevalence quit rates using the intent-to-treat (all patients) analysis is 23% at 4 weeks, 16% at 3 months and 14% at 6 months. Conclusion: Preliminary data on the Rochester Model is showing an effective yet affordable tobacco treatment program using hospital staff and medical students. Nurses serve as bedside counselors, unit champions and post-discharge call counselors. Hospitals, even with limited resources, can implement tobacco treatment programs using existing staff.

Nurses and Respiratory Therapists Lived Experience During COVID-19 Pandemic: A Qualitative Study.

Introduction: Nurses and respiratory therapists working on the frontline during the pandemic surge were short-staffed and worked extended hours while adding new tasks to already demanding workloads. As the world watched news covering COVID-19's effect, nurses and respiratory therapists lived through the daily stress of treating each patient with care, dignity, and compassion. Limited studies have focused on this population, which is vital to providing care and saving lives; research is needed to understand nurses' and respiratory therapists' experiences during the COVID-19 pandemic. Objective: The study aimed to understand nurses' and respiratory therapists' experiences during the COVID-19 pandemic. Methods: A qualitative descriptive study, informed by naturalistic philosophy, was designed to obtain a detailed account of participants' experiences during the pandemic surge. A purposive sample was recruited and enrolled from the community through professional organizations and snowball sampling from December 2021 to September 2022. Data was analyzed using thematic analysis. Results: Participants were seven registered nurses and six respiratory therapists employed full-time in an intensive care unit, step-down intensive care unit, emergency department, or medical-surgical unit; seven (53.8%) with an associate degree, and six (46.2%) with a bachelor's degree. Eight (66.7%) self-identified as White, one Asian, one non-Hispanic Black, and two Pacific Islanders. The mean age was 40, and 10 (76.9%) were female. Six primary themes emerged: (a) the work-life experience before the COVID-19 pandemic, (b) the work-life experience during the COVID-19 pandemic, (c) the personal life experience during COVID-19, (d) the coping period, (e) the professional role change, and (f) the work and personal life experiences post COVID-19 surge. Conclusion: The knowledge gained from this study can help improve understanding of the professional quality of life, the need for organizational and community support, and for healthcare professionals to seek help and practice self-care to prevent burnout and secondary traumatic stress.

Canadian respiratory therapists who considered leaving their clinical position experienced elevated moral distress and adverse psychological and functional outcomes during the COVID-19 pandemic. / Détresse morale et conséquences psychologiques et fonctionnelles négatives chez les thérapeutes respiratoires canadiens ayant envisagé de quitter leur poste clinique pendant la pandémie de COVID-19.

INTRODUCTION: Respiratory therapists (RTs) faced morally distressing situations throughout the COVID-19 pandemic, including working with limited resources and facilitating video calls for families of dying patients. Moral distress is associated with a host of adverse psychological and functional outcomes (e.g. depression, anxiety, symptoms of posttraumatic stress disorder [PTSD] and functional impairment) and consideration of position departure. The purpose of this study was to understand the impact of moral distress and its associated psychological and functional outcomes on consideration to leave a clinical position among Canadian RTs during the COVID-19 pandemic. METHODS: Canadian RTs (N = 213) completed an online survey between February and June 2021. Basic demographic information (e.g. age, sex, gender) and psychometrically validated measures of moral distress, depression, anxiety, stress, PTSD, dissociation, functional impairment, resilience and adverse childhood experiences were collected. RESULTS: One in four RTs reported considering leaving their position. RTs considering leaving reported elevated levels of moral distress and adverse psychological and functional outcomes compared to RTs not considering leaving. Over half (54.5%) of those considering leaving scored above the cut-off for potential diagnosis of PTSD. Previous consideration to leave a position and having left a position in the past each significantly increased the odds of currently considering leaving, along with system-related moral distress and symptoms of PTSD, but the contribution of these latter factors was small. CONCLUSIONS: Canadian RTs considering leaving their position reported elevated levels of distress and adverse psychological and functional outcomes, yet these individual-level factors appear unlikely to be the primary factors underlying RTs' consideration to leave, because their effects were small. Further research is required to identify broader, organizational factors that may contribute to consideration of position departure among Canadian RTs.

The experience of Saudi respiratory therapists dealing with COVID-19 patients: A qualitative study.

BACKGROUND: Healthcare professionals have fought hard to restrain the COVID-19 pandemic by providing high-quality care for their infected patients, but in doing so they have developed fears of becoming sick and feelings of isolation and loneliness. The lived experience of respiratory therapists (RTs) in Saudi Arabia who works with these infected patients needs further investigation. The study sought to describe the experiences and coping strategies of Saudi RT managing patients with COVID-19. MATERIALS AND METHODS: The study utilized qualitative research methods, specifically employing a phenomenological research design. A total of 25 Saudi RT (RTs) who were in direct contact with COVID-19 patients were selected after they agreed to participate in this study. The study followed a one-on-one semi-structured interview process using the Zoom platform. This qualitative data collection technique focuses on the participants' lived experiences and feelings to discover shared patterns. The data were analyzed via an inductive approach. RESULTS: Six themes were found in the RT perceptions including stress while treating COVID patients, managing the fear of catching of Covid 19, feelings towards COVID-19 patients, challenges faced by female RTs, workplace experiences, and excessive workload. CONCLUSIONS: RTs feelings dramatically changed throughout the COVID-19 pandemic. All the RTs have developed a self-copying style that has helped them improve their psychosocial behavior to face the pandemic. During the outbreak, frontline RTs' positive and negative emotions intertwined and coexisted. Negative emotions predominated in the beginning, while good feelings emerged gradually. Self-coping methods and psychosocial development were significant factors in RTs mental health while caring for COVID-19 patients.

Use of the Revised Second Victim Experience and Support Tool to Examine Second Victim Experiences of Respiratory Therapists.

BACKGROUND: Respiratory therapists (RTs) work alongside allied health staff, nurses, and physicians during stressful and traumatic events that can be associated with emotional and physiological implications known as second victim (SV) experiences (SVEs). This study aimed to evaluate SVEs of RTs, including both positive and negative implications. METHODS: RTs within a large academic health care organization across Minnesota, Wisconsin, Florida, and Arizona were asked to participate in an anonymous survey that included the validated Second Victim Experience and Support Tool-Revised to assess SVEs as well as desired support services. RESULTS: Of the RTs invited to participate, 30.8% (171/555) completed the survey. Of the 171 survey respondents, 91.2% (156) reported that they had been part of a stressful or traumatic work-related event as an RT, student, or department support staff member. Emotional or physiologic implications experienced by respondents as SVs included anxiety 39.1% (61/156), reliving of the event 36.5% (57/156), sleeplessness 32.1% (50/156), and guilt 28.2% (44/156). Following a stressful clinical event, 14.8% (22/149) experienced psychological distress, 14.2% (21/148) experienced physical distress, 17.7% (26/147) indicated lack of institutional support, and 15.6% (23/147) indicated turnover intentions. Enhanced resilience and growth were reported by 9.5% (14/147). Clinical and non-clinical events were reported as possible triggers for SVEs. Nearly half of respondents 49.4% (77/156) indicated feeling like an SV due to events related to COVID-19. Peer support was the highest ranked form of desired support following an SVE by 57.7% (90/156). CONCLUSIONS: RTs are involved in stressful or traumatic clinical events, resulting in psychological/physical distress and turnover intentions. The COVID-19 pandemic has had a significant impact on RTs' SVEs, highlighting the importance of addressing the SV phenomenon among this population.

Characterizing the mental health and functioning of Canadian respiratory therapists during the COVID-19 pandemic.

Introduction: Healthcare professionals (HCPs) appear to be at increased risk for negative psychological outcomes [e.g. depression, anxiety, post-traumatic stress disorder (PTSD), moral distress] and associated impacts on functioning throughout the COVID-19 pandemic. HCPs working on designated COVID-19 units may be further impacted than their colleagues not on these units given added demands of patient care and risk of contracting COVID-19. Little is known, however, about the mental health and functioning of specific professional groups beyond nurses and physicians, including respiratory therapists (RTs), over the course of the pandemic. Accordingly, the purpose of the present study was to characterize the mental health and functioning of Canadian RTs and compare profiles between RTs working on and off designated COVID-19 units.Methods: Canadian RTs completed an online survey between February and June 2021, including demographic information (e.g. age, sex, gender,) and measures of depression, anxiety, stress, PTSD, moral distress and functional impairment. Descriptive statistics, correlation analyses and between-groups comparisons were conducted to characterize RTs and compare profiles between those on and off COVID-19 units.Results: Two hundred and eighteen (N = 218) RTs participated in this study. The estimated response rate was relatively low (6.2%) Approximately half of the sample endorsed clinically relevant symptoms of depression (52%), anxiety (51%) and stress (54%) and one in three (33%) screened positively for potential PTSD. All symptoms correlated positively with functional impairment (p's < .05). RTs working on COVID-19 units reported significantly greater patient-related moral distress compared to those not on these units (p < .05).Conclusion: Moral distress and symptoms of depression, anxiety, stress and PTSD were prevalent among Canadian RTs and were associated with functional impacts. These results must be interpreted with caution given a low response rate, yet raise concern regarding the long-term impacts of pandemic service among RTs.

Research on RTs' mental health prior to and during the COVID-19 pandemic is scant, especially in comparison to other HCPs.RTs in the present study reported experiencing moral distress and clinically significant symptoms of depression, anxiety and PTSD, with associated functional impairment.One in three RTs screened positive for likely PTSD on the PCL-5.There is a need to provide RTs with adequate mental health supports and to understand the long-term impacts of pandemic service among RTs.

Utilizing Competence-Based Simulation to Improve Orientation Outcomes.

BACKGROUND: New graduate respiratory therapists (RTs), regardless of the degree program, receive limited preparation in neonatal/pediatric diseases and management. Experienced RTs typically have adult knowledge but limited exposure to pediatrics. We developed a program that included competence-based simulation to improve orientation success. METHODS: A 9-week orientation program curriculum with simulation-based competence assessment was developed to ensure all new hires gained knowledge and skills to perform pediatric clinical tasks. Each new hire individually completed the same simulation scenarios during the first week and last week of orientation. Curriculum changes were made over time based on performance in simulations and on-the-job knowledge and skills during and after orientation. Paired and unpaired t tests were used with P < .05 as significant. RESULTS: From January 2017-February 2020, the program had 3 updates. Noninvasive ventilation and decompensating patient scenarios were completed for all periods. Ninety-two new staff were oriented in period 1 = 29 (new graduate RTs 20, experienced RTs 9); period 2 = 17 (new graduate RTs 10, experienced RTs 7); period 3 = 24 (new graduate RTs 21, experienced RTs 3), and period 4 = 22 (new graduate RTs = 22). Remediation during orientation occurred in 15% of the staff. Seventy-one percent successfully advanced to ICU orientation after completion of the program. All staff improved scores between pre- versus post-simulations in all periods: mean difference ± SD period 1: new graduate RTs 32.0 ± 17.0, P < .001; experienced RTs 28.0 ± 18.9, P < .001; period 2: new graduate RTs 23.0 ± 15.2, P < .001; experienced RTs 29.0 ± 12.1, P < .001; period 3: new graduate RTs 26.0 ± 15.8, P < .001; experienced RTs 27.0 ± 15.1, P = .007; and period 4: new graduate RTs 19.0 ± 14.5, P < .001, paired t test. The scores between new graduate RTs and experienced RTs during post-simulation were not significantly different for period 1 (P = .35) but were significantly different for periods 2-4 (P = .040, unpaired t test). CONCLUSIONS: The use of a competence-based orientation program showed educational advancements and helped determine successful orientation completion.

A Delphi Survey of Canadian Respiratory Therapists' Practice Statements on Pediatric Mechanical Ventilation.

BACKGROUND: Pediatric mechanical ventilation practice guidelines are not well established; therefore, the European Society for Paediatric and Neonatal Intensive Care (ESPNIC) developed consensus recommendations on pediatric mechanical ventilation management in 2017. However, the guideline's applicability in different health care settings is unknown. This study aimed to determine the consensus on pediatric mechanical ventilation practices from Canadian respiratory therapists' (RTs) perspectives and consensually validate aspects of the ESPNIC guideline. METHODS: A 3-round modified electronic Delphi survey was conducted; contents were guided by ESPNIC. Participants were RTs with at least 5 years of experience working in standalone pediatric ICUs or units with dedicated pediatric intensive care beds across Canada. Round 1 collected open-text feedback, and subsequent rounds gathered feedback using a 6-point Likert scale. Consensus was defined as ≥ 75% agreement; if consensus was unmet, statements were revised for re-ranking in the subsequent round. RESULTS: Fifty-two RTs from 14 different pediatric facilities participated in at least one of the 3 rounds. Rounds 1, 2, and 3 had a response rate of 80%, 93%, and 96%, respectively. A total of 59 practice statements achieved consensus by the end of round 3, categorized into 10 sections: (1) noninvasive ventilation and high-flow oxygen therapy, (2) tidal volume and inspiratory pressures, (3) breathing frequency and inspiratory times, (4) PEEP and FIO2 , (5) advanced modes of ventilation, (6) weaning, (7) physiological targets, (8) monitoring, (9) general, and (10) equipment adjuncts. Cumulative text feedback guided the formation of the clinical remarks to supplement these practice statements. CONCLUSIONS: This was the first study to survey RTs for their perspectives on the general practice of pediatric mechanical ventilation management in Canada, generally aligning with the ESPNIC guideline. These practice statements considered information from health organizations and institutes, supplemented with clinical remarks. Future studies are necessary to verify and understand these practices' effectiveness.

Drivers of Burnout Among Critical Care Providers: A Multicenter Mixed-Methods Study.

BACKGROUND: Critical care practitioners have some of the highest levels of burnout in health care. RESEARCH QUESTION: What are key drivers of burnout across the multidisciplinary ICU team? STUDY DESIGN AND METHODS: We conducted a multicenter mixed-methods cohort study in ICUs at three diverse hospitals. We recruited physicians, nurses, respiratory therapists, and other staff members who worked primarily in an ICU. Participants completed the Maslach Burnout Inventory for Human Services Survey for Medical Personnel (MBI) and a qualitative focus group or interview using a phenomenologic approach. MBI subscales for emotional exhaustion, depersonalization, and lack of personal accomplishment were calculated. Emergent shared themes contributing to burnout were identified from qualitative interviews. RESULTS: Fifty-eight providers (26 physicians, 22 nurses, six respiratory therapists, three pharmacists, and one case manager) participated. Ten participants (17.9%) described their burnout as moderate to high. However, participants scored moderate or high levels across the three MBI subscales (emotional exhaustion, 71.4%; depersonalization, 53.6%; and lack of personal achievement, 53.6%). Drivers of burnout aligned with three core themes: patient factors, team dynamics, and hospital culture. Individual drivers included medically futile cases, difficult families, contagiousness of burnout, lack of respect between team members, the increasing burden of administrative or regulatory requirements at the cost of time with patients, lack of recognition from hospital leadership, and technology. All were highly interconnected across the three larger domains. Despite differences in MBI scores, most provider types described very similar drivers of burnout. INTERPRETATION: High levels of burnout were identified through the MBI, but participants did not self-report high levels of burnout, suggesting a lack of awareness. Drivers of burnout were highly interconnected, but factors related to team dynamics and hospital culture were most prominent and shared across provider types. The shared drivers of burnout across multiple provider types highlights the need for interventions focused on team- and system-level drivers.

Manual bag valve mask ventilation performance among respiratory therapists.

BACKGROUND: High peak pressures delivered via bag valve mask (BVM) can be dangerous for patients. OBJECTIVE: To examine manual ventilation performance among respiratory therapists (RTs) in a simulation model. METHODS: Respiratory therapists (n=98) were instructed to ventilate a manikin for 18 breaths. Linear regression was utilized to determine associated predictors with the outcomes: delivered tidal volume, pressure and flow rate. RESULTS: Among all participants, the mean ventilation parameters include a tidal volume of 599.70 ml, peak pressure of 26.35 cmH2O, and flow rate of 77.20 l/min. Higher confidence values were positively associated with delivered peak pressure (p=0.01) and flow rate (p=0.008). Those with the most confidence in using the BVM actually delivered higher peak pressures and flow rates compared to those with lower confidence levels. CONCLUSIONS: Our results emphasize the urgent need to create an intervention that allows providers to deliver safe and optimal manual ventilation.

Quality Management in Respiratory Care.

The word "quality" refers to the features of a product or service to which a certain value is ascribed. When it comes to hospital-based practices, quality has often been considered to be specific to the care provided. However, this specific perspective is transitioning toward a broader concept after the evolution of quality-improvement projects and quality frameworks at the organizational level. Respiratory therapy departments have been identified as an essential part of any hospital because the key nature of discipline for respiratory therapists is widely understood. Due to their professional accountability and professional values, respiratory therapists often have administrative roles in infection control practices and quality-improvement projects. Therefore, it would be ideal to have a core team of respiratory therapists trained in quality management and to initiate quality-improvement processes at the departmental level. Every respiratory therapy department should have its own quality-improvement team to assist with the process of training, implementation, and analysis. Thus, this article aimed to discuss the role of respiratory therapists and respiratory therapy departments in quality-improvement processes and projects to set benchmarks and enhance outcomes.