Understanding the Psychological

needs of long term weaning

patients

Vedran Dumbović, bacc. med. techn.

Adriano Friganović, dipl. med. techn.

Margita Poturić, bacc. med. techn.

CNSARICT

Weaning from mechanical ventilation

Most patients are easily and successfully weaned from mechanical ventilation on the first attempt. However, even for these easy-to-wean patients, organizational and clinician factors such as staffing levels, skill mix, experience, and decision-making hierarchy influence the weaning process and can delay weaning and extubation.

Such delays may result in prolonged duration of mechanical ventilation and stay in the intensive care unit (ICU) andincreased costs.

Approximately 30% of patients treated with mechanical ventilation experience difficult or prolonged weaning. For these patients, similar organizational and clinician factors influence the duration and success of weaning.

Because of the risk of further prolongation of mechanical ventilation, reintubation, and increased mortality, identificationof potentially modifiable factors that cause delays in weaning, unsuccessful weaning trials, and unsuccessful attempts in extubation is needed.

WEANING FROM MECHANICAL VENTILATION: A SCOPING REVIEW OF QUALITATIVE STUDIES;

By Louise Rose, PhD, Katie N. Dainty, PhD, Joanne Jordan, PhD, and Bronagh Blackwood, PhD;

AJCC AMERICAN JOURNAL OF CRITICAL CARE, September 2014, Volume 23, No. 5

Ref.:

What are Critical Care Nurses perceptions

of long-term MV patient in the ICU setting

Working in critical care is challenging and demanding

Majority of patients recovery is quick

Small but increasing number patients ICU stay is

complicated and prolonged

Long-term ICU patients have complex needs

Consequently they maybe perceived as “difficult” or

“unpopular” to care for

Clinical challenges of caring for the long-

term intensive care patient

Psychological challenges

- Supporting the patient emotionally

- Keeping long-term patients upbeat/interested

- Facing intimating and manipulative behavior

- Relatives’ anger and hostility

Patients’ family members, who know patients better than any health care provider does and who spend time at the bedside observing interactions between patients, theventilator, and clinicians, can offer important insights.

Organisational challenges associated

with long-term ICU patients

Staff allocation

Supporting and protecting the nursing team

Providing adequate support

Equipping ICU nurses with relevant

skills/knowledge

Psychological aspects of weaning

1) MV patients know that their ability to breath

depends on help from a machine

2) ET tube makes hard to communicate

3) Inability to talk : anxiety, helpness, anger,

despair, hopeless,…

4) Other stressors : dyspnea and sleep

difficulties

What are psychological needs…

An interview with long-term weaning

patient

Jimmie E. Owen, 38 years old

Heart transplant

ICU days 41

Intubated 4 times, MV more than 15 days

After last extubation passed already 35 days

All artificial support in ICU till he stayed there

- ET tube with MV

- R-VAD

- Hemodialysis

- Inotropes and vasopressors at CVC

Video

How to communicate with intubated

patients

Also we can use…

If we look ourselves in a mirror, we can

see that all our needs are similar

Conclusions

Caring for long-term critically ill patients can be

difficult and demanding

Adequate formal and informal support

mechanisms would help ICU nurses to meet the

very complex set of needs of long-term critically

ill patients

One of the goals was to understand decision-

making processes and patient’s experiences

Conclusions

Being delivered into the safe hands of health

care providers (feeling vulnerable and

dependent; struggling to communicate; feeling

safe with staff; being cared for in an unknown

environment) keep experience of the ICU

positive and made win-win type

Maximising the quality of care long-term

(weaning) patients receive while minimasing

the stress ICU nurses experience during care

delivery

And that’s my pshycological need every

morning…

Thank you…

any questions

???