All posts by Bob

Nurses Collaborate for Ventilator Weaning


              Patients that have serious illnesses often are admitted to the Intensive Care Unit (ICU). A majority of these patients are also on mechanical ventilation to assist with breathing after experiencing acute respiratory distress syndrome (ARDS) as a result of “either direct or indirect pulmonary injury” (Morton & Fontaine, 2013, p.233). Mechanical ventilation is used to  treat a patient that cannot breath on their own. Unfortunately, invasive artificial airways often come with their own complications and high costs.


              Mechanical ventilation is well know to cause ventilator associated pneumonia (VAP) and other nosocomial infections. Studies also show that the longer the length of time on a ventilator, the higher it correlates with hospital re-admissions and a draining of ICU resources (Douglas, Daly, Brennan, Gordon & Uthis, 2011). There is evidence based support for getting patients off of ventilators and sedation, as quickly and safely as possible.


              In the article, “Collaborative practice: development, implementation, and evaluation of a weaning protocol for patients receiving mechanical ventilation,” authors write about how patients are typically weaned off of the ventilator and identified a problem with the fact doctors decided subjectively to wean patients and it is not based on protocols (Grap, Strickland, Tormey, Keane, Lubin, Emerson, & … Sessler, 2003). The doctors would use different parameters and those parameters varied from each doctor and each hospital (Grap, 2003).


               Grap et al., have focused on using a multidisciplinary approach to wean  patients off of their ventilators sooner; this approach utilizes a standardized protocol for weaning the patients (2003). The article researched the medical respiratory ICU (MRICU) protocol which is composed of several scales, guidelines, and assessment tools to help identify if the patient is ready to be weaned (Grap et al., 2003). The article showed that “[p]atients receiving mechanical ventilation have shorter hospital stays and lower costs when a weaning protocol is used” (Grap et al., 2003, p. 455). The article also supported nurses autonomy and working with the respiratory therapist to individualize the weaning process; this encouraged strong communication within the interdisciplinary team (Grap et al., 2003).

Douglas, S., Daly, B., Brennan, P., Gordon, N., & Uthis, P. (2001). Hospital

readmission among long-term ventilator patients. Chest120(4), 1278-1286.

Grap, M., Strickland, D., Tormey, L., Keane, K., Lubin, S., Emerson, J., & … Sessler,

C. (2003). Collaborative practice: development, implementation, and

evaluation of a weaning protocol for patients receiving mechanical

ventilation. American Journal Of Critical Care12(5), 454-460.

Morton, P. G., & Fontaine, D. K. (2013). Essentials of Critical Care Nursing; a

               holistic approach. Philadelphia, PA: Wolters Kluwer.

Nurses with “White Caps” and now with “Apps”

Technology….to me…is amazing, wonderful, and once you learn how to use it effectively, is so helpful! I have been using my electronic medical record (EMR) at my job for almost two years and I still learn a new trick and short cut at least every couple of weeks. I have some reservations about the accuracy, generalizability, and the overall safety, but all in all, I feel that these are helpful tools that will only provide practitioners more knowledge right at their fingertips. I have already witnessed the providers searching on their phones for pharmacology.

For my own nursing future, I believe it will make my job easier in terms of finding the necessary information in times that I am unsure. A couple examples are, accessing Epocrates when a patient is on a medication I am unfamiliar with; also, the app for medical Spanish or google translator…I often have patients that have language barriers and with a little help it would make a world of a difference in their understanding and compliance.  A downside that I foresee, is having patients feel a false sense of empowerment with the information and they may either incorrectly self-medicate, or they may come in and argue with me or the providers because they are sure they have what they researched on the internet (I have already encountered this).

I feel like I will use technology more in the next few months because just going through the new apps available enticed me to download more and I am excited to try out my new sleep cycle app. I sleep talk and sleep walk so I have Excessive Daytime Sleepiness (EDS) and I am curious to see my data charted on this app of how often I stir. I also downloaded Medscape which may come in handy as a quick reference for my triages. I like to look things up and figure things out when they are new, so this app will expedite that.

I feel that the patient portals where they enter their data for blood pressure (BP) and blood sugars (BS) will be very helpful for providers if the patients are completing them correctly. This will eventually become a staple of assessments. The app for continuous heart monitoring will also be a helpful assessment tool.

Managing care at home through mobile technology will be extremely difficult for many people. Patients have difficulty operating their BP and BS monitors, let alone all these different devices. I do, however, feel that where there is a will there is a way and if any individual sees the benefits outweigh the costs, they will make stronger attempts at mastering these new technologies.

The safest way to evaluate the effectiveness of these technological advances is by testing them against evidence based data and our assessment skills. The patients will still need to come in for check-ups, this is not a replacement for face-to-face evaluations, this is just a tracker for continuity of care.

There is plenty of research that has been done to evaluate the effect of technology on patient care. Informatics has been a part of nursing for quite some time and the data is always evaluated as part of the nursing process. The more and more technology that is introduced, the more research will be completed.

As I mentioned before, some of the things I can anticipate as a “con” are the patients’ false sense of completely understanding their healthcare needs, the lack of knowledge on how to use the technology properly, the accuracy of their recordings, the accuracy of our technology for each patient, the lack of face-to-face assessments and treating the individual, and more. Some of the “pros” are the continuity of care, the accessibility to information, the patients’ involvement in their care and the encouragement towards health promotion. More pros are the savings in cost for the patient and healthcare agencies, the patients have access to their records faster, and more.

Down the technology road….

Greetings classmates and fellow bloggers. Here is the beginning of my path down the technology road…my first blog on my new website…

As you can see, this is me on the side menu, I was getting ready for my RN Pinning Ceremony in 2013. I initially wanted to go to school to be a doctor but I was placed in a vocational class to become a CNA my senior year of high school and stayed in nursing since then (13 years). I was a CNA for a couple years but the pay was horrible for all the hard work so I became a waitress and a nanny to put myself through college. I received an AA in Math and Science, an AA in Liberal Arts, and my ADN in Nursing. I finished a BA in Psychology at CSU San Bernardino and I am now completing my BSN at CSU Channel Islands.

On 10/4/2015, I will be married a year to Ismael Lozano. We just found out we are pregnant (still VERY early so keep those fingers crossed). I have two sisters and my parents will be married 40 years on 12/31/2015. I am very close with my family and my husband is close with his family as well.

I love to wine and dine, listen to live music, try new things, dance, sing karaoke, and play volleyball.

I work at an ambulatory care clinic in Thousand Oaks. These are the responsibilities of my position: Charge Nurse, triage Monday through Friday, eight to five, prescription refills and prior-authorizations for two providers, resource cart daily check, fluoride monthly reports, nurse visits: PPD readings, injections, wound care, patient self injection education, sample medication management: calling reps for stations A,B,C, and Urgent Care, receiving and stocking sample medications for stations A,B,C, and Urgent Care, Patient Assistance Program medication processing, medication room inspection and month-end report. I love my job. I hope to stay for a long time and eventually work there as a Nurse Practitioner.

Very early but very excited!!
Very early, but very excited!!