Rebecca Sherborne

Post Ventilation Patient Interview

The only patient that I have experience who was intubated was an
older gentleman, we met while I was shadowing a nurse at this time. He was
intubated four about three days due to sudden shortness of breath which
compromised his airway. He was very pleasant, although it was somewhat
hard to communicate because his voice was extremely raspy and I could not
always understand what he was saying. His wife was present at the bedside
which helped the patient remained calm, he was able to feed himself
however he was on a dysphagia three diet, meaning that he was able to
have thickened liquids and purred foods. During my experience here we were
able to communicate enough where he did not have to write down what he
was trying to say.
Patient interview
When I think of our patients being intubated I immediately think of
fear. Not being able to breath is probably one of the scariest and anxiety
stimulating situation a person can experience. If one of my patients were to
remember their intubation experience or even wake up with an endotracheal
tube in place I can imagine that they would be terrified especially if a
paralytic medication was used, I can imagine they would want loved ones
close by for comfort.
When interviewing the patient, we asked them about not only their
emotional and physical experienced of being intubated. When patients are
intubated many times they do not have much memory of the experience

however it is possible for them to remember some experiences. In this case

the patient did not hear anything. However, it is possible that she could have
been aware of noises from the machines in the rooms and even the
healthcare staff conversing around them. They also may be able to hear
family members voices which could be a source of comfort for them. During
this time, they may be awake or unconscious so they may be able to see all
the machines making the sounds and those providing care, in most cases the
patient is sedated for their comfort so they may not be awake. This patient
does not remember seeing much while being intubated because they were
sedated but he does remember the healthcare team standing around him as
they were discontinuing the intubation tube. The patient was aware vaguely
of the healthcare team moving him and even when his loved ones would hold
his hand. For this reason, as staff we should always speak directly to the
patient whether they are conscious or not and explain exactly what we are
doing to help them, this can help relieve anxiety about what they are
experiencing. Anxiety is extremely high when the patient is intubated,
especially because their ability to communicate is compromised. This patient
had both family and healthcare workers talking to them throughout this time
and was address the patient directly in a soft manner, this was done in order
to help alleviate the stress and anxiety the patient felt about the experience
as much as possible. Personally I was originally nervous when I entered the
room and saw that the patient was intubated, it was the first time I had ever
taken care of an intubated patient, but as I started working with the nurse I

became much more comfortable and I felt comfortable assessing the location
and general condition of the patient.
Reflection
After this interview I learned quite a few things, first as nurses we
should recognize that this is a scary time for both the patient and their
involved family and we should be sensitive to this. We should allow the
family to be present because having those we care about and trust nearby
can help calm the patient and help them feel more comfortable. If those
patients are awake, we should also make sure that we find a good way of
communication. We may not always be able to read the lips of these patients
or hear them after the tube has been removed so advocating for a while
board or a picture board should be incorporated into care. Lastly it is
important that we are regularly checking on these patients and providing
adequate oral care, turns, and even suctioning when it is warranted in order
to prevent complications.
Ventilation associated pneumonia is a safety and quality of care issue
that many patients still experience. Although there are several methods that
have been identified for prevention it still requires that staff understand and
implement these interventions. One way we can improve safety and quality
of care in these patients is adequate hand washing from those who are
providing care. In an article exploring the risks and strategies to prevent
vent-associated pneumonias they identified hand washing with antiseptics,
even if gloves are worn (Morrow & Kollef, 2011) as the most important

preventative measure for preventing vent-associated pneumonia. When we

intubate a patient we have put a tube in that is a direct access to the lungs
for bacteria, this makes hygiene practices extremely important. In order to
promote adequate hand washing practices, units should do random
compliance checks and observe if the healthcare staff are washing their
hands upon entering the room and again when they leave. If staff are found
to not be compliant they should receive further education on its importance
and should be assessed by a leader again in the future to evaluate further
compliance.

References:
Morrow, L., & Kollef, M. (2011). VAP prevention: Pharmacological strategies. Nosocomial and
Ventilator-Associated Pneumonia, 74-82. doi:10.1183/1025448x.10023110