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Biomedical subjects

M E Shekleton

Publications and source records attributed to M E Shekleton.

11 recordsLinked to original sources
PubMed1998

Weaning from mechanical ventilatory support: refinement of a model.

The American Association of Critical-Care Nurses sponsored the third National Study Group to advance the science of weaning from mechanical ventilatory support and to guide clinical practice. The study group proposed a model of weaning in 1994 to provide an organizing framework for scientific inquiry. Since the model was first proposed, the ongoing work of the study group has led to refinement of the model. The purpose of this brief communication is to inform critical care clinicians and researchers about the refinements.

Critical Care↗
PubMed1997

A volunteers in participatory sampling survey of weaning practices. The Third National Study Group on Weaning from Mechanical Ventilation.

The survey results of the VIPs membership described in this article add qualitative information to the growing body of scientific knowledge on weaning patients off ventilators. Clearly, quantitative studies exploring the efficacy of different weaning practices across the continuum must be done if we are to accurately compare practices and prescribe the "when" and "how" of weaning. To this end, the Third National Study Group is revising the proposed weaning model and model in order to further elucidate the state of the art and science of weaning.

Adult↗
PubMed1995

Weaning from long-term mechanical ventilation.

Although many investigators have attempted to identify weaning predictors and weaning modes for use in long-term mechanically ventilated patients, none has emerged as superior. Furthermore, few investigators have viewed the process of weaning as a dynamic continuum; thus, guidelines for care of these patients have yet to be developed. Facilitative methods and therapies to enhance weaning potential, although attractive, have little scientific basis for application. Care delivery systems, which focus on systematic, comprehensive and coordinated care, are promising because outcomes demonstrate that they are economical, safe, and effective. This article reviews the research on weaning adult, long-term mechanically ventilated patients, suggests future research directions, and highlights the scientific basis for practice guidelines.

Adult↗
PubMed1994

Terminal weaning from mechanical ventilation: a review.

Terminal weaning is a clinical intervention for withdrawing mechanical ventilatory support when such support is an unacceptable outcome for a patient. Withdrawal of life support must be done in a humane manner for the patient, the family, and the patient's care providers. Research-based directions for clinical practice are limited because of the paucity of research in this area. Recommendations for future study are related to methods, facilitative therapy, patient, family, and caregiver responses, and care delivery models.

Family↗
PubMed1994

Weaning from mechanical ventilation: concept development.

This article, the first in a series, is written to clarify the process of weaning from mechanical ventilation and to promote the development of a common language for understanding the complex weaning process. The Third National Study Group on Weaning From Mechanical Ventilation proposes a conceptual model and definitions that will provide a framework for future research on this important topic. This conceptual framework describes the preweaning phase, the weaning process, and the outcome phase of mechanical ventilation. Potential outcomes are completion of weaning, lack of completion, and terminal weaning. The weaning decision continuum incorporates: (1) when and how to begin the weaning process, (2) how to select therapies to assist with difficult weaning and chart progress during weaning, and (3) when to stop weaning if progress is no longer being made. An inherent assumption of this model is that each patient will display unique responses to the weaning process. The proposed conceptual framework and definitions provide a foundation for developing clinical practice guidelines and for guiding future ventilator weaning research.

Decision Making↗
PubMed1994

Weaning from short-term mechanical ventilation: a review.

The purposes of this article are to: identify gaps in the research literature on weaning adult patients from short-term mechanical ventilation, highlight the scientific base for practice guidelines, and suggest future research directions. Data bases from 1989 through June 1993 were reviewed, and relevant research articles were extracted, analyzed, and synthesized within the AACN Third National Study Group framework. Seminal work and other supportive literature also were used in this review. Despite considerable research on predictors and patient responses to weaning from short-term mechanical ventilation, few of the findings can be applied to clinical practice at this time. Less research is available on weaning modes and therapies that facilitate weaning from short-term mechanical ventilation; fruitful research in these areas depends in part on a better understanding of patient responses and accurate weaning predictors.

Dyspnea↗
PubMed1991

Respiratory muscle conditioning and the work of breathing: a critical balance in the weaning patient.

Normal ventilatory function depends on a balance between ventilatory demand and ventilatory capacity. The respiratory muscles play a critical role in achieving this balance. For patients experiencing ventilatory dysfunction, interventions that improve respiratory muscle function and therefore increase ventilatory capacity may be one way of restoring the balance and promoting ventilatory function. Respiratory muscle conditioning, or training the muscles to improve their strength and endurance, may be a useful clinical intervention in the weaning patient. Results of research show that muscle training may increase the ability of some patients to resume spontaneous ventilation. Continued research is needed to identify the appropriate training protocols for patients experiencing an acute imbalance between ventilatory demand and capacity.

Clinical Protocols↗
PubMed1987

Coping with chronic respiratory difficulty.

The major point of this article is that the pathologic process of chronic respiratory disease interacts with psychologic and psychosocial factors as determinants of the respiratory patient's quality of life. The assessment, support, and reinforcement of a patient's psychosocial assets and ability to cope with chronic respiratory difficulty can help enhance that quality. This outcome should be a primary consideration of the nurse caring for a respiratory patient despite the fact that, in this era of cost containment, improved life quality may be an outcome that is overlooked, ignored, or undervalued.

Adaptation, Psychological↗
PubMed1987

Ineffective airway clearance related to artificial airway.

Ineffective airway clearance occurs when an artificial airway is used because normal mucociliary transport mechanisms are bypassed and impaired. Nursing assessment and intervention are the keys to maintaining airway patency in the patient with an artificial airway in place. The assessment of breath sounds is critical to making a valid clinical judgment about airway patency. Nursing interventions such as tracheobronchial suctioning, postural drainage, and providing exogenous humidity to the inspired air are indicated to maintain airway patency, which is the goal of treatment. Suggested areas for future research related to this diagnosis include validation of the signs and symptoms which are proposed as being specific to the causes of ineffective airway clearance and the continuation of experimental studies to demonstrate the efficacy of various interventions for this nursing diagnosis.

Female↗
PubMedDate not supplied

Communicating with ventilator dependent patients.

One major psychosocial problem of mechanically ventilated patients is their inability to speak because of the cuffed endotracheal or tracheostomy tube obstructing the larynx and airflow. The authors analyze the research findings to suggest research-based strategies for communicating with ventilator patients.

Attitude to Health↗