Patient Need During Mechanical Ventilation Literature Review

Patient Need During Mechanical Ventilation Literature Review Review of literature is a systematic search of the published work to gain information about a research topic. It is a compilation that provides the ground work for the study. A literature review is a Critical analysis of a segment of a published body of knowledge through summary, classification and comparison of prior research studies, review of literature, and theoretical articles.(Wisconsin 2004) This chapter deals with the information collected in relation to the ypresent study through published and unpublished materials, which provided the foundation to carry out this study. In the present study the review of literature is organized and presented as  follows. Literature related to patients need during mechanical ventilation. Literature related to augmentive and alternative communication methods Literature related to patients satisfaction Literature related to patients need during mechanical ventilation Wojnicki-Johansson (2001) conducted a study among nurses to evaluate the communication of mechanically ventilated patients in the ICU (n = 22). Among the 22 patients, 19 patients have had good functional communication. Three patients reported that nurses were unable to understand their messages. The author suggested that nurses should critically evaluate their communication skills and frequently verify the content of communication with patients. Rotondi, Armando J. (2006) conducted a prospective cohort study on intensive care unit patients (n = 150 ) receiving mechanical ventilation. In this study the researcher collected data on patients physical(e.g pain) and psychological( anxiety) experiences with the mechanical ventilation. The study revealed that among two third of patients were strongly associated with experience of sleeplessness , fear , inability to communicate, pain, tense and loneliness. Bergbom-Engberg and Haljamae (2003) conducted a retrospective study, interviewed 158 patients on their recall of experiences while being mechanically ventilated 2 to 48 months after their ICU experience. Approximately half of the subjects reported experiencing feelings of anxiety/fear, agony/panic, and insecurity, and found it distressing not to be able to communicate properly with the nurses and their relatives. Lance  Patak, et al, (2004) conducted a descriptive study using qualitative and quantitative methods, a total of 29 critically ill patients, extubated within the last 72 hours,. It was found that 62% of patients (n = 18) reported a high level of frustration in communicating their needs while being mechanically ventilated. There was no significant difference between the duration of intubation and the level of frustration (Spearman r 5 .109, P 5 .573). Mechanically ventilated patients experience a high level of frustration when communicating their needs, and health care providers have a significant impact on the mechanically ventilated patients experience. Stacey M. Carroll (2004) used metasynthesis and understanding of non vocal mechanically ventilated patients experiences with communication. The final sample (n=111) included 12 qualitative studies. The data, methods, and theoretical frameworks were critically interpreted. The samples are divided into two groups. In the first group, the characteristics of nonvocal ventilated patients communication experiences were often not understood, which resulted in loss of control and negative emotional responses. In the second group, nonvocal patients wanted nursing care that was delivered in an individualized, caring manner. This facilitated positive interpersonal relations between the patient and the nurse. Johnson and Sexton (2007) interviewed (n=14) patients and identified 19 factors that caused distress for these patients. In this qualitative study, the inability to speak was identified by all participants as causing distress to some degree, from mild to extreme. In addition, other factors causing distress included pain/discomfort from the endotracheal tube, suctioning, inability to determine time, and noise. These distressing factors can be alleviated by health care professionals Kefang Wang et al, (2008) conducted a phenomenological approach and Giorgis phenomenological analysis procedure was used to analyse the data. Participants (n=11) surviving from mechanical ventilation were interviewed in-depth, described their experience which were: being in an unconventional environment, physical suffering, psychological suffering, and self-encouragement and self-reflection. Self-encouragement and self-reflection enhanced patients self-confidence, which was beneficial to recovering. Critical care nurses should place the highest priority on recognizing and meeting the needs of ventilated patients in intensive care units. Fatma Eti Aslan (2009) conducted a descriptive study with patients (n=300) in a cardiac surgery ICU post-operatively for a minimum of 48 h, had a sternal incision, chest tube, and required mechanical ventilation. Most patients described their pain as aching (n = 177) and throbbing (n = 154). The presence of chest tubes (n = 95), endotracheal tube suctioning (n = 47), change of dressings (n = 27) and the use of air mattresses (n = 20) were also identified as painful experiences for patients. Nuran TOSUN et al (2010), conducted a descriptive study on patients (n = 155) who were admitted to medical or surgical ICUs and the patients were interviewed with a semi-structured interview form, to determine the experiences related to mechanical ventilation (MV) The data were evaluated with Colaizzis qualitative research analysis method (91.41  ± 34.91). Physical restriction, dependency, air hunger, thirst, pain, inability to talk and difficulty to be understood were described as uncomfortable and stressful experiences for the patients. Flexible family visits, positive thinking, praying, hope for survival, care by experienced and friendly ICU nurses were effective for coping with stressful factors related to prolonged MV and the ICU environment Literature related to augmentive and alternative communication methods Stovsky et al. (1988) used a quasi-experimental design to compare two methods of communication in patients (n=40) receiving ventilator support after cardiac surgery. The study explored patients experiences and preferences for augmentative and alternative communication (AAC) methods during mechanical ventilation including yes/no questions, mouthing words/lip reading, facial expression reading, and use of an alphabet board, a magic slate board, a phrase board, and electronic scanning devices The experimental group (n = 20) was introduced to a communication board before surgery and they used the board during the postoperative period while receiving mechanical ventilation. The communication board used icons and pictures to represent basic needs (pain, fear, heat/cold, thirst, and bedpan). In contrast, the control group (n = 20) relied on standard care and on the experience of nurses. Patients in the experimental group were significantly more satisfied with communication using the board t han were patients in the control group (P = .05). Lawless (1975) conducted a study on ventilated patients (n=30) and the study described different types of boards that could be used to help patients communicate during mechanical ventilation: a magic slate board, magnetic plastic letters and board, an alphabet board, a picture board, and a simple writing board. Critical care nurses were used such type of AAC methods to assess their effectiveness in facilitating communication Reed (2008) conducted a study among nurses and patients regarding communication methods used to communicate. The study revealed that 60% of mechanically ventilated patients were extremely frustrated with their inability to communicate and 75% of nurses perceived their methods and 51% of patients preferred the picture board as their best method compared to other communication aids and basic methods, and 58% of nurses reported the picture board as the most beneficial method. Inke eh, light j à ¢Ã¢â€š ¬Ã†â€™kitko l (2008) done quantitative research regarding communication between nurses and patients (n=60) with complex communication needs (CCN). The Augmentative and alternative communication (AAC) strategies that can be used by nurses to facilitate more effective à ¢Ã¢â€š ¬Ã¢â‚¬Å¡communication with patients with CCN. Difficulties in communication between nurses and patients arise when patients are unable to speak. . Using AAC strategies will help nurses and patients better communicate with each other when speech is not an option. Literature related to patients satisfacion Annie (2007) performed an experimental control trial of patients (n=60), and the study demonstrated that 73% patients without the communication board found their communication process was inadequate. 80% found their communication was adequate with the communication. 63% of patients reported being unsatisfied with their communication process without the communication board and with the board, 77% were satisfied. Of those who used the Communication Board, 80% were satisfied with the board, 20% moderately satisfied and none reported unsatisfied. Nurses, however, reported 53% satisfaction, 30% moderately satisfied and 17% unsatisfied. Overall, the patients with the Communication Board reported higher satisfaction with communication (p AC Jansen,et al (2009) done a study, developed a questionnaire that consisted of 60 questions in eight domains (General satisfaction, Reception, Physical care, Mental care, Empathy and attention, Communication and information, Surroundings and Physical discomfort). Answering possibilities ranged from 1 (not satisfied) to 5 (completely satisfied). all consecutive adult patients from a 29-bed, tertiary-care, medical, surgical, neurosurgical and thoracic-surgical ICU were interviewed within 4 days after discharge. Demographics and clinical characteristics were obtained from electronic records. General linear modeling (GLM) with Bonferroni-Holmes correction was used to study the relationship between overall patient satisfaction scores and the eight domains, corrected for patient and ICU-related factors. The model was tested for clinically relevant interaction between determinants. Ninety-eight patients were interviewed. The mean overall patient satisfaction score was 4.60 (SD = 0.93). Of the eight domains, only Communication and information (P = 0.039) appeared to be significant in predicting general satisfaction. Also sex (P = 0.046), length of ICU stay (P = 0.042), the interaction between Communication and information and age (P = 0.016), and the interaction between Communication and information and Minimal Mental State Examination score (P = 0.013) were significant. An indepth analysis of Communication and information showed that the interaction of communication with birth country (P Parsa-Yekta.Z, . (2009) conducted a quasi experimental study to compare the effects of two types of communication methods on anxiety and satisfaction in patients (n=90) after cardiac and bypass surgery having intubation. Patients were randomly selected by divided into two groups (experimental and control). The researchers met all patients the day before the surgery explained the reason and use of the picture chart for the experimental group and the routine communication methods for the control group. Data collection was done through a questionnaire consisting of: 1) demographic specification and clinical history, 2) Spielburgers questionnaire for obvious anxiety and 3) visual analogue scale (10cm) for patient satisfaction evaluation which is undertaken the day after surgery and after extubation. The results of the G ² test and the Fishers exact test showed significant statistical differences between the two groups concerning the level of the patients anxiety and satisfaction. The use of the picture chart for the experimental group, decreased patients anxiety resulting from speech disability and increased their satisfaction with their communication with nurses as compared to the control group.

To Kill a Mockingbird by Harper Lee Essay -- To Kill a Mockingbird Essa

Prejudice has caused the pain and suffering of others for many centuries. Some examples of this include the Holocaust and slavery in the United States. In to Kill a Mockingbird, by Harper Lee racism was the cause of much agony to the blacks of a segregated South. Along with blacks, other groups of people are judged unfairly just because of their difference from others. The prejudice and bigotry of society causes the victimization of people with differences. Some who are discriminated against are those who are born differently than the majority. One person that is treated unfairly is Calpurnia, as you can see when Aunt Alexandra tried to get Atticus to fire Calpurnia, because in her eyes, Calpurnia wasn't a good enough female role model (p.136). This is a prejudice action, because Calpurnia is as good as a role model as Aunt Alexandra, if not better. Aunt Alexandra is a bigot and doesn't see the character of Calpurnia, just the color of her skin. Another person who is treated like an inferior is Scout by her teacher, because she knew how to read. "She discovered that I was literate and looked at me with more than faint distaste. (p.17)." Scout is treated like it is her fault that she knows more than the average child did. She learned earlier than others so she gets punished unjustly. Tom Robinson is also one who is discriminated by a biased community. Tom is found guilty by the jury in his case against the Ewells (p.211). The guilty verdict is a direct result of a racist...

Black Hawk Down Essay

The name Black Hawk Down used as the title of this book in our context originated from the helicopter (UH-60 Black Hawk) used during the raid in Mogadishu. This raid is said to be one of the most combative war Americans have ever engaged in from that of Vietnam. The mission took place in October 1993 when helicopters dropped American solders in the heart of Mogadishu with aim of abducting top lieutenants of Somalia Warlord Mohamed Farrah Aidid. This was under leadership of Thomas Matthews who was deployed in Mogadishu, he lead Task force Ranger. This war was referred to as Operative Gothic serpent although it was later referred to as Battle of Mogadishu by international opposed media to this battle. â€Å"The most significant combat action took place on October 3, when Task Force Ranger captured six of Aideed’s [sic] lieutenants and several militiamen in a daylight raid. During withdrawal operations, the Somalis shot down two UH-60 helicopters and U. S. forces remaining on the ground came under heavy fire as they attempted to carry out rescue operations and consolidate their positions† (Spiller, para 4). This episode translated to intense fire fight which saw about 300 Somali nationals killed and others seriously injured. On the side of Ranger several were killed and others wounded before intervention of Pakistan and Malaysia intervened hence withdrawal of the forces. The story on modern war by Mark Bowden, a report with the Philadelphia inquire tries to analyze battle of Mogadishu which started with attempts of the American solder to capture aides to Aidid. The operation strayed with Delta force personnel through help of US army Rangers entered Mogadishu through helicopters to start the operation. This entry surprised Somali who were not were not aware of this mission. This called for rehearsal for using grenade and was successfully able to bring chopper down hence there capability in fighting new enemies invading their soil. The shooting of Back hawk helicopters through use of grenade formed a battle field where the American fought frantically to ensure they salvage there comrades. In his book Bowden tries to give a narrative of this war through reconstruction of the materials he was able to get through intensive interviews to the participants of this war. In his story he divert from the notion military history which always portrays glory of war without disclosing episode of horror which always engulf these kind of wars. Black hawk down story is literally distinctive in its style and this can be attributed to the fact that Bowden is a journalist but not a historian and writes his description of the combat as a tale, relatively like a fiction story. This book is set to represent the actual event and happening of the battle of Mogadishu. Bowden accomplished this through widespread research, consultations with accomplices from the two sides of the conflicts; this is also done through help of footage recorded by aerial observation aircraft at the fight as well as from recordings of the radio traffic from the clash. This book represent a parable of leadership which was unable to control the discipline of military personnel giving a picture of failure of the so perceived as strongest army in world. This is because military was unable to contain undisciplined militia putting the most powerful military in a precarious circumstances. The author demonstrates a situation of overconfidence since American military from the word go never expected the situation can in any way go against them. On the side of Rangers and delta forces soldiers in Mogadishu battle has elaborated as failure. The leadership controlling the war to command daylight raid has been describe as failure in military point of view. This raid on the side of America army cannot boost of victory since the only achievement attained was only seizing and imprisoning Somali clan officials who part of the mission of the war. In return to this achievement, a body of dead American member of Ranger squad being drugged in the street watering small achievement realized before the massacre. Mogadishu Massacre was motivated by the silencing of Somali warlord Mohamed Farrah Aidid who was wrongly perceived to have Hitler like trait, and was said to be responsible for thousands of brutal killings. There was information that this warlord ruled Mogadishu and hijacked UN food shipment acting in aid of war causalities. Aidid was also accuse of waiting the US Marine withdrawal and declaring war on U. N. forces ensnaring and killing of Pakistan peacekeepers. This is the incident which translated to sending of Ranger on mission to dismantle advancement of Aidid and ensure restoration of order within Mogadishu and its environs. This was meant to stop Aidid force from disruption of Red Cross distribution centre and killing of innocent civilians. Aidid was a powerful leader of Habr Gidr a large clan with political control within Mogadishu which controlled past as well as present political activities in this region. â€Å"The Habr Gidr were the militarily more powerful of two main groups contending for control of Mogadishu. If the U. S. had killed Aidid, citizens of the Habr Gidr areas wouldn’t generally have felt liberated, like Afghans freed from the Taliban† (Kaus, 2002 para 6). This book highlights phases of US and UN activities in Somalia. Firstly there was humanitarian phase where unite nations use military for to ease deliveries of food with aim of controlling deaths which could have emanated from starvation. This initiative was carried beyond from provision of food to the nation building mission in Somalia by UN. National building can be termed as the second phase with ambitions of restoration of entire country. From the ambitious mission of rebuilding entire Somali country Aidid claimed of UN official being against his and his clan of the said links with the former Somali dictator Siad Barre who was Aidid rival. From these suspicions intimidation of nation building started from the Aidid and his clan making effort to be at risk. National building needed very conducive peaceful environment from all clans and when Aidid intimidation started meant sinking of the national building efforts. Conference to forge for peace were staged but what followed after that was lack of peace deal and Aidid stepped up mission of detaining there rival something viewed by UN as intention to intimidate the peace talk. Attempt to marginalize Aidid politically by UN followed something viewed as a wrong approach to someone who had a backing of entire clan behind him. This is because to realize peace in this situation a better approach could have been employed to ensure existing military structure and power are dismantled or contained. This was followed by attempt of UN tying to shut down Aidid radio which was popular in propagating anti-UN propaganda a fact which made Aidid to see UN being against him. This is the issue which translated to the Mogadishu war from the attempt of UN tying to kill Habr Gidr clan member. After this was the incident of Black hawk down and translated to killings of innocent civilian an army leadership which has been greatly blamed for failed victory. â€Å"Crisis leadership came the hard way for U. S. Army Colonel Thomas Matthews, who led the Task Force Ranger mission in Mogadishu, Somalia in 1993† (Lagace, para 1). The situation in Mogadishu Massacre called for life or death decisions which were to be guided by Thomas leadership. This is the leadership which has been condemned for failed success in the ranger mission. The decision made by Thomas on this day resulted to crisis witnessed in this episode making a good lesson for our leadership decision especially in the army forces where decision with dire consequence are made. Work Cited: Kaus, Mickey: What Black Hawk Down Leaves Out, 2002. Retrieved on 20th September 2008 from; http://www. slate. com/? id=2060941 Lagace, Martha: â€Å"Black Hawk Down†: Leading in Crisis, (2003). Retrieved on 20th September 2008 from: http://hbswk. hbs. edu/archive/3430. html Spiller, Ronald L. : Film Review: Black Hawk Down, (nd). Retrieved on 20th September 2008 from; http://www. smh-hq. org/gazette/features/blackhawkdown. html.

Divergent Views Of Capital Punishment - 958 Words

Divergent Views: Capital punishment as a Human Rights Issue According to the basic principles of global human rights; capital punishment or death penalty is a crime towards humanity and the most crucial and important human right, which is the right to life. As a result, any form of justification attached to it is not valid arguing on the basis of the human rights organization policies. In order to successfully argue out the topic of discussion, this section uses two antagonistic perceptions of the debate namely the abolitionists and retentionists point of view respectively. The aforementioned comes in handy when trying to present the various stands that each group supports and using their stands to analyse and understand the efficiency and effectiveness of capital punishment as a way of striking justice and punishing law offenders. An abolitionist is any individual who supports the abolition of a given practice, in this case, capital punishment. The abolitionist spirit has always aim ed at trying to impose well on that thought to be socially unacceptable. A good example is the abolitionists influence on the abolishment of slavery in the United States and globally. Abolitionists argue that capital punishment brings more harm than good from a psychological, emotional, mental, religious and social point of view. On the other hand of the table, the retentionists exist, opposing the efforts of abolitionists. Retentionists support the enforcement of capital punishment with aShow MoreRelatedThe Death Penalty Should Be Reintroduced Into The Australian Legal System1350 Words   |  6 Pageson this topic to make an in-depth analysis on this issue and how it would affect the country. Introduction (100-125) Should we put capital punishment to death? Nowadays In modern and civilized societies, its supporters have decreased in number considerably. Critics view the death penalty as inhumane and barbaric. 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