Abstract
The nurse functions as an independent practitioner, as part of the multi-disciplinary health team, during the delivery of nursing care to an adult patient on pressure-controlled ventilation in a critical care unit. Pressure controlled ventilation as a mode of mechanical ventilation is generally practiced in critical care units. Pressure controlled ventilation refers to a controlled mode of mechanical ventilation in which all breaths are pressure limited and time cycled, with no possibility for patient triggering, often achieved by sedation and / or paralysis (Hess & Kacmarek, 1996 : 20). Pressure-controlled ventilation is associated with a multiple of life-threathening complications such as barotrauma (Chlochesy, Breu, Cardin, Rudy & Whittaker, 1996 : 267 - 270). Therefore it is important to describe a framework according to which the nursing care of a patient on pressure-controlled ventilation in a critical care unit can be approached. Although general frameworks for the nursing care of a patient on mecahnical ventilation exists, no such specifc framework exists that describes the nursing needs of an adult patient on pressure controlled ventilation by the critical care nurse. Such a framework will be described in this article. The purpose of this article is to describe a framework for the nursing care of an adult patient on pressure-controlled ventilation in a critical care unit. An explorative, descriptive research-design (Mouton & Marais, 1990 : 44 - 46) was implemented to achieve this purpose. Based on a purposive study of both national and international literature and the triangulation thereof with other data-sources (Burns & Grove, 1993 : 277), like physicians and critical care nurses, a framework for the nursing care of an adult patient on pressure-controlled ventilation in a critical care unit is described. A cognitive analysis, that includes both inductive and deductive thinking strategies, is applied during the study of the literature. Trustworthiness in the study was ensured through the application of the following measures for trustworthiness, namely triangulation, prolonged engagement, peer-group discussion, referential adequacy, stepwise repeat, investigative auditing, and dense description (Lincoln & Guba, 1985 : 289 - 331). According to the framework described in this article, the nurse as independent practitioner functions as part of a multi-disciplinary health team during the nursing care of an adult patient on pressure-controlled ventilation in a critical care unit. The context in which the nurse functions during the nursing care of an adult patient on pressure-controlled ventilation in a critical care unit, guides his/her actions that he/she performs on the adult patient. As independent practitioner during the nursing care of an adult patient on pressure-controlled ventilation, the nurse is responsible and accountable to carry out certain clinical actions, that are applicable to the nursing care of an adult patient on pressure-controlled ventilation, based on a scientific-approach, through demonstration of certain abilities, within the legal-ethical, philosophical and management framework of his/her profession.
(Health SA Gesondheid : interdisciplinary research journal: 2002 7(3): 3-18)
