The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

A Respiratory Care Protocol Program in a Teaching Institution: A Nursing Perspective

Greg Nichols MSA, RRT, and Robert Messenger BS, RRT, Respiratory Care Division - Pulmonary Services Department, MetroHealth Medical Center, Cleveland, OH.

Introduction: In our institution, nurses have traditionally been the primary non-physician assessors of the patient's overall status. With the implementation of our patient driven protocols (PDPs), Respiratory Care now shared this assessment role with the additional latitude to start, stop and modify therapy. We sought to determine how this role change affected nurses' perceptions of this program and the Respiratory Care Practitioners at this large metropolitan teaching institution. Method: A 13 question survey was distributed to the nurses. The survey was designed to gain insight on their perceptions on how our PDP program had impacted timeliness, quality and appropriateness of the respiratory care rendered, and the professionalism of the participating RCPs. Additional questions addressed the respondents demographics within the institution, their knowledge of our PDP program goals, the number of their patients that had been on the PDP program, and if the program should be expanded to include additional procedures. 97 questionnaires were sent to nurses on the medical and surgical firms. Results: 58 of the 97 surveys were returned (59.8%). 30 Medical and 28 Surgical Nurses responded, representing an even distribution of respondents 51.7% and 48.3% respectively. 45 of the 58 (77.6%) responding nurses felt they understood the goals of the program. There was no clear delineation of the response differences when analyzed by division, area (i.e., acute care, ICU, rehabilitation), shift or length of employment at the medical center. The tables below delineate the responses:

Table 1

Significant Decrease No Increase Significant No

n = 58 Decrease Change Increase Response

Timeliness 2(3%) 4(7%) 9(16%) 31(53%) 11(19%) 1(2%)

Quality 0(0%) 2(3%) 14(24%) 29(50%) 13(22%) 0(0%)

Appropriateness 0(0%) 2(3%) 6(10%) 35(60%) 15(26%) 0(0%)

Professionalism 0(0%) 1(2%) 21(36%) 26(45%) 8(14%) 2(3%)

Table 2. Yes No No


n = 58

Should a PDP for hyperinflation be developed? 46(79%) 12(21%) 0(0%)

Should a PDP for pulmonary hygiene be developed? 56(97%) 2(3%) 0(0%)

Should a PDP for trach management be developed? 48(83%) 10(71%) 0(0%)

Conclusion: The results indicate a favorable perception of the program among the responding nurses. Greater than 60% of the respondents identified an improvement in the respiratory care resulting from the program (Table 1). Also, the respondents supported the specific concepts for further expansion of the program (Table 2). This survey indicates that Respiratory Care Services can be expanded through PDP resulting in a favorable exceptance and support by nurses.


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