Term of Award

Summer 1993

Degree Name

Master of Science in Nursing

Document Type and Release Option

Thesis (restricted to Georgia Southern)

Committee Chair

Camille P. Stern

Committee Member 1

Charlene Hanson

Committee Member 2

June Alberto

Abstract

Utilization of the endotracheal tube as a mechanism for maintaining control of airway patency and tissue oxygenation has been a standard of practice in modern critical care medicine. Complications can result from the accidental removal of the endotracheal tube from its proper position. This could lead to many severe ill effects including death. As a result, the prevention of accidental extubation becomes a priority for this patient population. The purpose of the study was to determine the effectiveness of the Accidental Extubation Risk Assessment Tool (AERAT) in identifying the level of risk of the ventilated patient for accidental extubation. The two research hypotheses tested were (1) that there is a relationship between the level of risk identified through utilization of the instrument and the incidence of accidental extubation, and (2) that there is a relationship between each identified risk factor and the incidence of accidental extubation. Betty Neuman's Systems Model was employed as a theoretical framework which addresses the goal of nursing as protecting the basic structure of the intubated patient by Identifying stressors that would provoke reaction (risk factors), by preventing stressor invasion (accidental extubation & complications), and by removing stressors that exist. The Accidental Extubation Risk Assessment Tool is an original, two part tool consisting of an assessment portion and a risk factor rating portion. It was designed to assess mechanical, physiological, and psychological factors. Unique to this study is the application of a weighted score to each risk factor designed to correlate with the likelihood that it increases the risk for accidental extubation. Content validity was established through review by 4 physicians and 3 critical care nurses. A prospective, nonexperimental study design using the risk assessment tool was employed. The population consisted of hospitalized patients admitted to a Medical-Surgical Intensive Care Unit who required mechanical ventilation and were at least 18 years of age. A convenience sampling technique was utilized with no controls for sex, race, education level, socioeconomic status, or diagnosis. The sample size was 55 patients with 60 episodes of ventilation. Prospective data collection was done on ventilated patients within 24, 48, and 72 hours of intubation and then weekly from the time of intubation until extubation, tracheotomy, or death. Retrospective data collection was done on every patient who experienced an accidental extubation. Data analysis included frequency distribution and chi-square application. The level of significance was set at p< .05. In testing the relationship between the level of risk identified and the incidence of accidental extubation, there were no significant differences between the interval checks in the groups who experienced accidental extubation and the group who did not. There was a significant difference between the participants who did not experience accidental extubation and the level of risk assessed retrospectively in the group that did experience accidental extubation. In testing the relationship between each risk factor and the incidence of accidental extubation, there was once again no significant differences between the interval checks in the groups who experienced accidental extubations and those who did not. There was again significant differences between the groups who did not experience accidental extubation and the retrospective assessment of the group who did experience accidental extubation. However, due to the small size of the sample and the presence of zero frequency in most of the cells, the validity of the findings are questionable. As a result, one can only suggest that there are differences as outlined in the level of risk and the incidence of accidental extubation as well as differences between specific risk factors and the level of risk for accidental extubations.

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