Nurses' Perception of the Extubation Process for the Stable Cardiac Surgery Patient

Wednesday, 15 July 2009: 11:05 AM

Linda L. Henry, PhD, RN1
Lisa M. Martin, PhD1
Linda Halpin, RN, MSN2
Janice White, RN, BSN3
1Cardiac Surgery Research, Inova Heart & Vascular Institute, Falls Church, VA
2Cardiovascular Step Down Unit, Inova Heart & Vascular Institute, Falls Church, VA
3Cardiovascular Intensive Care Unit, Inova Heart & Vascular Institute, Falls Church, VA

Learning Objective 1: gain insight into nurses' perceptions of extubating the stable cardiac surgery patient.

Learning Objective 2: understand the barriers of nurses in adhering to a extubation protocol of under 6 hours.

Purpose: Timely (early) extubation, defined as extubation within 6 hours from surgery, has been shown to improve outcomes for the stable cardiac surgery patient.  Our target time in our cardiovascular intensive care unit (CVICU) for these patients was exceeded in 25% of the patients.  The purpose of this study was to explore the CVICU nurses’ perceptions of the extubation process.

Methods: This was a descriptive, qualitative study to elicit the CVICU nurses’ thoughts on timely extubation.  The question, “Tell me what early extubation means to you?” was used to initiate conversation and in gathering information about the barriers they see to obtaining a timely extubation. After institutional approval, 3 focus groups were held; participating nurses were compensated. After consent, groups were audio-taped and transcribed verbatim. Two PhD trained qualitative researchers independently reviewed the transcripts for central themes.

Results: Fifteen nurses participated; current CVICU experience ranged from <2 years to >10 years.  Concerns centered on specific pieces of the extubation process which were potential barriers: visiting family, non functioning equipment and lag time in obtaining laboratory results.  Other concerns were the need to know more about patient outcomes and understanding why there was an emphasis on a 6 hour timeframe.  The overarching concern was the nurses’ need to make sure they were doing the “right thing” which meant extubating the patient when they felt “the patients were ready and stable”. 

Conclusion: Nurses expressed the biggest concern when extubating the stable cardiac surgery patient as wanting to do the right things for their patients.  Perceptions of having a timely extubation process were dependent on pieces of the extubation process such as safely extubating patients. Successful timely extubation requires nurses be provided with functioning equipment, knowledge of patient outcomes and further education of why stable patients should be extubated within 6 hours.