Reading Log 1

 

“At the time I guess I got a little more interested in the state of things within the state. I started to get a little political at that time and got a little more information about local people,” (http://www.jstor.org/stable/358929).

I choose this quote because I found the shared experiences of others an important component in learning. By listening to others speak about their personal experiences, I can learn to hear and think about their experiences and pick apart what the times were like and what the economical pressures were like. One can also begin to analyze life and how the overflowing of information from the affluent seems to over pour with no conscious intent onto the employees, or workers of the environment.

The passage also tells the reader a little more about the personal aspect of the worker and how important leadership plays a role into one’s development; Sponsors have a large involvement in the level of engagement to increase or decrease the learning of literacy. And it especially shows while reading the shared experiences.

“This analysis of sponsorship forces us to consider not merely how ones social group’s literacy practices may differ from another’s, but how everybody’s literacy practices are operating in differential economies, which supply different access routes, different degrees of sponsoring power, and different scales of monetary worth to the practices in use,”(http://www.jstor.org/stable/358929).

The analysis Brandt is talking about are the sponsors that one may encounter professionally, under her written accounts. Not only that but she finds that there are a diverse amount of backgrounds among individuals and the amount of resources available vary, and in an end result the career paths then vary. It shows that, although limited or unlimited of resources, or in this case sponsors, the end results, though varied are two completely separate paths.

“In whatever form, sponsors deliver the ideological freight that must be borne for access to what they have. Of course, the sponsored can be oblivious to or innovative with this ideological burden,”(http://www.jstor.org/stable/358929).

The recipient may be blind or aware of the valuable information that is presented to him or her. And what the individual chooses to do with that information will impact his or her outcome. While the sponsor has the power to reveal certain pieces of information or omit it. Does the sponsor want the other person to self improve? Or does the sponsor accidentally reveal important information? Or does the sponsor feel a duty being in higher power to be the teacher and conduct an informal ethical placement of teaching?

“Rather, these skills existed fragilely, contingently within an econonmic moment,” (http://www.jstor.org/stable/358929).

The way the economy is structured has an impact on literacy levels. As the economy changes so does the job market in which depicts the amount of literacy necessary for higher paying careers. So as long as higher paying careers are in demand, the likelihood that individuals will educate themselves to fill those positions, is higher. Which also ties into political structure which in the United States just so happens to be capitalism. Capitalism has a major impact in literacy because it motivates “the next best thing.”

Deborah Brandt is a reputable writer. Her article is published by the National Council of Teachers of English. The issue that is discussed is the relationship and (data collected) between sponsors and those learning from their sponsor (the recipient of the information, usually an employee, etc.) The factors that we should consider are how sponsorship guides the grounds for literacy and how it shapes the learner. For the reader, Brandt offers a variety of documented insights and explains in detail each portion of the observer’s experience and how that forms literacy into a marginalized or less marginalized category. Another words, how sponsors increase or decrease the dissemination or drive of literacy learning among learners.

The major claim is that literacy is learned and built upon the motivation of sponsors. This an agreeable argument, as most literacy is taught through sponsors. Whether a sponsor is physically there to teach or to teach through composition, literacy can be founded and given credit to by sponsors. The evidence that she offers are real encounters and experiences of individuals who were strongly motivated by their sponsors. She gives insight into different backgrounds and cultures and elaborates how their intrinsic drive to learn literacy often times brought them to very high roads of successes. She motivates the reader by giving real life insight which adds liveliness and accountability to her claims. In other words by offering real life experiences and insights it strongly backs up her argument by offering some evidence.

The counterargument she offers economic, political and education as the supporters

of learning literacy.

She gives credit to sponsors however does not deny the other forms of intake. She delves further into the economic and political drives that empower literacy however she does not bring forth supporting factors regarding education. In some instances she does, as one counterpart had attended University for accounting but she does not go into the structure and impact education has through literacy. Brandt does this purposefully so that way she can focus on her main topic. She develops her ideas through a very structured and concise format. Initially she begins her introduction explaining her argument. She gives definitions, examples, and elaborates into her ideas. Then further on she gives her support, which are the shared experiences from the learners and what they had learned from their sponsors.

As she has a very strong writing format she follows she also has rhetorical components in her writing. In regards to ethos, specifically she has a responsibility to share her thought process into her findings. In an implicit way, she has discovered new knowledge and is more than happy to enlighten the reader in her findings. This I feel definitely reaches out to the reader on an ethos level. In her style of writing she builds credibility and rupport with the reader but at the same time is offering crucial information herself, as a writer. This hints a little about the character of Brandt in which establishes an ethical and fair grounds from the author.

In regards to logos, Brandt is definitely right there with her logic. Meaning she is very intelligent in the way she expresses her ideas, she is very fair, and she knows what she is communicating about. She does not leave the reader lost, but yet very concisely explains bit by bit as her writing moves forward. The logos appeal in her writing has a lot to do with the knowledge that she offers in her writing. She gives insight and historical context to the twentieth century and then explores more information in detail from there. Her logic in her writing is to not force the information down the reader’s throat, but to offer plenty of valid examples and then backs them up with evidence, the real life experiences that are documented.

Brandt offers a lot of information on the basis of pathos. She does this because she becomes personal with the reader. When she writes one can sense the passion in her writing. And the topic in itself is a very emotional topic. It goes back to a nostalgic feeling when one looks back and reflects on his or her initial training in literacy, through sponsorship. In a way Brandt is trying to affect the reader through emotions. Emotions in a way do conflict with logic however since she offers information on not just only a pathos approach it is easy to believe her in her writing based off of both. An example of irony in her writing are the experiences in which learners come from completely different walks in life and she says that they end up both accomplishing the same thing. When she says this is she referring to meeting one’s goals? This is the instance in which she leaves irony for the reader which is very effective and up for interpretation.

The most difficult part of reading the article was the introduction. I found it very useful and interesting but she drew me in and I kept wanting to read more. Another aspect was the vocabulary. At times she referred to war, and I would have to look up a word or two every once in a while to resolve the discrepancy. This will strategy will definitely help for the future as it is key to understanding what is going on in the context. The article did not change my views because a lot of it I agreed with and felt familiar with. I agreed with her argument because I can reflect back on my sponsors and how they helped me with literacy. The most influential parts in her writing is her support (her real life experiences documented by others) . Not only is it effective but it is also interesting to listen about. Another piece I would like to add is about the economical component in which I forgot to mention entirely. The invisible hand that plays a role into all of this is the economic structure in which Brandt is implicitly giving credit to throughout the entire article. Thank you for pointing that out during lecture.

Alex Haley and Brandt :

While reading about Malcom X and his discovery into increasing the drive of his own literacy one can say that Malcom was his own sponsor and that some of his friends either through networking or family, also make in impact into his developmental stages. First, moreover Malcom talks about his letter that he is trying to write to Elijah Muhammad. He is extremely honest with the reader and himself that he did not even know how to without using slang. Another contributing factor was a friend of his Bimbi (prison-mate), he felt jealous that Bimbi was articulate and he was not. Malcom began his literacy through reading and writing out definitions from a dictionary. He only sought out to do this because he sensed his own inadequacy in literacy, therefore one could say that he is his own sponsor.

In reading the article written by Sherman Alexie, one learns about his sponsor of literacy. His first sponsor was a book, a comic actually of DC Comics, Batman. He admits that he cannot remember much about which comic it was or what the content was but that he had remembered it as reminder to learn to read. Throughout his life his father is also an indirect sponsor. His father passively sponsors his son by bringing home books to his son. Sherman Alexie speaks of his native background in which he observes that reading is not valued in his own culture. As soon as he comes to this finding he decides that he is going to step outside of the norm and better his literacy so that way he can better his future. He accomplishes this by reading everything that he can get his hands on (as does Malcom X from the previous reading) and he then throughout his adult life teaches literacy to other indians. Although Sherman is also his own teacher throughout his life, his initial remembrance to read stems from a Batman comic.

Donald Murray is different in his writing in comparison to Malcom X and Sherman Alexie. Murray is sixty when he is writing and his direction has a different motive. In his writings he himself is the sponsor rather than focusing on who his sponsors are. He finds various reasons for writing but he admits that all writing is autobiographical. He proves this by writing about different events in his life, giving a narrative to the reader about parts of his past. He also selectives specific poems for the reader to reflect on in order to dissect the personal narrative perspective, the autobiographical component.

In reading the poems, the author always explains what he or she is saying. It does not mean that the perspective is inaccurate, but does suggest that it is indeed autobiographical.  He doesn’t particularly view himself as his own sponsor yet views others around him that motivate him as sponsors. He says Harry, a friend that died, teaches him to appreciate life and to appreciate that he is still alive. I believe that the author is suggesting is that sponsors are an ongoing process, your learning never ends if you allow yourself to learn.

Delirium in the ICU

On a daily basis, 30,000 to 40,000 ICU patients in the United States suffer from delirium. Delirium is an acute brain dysfunction. It is believed the problem will only get bigger due to the increased age of our population. The article written by Maniou states multiple studies concluded delirium in mechanically ventilated patients is seen in 60-80% of ICU patients. The article also states that each day a patient spends in a state of delirium their risk of death is increased by 10%. Hypoactive delirium may be difficult to diagnose but it is important to recognize it because it may be an early sign of a serious medical condition, such as sepsis, pneumonia, MI, or PE. Delirium may also be linked to longer hospital stays and increased cognitive impairment on discharge. Risk factors associated with delirium include: increased age, severity of disease, use of medications such as psychoactive drugs, opiates and benzodiazepines. Other risks include the patient’s loss of control, loss of personal space, and loss of their ability to communicate. For these reasons it is important for nursing staff to be aware of this medical problem. Nurses must know how to recognize it and how to treat it, as delirium is harmful to patients and costly to hospitals. The Confusion Assessment Method-Intensive Care Unit is the most commonly used method to diagnose delirium, other tools include the delirium check list and The Intensive Care Delirium Screening Checklist. Nurses should be educated on effective methods to identify patients at increased risk for delirium, how to asses for delirium and appropriate interventions to manage the medical problem.

I do agree with the article. Medicine has many new advances and people are living longer than before. The older population is more fragile and sensitive, thus increasing their risk for delirium. It also seems that patients admitted to the hospital are more fragile and sick then in past years. It is important for all nurses to identity patients at risk, assess and implement nursing interventions to prevent complications. I think the next step needed to bring about awareness of this issue is staff education. As this is a big problem, nursing staff especially nurses caring for patients in ICU should be educated on the issue. I think nurse education is the most important step to identify and treat these patients. Nurses are the primary caregivers and we are the ones who interact with the patients the most. We are in the perfect position to assess and identify patients at increased risk for delirium. We are also in the perfect position to intervene to prevent long term complications.

As a nurse working in med/surg and acute rehabilitation I often encounter older patients who become disoriented when taking narcotics, sleeping and psychoactive medications. I believe that it is important to for all nursing staff not just ICU staff to get educated on delirium. Often the patients change in LOC is not associated or linked to these medications and it is important to recognize it and to be aware of the possible causes to prevent its reoccurrence. As nurses we are the doctor’s eyes and we are also the patient’s advocate and it is our responsibility to monitor, prevent and intervene in these situations. We must prevent long term complications and limit hospital costs.

Recourses

Maniou, M. (2012). Delirium: A distressing and disturbing clinical event in a intensive care unit. Health Science Journal, 6(2) 587-597.

 

The Dangers of Delirium

 

The dangers of delirium
Patient safety is an important part when it comes to nursing care. Nursing intervention can be done prior to help better patient outcomes. For example, patient’s that are treated in intensive care units need interventions that will provide safety before and after care. These patients are heavily sedated and on ventilators are particularly likely to become delirious; some studies place the rate as high as 85 percent. Delirium is basically inattention and confusion that represents the brain temporarily failing. A person who is delirious is unable to think clearly and can’t make sense of what is going on around him. But the condition is common among patients recovering from surgery and in those with something as easily treated as a urinary tract infection.
Regardless of its cause, delirium increases the risk of longer stays in the hospital, higher cost of care, can persist for months after discharge, more long-term cognitive impairment up to one year later and even death. Therefore it is important to provided safe care before and after treatment. Researchers estimate that about 40 percent of delirium cases are preventable. Many cases are triggered by the care patients receive like Mechanical ventilation is well known to cause ventilator associated pneumonia (VAP) and other nosocomial infections. Another example includes large doses of anti-anxiety drugs and narcotics or the environments of hospitals themselves, such as, a busy, noisy, brightly lit place where sleep is constantly disrupted and staff changes frequently. Overall there is evidence based support for getting patients off of ventilators and sedation, as quickly and safely as possible. Also, non-drug interventions, which included making sure patients’ sleep-wake cycles were preserved, that they had their eyeglasses and hearing aids and that were not dehydrated.

References
The Washington Post: Health and Science- “The perils of delirium” (2015). Retrieved on September 21, 2015 from: https://www.washingtonpost.com/national/health-science/the-perils-of-delirium/2015/06/01/0f263996-ed22-11e4-8666-a1d756d0218e_story.html

Final Draft

I flew through our house at incredible speed, grasping on to every pivot point I could to gain traction and speed in order to get to the kitchen table faster. There my mother cooked our favorite banana pancakes. Wes, my brother, and I especially liked banana pancakes because it meant there was both good food and a show. When banana pancakes were served, my mom would read chapters of our favorite book The Adventures of Captain Underpants.

Captain Underpants engaged my young mind because the story resonates around two main characters that write and sell comic books on the playground. I was especially interested in this plot design because I myself was interested in entrepreneurship from a young age and being a class clown. The main characters in Captain Underpants became my idols. George and Herold would always pull pranks at school, many of which I would emulate. After getting in trouble with the principle at school my mom stopped reading Captain Underpants at breakfast because it was determined my poor behavior was stemming from that particular reading. I believe that a lot of my young ideology was absorbed from my reading, much like how Murray believes writing changes ones ideology. “We become what we write. That is one of the great magics of writing.” (Murray 71). I was a child that liked what I couldn’t have and after several failed attempts at getting my mother to read more Adventures of Captain Underpants to me, I decided I would need to find the books and read them myself.

I never actively sought out literature until this moment. Never had I had the desire to read something so intensely that I was willing to go to a library and search for a book. I was fortunate enough to go to a middle school with a well stocked library. Most of my friends and fellow classmates saw this library as a muggy old ridden building guarded by a grey hair widow only concerned with late fees. To me, this library was a portal. It was an escape from what I thought was the real world and allowed me to become immersed in adventure. I am surprised to say that my first strive for literacy began because literacy was taken away from me. I wanted to read what I was not allowed to read simply because I fell in love with the story. Granted the story made me behave in a manner that adults found annoying but that was part of the reason I wanted to read it so bad, to be rebellious.

I grew up in a family that encouraged education. My mother being a lawyer and my father being an entrepreneur, reading and writing were considered critical parts of our child development. My brother and I always had access to books and technology. “Our house was filled with books. They were stacked in crazy piles in the bathroom, bedrooms, and living room.” (Alexie 12). I can recall my dads desk being piled with inspiring books I could not fully understand as a child. What I could understand was even more up lifting. My dad would say quotes to me such as, “it’s not who’s right, its whats right.” His face would glow with glee as he explained to me what these famous words meant. Seeing him so happy about a something he read made me genuinely curious about reading. “Sponsors, as I have come to think of them, are any agents, local or distant, concrete or abstract, who enable, support, teach, model, as well as recruit, regulate, suppress, or withhold literacy and gain advantage by it in some way. Just as the ages of radio and television accustom us to having programs brought to us by various commercial sponsors, it is useful to think about who or what underwrites occasions of literacy learning and use.” (Brandt 2). By Brants definition of a sponsor I can proudly say my mother, father, brother, library, and the new mysterious internet were my most influential sponsors.

My parents were the biggest sponsors of my reading and education in general. My father was always encouraging me to self educate myself and my mom was constantly introducing me to new books and magazines she thought I would find interest in. My father encouraged me to read articles on the internet, which at that time was rare because not many people thought of computers as methods of learning.
At an early age I became a skilled computer user. I knew more about the internet and how to work a computer than virtually all my peers. For this reason, the internet became my new adventure zone. I moved past captain underpants as the internet offers a seemingly unlimited amount of knowledge. Whenever something peaks my interest, the internet is my go to source for information. The Internet has become so pervasive that to be truly literate in 2015 demands some degree of technological fluency or at least familiarity. According to the Pew Internet & American Life Project, 73% of American adults had used the Internet or e-mail as of March 2006. I got lucky in that my parents pushed me onto the internet at a young age. Im proud to say that I used the internet well before 2006 and I believe that progressed my literacy in unmeasurable ways. I will always remember the Adventures of Captain Underpants as those stories paved the way for me to learn from my reading. My father is the reason I became so interested in computers. Being in the technology industry himself, he was a big believer that computers were no doubt going to be a huge part of our adult lives. Boy was he right.

Brandt, Deborah. “Sponsors of Literacy.” College Composition and Communication. 49.2 (1998): 165-185. Jstor. Web. 29 May 2015. (Available for download through Broome library database)

Alexie, Sherman. “The Joy of Reading and Writing: Superman and Me.” The Most Wonderful Books: Writers on Discovering the Pleasures of Reading. Eds. Michael Dorris and Emilie Buchwald. Minneapolis: Milkweed, 1997.  Web. 29 May 2015.

Murray, Donald M.. “All Writing Is Autobiography.” College Composition and Communication. 42.1 (1991): 66-74. Jstor. Web. 29 May 2015.

Smith, Aaron. “Internet Activities.” Pew Research Center Internet Science Tech RSS. N.p., 03 Apr. 2015. Web. 23 Sept. 2015.

Context for Mr. David Tweedy’s letter to Harold T. Johnson

Mr. David A. Tweedy wrote to Harold T. (Bizz) Johnson in December of 1969 highlighting the media’s effect of how soldiers were perceived, the constricts of legislative terminology, and the propaganda of the Vietnam Conflict.

Tweedy writes “They [the media] have distorted an11998048_10207317382991077_829765863_nd twisted every news media and picture that has appeared on the news and in the paper of our boys in Vietnam”. Kathleen McClancy writes in The Iconography of Violence: Television, Vietnam, and the Soldier Hero, “The Vietnam War expanded and dominated foreign policy just as television news was expanding to a half-hour format and surpassing newspapers as the primary source of information for Americans.” Although Tweedy’s description of the media rings with his own brand of bias, McClancy further writes that, “Vietnam was both the first and the last time “war” (generally signifying the horrors of combat) would be brought to the viewer so intimately or so immediately. Furthermore, the continual combat footage from Vietnam is believed to have influenced public opinion of the war so negatively that continuing the intervention became impossible for the American government.” Here McClancy discusses the intimacy of the conflict that the media was bringing to people’s homes for the first time. Although she writes that the media exposure influenced the anti-war sentiments of the early 1970’s, here Mr. Tweedy has been influenced to continue support for the troops and states “whether it is right or wrong is beyond my comprehension.”

Something I found interesting about Mr. Tweedy’s letter was his call of attention towards the terminology used for the Vietnam Conflict, “They are not allowed to fight this conflict as a war but are used as mediators at our expense and their blood.” In Dale Andrade’s, The Myth of Inevitable U.S. Defeat in Vietnam, he writes that the U.S. congress did not establish the conflict as a war because the U.S. intention was not Vietnam itself, but the prevention of a Communist influence from China. The lack of congressional approval meant a lower budget for military efforts, which angered some Americans, such as Mr. Tweedy.

Tweedy goes on to further state that “The people here [Americans] ought to stand behind them [the troops] and give them credit instead of holding protest on honoring the propaganda that has and is being spread throughout this country of ours by a misguided few with distorted pictures and unproven words of evidence.”  The media, along with an array of posters, were the medium through which much of the propaganda surrounding the war came through, such as Walter Cronkite’s CBS News Special Reports. Guy Raz, a host of NPR said of Cronkite’s news report on February 27, 1968, “Cronkite did something that changed America’s perception of the Vietnam War.”

 

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ICU Sedation Practices

The article : Changing the Sedation Status Quo in the ICU was very interesting to me because it talks about how hospitals are adopting new policies that limit the amount of time a patient is sedated in the ICU. The new treatment methods would allow patients to be awakened from sedation to assess for pain and removing them from a ventilator as soon as possible.  A growing body of research suggests that patients who are heavily sedated in the ICU are suffering from prolonged delirium. This can have long term effects on cognitive function long after the patient leaves the hospital (Landro, 2011).

Hospitals began rethinking the standard of care in the early 1990s, when patients reported suffering from depression, stress and extreme physical limitations linked to therapy they had received in the ICU (Landro, 2011). Studies conducted by Vanderbilt University show that new monitoring techniques will shorten the duration of delirium by decreasing the amount of potent sedatives a patient receives. Research from John Hopkin’s University shows that getting patients up and moving even when still on a ventilator can also prevent the muscle weakness that results when patients lose conditioning from misuse and the body becomes frail. Hospitals now plan to use milder sedation medication and to wean patients off as soon as possible and not put them back under. This will help patients to go home sooner and avoid having to go to a rehabilitation center.

I agree with this article, I think that it is not healthy to have patients sedated for a prolonged amount of time. If there is a way to get them moving sooner I think this would be beneficial for circulation, skin care, and oxygenation. However the research presented here also shows that in addition to the physical reasons there are also psychological reasons to wean patients from section sooner rather than later. Before reading this article and watching the videos, I had no idea that patients were experiencing delirium while sedated in the ICU. Furthermore it is also very concerning to see how the delirium they experienced in the ICU can affect their lives even months to years afterward. Some patients experience PTSD or depression that interferes with their daily lives. I think that if the amount of time a patient can be sedated can be shortened, and they can be ambulated sooner this will be therapeutic for the patient and will help them to recover sooner.

I think that the next step is to implement this practice in more hospitals by training ICU doctors and nurses. Educating healthcare professionals about delirium will help patients to get the support they need sooner.

 

 

References:

Landro, L. (2011, February 15). Informed Patient: Changing the Sedation Status Quo in the ICU. Retrieved September 24, 2015, from http://blogs.wsj.com/health/2011/02/15/changing-the-sedation-status-quo-in-the-icu/

Cardiac Treatment Evolves

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ICU Sedation

I was very surprised to learn how devastating and long-lasting ICU sedation can be on both the cognitive and physical effects are on ICU patients. It never occurred to me that some ventilator patients could and should be ambulated if possible. Even during my ICU rotation, which was only 2 days, I did not realize that sedation with benzodiazepines does not allow the patient to experience a normal sleep cycle. Even though sleep deprivation in critically ill patients has been well documented for more than 30 years (Tembo, Parker, & Higgins, 2013), clinicians still struggle with methods of care that seek to support restful sleep and prevent or alleviate sleep deprivation and nightmares. The study done by Tembo et al. (2013), explored the lived experiences of critically ill patients in ICU with daily sedation interruption. Patients reported “longing for sleep” and ‘being tormented by nightmares”. When the outcomes of patients with daily sedation interruption (DSI) where compared to those with continuous infusion the findings suggested that DIS did not result in psychological harm. Patients in the DSI group fared better for PTSD than those with continuous sedation. It was also found that the DSI group had a shorter length of stay in ICU.

Sleep deprivation is known for causing disorders of the mind, including delirium. The effects of sleep deprivation are both psychological and physiological. In addition to the types of medications used for sedation, the sounds, lighting, and continuous contact with care providers are all factors in poor sleep quality. Participants in the study report having nightmares for months after their ICU experiences. The study’s finding suggested a need for models of care that support restful sleep and prevent or alleviate sleep deprivation and nightmares.

The “Care of the Ventilated Patient – The New Paradigm” was one of the most informative videos about delirium in the ICU that I have seen. It was interesting to see how much of what we do help our patients, is actually harmful. This video that appears to have been created in March 2012, indicates that a study done 10 years previous showed that ICU stays can be reduced and patients benefit from DSI and less sedation. Ten years later and we still haven’t figured it out. I have no experience in the ICU but would be interested to know if there are significant changes in how patients are sedated today.

Tembo, A. C., Parker, V., & Higgins, I. (2013). The experience of sleep deprivation in intensive care patients: Findings from a larger hermeneutic phenomenological study. Intensive and Critical Care Nursing, 29, 310-316.

Nurses Collaborate for Ventilator Weaning

Situation

              Patients that have serious illnesses often are admitted to the Intensive Care Unit (ICU). A majority of these patients are also on mechanical ventilation to assist with breathing after experiencing acute respiratory distress syndrome (ARDS) as a result of “either direct or indirect pulmonary injury” (Morton & Fontaine, 2013, p.233). Mechanical ventilation is used to  treat a patient that cannot breath on their own. Unfortunately, invasive artificial airways often come with their own complications and high costs.

Background

              Mechanical ventilation is well know to cause ventilator associated pneumonia (VAP) and other nosocomial infections. Studies also show that the longer the length of time on a ventilator, the higher it correlates with hospital re-admissions and a draining of ICU resources (Douglas, Daly, Brennan, Gordon & Uthis, 2011). There is evidence based support for getting patients off of ventilators and sedation, as quickly and safely as possible.

Assessment

              In the article, “Collaborative practice: development, implementation, and evaluation of a weaning protocol for patients receiving mechanical ventilation,” authors write about how patients are typically weaned off of the ventilator and identified a problem with the fact doctors decided subjectively to wean patients and it is not based on protocols (Grap, Strickland, Tormey, Keane, Lubin, Emerson, & … Sessler, 2003). The doctors would use different parameters and those parameters varied from each doctor and each hospital (Grap, 2003).

Resolution

               Grap et al., have focused on using a multidisciplinary approach to wean  patients off of their ventilators sooner; this approach utilizes a standardized protocol for weaning the patients (2003). The article researched the medical respiratory ICU (MRICU) protocol which is composed of several scales, guidelines, and assessment tools to help identify if the patient is ready to be weaned (Grap et al., 2003). The article showed that “[p]atients receiving mechanical ventilation have shorter hospital stays and lower costs when a weaning protocol is used” (Grap et al., 2003, p. 455). The article also supported nurses autonomy and working with the respiratory therapist to individualize the weaning process; this encouraged strong communication within the interdisciplinary team (Grap et al., 2003).

Douglas, S., Daly, B., Brennan, P., Gordon, N., & Uthis, P. (2001). Hospital

readmission among long-term ventilator patients. Chest, 120(4), 1278-1286.

Grap, M., Strickland, D., Tormey, L., Keane, K., Lubin, S., Emerson, J., & … Sessler,

C. (2003). Collaborative practice: development, implementation, and

evaluation of a weaning protocol for patients receiving mechanical

ventilation. American Journal Of Critical Care, 12(5), 454-460.

Morton, P. G., & Fontaine, D. K. (2013). Essentials of Critical Care Nursing; a

               holistic approach. Philadelphia, PA: Wolters Kluwer.