Bed Aids in Prone Positioning for Patients with Acute Respiratory Distress Syndrome (ARDS) and COVID-19
The breaking of the COVID-19 pandemic came with severe respiratory complications that include acute respiratory distress syndrome or ARDS (St. John, 2021). Most of these patients would end up in the intensive care unit (ICU) for critical care and sometimes mechanical ventilation (that was later found to increase mortality). With ARDS, these patients manifested with severe hypoxemia. According to Vollman et al. (2017), patients with severe hypoxemia show a partial pressure of arterial oxygen (PaO2)/ fraction of inspired oxygen (FiO2) ratio os below 150 mmHg. Positioning for Patients with Acute Respiratory Distress Syndrome (ARDS) and COVID-19
The positive end-expiratory pressure (PEEP) will also be at least 5 cm H2O. To help these patients ventilate sufficiently and reduce distress to them, pronation therapy with the mechanical RotoProne bed is suggested in this paper (Vollman et al., 2017; Wiggermann et al., 2020). In the healthcare setting in question, this technological bed and therapy has only recently been introduced at the facility’s ICU for the care of the COVID-19 patient and others with ARDS. One of the patients currently benefiting from the RotoProne therapy is a 62 year-old Caucasian male who contracted COVID-19 two weeks ago but who is now being weaned of the pronation therapy back to supine position. His oxygen saturation levels while supine are now much better than before. The purpose of this paper therefore is to present the mechanical RotoProne bed in critical care as the solution to the severe hypoxemia of ARDS caused by COVD-19 and other conditions. Positioning for Patients with Acute Respiratory Distress Syndrome (ARDS) and COVID-19
Explanation and Background
The suggested pronation therapy that is provided by the RotoProne bed involves rotating the patient while strapped in bed from the supine position to the prone position. This is because when in the supine position, ventilator-induced lung injury is common. Also, oxygenation in the supine position is not as effective as in the prone position in patients with ARDS (Vollman et al., 2017). Compared to manual proning, the mechanical proning bed is safer and more efficient. It removes the need for a lot of manpower and prevents injury to both the patient and the nursing staff. A typical RotoProne bed has a touch screen at the foot of the bed from which the critical care nurse operates buttons that are labelled. Typically the buttons are the prone/ supine button, the therapy settings button, the scale button, the surface position button, the park button, the therapy meters button, and the “off” button amongst other functionalities.
The RotoProne bed rotates itself with the patient when commanded from the touch screen. It turns the patient from the supine position to the prone position without changing the pressure dynamics on the pressure areas of the patient. It tilts slowly and therapeutically compared to manual tilting that the patient remains safe and undisturbed. This pronation therapy is indicated in patients with ARDS such as the one caused by COVID-19, in patients whose secretions require a postural drainage technique, in the management of wounds that are located at the back, in patients at risk of pressure sores who require relief of some pressure from the sacral region of the body, in critically ill patients that are used to sleeping while prone at home and now require therapeutic sleep, and in diagnostic and therapeutic procedures that require prone positioning (Vollman et al., 2017). No medication is required for pronation therapy apart from the ones already prescribed for the patient. However, the RotoProne bed for pronation therapy has considerable cost implications. The bed can be rented at a starting daily fee of $1,000.
Risks and Benefits
Pronation therapy with the mechanical RotoProne bed benefits the patient in many ways. To begin with, it enables better oxygenation in patients who are suffering from ARDS. For patients that have a lot of secretions, pronation will help them with drainage of the secretions and prevent aspiration. If the patient is at an increased risk of developing pressure sores at the sacral region, pronation therapy will help prevent the occurrence of this. In the event that a critically ill patient has a sever wound at the back such as an accident victim, pronation therapy allows for the proper visualization and caring of that wound. Lastly but not least is the patient that is t undergo a diagnostic test or an operative procedure at the back. These are facilitated by pronation therapy.
The ways to promote positive outcomes include training of the critical care nurses on the proper use of the RotoProne bed, education of the patient’s family (and the patient if they are not sedated), and proper maintenance of the mechanical RotoProne bed. There are a number of complications that may arise from pronation therapy and use of the RotoProne bed. According to Binda et al. (2021), these include medical device displacement, development of pressure ulcers, and bleeding. The considerations for preventing complications should include greater surveillance and monitoring of patients on pronation therapy as well as better risk assessment by the critical care nurses.
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Interdisciplinary Team’s Roles and Responsibilities
The critically ill patient in the ICU on pronation therapy is cared for by a multidisciplinary team comprising of a number of members. This is because the needs of the patient with ARDS or any other indication for pronation therapy are manifold. These multidisciplinary team members include the physician, the case manager, registered critical care nurses, the critical care nurse practitioner (CCNP), physical therapist, nurse assistants, the nutritionist/ dietician, and researchers amongst others. All these disciplines work for the benefit of the patient through interprofessional collaboration.
In the use of the pronation bed it is the duty of the registered critical care nurses to ensure that the patient is safe and comfortable. This includes assessing constantly for risk and the potential development of pressure ulcers. The physical therapist ensures that the patient does not remain stiff and develop deep venous thrombosis or thromboembolism. The dietician’s role is to make sure that the liquid feeds that the patient is getting are nutritious and well balanced. The critical care nurse practitioner and the physician prescribe the pronation therapy as well as the medications and intravenous fluids that the patient gets. Finally, the nurse assistants are there to ensure that there is cleanliness of equipment and the floor and that all soiled linen and instruments are cleaned and autoclaved if need be. They can also assist with the activities of daily living (ADLs) for the patient.
The roles of the nurse as a member of the multidisciplinary team include operating the touch screen when tilting the bed, assessing the patient for risk of pressure ulcers or complications such as bleeding, performing pressure area care, and documenting care performed such as the amount of time that the patient has been in the prone position. This is important because studies have found that the development of prone-related pressure ulcers is a factor of the amount of time that the patient has been in that position (Binda et al., 2021). The nurse (the registered critical care nurse) also acts as a supportive professional to the other team members as she is the one with the patient all the time. The role of the CCNP is different from that of the RN because the CCN is a clinician in their own right. That means they can prescribe and order investigations. One challenge in working with an interdisciplinary team is the lack of effective communication. Positioning for Patients with Acute Respiratory Distress Syndrome (ARDS) and COVID-19
Nursing Scope of Practice
The knowledge needed by the RN to provide the care required using the RotoProne bed is not acquired during routine nursing training. It is knowledge that has to be taught during further training or acquired during in-house training. The RN needs computer skills in working with operating systems that have several interfaces. This is because the touch screen on the bed has a graphical user interface or GUI. The RN also needs skills that are required to accurately assess for risk such as bleeding risk or pressure ulcer risk. These will help to keep the patient safe. Finally, the attitudes that the RN must have to provide ffective care for the critically ill patient who is on the pronation therapy is that of understanding, compassion, empathy, selflessness, servant leadership.
The information to be taught to the patient and/ or family includes that on the benefits of pronation therapy, the approximate duration of time the patient may remain on pronation therapy (based on experience), the complications that may arise during pronation therapy, the consults that may be required to be made, the importance of spiritual care, and what to prepare and also expect for the transition of care to the home environment. For the concious patient, this information will be taught at the bedside as he nurses provide the daily care. For the next of kin, this teaching can be done with confidentiality in a room where other people are not present. The teaching should be verbal and face-to-face but also visual aids can be provided such as pamphlets.
Potential cultural considerations to teaching must be taken into account. This is because multiculturalism and cultural competence/ sensitivity are important components of care. The nurses must respect the beliefs and opinions of the patient and their family and as much as possible align them with the care objectives. The effectiveness of the teaching will be evaluated by how the family and the patient verbalize their perception of the care that is provided at the facility.
The technological innovation of mechanical pronation beds such as the RotoProne bed has revolutionized the care of critically ill patients with respiratory distress. This has been seen clearly during this period of the COVID-19 pandemic in which the infection has been causing severe ARDS. The care of patients on pronation therapy requires a multidisciplinary team and a number of complications may also arise. The registered nurse has a critical role in assessing for risk to prevent some of these complications.
TOPIC : Bed Aids in Prone Positioning for Patients with Acute Respiratory Distress Syndrome (ARDS) and COVID 19 patients.
Write a 4-5 pages paper (not including the title page or reference page) using APA format
Paper on therapeutic modality: proning beds :
-using manual techniques
–using mechanical pronation beds ex. Rotoprone beds
Paper include the following sections (detailed criteria listed below and in the Grading Rubric):
- Introduction – 5 points/5%
- The chosen therapeutic modality or healthcare technology meets one of the following criteria:
o Has been introduced recently at the bedside for care of the complex adult patient. Positioning for Patients with Acute Respiratory Distress Syndrome (ARDS) and COVID-19
o Is a non-traditional modality for very ill patients in special circumstances.
o Is being used in a new way to treat a patient with complex needs.
o Requires specific training above and beyond general entry-level nursing education.
- Introduce the therapeutic modality or healthcare technology.
- Name the therapeutic modality or healthcare technology.
- A brief fictional case is used to illustrate the therapeutic modality or healthcare technology.
- Explanation and Background– 15 points/15%
- Include a clear description of the therapeutic modality or healthcare technology.
- Discuss how the therapeutic modality or healthcare technology works.
- Describe the patient population it is used for.
- Include medication, safety, and cost considerations as applicable.
- Risks and Benefits– 15 points/15%
- Describe how the therapeutic modality or healthcare technology can benefit the patient.
- Discuss ways to promote positive outcomes.
- Explain the complications that may arise.
- Discuss considerations for preventing complications
- Interdisciplinary team’s Roles and Responsibilities– 20 points/20%
- Identify all interdisciplinary team members caring for the patient, such as respiratory therapy, assistive
personnel, providers, case managers, clinical nurse specialists, and researchers.
- Describe the roles and responsibilities of each member of the healthcare team that is involved in the use of the therapeutic modality or healthcare technology.
- Discuss the roles and responsibilities of the nurse as a member of the interdisciplinary team caring for the patient.
- Discuss one challenge in working with an interdisciplinary team.
- Nursing Scope of Practice – 15 points/15%
- Discuss the knowledge needed for the Registered Nurse to provide care for the patient using the
therapeutic modality or healthcare technology.
- Describe skills needed for the Registered Nurse to provide care for the patient using therapeutic modality
or healthcare technology.
- Discuss attitudes needed for the Registered Nurse to provide care for the patient using therapeutic
modality or healthcare technology.
- Patient Education – 20 points/20%
- Describe the information to be taught to the patient and/or family.
- Discuss how information will be taught.
- Discuss potential cultural considerations to teaching.
- Explain how the effectiveness of the teaching will be evaluated.
- Conclusion – 5 points/5%
- Provide a summary of the paper.
- No new information is introduced.
- Include additional resources for further learning.
- APA Style and Organization – 5 points/5%
- References are submitted with paper.
- Uses current APA format and is free of errors.
- Grammar and mechanics are free of errors.
- At least three (3), nursing, scholarly, peer reviewed, primary sources from the last 5 years, excluding the textbook, are provided.
Positioning for Patients with Acute Respiratory Distress Syndrome (ARDS) and COVID-19