You spent much of your time in nursing school learning about what might go wrong with clients and their care. This makes sense; after all, nurses need to deal with problems and illnesses. Many test questions that your nursing school faculty wrote focused on what was wrong with clients and their care. In order to prove minimum competence, the beginning practitioner must demonstrate the ability to make appropriate nursing judgments. Competent nursing judgments include
recognizing both expected and unexpected behaviors, so it is important for you to recognize expected outcomes on the NCLEX-RN® exam. Expected outcomes are the behaviors and changes you think are going to occur as a result of nursing care. These outcomes allow the nurse to evaluate whether goals have been met. Here is the path to finding the correct answer for Expected Outcomes questions: Show
 Look at the following question. If this question were included on one of your medical/surgical tests, you would assume that a problem was being described. So you would choose an answer choice that involves “fixing” the problem. Let’s look at this question. (1) “Increase the rate of oxygen flow the client is receiving.” This is unnecessary because his O2 is within normal limits. Eliminate. The Reworded Question: What should you
do for this client? To answer this question you need to know what these vital signs indicate. (1) “Notify the physician that the client has become hypotensive and obtain an order to administer IV fluids.” The blood pressure has decreased due to vasodilatation. Decreased blood pressure is expected. Eliminate. Previous: NCLEX Strategies: Don’t Predict
Answers Emerg (Tehran). 2017; 5(1): e39. Published online 2017 Jan 11. Oxygen is a drug and physician and nurses should be familiar with the effects and potential risks of oxygen therapy. The current study aimed to assess familiarity of physicians and nurses with
various aspects of oxygen therapy. In this cross sectional study, the familiarity of physicians and nurses with various aspects of oxygen therapy in a teaching hospital was evaluated using a validated questionnaire. The collected data were analyzed using SPSS 21 software. 57 physicians and 79 nurses returned the completed questionnaire (response rate
97.1%). Mean clinical work experience of participants was 6.9±5.7 (1–15) years. 98.2% of physicians believed that oxygen therapy can be associated with risk and should be recorded in the patient's medical file. These measures were 92.4% and 98.2% for nurses. 38 (27.9%) participants correctly pointed out the reasons for oxygen therapy. Regarding necessary measurements and monitoring for oxygen therapy, 49 (86%) physicians and 65 (82.3%) nurses chose the correct answer. In
addition, regarding necessity of blood gas analysis during oxygen therapy, 44 (77.2%) physicians and 55 (69.6%) nurses chose the correct answer. The findings showed that the familiarity level of participants with some aspects of O2 therapy such as its indications, necessary measurements and monitoring during therapy, and identifying delivery devices was fair to weak (<80%). Key
Words: Oxygen, oxygen inhalation therapy, knowledge, adverse effects, physicians, nurses Oxygen is one of the most common drugs used in secondary care in hospital. Oxygen is an essential component of resuscitation, acute medical care, basic life support, anesthesia and postoperative care. When oxygen is used appropriately, it can save lives. On the other hand, any errors in oxygen therapy can
worsen a patient’s condition and can even be life-threatening (1). Nowadays, the benefits and potential complications of oxygen therapy are well known; however, oxygen therapy is often done without special attention and sufficient knowledge (-). There are several guidelines and protocols for appropriate oxygen therapy
(2, 6). It has been shown that use of protocols for oxygen therapy in hospital wards can be very helpful in reducing errors during this process (-). Previous studies have evaluated the use of oxygen in hospitals
(10, 11). These studies reveal that doctors often prescribe oxygen improperly and without adequate supervision. Modified charts for prescribing oxygen and related requirements have been proposed
(2, 11). Dodd et al. have shown that introduction of a specific prescription chart for oxygen improves the quality of its prescription by junior doctors from 55% to 91%. However, these recommendations had a positive effect on patient care only if health
professionals had proper information and sufficient understanding of oxygen therapy and its correct administration (12). To ensure the safe and effective oxygen delivery, flow rate, dose, devices, time, and method of monitoring should be given special attention and doctors and nurses should be familiar with the effects and potential risks of oxygen therapy. Based on the above-mentioned, this study aimed to assess familiarity of physicians and nurses with various aspects of oxygen therapy. Study design: This cross sectional study was conducted in a teaching hospital affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran, in 2014. The familiarity of physicians and nurses with various aspects of oxygen
therapy was evaluated using a predesigned questionnaire. After a full explanation about the study design, written informed consent was obtained from all nurses and physicians. All information about the participants was kept confidential. The study protocol was approved by the ethics committee of Shahid Beheshti University of Medical Sciences. Participants 60 physicians and 80 nurses working in different hospital wards were enrolled.
All participants had some experiences in oxygen therapy. It was assumed that all participants had the basic skills and training about oxygen therapy. Questionnaires were anonymous and 20 minutes were given to each participant to complete the questionnaire without conferring. Questionnaire Internet search for international and local oxygen delivery guidelines was done and the most common and appropriate ones were used for designing a
questionnaire (13, 14). Two consultant respiratory physicians, independently evaluated and confirmed the questionnaire items and responses. It was expected that questions about parameters in oxygen therapy would assess topics that all doctors and nurses had undergone in education and training courses. In the first part of the questionnaire, participants were asked to identify oxygen delivery devices and choose their correct names. Then in the second part, a variety of questions
about how to prescribe and deliver oxygen, and reasons for oxygen prescription were asked. The familiarity rate was categorized into five groups based on Likert scale: ≥ 90% as excellent, 80-90% good, 70-80% fair, 60-70% weak and < 60% poor. Statistical analysis Data from the completed questionnaires were extracted and analyzed using SPSS version 17. To describe the data, frequency, percentage, mean, standard deviation, median, and interquartile range (IQR) were used. ResultsBaseline characteristics 60 physicians and 80 nurses were studied. The response rate was 97.1%, and a total of 136 participants [57 physicians (54.4% female) and 79 nurses (70.9% female)] were involved. Average work experience of participants was 6.9 ± 5.7 years (1-14). 70 (51.5%) participants stated that there was a protocol to prescribe oxygen in their ward. The usual method of oxygen delivery in hospital wards were nasal cannula (58.1%) and simple mask (33.1%), respectively. Table 1 shows the usage percentage of different O2 delivery devices in the studied hospital. Table 1The most often used oxygen delivery devices in Imam Hossein hospital
Knowledge 98.2% of physicians believed that oxygen therapy can be associated with risk and should be recorded in the patient's medical file. These measures were 92.4% and 98.2% for nurses. Table 2 shows the familiarity percentage of participants with different oxygen delivery devices. 38 (27.9%) participants correctly pointed out the reasons for oxygen therapy. Regarding necessary measurements and monitoring for oxygen therapy, 49 (86%) physicians and 65 (82.3%) nurses chose the correct answer. In addition, regarding necessity of blood gas analysis during oxygen therapy, 44 (77.2%) physicians and 55 (69.6%) nurses chose the correct answer. Table 2Familiarity of participants with different oxygen delivery devices
Data were presented as number and percentage. DiscussionThe findings showed that the familiarity level of participants with some aspects of O2 therapy such as its indications, necessary measurements and monitoring during therapy, and identifying delivery devices was fair to weak (<80%). Previous studies had evaluated the use of oxygen at hospitals in other countries (10, 11). In a study conducted in 2006 by Ganeshan et al., knowledge of 53 nurses and 40 doctors that worked in intensive care unit of the General Hospital in UK and were active in oxygen prescription, was evaluated. 25% of the physicians and 50% of the nurses could not prescribe the right dose and method of oxygen therapy in cardiorespiratory arrest cases. They concluded that doctors and nurses did not have sufficient knowledge and understanding of oxygen therapy (9). In a similar study, Brokalaki et al. assessed the knowledge of oxygen therapy in seven hospitals in a major city of Greece, in 2004. The questionnaire was completed by 105 head-nurses. The results showed that training programs, protocols and guidelines should be mandatory to ensure proper use of oxygen therapy by nursing personnel (14). In our study, approximately half of participants said that there is no protocol to prescribe oxygen in their wards, despite the existence of several international guidelines for proper oxygen therapy (2, 6). However, only 51.9 to 78.9% of the nurses and doctors recognized O2 delivery devices such as non-rebreathing mask with reservoir bag, which is consistent with Ganeshan et al. results (13). In the present study, only 38 participants (27.9%) correctly pointed out the indications for oxygen therapy, namely decreased level of consciousness, chest pain, respiratory distress, seizure, severe respiratory infections and sepsis. 98.2% of physicians and 92.4% of nurses believed that oxygen therapy can be associated with risk. Any error in oxygen therapy could lead to worsening of the patient's status and can even be life-threatening (1). Although oxygen is used for the treatment of hypoxia, it can be deadly and should be considered as a drug (2). In our study, 33 (57.98%) physicians and 47 (95.5%) nurses believed that oxygen is a drug. In another study, it was shown that 59% of a hospital's head nurses believe that oxygen is a drug and should be administered with prescription, while 41% believe that the oxygen is a gas that improves patients’ breathing (14). This study reveals that the knowledge of doctors and nurses on how to correctly use oxygen is fair to weak (in some aspects) and this could have a harmful effect on their performance. It is clear that more emphasis on training in oxygen therapy is necessary during basic training courses for doctors and nurses; and constant and dynamic monitoring on personnel’s learning and performance should be applied. Therefore, more consideration and further theoretical and practical training courses in this field seems to be necessary. Small sample size and failure to evaluate the attitude and practice of participants are among the limitations of the present study and it is recommended to conduct more studies in this regard. Conclusion:The findings showed that the familiarity level of participants with some aspects of O2 therapy such as its indications, necessary measurements and monitoring during therapy, and identifying delivery devices was fair to weak (<80%). Therefore, more consideration and further theoretical and practical training courses in this field seems to be necessary. AcknowledgmentMany thanks to colleagues for their assistance and consultation in designing the questionnaire. Warm thanks to respected doctors and nurses who helped in carrying out our plan and completed the questionnaires with patience; without their assistance this project was not possible. Authors’ contributions:All authors passed four criteria for authorship contribution based on recommendations of the International Committee of Medical Journal Editors. Conflict of interest:None. Funding support:Special thanks to Clinical Research Development Unit of Imam Hossein Hospital, affiliated to Shahid Beheshti University of Medical Sciences, for the registration and financial support. References1. Fitzgerald JM, Baynham R, Powles AC. Use of oxygen therapy for adult patients outside the critical care areas of a university hospital. Lancet. 1988;1(8592):981–3. [PubMed] [Google Scholar] 3. Kallstrom TJ. AARC Clinical Practice Guideline: oxygen therapy for adults in the acute care facility--2002 revision & update. Respir Care. 2002;47(6):717–20. [PubMed] [Google Scholar] 4. Al-Mobeireek AF, Abba AA. An audit of oxygen therapy on the medical ward in 2 different hospitals in Central Saudi Arabia. Saudi Med J. 2002;23(6):716–20. [PubMed] [Google Scholar] 5. Small D, Duha A, Wieskopf B, et al. Uses and misuses of oxygen in hospitalized patients. Am J Med. 1992;92(6):591–5. [PubMed] [Google Scholar] 6. Howell M. An audit of oxygen prescribing in acute general medical wards. Prof Nurse. 2001;17(4):221–4. [PubMed] [Google Scholar] 7. Fulmer JD, Snider GL. American College of Chest Physicians (ACCP)--National Heart, Lung, and Blood Institute (NHLBI) Conference on oxygen therapy. Arch Intern Med. 1984;144(8):1645–55. [PubMed] [Google Scholar] 8. Guyatt GH, McKim DA, Weaver B, et al. Development and testing of formal protocols for oxygen prescribing. Am J Respir Crit Care Med. 2001;163(4):942–6. [PubMed] [Google Scholar] 9. Snider GL, Rinaldo JE. Oxygen therapy, oxygen therapy in medical patients hospitalized outside of the intensive care unit. Am Rev Respir Dis. 1980;122(5 Pt 2):29–36. [PubMed] [Google Scholar] 10. Considine J, Botti M, Thomas S. The effects of specific educational preparation on emergency nurses' clinical decisions regarding supplemental oxygen administration. Nurs Health Sci. 2006;8(2):73–80. [PubMed] [Google Scholar] 11. Eastwood GM, Reeves JH, Cowie BS. Nasopharyngeal oxygen in adult intensive care--lower flows and increased comfort. Anaesth Intensive Care. 2004;32(5):670–1. [PubMed] [Google Scholar] 12. Dodd ME, Kellet F, Davis A, et al. Audit of oxygen prescribing before and after the introduction of a prescription chart. BMJ. 2000;321(7265):864–5. [PMC free article] [PubMed] [Google Scholar] 13. Ganeshan A, Hon LQ, Soonawalla ZF. Oxygen: Can we prescribe it correctly? Eur J Intern Med. 2006;17(5):355–9. [PubMed] [Google Scholar] 14. Brokalaki H, Matziou V, Zyga S, et al. Omissions and errors during oxygen therapy of hospitalized patients in a large city of Greece. Intensive Crit Care Nurs. 2004;20(6):352–7. [PubMed] [Google Scholar] Articles from Emergency are provided here courtesy of Shahid Beheshti University of Medical Sciences Which of the following are indications for oxygen therapy?Indications for Oxygen Therapy
An acute situation in which hypoxemia is suspected. Substantiation of hypoxemia is required within an appropriate period of time following initiation of therapy. Severe trauma. Short-term therapy (e.g., carbon monoxide poisoning) or surgical intervention (e.g., post-anesthesia recovery).
What are the nursing considerations for oxygen therapy?Key points. Hypoxia is an indication that oxygen therapy should be started.. If blood oxygen levels are not low, oxygen will not treat breathlessness.. A target oxygen saturation range should be prescribed to guide therapy.. A lower target saturation range should be prescribed for patients at risk of hypercapnia.. What is the earliest indication to administer oxygen therapy?Indications for acute oxygen
Give oxygen empirically in patients with cardiac or respiratory arrest or when there is respiratory distress or hypotension. Arterial blood gases should be analysed as soon as possible to assess the degree of hypoxaemia, partial pressure of carbon dioxide (Pco2), and acid-base state.
What are the guidelines for oxygen therapy?The 3 main recommendations include: Acutely ill adult medical patients (with exceptions) should stop oxygen therapy no higher than 96% saturation. (strong recommendation) Patients with acute stroke or MI should not start oxygen therapy between 90% and 92% saturation.
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