Wayne State University

Study on standardized nurse-led algorithm to ensure patient respiratory comfort during ventilator withdrawal receives $2.4 million National Institute of Nursing Research award

Supporting a patient or family’s decision to remove artificial ventilation and allow for natural death requires palliative care, aimed at the prevention and relief of suffering.  Nurses — who are continuously present and engaged in care at the patient’s bedside — play a key role in this care.

Wayne State University College of Nursing professor Margaret L. Campbell, Ph.D., RN, FPCN and her research team were recently awarded a five-year, $2.4 million research grant from the National Institute of Nursing Research (NINR) of the National Institutes of Health (NIH) to test an algorithm intended to help nurses provide improved palliative care. Campbell and her research team will gather data from ethnically diverse patients in four medical intensive care units (MICUs) to scientifically test the algorithm based on an objective measure of distress — the Respiratory Distress Observation Scale (RDOS), which Campbell developed. The MICUs participating in this study include the Henry Ford Health System, University of Michigan, Harper University and Detroit Receiving Hospitals.

The RDOS was developed to guide palliative care clinicians when patients experience difficult or labored breathing — known as dyspnea — and cannot self-report any breathing discomfort. The RDOS will guide clinical care during the removal of life support, as ventilator withdrawal at the end of life is currently a largely unstandardized process in most MICUs.

“Difficulty breathing plagues a lot of people at the end of life, and it can be one of the worst symptoms,” said Campbell.

A nurse’s ability to ensure comfort for patients experiencing dyspnea during and following ventilator withdrawal could include changing the person’s position and administering low doses of morphine. Campbell noted, “These regimens are all best guided by an objective assessment, such as the RDOS.”

Formerly a Palliative Care Service nurse practitioner at Detroit Receiving Hospital, Campbell knows firsthand the gap in evidence-based palliative care guidelines. To provide optimal palliative care, she began establishing standardized assessments and evidence-based care methods for the terminally ill and dying under her watch. Now an internationally recognized palliative care scholar, she intends to make that guesswork no longer necessary for nurses providing end-of-life care.

“This National Institutes of Nursing Research award will allow Dr. Campbell and her team to further improve palliative care standards in the interest of patients and families, and will expand the body of nursing science in end-of-life care.  As a college of nursing in an urban research university, this work supports the very core of our mission,” said Dean Laurie M. Lauzon Clabo.