Mental Health of Respiratory Therapists Performing Terminal Extubations

Abstract

Background:

Terminal extubation (TE) is defined as the planned extubation leading to death. During the COVID-19 pandemic, we perceived an increase in RTs performing TE alone, and were concerned about the mental health impact from this practice. We surveyed RTs to assess mental health impacts related to TE and access to available support.

Methods:

Interior Health (IH) has 207 RTs working in community and small to tertiary hospitals. 64 out of 207 RTs participated in a 17-question survey. Logic branching was used, thus some respondents completed fewer than 17 questions. Representation was from a wide spectrum of career experience: 9% 0-2 years, 14% 2-5 years, 20% 5-10 years, 30% 10-20 years, and 30% > 20 years of experience. IH Privacy Impact department and ARECCI IRB approved this survey.

Results:

61% (n = 39) of RTs surveyed continue to carry thoughts of TE more than 3 months later. Of those 39 RTs, 59% think of a past TE at least once a month, 26% remember the extubation at least once year, and 18% continue to reflect on a TE 10 years or more after the event. 98% of respondents indicated their site either did not have a policy or they were unaware of a policy requiring a supervisor to check in after a TE. 75% of participants indicated that their supervisor never checks in following a TE, conversely only 2% of RTs always receive a check-in. This could be explained by the survey finding that only 4% of respondents in supervisory positions have received training on how to provide mental health support. 59% of the RTs said they never utilize support such as organized debriefings or a counselor. Since COVID-19 started, 53% of the RTs had an increase in the expectation to perform TE alone. 45% of RTs prefer having a second provider present to assist with medical care or liaise with family, while 45% were uncertain if a second provider is always required. 14% of RTs indicated that performing TE was a factor in leaving an area of practice. This may be an underestimate as the survey was not distributed to RTs working in the private sector, or who have left the profession.

Conclusions:

Within the RT profession there is a culture of being strong despite emotionally difficult aspects of our role, such as TE. These survey results indicate that TE events can have a long-lasting impact on RTs. Not only might this affect their mental health, but also their career trajectory. This study revealed there are gaps in education, training and guidelines that could improve support and potentially reduce future harm to RTs’ mental health.

MENTAL HEALTH IMPACT QUESTIONS

Questions	Yes	No
If you no longer work in an area that performs terminal extubations, was this a factor in leaving that area of practice? (N=36)	14%	86%
Have you ever performed a terminal extubation without another healthcare worker in the room? (N=64)	80%	20%
For RTs currently performing extubations, since the start of the COVID-19 pandemic, have you experienced an increase in the expectation or requests for you to extubate patients alone? (N=53)	53%	47%
Do you ever think about a terminal extubation(s) that you performed or assisted with which occurred more than 3 months ago? (N=64)	61%	39%

MENTAL HEALTH SUPPORT QUESTIONS

Questions	Yes	No	Uncertain
When performing terminal extubations, do you prefer to have a second health care provider in the room to assist with medical care of the patient or liaise with family members? (N=64)	45%	9%	45%
Do you think the mental health of respiratory therapists would benefit from a guideline or policy requiring two healthcare providers be present for every terminal extubation? (N=64)	44%	20%	36%
Does/did the hospital you work at have a policy or guideline requiring a supervisor or manager to check in with you after being involved in a terminal extubation? (N=64)	2%	77%	22%
Do you think the mental health of respiratory therapists would benefit from a manager or supervisor connecting with staff after terminal extubations? (N=64)	53%	9%	38%
If you have been or currently are a shift supervisor or manager, did you ever receive education on how to support staff after a terminal extubation? (N=25)	4%	96%	N/A
As a frontline clinician did you ever receive education on how to support family members and colleagues during or following a terminal extubation? (N=64)	6%	94%	N/A
Following a terminal extubation, do/did you consistently have access to other supports such as organized debriefings or a counsellor? (N=64)	23%	77%	N/A