The Impact of Terminal Extubation and End-of-Life Care on Respiratory Therapists

Abstract

Background:

Mechanical ventilation is a life-sustaining therapy that is routinely initiated, managed, and in many cases terminated by the respiratory therapist (RT). The termination of life support can lead to immediate and longer lasting feelings of anxiety and stress for respiratory therapists performing terminal extubations. The purpose of this study was to explore the implications of participating in end-of-life care activities for RTs.

Methods:

An online self-administered questionnaire was distributed to respiratory care department supervisors in multiple states across the US to recruit a convenience sample of RTs from each of the hospital departments invited. The survey was developed based on a review of previous published survey instruments and recommendations from physicians with expertise in the content area.

Results:

Of the 187 questionnaires returned, 173 were included for analysis. The majority of RTs participating in this study were female (74%) and had at least 11 years of experience (52%). All RTs indicated participating in at least one terminal extubation, with 52.6% performing >25. Nearly 65% reported experiencing internal emotions after participating in a terminal extubation, and 55% indicated that it was one of the hardest responsibilities of their job. RTs expressed feelings of anxiety (28.3%) and stress (22%) when entering a patient’s room for a terminal extubation. However, 60% expressed comfort with providing emotional support to family members during a terminal extubation. Nearly 60% indicated that they did not receive any training on terminal extubations or end-of-life care in their respiratory therapy education programs. 71% of RTs reported that they did not feel prepared to participate in end-of-life activities upon entry to clinical practice. The majority of RTs in this study suggested that periodic debriefing sessions with other RTs and clinicians (63%) and training (52%) would be helpful to improve end-of-life care experiences.

Conclusions:

RTs experienced varying levels of anxiety, stress, and internal emotions with performing terminal extubations and felt unprepared in dealing with this part of their job. RTs expressed a desire for debriefing opportunities and training on end-of-life care activities.