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The roles and responsibilities of an advanced practice nursing team for coordinating extracorporeal life support in
Yee Hian Quah1, Paul Ross2, Jayne Sheldrake1
1Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC 3004, Australia.
Introduction:
Extracorporeal membrane oxygenation (ECMO) is a type of mechanical circulatory support that is increasingly utilised for severe cardiorespiratory failure in the intensive care unit (ICU) setting. ECMO is resource-intensive, and as a result, the development of ICU-led ECMO teams has provided opportunities for specialist nursing roles and new care delivery models.
Objectives:
The aim of this study was to explore and describe the roles and responsibilities of a novel ECLS-APNT nursing team (ECLS-APNT) in a high-volume ECMO ICU.
Design:
A descriptive qualitative design was applied using a combination of semistructured interviews and confirmatory observation in the clinical ICU setting.
Setting:
The study was conducted in a tertiary ICU in Melbourne, Australia, which provides specialist statewide referral services for ECMO, mechanical circulatory support, and heart and lung transplantation. The ICU admits over 3000 adult and paediatric patients per year, caring for more than 100 ECMO supported patients per year. The ICU provides both venovenous and venoarterial-including extracorporeal cardiopulmonary resuscitation-modes of ECMO.
Participants:
The ECLS-APNT members participated in this study.
Main Outcome Measures:
An inductive approach to content analysis was utilised to identify themes.
Results:
Six semistructured interviews and 23.5 h of direct observation of the ECLS-APNT were conducted. Five themes concerning the roles and responsibilities of the ECLS-APNT were identified from the interviews and direct observation: (i) internal responsibilities; (ii) external responsibilities of working in an ECMO referral ICU; (iii) beyond ECMO support; (iv) care transitions from clinical deterioration to weaning, bridge-to-transplant, or end of life care; and (v) governance and service quality enhancement to ensure the provision of a "24/7" service.
Conclusions:
The ECLS-APNT's roles and responsibilities are not limited to the patient-circuit interface. Their innovative-driven practices extend into strategically balancing localised centre needs with statewide service demands such as clinical governance and supporting care transitions (e.g., bridging from ECMO support to transplant).
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