Nursing the ARDS patient in the prone position: the experience of qualified ICU nurses.

The revival of the use of the prone position as a treatment for acute respiratory distress syndrome (ARDS) has been well documented in the medical literature, but there is little information regarding the difficulties of nursing patients in this position. The purpose of this study was to increase the body of knowledge by exploring the experiences of nurses who had cared for a patient in the prone position. A questionnaire was sent to all registered nurses in four large intensive care units (ICUs) to determine the main areas of concern when nursing patients in the prone position. There was a 62% response rate. Following this, a sample of 12 nurses volunteered to participate in three focus group interviews to further explore the issues. The main difficulties experienced related to the manoeuvre, including the timing of the move, the number of personnel and the co-ordination required. Problems experienced in providing nursing care related to pressure areas, suctioning, accidental injuries and management of emergencies. Deficits in knowledge of ARDS and skills in handling communication with relatives were also identified. As a result of this exploration, guidelines have been developed, focusing mainly on the manoeuvre, organizational and nursing issues, to provide guidance in caring for a patient when being nursed in the prone position.