Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Jane M. Georges (Chair), Joseph F. Burkard, David C. Willms


adult, cognitively impaired, critical care, dyspnea, RDOS, scale development


The Respiratory Distress Observation Scale (RDOS) is relatively new and has not been extensively evaluated. The purpose of this study was to, a) explore the incidence and severity of respiratory distress in the cognitively impaired adult patient on mechanical ventilation, b) examine the relationships between respiratory distress, pain, and agitation in that same population and, c) compare the differences in RDOS scoring results at a 1 minute versus 3 minute observation period. This study had Institutional Review Board approval and took place in a large metropolitan medical intensive care unit. Our subjects consisted of 148 cognitively impaired adults on mechanical ventilation. Our team found that 26% of our subjects experienced respiratory distress for over 5 hours aggregate per day. Patients on mechanical ventilation experience dyspnea even if cognitively impaired. The RDOS slightly correlated with pain as measured by the Critical-Care Pain Observation Tool (CPOT) score (rs = .15, p = .02). However, restlessness as measured by the Richmond Agitation and Sedation Scale (RASS) as compared to the RDOS score showed differentiation (rs = -.02, p = .76). Finally, our findings indicate that 1 minute of observation was as good as 3 minutes in terms of obtaining a score on the RDOS. This result has practical implications for use, research, and study with this scale since direct care staff is more likely to utilize a scale that takes less time. Our findings recommend further testing of the RDOS in the critical care population. Due to the limited amount of research on respiratory distress in the cognitively impaired patient prior to this research, this manuscript contributes to the body of knowledge on the clinical state of cognitively impaired adults on mechanical ventilation.

Document Type

Dissertation: Open Access