Nurses’ conceptions of facilitative strategies of weaning patients from mechanical ventilation—A phenomenographic study

Eckerblad, Jeanette; Eriksson, Heléne; Kärner, Anita; Edéll-Gustafsson, Ulla

doi:10.1016/j.iccn.2009.06.008

Cited by 12 publications

(7 citation statements)

References 27 publications

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“…Most reviews of weaning from mechanical ventilation have examined only quantitative data [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Range of health care professionals [25][26][27][28][29][30][31][32][33][34][35] Patients only [36][37][38][39][40][41][42][43][44][45] Physicians only (intensivists or anesthetists working in intensive care units) [46][47][48][49] Patients' family members 50,51 Patients and nurses Participant interviews and observation 12,13,27,28,[31][32][33]40<...>…”

Section: Discussionmentioning

confidence: 99%

Weaning From Mechanical Ventilation: A Scoping Review of Qualitative Studies

Rose

Dainty

Jordan

et al. 2014

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. List 3 key factors that influence ventilator weaning. 2. Define a scoping review. 3. Describe the steps in conducting a scoping review.To read this article and take the CNE test online, visit www.ajcconline.org and click "CNE Articles in This Issue." No CNE test fee for AACN members.By Louise Rose, PhD, Katie N. Dainty, PhD, Joanne Jordan, PhD, and Bronagh Blackwood, PhDBackground Weaning from mechanical ventilation is influenced by patient, clinician, and organizational factors.Objective To identify factors that may influence weaning and adoption of weaning strategies and tools, clinicians' perceptions of weaning strategies, and weaning experiences of patients and patients' families. Method A scoping review of indexed and nonindexed publications was done. Qualitative studies of health care providers, patients, and patients' families involved in weaning were included. Two investigators independently screened 8350 publications and extracted data from 43 studies. Study themes were content analyzed to identify common categories and themes within the categories. Results The study sample consisted of nurses in 15 studies, nurses and patients in 1 study, various health care providers in 11, patients in 10, and physicians in 4. Categories identified were as follows: for nurses, role or scope of practice, informing decision making, and influence on weaning outcome; for health care providers, factors influencing weaning decisions or use of protocols, role or scope of practice related to weaning, and organizational structure or practice environment; for patients, experience of mechanical ventilation and weaning, experience of the intensive care environment, psychological phenomena, and enabling success in weaning; and for physicians, tools or factors to facilitate weaning decisions and perceptions of nurses' role and scope of practice. However, even for these easy-to-wean patients, organizational and clinician factors such as staffing levels, skill mix, experience, and decision-making hierarchy influence the weaning process and can delay weaning and extubation. Such delays may result in prolonged duration of mechanical ventilation and stay in the intensive care unit (ICU) and increased costs.3 Approximately 30% of patients treated with mechanical ventilation experience difficult or prolonged weaning. 4 For these patients, similar organizational and clinician factors influence the duration and success of weaning. Because of the risk of further prolongation of mechanical ventilation, reintubation, and increased mortality, 5,6 identification of potentially modifiable factors that cause delays in weaning, unsuccessful weaning trials, and unsuccessful attempts in extubation is needed.An important step in ascertaining patient, clinician, and organizational factors that influence weaning is obtaining the views and perceptions of clinicians, patients, and patients' families who experience the process. Using...

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Section: Discussionmentioning

confidence: 99%

Weaning From Mechanical Ventilation: A Scoping Review of Qualitative Studies

Rose

Dainty

Jordan

et al. 2014

American Journal of Critical Care

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“…An important priority for critical care clinicians is therefore to discontinue mechanical support as soon as possible ( 1 - 3 ). Weaning from mechanical ventilation can amount to up to 40% of the patient’s total ventilator time ( 4 ). Weaning is described as a gradual reduction of ventilator support until the patient no longer requires ventilator assistance or until a further reduction is neither feasible nor realistic ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

“…Only a small number of qualitative studies have previously explored the weaning process from the perspective of nursing care. These qualitative studies ( 4 , 11 , 12 ) highlight the complex nature of weaning as well as the important role that nurses’ play in the procedure.…”

Section: Introductionmentioning

confidence: 99%

“…A holistic approach to weaning was previously proposed as a comprehensive model of caring ( 10 , 13 , 14 ). According to the literature, the experience of nurses is one of the key factors affecting holistic care during weaning from mechanical ventilation ( 4 , 11 , 15 ). Inexperienced nurses rely on only physiological parameters and the patient’s medical history, and so their care lacks the holistic approach (e.g., knowing the patient through interaction and continuity of care), which is necessary when making relevant decisions ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

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Holistic Care for Patients During Weaning from Mechanical Ventilation: A Qualitative Study

Khalafi

Elahi

Ahmadi

2016

Iran Red Crescent Med J

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BackgroundWeaning patients from mechanical ventilation is a complex and highly challenging process. It requires continuity of care, the overall assessment of patients, and a focus on all aspects of patients’ needs by critical care nurses.ObjectivesThe aim of the present study was to explore holistic care while patients are being weaned from mechanical ventilation from the perspective of the critical care nurses.MethodsThe study was carried out in the intensive care units (ICUs) of six hospitals in Ahvaz, Iran, from 2014 to 2015. In this qualitative study, 25 ICU staff including nurses, nurse managers, and nurse educators were selected by means of purposive sampling. Semi-structured interviews were used for data collection. The interview transcripts were then analyzed using qualitative content analysis.ResultsThe four main themes that emerged to explain nurses’ experiences of holistic care when weaning patients from mechanical ventilation include continuous care, a holistic overview of the patient, promoting human dignity, and the overall development of well-being.ConclusionsIt was found that avoiding routine pivotal expertise, increasing consciousness of the nonphysical aspects of patients while providing treatment and presenting exclusive care, utilizing experienced ICU nurses, and placing more emphasis on effective communication with patients in order to honor them as human beings can all enhance the holistic quality of care.

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“…Previous nursing research has mainly focused on the introduction of weaning protocols (Crocker, ; Mårtensson and Fridlund, ; Goodman, ; Hansen and Severinsson, ; Hansen and Severinsson, ) and only a small number of qualitative studies explore the weaning process from the perspective of nursing care. These qualitative studies (Gelsthorpe and Crocker, ; Eckerblad et al , ; Lavelle and Dowling, ) show the complex nature of weaning and the important roles nurses' play in this procedure. It is pointed out that decisions are often based on physiological parameters and that the collaboration in the team has an impact.…”

Section: Introductionmentioning

confidence: 99%

Weaning from mechanical ventilation: factors that influence intensive care nurses' decision‐making

Tingsvik

Johansson

Mårtensson

2014

Nursing in Critical Care

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Nurses’ conceptions of facilitative strategies of weaning patients from mechanical ventilation—A phenomenographic study

Abstract: Nurses conceptions of facilitative strategies of weaning patients from mechanical ventilation-A phenomenographic

Cited by 12 publications

References 27 publications

Weaning From Mechanical Ventilation: A Scoping Review of Qualitative Studies

Weaning From Mechanical Ventilation: A Scoping Review of Qualitative Studies

Holistic Care for Patients During Weaning from Mechanical Ventilation: A Qualitative Study

Weaning from mechanical ventilation: factors that influence intensive care nurses' decision‐making

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