Workforce profile, organisation structure and role responsibility for ventilation and weaning practices in Australia and New Zealand intensive care units

Rose, Louise; Nelson, Sioban; Johnston, Linda; Presneill, Jeffrey

doi:10.1111/j.1365-2702.2007.02129.x

Cited by 48 publications

(64 citation statements)

References 43 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%

“…We identified only 1 study of weaning in children, so our findings primarily relate to weaning of adult ICU patients. Studies were divided between those that identified factors important to individualized care and experience and those that investigated methods of standardizing care, such as objective parameters 10 Clochesy et al, 11 and Rose et al 22 were excluded from the thematic grid. These studies were surveys that incorporated comments from open-ended questions that were not developed into themes or categories.…”

Section: Methodsmentioning

confidence: 99%

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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%

Section: Methodsmentioning

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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“…In comparison, weaning management in the current Australian study involved unlimited assessment of weaning and extubation readiness performed by experienced and relatively autonomous critical care nurses using a 1:1 nurseto-patient ratio, supported by 24-h house medical staff and twice-daily rounds by intensivists. These organisational features are common to Australian ICUs in which ICU nurses commonly titrate ventilation and manage respiratory therapy according to physician-set physiologic targets [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

A randomised, controlled trial of conventional versus automated weaning from mechanical ventilation using SmartCare™/PS

et al. 2008

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“…The survey instrument was a previously validated questionnaire used to describe nursing roles and responsibilities for mechanical ventilation in adult ICUs in Australia and New Zealand 19 and 8 European countries, including the United Kingdom. 20 Wording was adapted and the questionnaire was validated for the UK pediatric setting by using a panel of 4 interprofessional pediatric experts who assessed clinical sensibility as recommended by Burns and colleagues.…”

Section: Survey Instrumentmentioning

confidence: 99%

“…[14][15][16][17][18] Similar components of complex clinical interventions that affect outcomes of weaning protocol trials may exist in adult ICUs and PICUs. A recent international survey on clinicians' roles and responsibilities for mechanical ventilation and weaning in adult ICUs 19 showed that nurse to patient ratios other than 1 to 1 resulted in a reduced likelihood of nurses adjusting ventilator settings and determining extubation readiness and weaning failure. The survey also showed that use of weaning protocols increased collaborative decision making.…”

mentioning

confidence: 99%

Role Responsibilities in Mechanical Ventilation and Weaning in Pediatric Intensive Care Units: A National Survey

Blackwood¹,

Junk²,

Lyons³

et al. 2013

American Journal of Critical Care

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Background Organizational processes affect the duration of mechanical ventilation in adult and pediatric intensive care units, but surprisingly little is known about role responsibilities for mechanical ventilation and weaning and related contextual factors that may influence timely liberation from mechanical ventilation. Objective To determine the professional group and seniority of clinicians responsible for key decisions regarding ventilation and weaning; use of ventilation protocols and automated closed loop systems; and provision of education on mechanical ventilation. Methods Mailed survey to nurse managers of pediatric intensive care units in the United Kingdom. Results Response rate was 61%. In most units, nurse managers reported that physicians and nurses usually collaborated in making decisions about initializing (63%) and adjusting (94%) ventilator settings and for determining weaning readiness (88%), weaning method (59%), extubation readiness (82%), and weaning failure (100%). Protocols for mechanical ventilation were available in 35% of units, some specific to weaning (18%) and others for noninvasive ventilation (35%). Automated closed loop systems were used in 18% of units. Competency training was required before nurses could adjust ventilator settings in 35% of responding units; in the remaining units, settings were adjusted by nurses who had no specific competency training. Conclusions Key decisions were mainly collaborative, but nurses were limited in their ability to adjust ventilator settings independently. This limitation may be due to a lack of standardized competency programs and the infrequent use of non-physician-led weaning protocols and automated systems. These findings indicate some ways of improving processes to avoid delays in ventilator weaning.

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Workforce profile, organisation structure and role responsibility for ventilation and weaning practices in Australia and New Zealand intensive care units

Cited by 48 publications

References 43 publications

Weaning From Mechanical Ventilation: A Scoping Review of Qualitative Studies

Weaning From Mechanical Ventilation: A Scoping Review of Qualitative Studies

A randomised, controlled trial of conventional versus automated weaning from mechanical ventilation using SmartCare™/PS

Role Responsibilities in Mechanical Ventilation and Weaning in Pediatric Intensive Care Units: A National Survey

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