Difficult to Wean Patients: Cultural Factors and their Impact on Weaning Decision-Making

K Kydonaki, Guro Huby, Jennifer Tocher

Research output: Contribution to journalArticlepeer-review

Abstract

Aims and objectives. This study aimed to examine the elements of the intensive care environment and consider the impact
on nurses’ involvement in decision-making when weaning from mechanical ventilation.
Background. Optimal management of difficult to wean patients requires the dynamic collaboration of all clinicians and the
contribution of their knowledge and skills. The introduction of weaning protocols has increased nurses’ input in decisionmaking,
but there are various elements of the decision environment that impact on their involvement, which have been given
little consideration.
Design. Ethnography was used as the research design for this study.
Methods. Fieldwork took place in two tertiary hospitals in Greece and Scotland for five months each to unveil clinicians’
behaviour and interactions during the weaning practice. Observation was based on the weaning process of 10 Scottish and 9
Greek long-term ventilated patients. Semi-structured interviews followed with nurses (n = 33) and doctors (n = 9) in both
settings to understand nurses’ perceived involvement in weaning decision-making. Thematic analysis of interviews and field
notes followed using the Qualitative Data Analysis software NVivo. Clinicians’ participation was voluntary.
Results. The main themes identified were the (1) organisation of the units (time and structure of the ward rounds, staff levels
and staff allocation system), (2) the inter- professional relationships, (3) the ownership and accountability in weaning
decision-making and (4) the role of the weaning protocols. These elements described the culture of the ICUs and defined
nurses’ role in weaning decision-making.
Conclusions. Clinical decision-making is a multi-dynamic process specifically in complex clinical situations such as weaning
from mechanical ventilation. This paper suggests that weaning practice should be considered in relation to the elements of
the clinical environment to provide an individualised and patient-centred weaning approach.
Relevance to clinical practice. Methods to enhance nurses’ role in teamwork and collaborative decision-making are suggested.
Key words: decision-making, ethnography, intensive care, mechanical ventilation, weaning
Original languageEnglish
JournalJournal of Clinical Nursing
Volume23
Issue number5-6
Early online date3 Nov 2013
DOIs
Publication statusPublished - 3 Nov 2013

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