A comparative study examining the decision-making processes of medical and nursing staff in weaning patients from mechanical ventilation.
A prolonged period of mechanical ventilation is costly for both the patient, in terms of the risk of complications such as ventilator-acquired pneumonia, and to the health service due to the high cost of maintaining a patient in intensive care. The recognition of the role nurses can play in the weaning process and the desire to try and reduce weaning times led to the introduction of nurse-managed weaning on the intensive care unit which is the focus of this study. This means that both doctors and nurses are now responsible for making decisions about weaning. Flexible guidelines for weaning were devised which still require a large element of individual, clinical decision-making during the process. At every stage in the weaning process clinicians are required to make judgments about patient responses, using these judgments as the basis for their decision-making. This study examined the ways doctors and nurses make these decisions. Semi-structured interviews were conducted with doctors and senior nurses. A grounded theory approach was used to analyse the results and the key themes of Treatment, Balance, Making Progress and The Individual were identified which were found to be linked with particular methods of decision-making.
Taylor
Fran
F
Intensive Care Unit, Bassetlaw District General Hospital, 19 George St., Worksop, Notts S80 1QJ, UK. fran_taylor@mailcity.com
D000465:Algorithms; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003422:Critical Care / Q000379:methods; D003657:Decision Making; D006801:Humans; D019545:Intuition; D007600:Judgment; D008128:Logic; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods / Q000451:nursing; D024802:Nurse's Role / Q000523:psychology; D009730:Nursing Assessment; D015404:Nursing Methodology Research; D009736:Nursing Process; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010819:Physician's Role / Q000523:psychology; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D015300:Ventilator Weaning / Q000379:methods* / Q000451:nursing