title: Ventilatory weaning: a case study of protracted weaning.
abstract: BACKGROUND
  Dysfunctional ventilatory weaning response (DVWR) is characterized by interrupted and prolonged weaning. This reflective analysis presents how using nursing diagnoses in critical care can raise awareness of, and provide strategies for, managing problems related to ventilatory weaning.
  
  
  OBJECTIVE
  To examine and reflect upon why one patient took so long to wean from the ventilator using the structured approach of instrumental case study and nursing diagnosis to explain aspects of the weaning process.
  
  
  METHODS
  This case study examines one patient's experiences around ventilatory weaning using selected nursing diagnoses, exploring the implications that physiological, social, emotional and psychological factors have on both weaning and healing processes in critical care. By using dialogue, an explicit texture is presented of how one patient felt, with particular resonance to the relationships she had and the impact they made. Various nursing diagnoses proved useful in determining why this patient had an extended weaning trajectory and included DVWR, ineffective breathing pattern, impaired spontaneous ventilation, anxiety and impaired verbal communication. There were specific points of interest, in particular her anxiety, which proved a major factor, and her significantly improved functional status after the critical care episode. A DVWR may be minimized by nursing presence, reassurance and respect for patient autonomy. Complex anatomy and physiology contributes to protracted weaning and a DVWR and is compounded by anxiety. Furthermore, there is a significant element of nursing care, timely reassurance and presence, which can have a positive impact on patient well-being.
  
  
  CONCLUSIONS
  This reflective analysis highlights the benefits and importance of the nurse-patient relationship during what was a very protracted ventilatory wean. This shared trajectory enabled significant patient empowerment, and this case study gives the patient the voice she temporarily lost.
authors.affiliation: Critical Care Unit, Royal Marsden Hospital, London, UK. nataliepattison@hotmail.com
authors.forename: Natalie
authors.initials: N
authors.lastname: Pattison
authors.forename: Jennifer
authors.initials: J
authors.lastname: Watson
mesh_terms: D001007:Anxiety; D003144:Communication Barriers; D005260:Female; D006801:Humans; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009733:Nursing Diagnosis; D012944:Social Support; D015300:Ventilator Weaning / Q000451:nursing* / Q000523:psychology