title: Physicians' perceptions of protocol-directed weaning in an intensive care unit in Norway.
abstract: The aim of this paper is to identify physicians' perceptions of protocol-directed weaning from mechanical ventilation in an intensive care unit in Norway. Errors occur in the absence of procedures, plans, and a team culture. Standardized weaning protocols, or pathways, offer a systematic approach. The focus group method was used. Four themes emerged: (i) acceptance, where the participants perceived the protocol as having a positive influence on the weaning process, although some barriers were identified, such as its failure to facilitate the "difficult-to-wean" patient; (ii) indignant responses, which gave the impression that the protocol was prescribed for the benefit of the nurses; (iii) ambivalence was evident in the two different approaches to the weaning process when problems occurred, which were "directing" and "collaborating"; and (iv) continuity and professional competence were perceived as important aspects of the weaning process. An unclear pattern of responsibility and poor interprofessional collaboration and communication were reported.
authors.affiliation: Department of Anesthesia and Intensive Care, Stavanger Hospital, Stavanger, Norway. habs@sus.no
authors.forename: Britt Saetre
authors.initials: BS
authors.lastname: Hansen
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Severinsson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003422:Critical Care / Q000379:methods / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009664:Norway; D024802:Nurse's Role; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D017009:Professional Autonomy; D011787:Quality of Health Care; D012121:Respiration, Artificial / Q000592:standards; D015300:Ventilator Weaning / Q000451:nursing / Q000592:standards*