title: Weaning from mechanical ventilation: a scoping review of qualitative studies.
abstract: BACKGROUND
  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.
  
  
  METHODS
  A scoping review of indexed and nonindexed publications (1990-2012) 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.
  
  
  CONCLUSIONS
  Important issues identified were perceived importance of interprofessional collaboration and communication, need to combine subjective knowledge of the patient with objective clinical data, balancing of weaning systematization with individual needs, and appreciation of the physical and psychological work of weaning.
authors.affiliation: Louise Rose is TD Nursing Professor of Critical Care Research, Sunnybrook Health Sciences Centre, an associate professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, research director, Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital, and an adjunct scientist, Mt Sinai Hospital and the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario. Katie N. Dainty is a scientist, Rescu and Li Ka Shing Knowledge Institute, St Michael's Hospital, assistant professor, Institute of Health Management, Policy and Evaluation, University of Toronto. Joanne Jordan is a research associate, Revive Charity for the regional intensive care unit, Royal Victoria Hospital, and Bronagh Blackwood is a senior lecturer, Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland. louise.rose@utoronto.ca.
authors.forename: Louise
authors.initials: L
authors.lastname: Rose
authors.affiliation: Louise Rose is TD Nursing Professor of Critical Care Research, Sunnybrook Health Sciences Centre, an associate professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, research director, Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital, and an adjunct scientist, Mt Sinai Hospital and the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario. Katie N. Dainty is a scientist, Rescu and Li Ka Shing Knowledge Institute, St Michael's Hospital, assistant professor, Institute of Health Management, Policy and Evaluation, University of Toronto. Joanne Jordan is a research associate, Revive Charity for the regional intensive care unit, Royal Victoria Hospital, and Bronagh Blackwood is a senior lecturer, Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland.
authors.forename: Katie N
authors.initials: KN
authors.lastname: Dainty
authors.affiliation: Louise Rose is TD Nursing Professor of Critical Care Research, Sunnybrook Health Sciences Centre, an associate professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, research director, Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital, and an adjunct scientist, Mt Sinai Hospital and the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario. Katie N. Dainty is a scientist, Rescu and Li Ka Shing Knowledge Institute, St Michael's Hospital, assistant professor, Institute of Health Management, Policy and Evaluation, University of Toronto. Joanne Jordan is a research associate, Revive Charity for the regional intensive care unit, Royal Victoria Hospital, and Bronagh Blackwood is a senior lecturer, Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland.
authors.forename: Joanne
authors.initials: J
authors.lastname: Jordan
authors.affiliation: Louise Rose is TD Nursing Professor of Critical Care Research, Sunnybrook Health Sciences Centre, an associate professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, research director, Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital, and an adjunct scientist, Mt Sinai Hospital and the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario. Katie N. Dainty is a scientist, Rescu and Li Ka Shing Knowledge Institute, St Michael's Hospital, assistant professor, Institute of Health Management, Policy and Evaluation, University of Toronto. Joanne Jordan is a research associate, Revive Charity for the regional intensive care unit, Royal Victoria Hospital, and Bronagh Blackwood is a senior lecturer, Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland.
authors.forename: Bronagh
authors.initials: B
authors.lastname: Blackwood
mesh_terms: D001291:Attitude of Health Personnel; D003657:Decision Making; D006801:Humans; D007400:Interprofessional Relations; D024802:Nurse's Role; D016134:Organizational Policy; D017060:Patient Satisfaction; D010820:Physicians / Q000523:psychology; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D015300:Ventilator Weaning / Q000379:methods / Q000523:psychology*