title: Understanding nurses' decision-making when managing weaning from mechanical ventilation: a study of novice and experienced critical care nurses in Scotland and Greece.
abstract: OBJECTIVE
  To examine how nurses collect and use cues from respiratory assessment to inform their decisions as they wean patients from ventilatory support.
  
  
  BACKGROUND
  Prompt and accurate identification of the patient's ability to sustain reduction of ventilatory support has the potential to increase the likelihood of successful weaning. Nurses' information processing during the weaning from mechanical ventilation has not been well-described.
  
  
  METHODS
  A descriptive ethnographic study exploring critical care nurses' decision-making processes when weaning mechanically ventilated patients from ventilatory support in the real setting.
  
  
  METHODS
  Novice and expert Scottish and Greek nurses from two tertiary intensive care units were observed in real practice of weaning mechanical ventilation and were invited to participate in reflective interviews near the end of their shift. Data were analysed thematically using concept maps based on information processing theory. Ethics approval and informed consent were obtained.
  
  
  RESULTS
  Scottish and Greek critical care nurses acquired patient-centred objective physiological and subjective information from respiratory assessment and previous knowledge of the patient, which they clustered around seven concepts descriptive of the patient's ability to wean. Less experienced nurses required more encounters of cues to attain the concepts with certainty. Subjective criteria were intuitively derived from previous knowledge of patients' responses to changes of ventilatory support. All nurses used focusing decision-making strategies to select and group cues in order to categorise information with certainty and reduce the mental strain of the decision task.
  
  
  CONCLUSIONS
  Nurses used patient-centred information to make a judgment about the patients' ability to wean. Decision-making strategies that involve categorisation of patient-centred information can be taught in bespoke educational programmes for mechanical ventilation and weaning.
  
  
  CONCLUSIONS
  Advanced clinical reasoning skills and accurate detection of cues in respiratory assessment by critical care nurses will ensure optimum patient management in weaning mechanical ventilation.
authors.affiliation: School of Nursing, Midwifery & Social Care, Edinburgh Napier University, Edinburgh, UK.|School of Health in Social Science, Nursing Studies, University of Edinburgh, Edinburgh, UK.|NHS Lothian, Edinburgh Critical Care Research Group, Edinburgh, UK.
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Kydonaki
authors.affiliation: Faculty of Health and Social Studies, University College Østfold, Halden, Norway.|School of Health in Social Science, University of Edinburgh, Edinburgh, UK.
authors.forename: Guro
authors.initials: G
authors.lastname: Huby
authors.affiliation: School of Health in Social Science, University of Edinburgh, Edinburgh, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tocher
authors.affiliation: NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Brisbane, Qld, Australia.|Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Qld, Australia.|School of Health Sciences, City University London, London, UK.|Nursing Practice Development Unit, Princess Alexandra Hospital, Woolloongabba, Qld, Australia.
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Aitken
mesh_terms: D000328:Adult; D064648:Critical Care Nursing; D003657:Decision Making; D005260:Female; D006115:Greece; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009736:Nursing Process; D012606:Scotland; D015300:Ventilator Weaning / Q000451:nursing*; D055815:Young Adult
keywords: cognitive process; critical care nurses; decision-making; mechanical ventilation; observation; weaning