Nurses' conceptions of facilitative strategies of weaning patients from mechanical ventilation--a phenomenographic study.

BACKGROUND Mechanical ventilator withdrawal can amount up to 40% of total ventilator time. Being on a mechanical ventilator is associated with risk of anxiety, post-traumatic stress syndrome, nosocomial pneumonia and premature mortality. PURPOSE The purpose of the present study was to describe different conceptions of nurses' facilitating decision-making strategies regarding weaning patients from mechanical ventilations cared for in intensive care unit (ICU). METHOD Semi-structured interviews were analysed within the phenomenographic framework. Twenty ICU nurses were interviewed. FINDINGS The findings revealed three main categories of nurses' facilitating decision-making strategies: "The intuitive and interpretative strategy" featured nurses' pre-understandings. "The instrumental strategy" involved analysis and assessment of technological and physiological parameters. "The cooperative strategy" was characterised by interpersonal relationships in the work situation. Absence of a common strategy and lack of understanding of others' strategies were a source of frustration. The main goals were to end mechanical ventilator support, create a sense of security, and avoid further complications. CONCLUSION Although these findings need to be confirmed by further studies we suggest that nurses' variable use of individual strategies more likely complicate an efficient and safe weaning process of the patients from mechanical ventilation.