A Qualitative Study of Factors Affecting Sustainable Implementation of a Mechanical Ventilation Weaning Protocol
Keywords:
Barriers to research utilization, Intensive care unit, Mechanical ventilation weaning, Practice protocol, Qualitative researchAbstract
Use of a protocol for weaning patients from mechanical ventilation improves quality of care and reduces practice variation and cost of care. The introduction of a weaning protocol into practice, however, does not ensure that it will be used sustainably. The objective of this study was to explore healthcare provider perceptions of factors influencing sustained implementation of a mechanical ventilation weaning protocol using a descriptive, qualitative approach with observation of practice, focus group discussion, and in-depth interviews. The participants were 55 healthcare providers working in intensive care units in four tertiary care hospitals. Data were analyzed by thematic analysis. Four themes emerged from the data: staff attitude and competence, organizational support, multidisciplinary collaboration, and implementation feasibility. The themes provide insight into factors that are expected to promote sustained implementation of a mechanical ventilation weaning protocol. Addressing factors found in this study may help create best practices for sustained implementation of a mechanical ventilation weaning protocol, and perhaps other practice protocols. Research is needed to determine the impact of addressing these factors on sustainability of mechanical ventilation weaning protocols and weaning outcomes.
References
1. Kollef MH, Micek ST. Using protocols to improve patient outcomes in the intensive care unit: Focus on mechanical ventilation and sepsis. Semin Respir Crit Care Med. 2010 31(1):19-30.
2. Kirakli C, Ediboglu O, Naz I, Cimen P, Tatar D. Effectiveness and safety of a protocolized mechanical ventilation and weaning strategy of COPD patients by respiratory therapists. J Thorac Dis. 2014 6(9):1180-1186.
3. Hansen BS, Severinsson E. Physicians’ perceptions of protocol-directed weaning in an intensive care unit in Norway. Nursing & Health Sciences. 2009 11(1): 71-76.
4. Blackwood B, Alderdice F, Burns K, Cardwell C, Lavery G, O’ Hallo ran P. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. British Medical Journal. 2011 342: c7237.
5. Chaiwat O, Sarima N, Niyompanitpattana K, Komoltri C, Udomphorn Y, Kongsayreepong S. Protocol-directed vs. physician-directed weaning from ventilator in intraabdominal surgical patients. Journal of the Medical Association of Thailand. 2010 93(8): 930-6.
6. Roh JH, Synn A, Lim CM, Suh HJ, Hong SB, Huh JW, et al. Weaning protocol administered by critical care nurses for the weaning of patients from mechanical ventilation. J Crit Care. 2012 27(6):549-55.
7. Woody N. Ventilator Weaning Protocols: Influencing Outcomes and Promoting Success. Graduate Research Projects. 2013. [cited 2015 December 15]. Available from http://knowledge.e.southern.edu/gradnursing/23
8. Teixeira C, Maccari JG, Vieira SR, Oliveira RP, Savi A, Machado AS, et al. Impact of a mechanical ventilation weaning protocol on the extubation failure rate in difficultto-wean patients. J Bras Pneumol. 2012 38(3):364-37.
9. Stirman SW, Kimbery J, Cook N, Calloway A, Castro F, Charns M. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implementation Science. 2012 7: 1-19.
10. Maher L, Gustafson D, Evans A. Sustainability model and guide. NHS Institute for Innovation and Improvement. NHS Institute for Innovation and Improvement. 2010 [cited 2015 June 26].Available from http://www. institute.nhs.uk/sustainability_model/general/ welcome_ to_sustainability.html
11. Tuit PK, George EL. The role of the clinical nurse specialist in facilitating evidence- based practice within university setting. Critical Care Nursing Quarterly 33(2):117-2
12. Ploeg J, Skelly J, Rowan M, Edwards N, Davies B, Grinspun D, et al. The role of nursing best practice champions in diffusing practice guidelines: A mixed methods study. Worldviews on Evidence-Based Nursing. 2010. https://www.researchgate. net/ profile/Jennifer_Skelly/publication/ 46819333
13. White V, Currey J, Botti M. Multidisciplinary team developed and implemented protocols to assist mechanical ventilation weaning: A systematic review of literature. Worldviews on Evidence-based Nursing. 2010 8(1): 51-59.
14. Bumroongkit C, Liwsrisakun C, Deesomchok A, Theerakittiku T, Pothirat C. Efficacy of weaning protocol in medical intensive care unit of tertiary care center. Journal of the Medical Association of Thailand. 2005 88(1): 52-57.
15. Choatseenin M. Effects of multidisciplinary ventilator weaning team approach on weaning time and weaning success of surgical critically ill patients. [Unpublished master’s thesis]. Chiang Mai, Thailand: Chiang Mai University; 2005. [in Thai].
16. Pisitkul, K., Palawatvichai, A., Thitivichiean, S. Decreasing in weaning time by using ventilator weaning protocol in Phramongkultklao Hospital. Thai Journal of Tuberculosis and Chest Diseases. 2008 23(2): 63-71. [in Thai].
17. Chatburn RL, Deem SM. Should weaning protocols be use with all patients who receive mechanical ventilation? Respiratory Care. 2007 52 (5): 609-619.
18. Titler M. Translating research into practice. American Journal Nurses. 2007 107 (6) : 26-33.
19. De Vos M, Van der Veer S, Graafmans WC, De Keizer N, Jager. KJ, Westert GP, et al. Implementing quality indicators in intensive care units: exploring barriers to and facilitators of behavior change. Implement Science. 2010 5(2): 1-8.
20. Sinuff T, Cook D, Glacomini M, Heyland D, Dodek P. Facilitating clinician adherence to guidelines in the intensive care unit: a multicenter, qualitative study. Critical Care Medicine. 2007 35 (9): 2083-2089.
21. Rose, L. Interprofessional collaboration in the ICU: how to define?. British Association of Critical Care Nurses. 2011 16(1): 1- 9.
22. Scheirer MA, Dearing JW. An Agenda for Research on the Sustainability of Public Health Programs. American Journal of Public Health: November 2011 101(11): 20592067.
23. Thongchai C, Bumroongkit C, Jittawatanarat K, Puengbanhan K, Chuajedton P. Effectiveness of evidence-based ventilator weaning guidelines implementation among patients in surgical critical care units: A multisite study. Thai Journal of Nursing Research. 2007 11(1), 35-48.
24. Danckers M, Grosu H, Jean R, Cruz RB, Han O, Awerbuch E, et al. Nurse-driven, protocol-directed weaning from mechanical ventilation improves clinical outcomes and is well accepted by intensive care unit physicians. Journal of Critical Care. 2013 28, 433– 441.
25. Medves J, Godfrey C, Turner C, Paterson M, Harrison M, MacKenzie L, et al. Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice. International Journal of Evidence-based Healthcare. 2010 8: 79 - 89.
26. Sandelowski M. Focus on research methods whatever happened to qualitative description? Research in Nursing & Health. 2000 23: 334- 340.
27. Magnet Recognition Program Overview. 2015 [cited 2015 January 2]. Available from htt://www.nursecredetialing. org/magnet/program overview.
28. Braun V. Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006 3(2): 77101
29. Lincoln SL. Guba EG. Naturalistic inquiry. Newbury Park: Sage Publications; 1985.
30. Rogers EM. Diffusion of innovations (5th ed.). New York: Collier Macmillan Publishing. 2003.
31. Gerard TD, Ely EW. Protocol-Driven ventilator weaning reviewing the evidence. Clinical Chest Medicine. 2008 29 (2) : 241- 252.
32. Weingarten SR, Henning JM, Badamgarav E, Knight K, Hasselblad V, Gano Jr A, et al. Interventions used in disease management programs for patients with chronic illness which ones work? Meta-analysis of published reports. British Medical Journal. [cited 2014 January 15]. Available from http:// www.ncbi.nlm. nih.gov/pmc/articles/ PMC130055/ pdf/925.pdf
33. Eckerblad J, Eriksson H, Krner A, Edll-Gustafsson U. Nurses’ conceptions of facilitative strategies of weaning patients from mechanical ventilation - A phenomenographic study. Intensive and Critical Care Nursing. 2009 25: 225—232.
2. Kirakli C, Ediboglu O, Naz I, Cimen P, Tatar D. Effectiveness and safety of a protocolized mechanical ventilation and weaning strategy of COPD patients by respiratory therapists. J Thorac Dis. 2014 6(9):1180-1186.
3. Hansen BS, Severinsson E. Physicians’ perceptions of protocol-directed weaning in an intensive care unit in Norway. Nursing & Health Sciences. 2009 11(1): 71-76.
4. Blackwood B, Alderdice F, Burns K, Cardwell C, Lavery G, O’ Hallo ran P. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. British Medical Journal. 2011 342: c7237.
5. Chaiwat O, Sarima N, Niyompanitpattana K, Komoltri C, Udomphorn Y, Kongsayreepong S. Protocol-directed vs. physician-directed weaning from ventilator in intraabdominal surgical patients. Journal of the Medical Association of Thailand. 2010 93(8): 930-6.
6. Roh JH, Synn A, Lim CM, Suh HJ, Hong SB, Huh JW, et al. Weaning protocol administered by critical care nurses for the weaning of patients from mechanical ventilation. J Crit Care. 2012 27(6):549-55.
7. Woody N. Ventilator Weaning Protocols: Influencing Outcomes and Promoting Success. Graduate Research Projects. 2013. [cited 2015 December 15]. Available from http://knowledge.e.southern.edu/gradnursing/23
8. Teixeira C, Maccari JG, Vieira SR, Oliveira RP, Savi A, Machado AS, et al. Impact of a mechanical ventilation weaning protocol on the extubation failure rate in difficultto-wean patients. J Bras Pneumol. 2012 38(3):364-37.
9. Stirman SW, Kimbery J, Cook N, Calloway A, Castro F, Charns M. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implementation Science. 2012 7: 1-19.
10. Maher L, Gustafson D, Evans A. Sustainability model and guide. NHS Institute for Innovation and Improvement. NHS Institute for Innovation and Improvement. 2010 [cited 2015 June 26].Available from http://www. institute.nhs.uk/sustainability_model/general/ welcome_ to_sustainability.html
11. Tuit PK, George EL. The role of the clinical nurse specialist in facilitating evidence- based practice within university setting. Critical Care Nursing Quarterly 33(2):117-2
12. Ploeg J, Skelly J, Rowan M, Edwards N, Davies B, Grinspun D, et al. The role of nursing best practice champions in diffusing practice guidelines: A mixed methods study. Worldviews on Evidence-Based Nursing. 2010. https://www.researchgate. net/ profile/Jennifer_Skelly/publication/ 46819333
13. White V, Currey J, Botti M. Multidisciplinary team developed and implemented protocols to assist mechanical ventilation weaning: A systematic review of literature. Worldviews on Evidence-based Nursing. 2010 8(1): 51-59.
14. Bumroongkit C, Liwsrisakun C, Deesomchok A, Theerakittiku T, Pothirat C. Efficacy of weaning protocol in medical intensive care unit of tertiary care center. Journal of the Medical Association of Thailand. 2005 88(1): 52-57.
15. Choatseenin M. Effects of multidisciplinary ventilator weaning team approach on weaning time and weaning success of surgical critically ill patients. [Unpublished master’s thesis]. Chiang Mai, Thailand: Chiang Mai University; 2005. [in Thai].
16. Pisitkul, K., Palawatvichai, A., Thitivichiean, S. Decreasing in weaning time by using ventilator weaning protocol in Phramongkultklao Hospital. Thai Journal of Tuberculosis and Chest Diseases. 2008 23(2): 63-71. [in Thai].
17. Chatburn RL, Deem SM. Should weaning protocols be use with all patients who receive mechanical ventilation? Respiratory Care. 2007 52 (5): 609-619.
18. Titler M. Translating research into practice. American Journal Nurses. 2007 107 (6) : 26-33.
19. De Vos M, Van der Veer S, Graafmans WC, De Keizer N, Jager. KJ, Westert GP, et al. Implementing quality indicators in intensive care units: exploring barriers to and facilitators of behavior change. Implement Science. 2010 5(2): 1-8.
20. Sinuff T, Cook D, Glacomini M, Heyland D, Dodek P. Facilitating clinician adherence to guidelines in the intensive care unit: a multicenter, qualitative study. Critical Care Medicine. 2007 35 (9): 2083-2089.
21. Rose, L. Interprofessional collaboration in the ICU: how to define?. British Association of Critical Care Nurses. 2011 16(1): 1- 9.
22. Scheirer MA, Dearing JW. An Agenda for Research on the Sustainability of Public Health Programs. American Journal of Public Health: November 2011 101(11): 20592067.
23. Thongchai C, Bumroongkit C, Jittawatanarat K, Puengbanhan K, Chuajedton P. Effectiveness of evidence-based ventilator weaning guidelines implementation among patients in surgical critical care units: A multisite study. Thai Journal of Nursing Research. 2007 11(1), 35-48.
24. Danckers M, Grosu H, Jean R, Cruz RB, Han O, Awerbuch E, et al. Nurse-driven, protocol-directed weaning from mechanical ventilation improves clinical outcomes and is well accepted by intensive care unit physicians. Journal of Critical Care. 2013 28, 433– 441.
25. Medves J, Godfrey C, Turner C, Paterson M, Harrison M, MacKenzie L, et al. Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice. International Journal of Evidence-based Healthcare. 2010 8: 79 - 89.
26. Sandelowski M. Focus on research methods whatever happened to qualitative description? Research in Nursing & Health. 2000 23: 334- 340.
27. Magnet Recognition Program Overview. 2015 [cited 2015 January 2]. Available from htt://www.nursecredetialing. org/magnet/program overview.
28. Braun V. Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006 3(2): 77101
29. Lincoln SL. Guba EG. Naturalistic inquiry. Newbury Park: Sage Publications; 1985.
30. Rogers EM. Diffusion of innovations (5th ed.). New York: Collier Macmillan Publishing. 2003.
31. Gerard TD, Ely EW. Protocol-Driven ventilator weaning reviewing the evidence. Clinical Chest Medicine. 2008 29 (2) : 241- 252.
32. Weingarten SR, Henning JM, Badamgarav E, Knight K, Hasselblad V, Gano Jr A, et al. Interventions used in disease management programs for patients with chronic illness which ones work? Meta-analysis of published reports. British Medical Journal. [cited 2014 January 15]. Available from http:// www.ncbi.nlm. nih.gov/pmc/articles/ PMC130055/ pdf/925.pdf
33. Eckerblad J, Eriksson H, Krner A, Edll-Gustafsson U. Nurses’ conceptions of facilitative strategies of weaning patients from mechanical ventilation - A phenomenographic study. Intensive and Critical Care Nursing. 2009 25: 225—232.
Downloads
Published
2016-04-27
How to Cite
1.
Wongrostrai Y, Fongkaew W, Pinyokham N, Hanneman SK. A Qualitative Study of Factors Affecting Sustainable Implementation of a Mechanical Ventilation Weaning Protocol. PRIJNR [Internet]. 2016 Apr. 27 [cited 2024 Apr. 18];20(2):132-47. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/38554
Issue
Section
Original paper
License
Copyright: The Pacific Rim International Journal of Nursing Research, Thailand Nursing & Midwifery Council has exclusive rights to publish, reproduce and distribute the manuscript and all contents therein.
.png)
