Challenges and Responsibilities of Critical Care Nurses in the Weaning Process from Mechanical Ventilation for Patients Post-Cardiothoracic Surgery: A Qualitative Study

Abstract

Background: The responsibilities of critical care nurses for mechanical ventilation (MV) management may differ among countries, particularly in the weaning process. Aim: To identify nurses' perceptions, roles, and challenges regarding the weaning process for patients in intensive care units (ICUs) in Denmark, Egypt, and the Kingdom of Saudi Arabia (KSA). Methods: This study was a qualitative study using a phenomenological-hermeneutic design. Results: Nurses in Egypt and the KSA were more likely to independently adjust ventilator settings. They used body language, facial expressions, and eye contact to communicate with patients. They prepared patients for the weaning process following physicians' orders. They provided routine nursing care with no specific nursing guidelines or protocols for the weaning process. In contrast, the nurses in Denmark checked the ventilator settings frequently, assessed the consistency of secretions, and frequently performed endotracheal suctioning. They used body language, facial expressions, and eye contact, and they used low technology devices (e.g. word or picture charts, alphabet boards and rewritable magnetic boards) and advanced technological devices (e.g. electronic voice output communication aids through a computer) to communicate with their patients. Moreover, the criteria for weaning and the protocol were used to wean patients from MV. Unfortunately, no protocol was applied for patients with long-term MV. Therefore, the weaning of these patients was conducted by consultation between the nurses and physicians. Conclusion: The use of weaning protocols in Danish settings is an excellent example of collaborative teamwork to apply the best practices in MV weaning processes. It is recommended that nurses in Arab countries apply this experience.