Weaning From Mechanical Ventilation: A Scoping Review of Qualitative Studies

Background: Weaning from mechanical ventilation is influenced by patient, clinician and organisational 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. Method: A scoping review of indexed and non indexed 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 outcomes; for health care providers, factors influencing weaning decisions or use of protocols, role or scope of practice related to weaning, and organisational 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.