Perceived decisional responsibility for mechanical ventilation and weaning: a Norwegian survey

Abstract

Aim: To explore variability in perceptions of nurse managers and physician directors regarding roles, responsibilities and clinical-decision making related to mechanical ventilator weaning in Norwegian intensive care units (ICUs).

Background: Effective teamwork is crucial for providing optimal patient care in ICU. More knowledge on nurses' and physicians' perceptions of responsibility in clinical decision-making for mechanical ventilation is needed.

Methods: Self-administered survey of mechanical ventilation and weaning responsibilities was sent to nurse managers and physician directors of Norwegian adult ICUs. Nurses' decisional influence and autonomy were estimated on a numeric rating scale (NRS) from 0 to 10 (least to most).

Results: Response rate was 38/60 (63%) nurses and 38/52 (73%) physicians. On the NRS nurse managers perceived the autonomy and influence of nurses' ventilator decisions higher than physician directors: median of 7 (IQR 5-8) (nurses) versus 5 (3-6) (physicians), (p < 0·01), and 8 (7-9) (nurses) versus 7 (5-8) (physicians), (p < 0·01) respectively. Respondents agreed that nurses collaborated in assessment of patient response to ventilator changes and titrating ventilator settings: 92% of nurses and 87% of physicians, (p = 0·46), and recognizing weaning failure 84% of nurses and 84% of physicians, (p = 0·96). Physician directors perceived significantly less collaborative decision-making on weaning method (p = 0·01), weaning readiness (p = 0·04) and readiness to extubate (p < 0·01) than nurse managers. Both groups acknowledged the importance of 'knowing the patient' for weaning success, and agreed that the assessment of work of breathing, well-being, and clinical deterioration were important for determining weaning tolerance.

Conclusions: Nurse managers perceived nurses to have greater autonomy, influence and collaborative interaction regarding decisions on mechanical ventilation than physician directors. Greater awareness and acknowledgment of nurses' role may promote interprofessional collaboration and improve patient care.

Keywords: Critical care; Mechanical ventilation; Nursing; Role of health care professionals; Weaning from mechanical ventilation.