Qualitative analysis of patients' work during mechanical ventilation and weaning

OBJECTIVE: To describe patients' recollections of their experiences during mechanical ventilation and weaning and to extend an evolving nursing theory of weaning. DESIGN: A qualitative approach that used grounded theory techniques. PATIENTS AND METHODS: We surveyed 20 hospitalized patients who had recently undergone mechanical ventilation and weaning from the ventilator in a critical care unit. Included in the analysis were any thoughts, feelings, or actions recalled by the patients that were related to the weaning experience. RESULTS: During ventilation and weaning, patients were engaged to various degrees in what they called ''work,'' which consisted of their efforts to assist in their adjustment and recovery. This work had four themes: sense making, enduring, preserving self, and controlling responses. These themes represented activities by which patients dealt with their personal concerns and cooperated with the therapeutic plan. CONCLUSIONS: Despite good care during the process, mechanical ventilation and weaning are stressful experiences that require active participation by patients. Patients' work needs to be understood and supported by clinicians to facilitate recovery from mechanical ventilation and weaning.