Mechanical Ventilation in Swedish Intensive Care Units

Topic: Medicine Words: 940 Pages: 3 Apr 8, 2022

Abstract

The study under review used a descriptive design and a sample consisting of head nursing professionals and senior doctors working in participating ICUs in Sweden not only to investigate the creation and propagation of guidelines on mechanical ventilation (MV) in ICUs but also to evaluate how the available evidence base for MV is applied in clinical guidelines and everyday practice. The findings demonstrated a high occurrence and use of guidelines regarding the procedure in Swedish ICUs; however, it was found that the guidelines fail to include patients’ experiences and their application vary across practice settings due to individual inclinations, low awareness level, and alteration to patients’ needs.

Citation

Catrine, A., Vogel, G., Soderberg, A., Blomsquist, H., & Wengstrom, Y. (2013). Use of evidence in clinical guidelines and everyday practice in Swedish intensive care units. Worldviews on Evidence-Based Nursing, 10(4), 198-207.

Synopsis

Purpose of Study

The study sought to address the lack of national guidelines for mechanical ventilation (MV) in Sweden and limited knowledge related to which evidence on MV is applied in everyday practice in the country’s ICUs by not only examining the creation and distribution of guidelines on MV in the high-dependency units but also evaluating how the existing evidence base for MV is applied in clinical guidelines and daily practice.

Study Sample

The sample for this particular study comprised ICU head nurses and senior doctors and was attained by appealing to all general ICUs in the country to participate. Although the sampling strategy was not discussed, the researchers probably used the purposive sampling technique as they were interested in participants with in-depth knowledge regarding the use and dissemination of MV evidence.

Inclusion or Exclusion Criteria

Although the authors did not mention the standards used to include or exclude participants from the study, probably, seniority, duty station (ICU), and in-depth knowledge of the main issues of interest served as the main inclusion criteria.

Participants

55 of the 65 ICUs in Sweden took part in the study, with 55 chief nurses and 45 senior doctors participating in the data collection process. Consequently, the response rate for head nurses was 84.6%, while that of senior physicians was 69.2%.

Methods of Data Collection

After the completion of a national mail survey conducted in the spring of 2011 to evaluate the occurrence/use of MV guidelines and the evidence-based associated with the procedure, individual telephone interviews were done with ICU managers (chief nurses and senior doctors) to explore the application and distribution of MV evidence. It is important to note that 21 Swedish county councils were used to identify all anesthetic sections with ICUs in surgical or medical care to facilitate the dissemination of study information and recruitment of participants in areas where consent was obtained (Catrine, Vogel, Soderberg, Blomsquist, & Wengstrom, 2013).

Both quantitative and qualitative data were collected using the two data collection techniques; SPSS was employed to analyze and interpret quantitative information from the mail survey and structured data from telephone interviews, while qualitative content analysis was used to analyze qualitative data arising from open-ended items.

Testing of Intervention/Treatment/Clinical Protocol

No intervention protocol was tested as the design was descriptive and the study was not concerned with the testing of experimental interventions against control conditions.

Main Findings of Study

The study found that (1) there is a high occurrence of guidelines concerning MV in the country’s ICUs, although no guideline demonstrates how evidence is usually sought or appraised, (2) clinical guidelines in the Nordic country do not consider patients’ experiences of MV and are often developed by inter-departmental professionals who share information via the ICUs website, and (3) the guidelines are primarily applied as a foundation for MV bedside management, though they usually vary due to individual inclinations, low awareness level, and alteration to patients’ needs (Catrine et al., 2013).

Credibility

Question	Response (Yes/No/Not clear) and Explanation
“If the study is published in a peer-reviewed journal?”	Yes, because the article appears when a search is limited to “peer-reviewed journals” only, implying that all articles appearing in the “Worldviews on Evidence-Based Nursing” are peer-reviewed.
“If research/experimental design is appropriate?”	Yes
“If the data obtained and the data analysis conducted to answer the research question?”	Yes
“If the measuring instruments used in this study are reliable and valid?”	Yes, because the telephone interview guide was pilot tested with knowledgeable registered nurses who were at the time not employed in the sampled ICUs to remove ambiguity and lack of response alternatives.
“If important extraneous variables and potential bias controlled for in this study?”	Yes
“If the study was free of extraneous variables introduced by how, when, and where the study was done?”	No
“If findings are consistent with previous findings from other studies in this area of study?”	Yes
“If the study findings are credible?”	All yes

Conclusion

Overall, it is true that more studies need to be done to address the lack of knowledge on which strategies are most effective for attaining, developing, and implementing evidence in advanced healthcare environments such as ICUs to stimulate knowledge translation and ensure existing limitations (e.g., lack of patient perspectives in the gathering and development of evidence) are successfully dealt with.

The findings of this study would probably have been different if it was undertaken with nurses in the United States of America due to variations in clinical practice guidelines and existing evidence base. Lastly, the findings of this study are similar to what happens in own clinical practice setting, particularly in terms of excluding patient experiences in the development of clinical practice guidelines and variation of guidelines across practice settings due to personal preferences, lack of awareness, and adjustment to patients’ needs.

Reference