OBJECTIVE: Although practice guidelines for noninvasive ventilation (NIV) for patients with acute respiratory failure (ARF) have the potential to improve processes of care and patient outcomes, clinicians' views about life support technology guidelines are not well understood. The objective was to understand the knowledge about and attitudes toward an NIV guideline for patients with ARF and potential barriers to its use. DESIGN: Qualitative study based on individual, in-depth, semistructured interviews. SETTING: St. Joseph's Healthcare, Hamilton, Ontario. SUBJECTS: Thirty clinicians (six attending physicians, five residents, 12 nurses, and seven respiratory therapists) who used NIV for chronic obstructive pulmonary disease and congestive heart failure patients with ARF, before and after NIV guideline implementation. INTERVENTIONS: We elicited knowledge and attitudes about, behaviors toward, and barriers to our institutional NIV guideline. We transcribed all interviews and analyzed data in triplicate using grounded theory to identify themes and develop a framework for understanding clinicians' views on guidelines. MEASUREMENTS AND MAIN RESULTS: The NIV guideline was perceived to define individual clinical responsibilities, improve clinician comfort with use of technology, increase patient safety, and reduce practice variability. Barriers to guideline use included lack of awareness of the guideline, unclear guideline format and presentation, and reluctance about changing practice. Contrary to previous research, participants in this study did not report that the practice guideline limited clinical autonomy. Clinicians used the guideline variously as an educational resource, to access monitored beds, to avoid clinical conflict, or to leverage professional credibility. CONCLUSIONS: This qualitative study illustrated how the NIV guideline at our institution is understood as a tool that facilitates the multidisciplinary care of patients with ARF. Guideline use may be enhanced through education to improve guideline awareness and increase comfort with recommended practices. Developers should be aware of the role of guidelines for purposes other than bedside decision making for individual patients.
OBJECTIVE: Although practice guidelines for noninvasive ventilation (NIV) for patients with acute respiratory failure (ARF) have the potential to improve processes of care and patient outcomes, clinicians' views about life support technology guidelines are not well understood. The objective was to understand the knowledge about and attitudes toward an NIV guideline for patients with ARF and potential barriers to its use. DESIGN: Qualitative study based on individual, in-depth, semistructured interviews. SETTING: St. Joseph's Healthcare, Hamilton, Ontario. SUBJECTS: Thirty clinicians (six attending physicians, five residents, 12 nurses, and seven respiratory therapists) who used NIV for chronic obstructive pulmonary disease and congestive heart failurepatients with ARF, before and after NIV guideline implementation. INTERVENTIONS: We elicited knowledge and attitudes about, behaviors toward, and barriers to our institutional NIV guideline. We transcribed all interviews and analyzed data in triplicate using grounded theory to identify themes and develop a framework for understanding clinicians' views on guidelines. MEASUREMENTS AND MAIN RESULTS: The NIV guideline was perceived to define individual clinical responsibilities, improve clinician comfort with use of technology, increase patient safety, and reduce practice variability. Barriers to guideline use included lack of awareness of the guideline, unclear guideline format and presentation, and reluctance about changing practice. Contrary to previous research, participants in this study did not report that the practice guideline limited clinical autonomy. Clinicians used the guideline variously as an educational resource, to access monitored beds, to avoid clinical conflict, or to leverage professional credibility. CONCLUSIONS: This qualitative study illustrated how the NIV guideline at our institution is understood as a tool that facilitates the multidisciplinary care of patients with ARF. Guideline use may be enhanced through education to improve guideline awareness and increase comfort with recommended practices. Developers should be aware of the role of guidelines for purposes other than bedside decision making for individual patients.
Authors: Sean P Keenan; Tasnim Sinuff; Karen E A Burns; John Muscedere; Jim Kutsogiannis; Sangeeta Mehta; Deborah J Cook; Najib Ayas; Neill K J Adhikari; Lori Hand; Damon C Scales; Rose Pagnotta; Lynda Lazosky; Graeme Rocker; Sandra Dial; Kevin Laupland; Kevin Sanders; Peter Dodek Journal: CMAJ Date: 2011-02-14 Impact factor: 8.262
Authors: Keela Herr; Marita Titler; Perry G Fine; Sara Sanders; Joseph E Cavanaugh; John Swegle; Xiongwen Tang; Chris Forcucci Journal: Pain Med Date: 2012-07-03 Impact factor: 3.750
Authors: Ann B Kennedy; Jerrilyn A Cambron; Patricia A Sharpe; Ravensara S Travillian; Ruth P Saunders Journal: Int J Ther Massage Bodywork Date: 2016-09-09
Authors: Denise S Rolim; Filomena R B Galas; Lucilia S Faria; Erica F Amorim; Marisa M Regenga; Eduardo J Troster Journal: Pediatr Cardiol Date: 2020-02-05 Impact factor: 1.655
Authors: Mitchell M Levy; R Phillip Dellinger; Sean R Townsend; Walter T Linde-Zwirble; John C Marshall; Julian Bion; Christa Schorr; Antonio Artigas; Graham Ramsay; Richard Beale; Margaret M Parker; Herwig Gerlach; Konrad Reinhart; Eliezer Silva; Maurene Harvey; Susan Regan; Derek C Angus Journal: Intensive Care Med Date: 2010-01-13 Impact factor: 17.440
Authors: Ina D'Haene; Robert H Vander Stichele; H Roeline W Pasman; Nele Van den Noortgate; Johan Bilsen; Freddy Mortier; Luc Deliens Journal: BMC Palliat Care Date: 2009-12-30 Impact factor: 3.234