Physicians' perceptions of protocol-directed weaning in an intensive care unit in Norway.

The aim of this paper is to identify physicians' perceptions of protocol-directed weaning from mechanical ventilation in an intensive care unit in Norway. Errors occur in the absence of procedures, plans, and a team culture. Standardized weaning protocols, or pathways, offer a systematic approach. The focus group method was used. Four themes emerged: (i) acceptance, where the participants perceived the protocol as having a positive influence on the weaning process, although some barriers were identified, such as its failure to facilitate the "difficult-to-wean" patient; (ii) indignant responses, which gave the impression that the protocol was prescribed for the benefit of the nurses; (iii) ambivalence was evident in the two different approaches to the weaning process when problems occurred, which were "directing" and "collaborating"; and (iv) continuity and professional competence were perceived as important aspects of the weaning process. An unclear pattern of responsibility and poor interprofessional collaboration and communication were reported.