'In a way, you have to pull the patient out of that state …': the competency of ventilator weaning.

The introduction of the weaning protocol has reduced weaning time and improved results in patients. However, the evidence is inconsistent. This may reflect that the use of a protocol should not exclude individual considerations and clinical judgement. However, the significant aspects of the context and the competency important in the nurse-patient relationship in weaning have not yet been sufficiently described. This study aimed at exploring these aspects of weaning. Qualitative data from six in-depth interviews and field observations of three experienced intensive care nurses in weaning situations were analysed through systematic text condensation within a hermeneutic-phenomenological approach. Competency appeared to be based on thorough knowledge of physiology and ventilator skills, but also on knowing the patient, helping the nurse connect the meaningless to the meaningful for the patient. Behaving competently involves a continuous dialogue with the situation, observation of the patient's body language and symptoms over a period of time and the ability to see the interrelationships of all these elements. Competency in ventilator weaning may thus be linked to personal qualifications, while it is simultaneously dependent on a professional community that both confirms and acknowledges this competency.