Practical wisdom: a qualitative study of the care and management of non-invasive ventilation patients by experienced intensive care nurses

OBJECTIVES: To describe the reasoning and actions of experienced nurses caring for patients with non-invasive ventilation due to acute respiratory failure from chronic obstructive pulmonary disease.

INTRODUCTION: Treatment success for patients requiring non-invasive ventilation remains challenging. Understanding the reasoning and actions of experienced nurses that care for patients with non-invasive ventilation can identify how nurses contribute to treatment success, and this information can be used to train less experienced nurses to provide excellent care.

DESIGN: Qualitative descriptive study. A secondary analysis on data of qualitative participant observations during non-invasive ventilation treatment and additional six interviews with experienced ICU nurses was carried out in 2012.

RESULTS: The experienced nurses exhibited 'practical wisdom'. Each nurse could stay alert to the patient's condition and respond to NIV. Conceptualisation of the complexities in nurses' reasoning and actions illustrated their tendency to separate problematic situations into three interrelated components: (1) achieving non-invasive adaptation, (2) ensuring effective ventilation and (3) responding attentively to patients' perceptions of non-invasive ventilation. Each component comprises a set of nursing reasoning and actions that experienced nurses use to achieve treatment success.

CONCLUSIONS: Understanding how experienced nurses think and act during non-invasive ventilation care may help to optimise continuing professional development and help educate junior nurses.