Introduction
The weaning experience from mechanical ventilation is analyzed using some important inferences from both medical practitioners and patients. However, most of the studies have only focused on the views given by physicians on the weaning experiences instead of focusing on the patients. This may give the physicians or nurses vast knowledge on how to critically up-grade the whole process for the sole benefit of patients (Strauss and Corbin, 1990).
Qualitative Research and Grounded Theory
According to Creswell (1998), qualitative research is defined as an inquiry process of understanding that is based on distinct methodological traditions practices which explore social or human problem. It helps in building an understanding on how people see and build their lives as important processes, how they relate to one another and finally interpret the relationships within the context of social environment (Black, 1994). This research seeks to establish an understanding between the research objectives and findings from the interview. Grounded theory has been used to interpret the data collected. Collecting, interpreting and understanding of data is done best in grounded theory, where the collection of data, its analysis and theory stand in reciprocal relationship whereby the area of study is proved relevant by the research undertaken (Strauss and Corbin, 1990; Hammersley,1992).
Research question
This research aimed to answer the question on what kind of experiences patients undergo after weaning from mechanical ventilation. Studies on weaning from mechanical ventilation reveal some truth on the emotional effects it has on patients. Some aspects need to be developed and examined to establish on the quality of interactions and experiences between patients, nurses and the ventilation machine.
Data collection
The method used to generate data in this research was both flexible and very sensitive to the area where data was collected. The major method adopted in this research was in-depth interviews (Minichiello, Sullivan, Greenwood and Axford, 2003).
Rationale for using in-depth interviews
In-depth interviews were used to help gain an understanding on how the patients respond emotionally and psychologically and how they interpret their interactions based on the entire social environment. In-depth interviews are considered flexible and easy to understand since they are generally open-ended, neutral, sensitive and very clear to the respondent. The structure provided by the method allowed for open conversations that provided detailed information about the interviewees general experiences (Whyte, 1982). In-depth interviews were used to help in deep understanding of the social and physical settings of the environment where it is undertaken, the traditions, values, effects and roles practised by the respondents.
Interview guide
A group of ten patients were to be interviewed; this was to be done on those who had undergone weaning from mechanical ventilation. These patients had previously undergone various weaning attempts which were never successful. Some instruments were used to establish on the validity of the process, these include; multidimensional health locus that controls scales, instrument that measures hope, scale for measuring the level of fear and other responses to treatment (Pawson, 1996). Previous researches have revealed that most of the respondents being interviewed are always ready to provide detailed information that is required on condition that the interviewer provides them with guideline on what is required. In this research the in-depth interview used was structured in such a manner as to reveal the nature of treatment, interaction, level of patient satisfaction and the level of collaboration between the nurses.
During the exercise a list of questions was prepared which helped as guideline to relevant answers that were required (See Appendix I). This formed the basic outline for the entire interview. The interview started by asking simple questions before the respondent was engaged in more sensitive questions, this was preceded by introduction and the understanding of the interviewees’ background by asking about their health status, a brief history on how they came be in such like an environment, one typical question used was “What can you say about the type of services that you receive owing to your condition”. Then the respondents were asked to scrutinize their condition at present in relation to when they were inside the mechanical ventilator. One of the typical questions was like “how do you feel about your status and what conclusion can you draw from all the experience?” However some respondents at times found themselves stating responses that were outside the questions asked, prompting some adjustments to majority of the questions depending on the interviewee responses. Finally the interviewer sought for clarifications from the respondents on whether some areas needed discussion which might have not been tackled by the questions (Whyte, 1982).
Critique
In this interview the relevance of the respondents to the research question was considered. The method used in selecting the patients was also reviewed for any discrepancies and the accuracy of the processes used in collecting the data. The validity and appropriateness of the methodology were examined to establish whether it could support the findings on the whole research process. The data was checked for appropriate findings and analysis (Giacomini and Cook, 2000). Only relevant data was collected organized, analysed to suit the objective of the study. The validity of the findings in this interview required the use of multiple data sources and collection methods. It was also necessary for the results to be collected in various stations and comparison made to ascertain the relevance of the study to theory in books (Emden and Sandelwoski, 1999)
Respondents were however used appropriately based on qualitative research to answer the question of the study. The method used to explain how the respondents were chosen was not provided (Stake, 1994). The interview guides were provided but not the transcribed tapes. The whole information was however analysed to prove the accuracy of the research. Instruments were used in some circumstances to quantify the level of some emotional effects; this did not in any way serve the qualitative purposes of this research. Comparison was made after the interview between the patients with negative and positive responses. Other methods which do not fall under qualitative analysis were used to establish the factors that led to psychological or emotional effects; one of the methods suggested was psychiatric treatment. Weaning failure needs to be identified earlier before it produces some side effects on the patient and also the patient’s experiences need to be established medically since there are chances of some patients giving in-appropriate information. This was however, not provided for within the methods applied in this research.
Approaches took to ensure adherence to ethical principles in the collection of data, drawing on the literature about ethical conduct of research
Before the start of the interview, each interviewee was requested to sign a consent form after reading and agreeing with the written conditions. Then the interview process was audio-taped and transcribed for confidentiality purposes. Each respondent was given a code name which was used instead of their real names; this ensured that there was no possibility of linking individuals to any information given. The code names used were as given below;
The necessary clarifications were made to the respondents and informed of their right to withdraw from the process in any stage they feel uncomfortable with. They were not allowed to respond beyond what they were comfortable with; this provided them with the freedom to express their experiences with lots of confidence (National Health and Medical Research Council, 2007).
Data preparation
The data from all the interactions were electronically recorded and then transcribed by trained technician following the prescribed method. The total number of encounters was ten with each interview lasting for at least 30 minutes. Those involved in interviewing were qualified researchers having vast experience in qualitative research methods (Wunderlich, Perr and Lavin, 1999).
The objective of this study was to understand the reactions of the patients during weaning from the mechanical ventilation. The interviews were conducted from the homes of the respondents. They were asked to discuss and share in details their experiences during the time they were under mechanical ventilation and after being removed from the machine. The interview was undertaken several months after the patient’s subjection to mechanical ventilation. The data collections methods also included observation of the body language during the interview process (Holman, 1993). The data was ultimately prepared and organized by the researchers using computer software program.
Analysis of data
The study examined the patient’s view on their weaning experiences from the mechanical ventilation. This assisted in the improvement of the whole practice by health practitioners to ensure that patients received good treatment. The analysis of the data was done after the data was fully generated from the field. Data collection was followed by the process whereby the data was grouped into themes which assisted in detailed description of the research based on the social settings. The validity of the research was based on transparency and viability of the message conveyed (Rubin and Rubin, 1995). Individual narrative interviews were conducted concurrently with the process of transcription and coding of data which were later concentrated and categorized for analysis.
The following themes were generated from the responses on ventilator weaning and treatment implications associated with it; a) physical care administered and the medical aid experienced by patients, b) the major consequences of mechanical ventilation on senses, c) the relationship existing between the patients and physicians, d) the events that take place before the ventilation process and appreciations on the work of weaning. The analysis also covered some nursing practices that support the weaning process like making the environment conducive for patients, psychological assistance like making the patients understand some aspects of the process, and also physiological factors. All these practices offered some emotional support to the patients (Logan and Jenny, 1991; May, 2000).
The basic processes on how the data was generated were revealed through transparency, which enabled easy assessment of the benefits of the study. This was enhanced by the clear records and the notes taken during the interview process (Kirby and McKenna, 1989). Most of the information on this research was provided by the detailed literature review that provided healthcare information. This helped in identifying the relevance of the study to other situations. The notes taken from the interview also included some non-verbal communications that seem relevant to describing the question at hand and all interpretations recorded in form of content memo, this ensured no loss of information (Crotty, 1998).
Inductive coding was used to reveal how consistent the research was with the information given. The data was broken down and re-organized to achieve the intended objective. The grouped data were then categorized for comparison that help in providing the practical reality of the research (Straus and Corbin, 1990). There was the use of peer debriefing which ensured that the required consistency was achieved. For coding, the interview scripts were scrutinized to ensure identification of similar or different opinions, the similar ideas were identified substantiated and all the comments highlighted within the transcript margins. Two different evaluators were used each making his coding frame for sampling the sub-transcripts (sub-sample used n=2). The different findings were compared to ensure accuracy of the data code. From this a coding frame was produced that was appropriately used on the whole data collected. The data was thoroughly compared and analysed totally with the requirements as per grounded theory approach.
Results
The themes developed from the weaning process revealed the obstacles that hinder efficiency of the whole ventilation process. The respondents who were interviewed had various complains on the normal functioning of their system like breathing after being placed on the ventilators for the second time running. This revealed that the patients required medical assistance during the ventilation process. Most of the patients’ responses were that they felt more comfortable whenever they were out of the ventilator. This therefore calls for thorough explanation on the expectations of the patients once under the mechanical ventilation. It was found out that at times the functioning of the ventilator was out of sync with the patients’ breathing movements (Latimer, 2003).
Patients complained of severe stress during the process of weaning especially those who were already suffering from diseases associated with lungs. There was anxiety as to the duration of time patients were to take on the mechanical ventilator. This was because of the unpredictable effects associated with being on the ventilator for quite some time. Most of the patients were very uncomfortable with the weaning process since it also interfered with their communication. The study revealed the frustration and uncertainties that surround weaning process and the important role of nurses during the whole process (Schwandt, 1997).
The results showed that the whole experience on mechanical ventilator was horrible to the patients. It made the patients depend mostly on the external forces for survival rather than depending on their natural inner strength. Successful weaning led to stress free life since the patient’s condition was reduced to normal functioning of body organs.
Limitations of methodology and methods chosen
The method used, in-depth interview, offered very flexible and detailed data. Despite all these, there were some limitations associated with it; first it required too much time and a lot of resources hence the research could not cover large sample of people. So much time was required to conduct interviews since the respondents needed assurance on the type of questions asked, also time to transcribe the interview and analyse the data was limited. The responses were a little bit affected with biasness due to the interviewees’ status during the interview.
Much effort was required to make the respondents comfortable, secure and interested in the responses they were giving. There was also the challenge of using acceptable and workable techniques which includes appropriate body language. There is no possibility of generalizing the results because of the use of small samples.
Discussion
This study used the grounded theory analytical approach; the results obtained revealed in-depth experiences that patients have while undergoing treatment. This is of importance to the healthcare department since it provides a very good ground for improvement. The consequence of failed weaning was very apparent and made some of the most devastating effects on patients’ health. The loss of psychological soberness and emotions were some of the experienced results of weaning failure, this calls for closer attention that the patients require during the process (Ritchie, 2003).
Field observations, interviews and the analysis used in this research assisted in the collection of up-to-date qualitative data (Mays and Pope, 2000). The methods used enabled desired results and conclusions to be made on the social and general behaviour of the patients. The level of information provided by the data was able to support the allegations made on patient’s discomfort. The conceptual framework used was sensible enough and provided explicit explanation listing the examples that made easy interpretation and understanding of the results. However, there is a bit challenging on how to merge the detailed methodological section with the results. The research had been conducted on those who are literate, but those who could not speak English as a language were ignored. The profile provided by the findings proved that more research should be done on this but in a different region. However, the results obtained in this research is recommended for educational and treatment purposes (Ritchie, 2003).
Conclusion
The use of in-depth interview was meant to allow for face to face interaction with the patients. The duration of time that was taken to interview each patient allowed for full examination of their ideas and reactions. Many interviews were conducted to ensure accuracy of the data collected. Triangulation of data sources ensured that all the information was scrutinized for consistency purposes (Schwandt, 1997). Incidences and categories were compared to establish the differences and similarities that existed during the interview. Each of the patient’s and the health-care practitioner views were sampled and compared as advocated by the theory.
References
Black, N. (1994). Why we need qualitative research. J Epidemiol Community Health (48), 425-426
Creswell, J. W. (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, CA: Sage.
Crotty, M. (1998). The foundations of social research: Meaning and perspective in the research process. Sydney: Allen and Unwin.
Emden, C. & Sandelwoski, M. (1999). The good, the bad and the relative, part two: Goodness and the criterion problem in qualitative research. International Journal of Nursing Practice, (5), 2-7.
Giacomini, K. & Cook, D. (2000). Users guides to the medical literature: qualitative research in health care: part B. What are the results and how do they help me care for my patients? JAMA (284),478-482.
Hammersley, M. (1992). What’s wrong with ethnography? Methodological explorations. London: Routledge.
Holman, R. (1993). Qualitative inquiry in medical research. J Clin Epidemiol. (48)29-36.
Kirby, S., & McKenna, K. (1989). Experience, research, and social change: Methods from the margins. Toronto: Garamond Press.
Latimer, J. (ed.). (2003). Advanced qualitative research for nursing. Oxford: Blackwell Science.
Logan J. & Jenny J. (1991). Interventions for the nursing diagnosis of dysfunctional ventilator weaning response: a qualitative study. Paper presented at: Classification of Nursing Diagnoses: Proceedings of the Ninth Conference, Orlando, FL.
Mays, N. & Pope, C. (2000). Qualitative research in health care: assessing quality in qualitative research. BMJ (320), 50-52.
May, T. (2001). Social research: Issues, methods and process. Buckingham: Open University Press.
Minichiello, V., Sullivan, G., Greenwood, K. & Axford, R. (Eds.). (2003). Research methods for nursing and health sciences ( 2 nd ed. ). Sydney: Addison Wesley.
National Health and Medical Research Council (NHMRC). (2007). National Statement on ethical conduct in human research. Canberra: AGPS. Web.
Pawson, R. (1996). Theorizing the interview. British Journal of Sociology, 47 (2), 295-313.
Ritchie, J. & Lewis, J. (2003). Qualitative research practises: A guide for social science students and researchers. London: Sage.
Rubin, H., & Rubin, I. (1995). Qualitative interviewing: The art of hearing data. London: Sage.
Schwandt, T. A. (1997). Qualitative inquiry: A dictionary of terms. Thousand Oaks, CA: Sage.
Stake, R.E.(1994). Case studies. Da, NK Lincoln, YS eds. Handbook of qualitative research Sage Publications. Thousand Oaks, CA
Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. London: Sage.
Whyte, W. F. (1982). Interviewing in field research. In: R. G. Burgess (Ed.), Field research: A sourcebook and field manual. London: George Allen and Unwin.
Wunderlich, R., Perry, A. & Lavin, M. (1999). Patients’ perceptions of uncertainty and stress during weaning from mechanical ventilation. Dimens Crit Care Nurs (18),2-10.