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Nurse Decision Making and Attitudes About Circuit Disconnection During Ventilator Therapy at a Swedish Neonatal Intensive Care Unit

Larsson, Christina, RN; Karlsson, Victoria, RN; Blomqvist, Ylva Thernström, PhD, RN

Section Editor(s): Dowling, Donna PhD, RN; ; Thibeau, Shelley PhD, RNC-NIC;

doi: 10.1097/ANC.0000000000000564
Original Research

Background: There are many challenges to providing care to infants in need of ventilator therapy. Yet, few studies describe the practical handling of the ventilator circuit during nursing care.

Purpose: To describe neonatal intensive care unit (NICU) nurses' decision making regarding whether or not to disconnect the ventilator circuit when changing the infant's position and to investigate the grounds for their decisions.

Methods: A descriptive questionnaire study with both quantitative and qualitative elements was conducted. In 2015, a convenience sample of nurses working in an NICU completed a questionnaire including both closed-ended and open-ended, free-text questions. Answers to the closed-ended questions were analyzed with descriptive statistics, whereas answers to the free-text questions were analyzed using qualitative content analysis.

Results: Nurses' decisions on whether to disconnect or keep the ventilator circuit closed were based on the infant's needs for ventilator support. The nurses gave several reasons and motivations both for why they disconnected the circuit and for why they did not. The handling of the circuit and the reasons and motivations given were inconsistent among the nurses.

Implications for Practice: This study highlights the need for continuous, repetitive education and training for NICU nurses, as well as demonstrating the importance of clear and distinct guidelines and working methods regarding the care of infants on ventilator support.

Implications for Research: Future research should continue to find ways of working and handling an infant on ventilator support that are least harmful to the infant.

Neonatal Intensive Care Unit, University Hospital, Uppsala, Sweden (Mss Larsson and Karlsson and Dr Blomqvist); and Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden (Ms Karlsson and Dr Blomqvist).

Correspondence: Ylva Thernström Blomqvist, PhD, RN, Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden (

Authors' contributions: C.L., V.K., and Y.T.B. were all responsible for the study design; C.L. recruited participants, C.L. and Y.T.B. made the initial data analysis and the first drafting of the manuscript; C.L., V.K., and Y.T.B. all made critical revisions to the paper. All authors have given a final approval of the version submitted.

This study was funded by Uppsala County Council, Uppsala, Sweden.

No conflict of interest has been declared by the authors.

© 2018 by The National Association of Neonatal Nurses