PANDA: Development and evaluation of a nursing competence team of respiratory therapists and advanced practice nurses to optimize the weaning process : Protocol of a two-phase feasibility study

Weaning critically ill patients from mechanical ventilation (MV) is an important challenge of intensive care unit (ICU) management. Internationally, MV is often supported by respiratory therapists (RT) as specially trained nurses and advanced practice nurses (APN) with a master's degree, all functioning within an interdisciplinary treatment team. Currently, there is limited research focusing on the process and effectiveness of collaboration between RT and APN as a nursing competence team (NCT) in the context of the weaning process in MV.

To identify factors that promote and inhibit the feasibility of an NCT team to improve the MV weaning process in ICUs and to assess the feasibility of a future confirmatory study applying patient- and nursing-sensitive outcomes.

A single-center, mixed methods, two-phase feasibility study will be carried out on two ICUs with 48 beds at the Clinic for Thoracic and Cardiovascular Surgery in a university hospital. In study phase I, six focus-group interviews (FGs) will be conducted with nurses, physicians, and physiotherapists at three measuring points (t₀: before implementation; t₁ and t₂: 6 and 12 months, respectively, after implementation of the NCT). Three separate FGs will be conducted with the NCT team at the same measuring points. Data will be analyzed using Kuckartz's content analysis method. Study phase II will be carried out as a before-and-after study over 12 months by, e.g., assessing patients' duration of MV, delirium, pain, anxiety, and mobilization. Retrospective patient data for the period 2022-2023 will be used from the hospital documentation system. In the after-study, data will be prospectively collected.

Our two-phase feasibility study will generate important information on the feasibility of an NCT focusing on the implementation process and weaning outcomes in patients with MV, providing an important basis for future studies.