Abstract:
Introduction: Non-invasive ventilation (NIV) is an alternative method for
providing safe mechanical ventilatory assistance to adult patients
presenting with acute respiratory failure. Internationally the utilisation of
NIV has increased by 400% during the past decade. The clinical pathway
for NIV was collaboratively developed by the multidisciplinary team in the
critical care unit in 2012, but implementation into practice did not realise
as anticipated. As the burden of chronic disease rises in South Africa, the
healthcare system is under pressure to provide evidence-based and costeffective
care to more patients. Avoiding endotracheal intubation reduces
the patient’s risk of complications which lengthens the hospitalisation
period and the cost of hospitalisation. The utilisation of clinical pathways
in the South African context is limited.
Aim: The overall aim of the study was implementation and evaluation of
the outcomes of a person-centred clinical pathway for non-invasive
ventilation in the critical care unit.
Research methodology: Mixed method design through a personcentred
practice development approach utilising emancipatory action
research. Several data collection methods are used throughout the
phases of the study. A critical realist worldview was held which
incorporated the principles of a person-centred approach through
collaboration, inclusion and participation. The study was conducted in
three interdependent and interrelated phases. During Phase 1, the
culture of the critical care units was assessed using a validated 37-item
questionnaire to establish the perceptions of the critical care nurses
related to evidence implementation. A total of twenty-three registered
nurses participated. Additionally, the content of the clinical pathway was
adapted following a rigorous literature review in collaboration with the
internal facilitators and validated via a Delphi with critical care experts.
Phase 2 was dedicated to the collaborative development of an implementation strategy for the implementation of the clinical pathway in
the critical care unit. During Phase 3, the outcomes of the implementation
of the clinical pathway for NIV was evaluated.
Findings: The collaborative utilisation of a person-centred practice
development approach for the implementation and evaluation of the
clinical pathway for NIV, aided the researcher in identifying moral injury
amongst critical care nurses, which inhibits the implementation of
research evidence into practice.
