What barriers do paediatric nurses encounter when attempting to wean paediatric patients off humidified high flow nasal cannula oxygen therapy? A qualitative study

Purpose
This study aimed to explore nurse perceptions of barriers and facilitators to weaning humidified high flow nasal cannula (HHFNC) in Australian paediatric settings.

Design and methods
A qualitative descriptive two phased study was conducted across Australia. Purposeful sampling and snowballing technique were used to recruit nurses with the study advertised widely on social media nursing groups. Phase One data collection was via a survey with open and closed ended questions, and Phase Two via semi-structured interviews. Data were analysed using descriptive statistics (Phase One) and thematic analysis (Phase One and Two) to identify themes and patterns in the narrative.

Results
Phase one: 36(56.25 %) participants identified their workplace had clear guidelines, 57(89.06 %) received education on HHFNC and 34(57.63 %) experienced barriers when weaning. Three themes and nine subthemes were identified i) variable clinical process for weaning HHFNC, ii) knowledge and skills and iii) clinical observation and assessment of the child. Phase two: four themes and nine subthemes were identified, i) ‘There doesn't seem to be any pattern’: no evidence to guide practice, ii) Nursing and medical led weaning, iii) Knowledge and skills and iv) Family centred approaches to weaning.

Conclusions
Current research on HHFNC does not consider best practice for weaning. This study identified barriers as inconsistency in weaning practice and availability of guidelines and facilitators were a robust education program and confidence in weaning. Multidisciplinary team need to collaborate to determine standardised weaning practice.

Practice Implications
Further research is essential to determine best practice weaning methods and inform national/international guidelines.