Skip to main content

Table 4 The category, Targeting HAP through multiple nursing care actions

From: Registered nurses’ experiences of providing respiratory care in relation to hospital- acquired pneumonia at in-patient stroke units: a qualitative descriptive study

“… it is often the PT who prescribes. It is usually the PT who initiates it or the RN when he or she considers it as appropriate, but then it is us nurses, who will execute it.” (Q1, RN/B)
“It is often them [The PT] approaching us, stating, ‘They should do the PEP training once an hour and they should be out of bed three times per 24 h for least 1 h.’ It is often they who prescribe what we should do with the patients.” (Q2, RN/D)
“It is the PT who follows up on the PEP exercises, they are really good, and it works well, I think… I do it because I know by experience that it works, that it is good.” (Q3, RN/F)
“Resistant breathing and stuff like that, it is a bit bad, I have to say, that it is not working optimally, but the PT might do it; otherwise, they have to have a schedule or demand that people should do it, but there is no time for that.” (Q4, RN/C)
“To prevent pneumonia, first and foremost mobilisation is important so that the lungs are properly ventilated.” (Q5, RN/K)
“I don’t maybe think that one has the focus exactly there at regular [that mobilisation of the bedridden patient] is about HAP; it is more pressure ulcers one think about.” (Q6, RN/F)
“When the patients are reasonably stable, we try to position them at the bedside as early as possible, and we do have help from the PT and from the occupational therapist (OT). So, I think one is really good at trying to get them out of bed.” (Q7, RN/F)
“I think that it is both the OT and the RN who see to it. The PT we have here has reasonably close communication, and I think that the OTs themselves come in and say that it is important that this patient gets out of bed.” (Q8, RN/D)
“Over time the patient has developed HAP because one doesn’t have—I can’t say why—maybe lack of time, that one has not been able to mobilise the patient or because the patient is a ‘hoist’ patient with whom we deal at the end and then everything else happens during the day, so one forgets to take the patient out of bed.” (Q10, RN/G)
“We put out the lists and tick off that oral care is done, maybe not as often as it should. Some hardly eat anything, and patients using a nasogastric tube should get oral care much more often. If a patient aspirate, there is a risk that the bacteria gets [down in the lungs]. So, it is really important with oral care for those patients.” (Q11, RN/L)
“What I feel is that we miss a little; what we miss is actually oral care. There are bacteria in the oral cavity that are dangerous. One should be better at doing oral care before dysphagia assessment or when eating whatsoever.” (Q12, RN/A)
“It is more about us doing oral care to avoid fungal infections, dryness, and rifts. I don’t believe that a lot of us address it. We have had lectures about what causes aspiration pneumonia, that it is bacteria in the oral cavity, but I do not know how many of us that consider that part.” (Q13, RN/B)
“I make sure that the patients are sat up at mealtime, even if they are bedridden, so one must really follow up and almost position them in cardiac position so that they sit as good as possible.” (Q14, RN/G)
“Sometimes, we do not have enough resources. Then, unfortunately, they are recumbent in bed and are getting fed there, and that is not the most optimal feeding situation one can experience, but we really try to raise them up as much as possible, we do.” (Q15, RN/L)
“One learns a lot from each other, and it is facilitated by working evenings, weekends, and nights when [others on a multidisciplinary team] are not present but one has still learned a lot from them to build competence. Everyone has their part. I think it is really important, as then you get the best out of each of them.” (Q16, RN/A)
“The speech therapists (ST) write their assessments so that we can read it, and they come back and [we] are given an oral report that recommends what the type of diet should be. So, we receive rather clear instructions. Then, it is always the medical doctor’s (MD) decision. We have a good relationship with the MDs, and we have a good team. So, if the RN says that this patient can’t swallow and the ST ordinates nil per mouth, then the patient gets an NGFT immediately.” (Q17, RN/E)