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Table 5 The category, Challenges in providing respiratory care to patients in risk of HAP

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

“In general, around stroke, one talks about the risk of pneumonia, but I do not know to what degree we raise the issue or the question.” (Q1, RN/B)
“Now, talking about [HAP], one realises that we are lacking. We do not have proper dialogues about [the risks], which is rather interesting. If one could discuss how to prevent it, it would have been a wake-up call for us.” (Q2, RN/A)
“‘We do risk assessments on all patients for fall, nutrition, and pressure ulcers, one does care plans, and we have them on the board by the nursing station… but I have not yet seen one for pneumonia, and I think that would be good, I don’t know how, but [if we] had something for pneumonia, preventative like all the others, pressure ulcers, nutrition and falls.” (Q3, RN/K)
“I think that most of us know in a way why we do these things, that it is important, but it is really easy to prioritise it down.” (Q4, RN/D)
“I believe that if [we] could initiate all interventions and actions as we should, then we could prevent HAP. “I experience that we have too few staff to do it in a good way because there is a lot to be done when they arrive and sometimes many arrive on the same day. Some have had three red codes within half an hour with only two staff —one RN and one HCA — then it is really hard to find time for it all and do it well.” (Q5, RN/C)
“The number of patients—instead of seven, one has 17—is far from optimal. And when one has more patients with multiple illnesses with more risk factors, there are also more problems, and unfortunately, the less control one has over keeping up. There were days when [one] did not get out.” (Q6, RN/H)
“First of all, it is very medically oriented, if it is a bleed or to give thrombolytic treatment if it is an infarction. Then it might not be so much orientation towards nursing as it is about saving the brain.” (Q7, RN/B)
“Particularly now when we have single rooms besides the observation room, it results in that one doesn’t see or interact with the patients in the same way as one does when patients are in a four- or two-bed room. If you went to one patient, you saw the others too.” (Q8, RN/A)
“The speech therapist arrives and says, ‘He swallowed, so let’s follow this track now.’ However, it is seldom that the words preventing HAP is a part of it. But it feels like it is implicit and that everyone should understand that is why we do it. “If the ST says this is to prevent pneumonia, then [the RNs] maybe start to initiate other interventions, so we help each other. Instead of initiating one or two interventions, we can initiate three. We do initiate actions in the team, but we are not talking about why we are initiating them.” (Q9, RN/G)
“I think that the challenge is staff turnover, the issue of competence, that you shift a lot, and [there] is a lot that one is expected to know.” (Q10, RN/B)
“Yeah, maybe the one you work with doesn’t possess so much knowledge about how the patients can develop pneumonia, pressure ulcers, and all kind of complications. I think that this knowledge might be lacking among our staff.” (Q11, RN/K)
“Alternatively, lack of competence, those with the [right] competence lacks time as they know everything that needs to be done. Those not really knowing might not understand this and don’t do as much. We who know what to do work ourselves to death.” (Q12, RN/C)
“[They] can have everything, from a [slight] weakness in the hand to being completely paralysed, not being able to understand what I say or to make [themselves] understood. So, it is a lot one needs to think about. If one arrives as a new nurse to a patient with acute stroke, it is most certainly challenging.” (Q13, RN/F)