Healthcare providers’ cognitive perception and experience of shared decision-making of nurse-led weaning of patients on invasive mechanical ventilation:a qualitative study

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However, some issues have been revealed, and there has not yet been in-depth research on the understanding and experiences of healthcare personnel regarding this decision-making approach. Objective To clarify healthcare professionals' perspectives on the shared decision-making model for nurse-led weaning of patients on invasive mechanical ventilation and to determine improvement measures to promote the routine implementation of the model. Methods An interview outline was developed based on the SWOT model. Using purposive sampling, seven physicians, sixteen nurses, and seven respiratory therapists working in the intensive care unit of Shanghai Tenth People's Hospital from June to August 2025 were selected for semi-structured interviews,and content analysis method was used for data analysis. Results Four themes were extracted for internal advantages: alleviating the pressure on doctors in diagnosis and decision-making; clinical nurses' capability and willingness to implement; improving the success rate of weaning critically ill patients; and enhancing recognition among patients, families, and surgeons, thereby increasing the department's patient loyalty. Four themes were extracted for internal weaknesses:increased work pressure; lack of decision-support tools; smoothness of implementation processes; and ineffective human resource allocation mechanisms; and insufficient information technology. The external opportunities identified two themes: support from departmental policies and culture; and a solid evidence base. The external threats encompassed three themes: poor communication between medical staff; cognitive differences among healthcare personnel regarding weaning; and insufficient confidence in nurses taking the lead. Conclusion The nurse-led shared decision-making for weaning patients off invasive mechanical ventilation has certain advantages. In the future, it should leverage existing opportunities, mitigate internal weaknesses, acknowledge external threats, and develop a standardized nurse-led shared decision-making model for weaning patients off invasive mechanical ventilation to promote the best evidence-based practices in this area. Clinical Trial Number Not applicable.This research is a qualitative study. Shared decision-making invasive mechanical ventilation weaning SWOT analysis qualitative study Introduction The process of weaning patients from mechanical ventilation in a medical setting is complex and dynamic. The timing for weaning is influenced by multiple factors, including the underlying condition, the patient's status, the mode of respiratory support, and the level of support provided[ 1 ].The guidelines recommend establishing a weaning plan at the onset of mechanical ventilation, with daily weaning assessments[ 2 ]. These assessments should include evaluations of the patient's clinical symptoms, signs, and respiratory function, as well as the selection of a weaning mode. The assessment process is extensive and complex. The shared decision-making model refers to the process by which both doctors and patients communicate about different treatment options and ultimately reach a consensus decision[ 3 ]. Research indicates that the involvement of nurses with professional expertise in shared decision-making can facilitate its effective implementation[ 4 ]. Previous studies have shown that nurse-led extubation can significantly shorten the duration of mechanical ventilation and reduce ICU length of stay, making it a safe and effective weaning model. It has the potential to improve ICU operational efficiency and reduce healthcare costs[ 5 – 7 ]. Therefore, the implementation of nurse-led shared decision-making for weaning patients from invasive mechanical ventilation has become a new practice aimed at increasing the success rate of weaning, reducing healthcare costs, and enhancing critical care capabilities. The Intensive Care Unit of Shanghai Tenth People's Hospital is implementing nurse-led shared decision-making for extubation in patients undergoing invasive mechanical ventilation. Although certain effects have been achieved, many issues have been identified during the operation process.Research reports indicate that the true feelings of healthcare professionals during the implementation process are key to promoting the improvement of shared decision-making quality [ 8 , 9 ]. However, there has been no in-depth research on healthcare providers’understanding and experiences of this decision-making approach. Therefore, this study employs qualitative research methods and SWOT analysis to clarify the views of three stakeholder groups—doctors, nurses, and respiratory therapists—on the advantages, disadvantages, opportunities, and threats of nurse-led shared decision-making for weaning patients from invasive mechanical ventilation[ 10 , 11 ]. The aim is to optimize the nurse-led shared decision-making model for weaning patients from invasive mechanical ventilation, promote the best evidence-based practices for nurse-led shared decision-making, and provide guidance and suggestions for further improvement and promotion of this decision-making approach. Objects and Methods Research Subjects In June to August 2025, clinical doctors, nurses, and respiratory therapists from ICU at Shanghai Tenth People's Hospital who met the criteria were selected as research subjects. Inclusion criteria for clinical doctors: ① At least 1 year of clinical work experience in ICU; ② Previous involvement in the clinical weaning of patients on invasive mechanical ventilation; ③ Received training related to shared decision-making; ④Voluntary participation in this research. Exclusion criteria: ① Doctors who were on leave or have been on leave for more than 1 year with less than 6 months of active duty; ② Interns or trainees. Inclusion criteria for clinical nurses: ① At least 2 years of clinical work experience in ICU; ② Previous involvement in the clinical weaning of patients on invasive mechanical ventilation; ③ Received training related to shared decision-making; ④ Voluntary participation in this research; ⑤ Implemented shared decision-making for weaning from invasive mechanical ventilation in ≥ 20 cases. Exclusion criteria: ① Those who were on leave, away on task, or in training during the study period; ② Interns or trainees. Inclusion criteria for respiratory therapists: ① At least 1 year of clinical work experience in ICU; ② Previous involvement in the clinical weaning of patients on invasive mechanical ventilation; ③ Received training related to shared decision-making; ④ Voluntary participation in this research. Exclusion criteria: ① Doctors who were on leave or have been on leave for more than 1 year with less than 6 months of active duty; ② Interns or trainees. The sample size was determined by the saturation of interview data, specifically when the selection of research subjects exhibited maximum variability, and no new information emerged or information was repeated; at this point, the sample size reached saturation. This study included 7 doctors, numbered D1 to D7; 16 nurses, numbered N1 to N16; and 7 respiratory therapists, numbered R1 to R7. General information of the interviewed medical staff is detailed in Table 1 . Table 1 General information of interviewed medical staff Number Age (years) Gender ICU stay (years) Title Department D1 52 male 28 Chief Physician CCM D2 39 male 17 Attending Physician CCM D3 35 female 15 Attending Physician CCM D4 47 male 25 Associate Chief Physician CCM D5 48 female 20 Attending Physician EICU D6 32 female 5 Attending Physician EICU D7 51 male 12 Associate Chief NICU N1 28 female 4 Nurse EICU N2 29 male 5 Nurse EICU N3 27 female 3 Nurse EICU N4 28 male 4 Nurse EICU N5 26 female 4 Nurse EICU N6 29 female 5 Nurse EICU N7 27 female 4 Nurse EICU N8 35 male 10 Chief Nurse NICU N9 29 female 5 Nurse NICU N10 43 female 21 Chief Nurse NICU N11 45 female 23 Chief Nurse CCM N12 36 female 16 Nurse CCM N13 26 female 4 Nurse CCM N14 38 male 12 Nurse CCM N15 37 female 14 Chief Nurse EICU N16 40 female 17 Chief Nurse EICU R1 28 female 6 Technician CCM R2 26 female 4 Technician EICU R3 40 female 15 Chief Technician CCM R4 37 female 14 Technician CCM R5 32 male 9 Technician CCM R6 27 female 3 Technician CCM R7 28 female 4 Technician CCM Methods Sampling Method This study employed purposive sampling methods, combined with a sampling strategy that maximizes the diversity of the research subjects. Factors such as the type of work of medical staff, age, gender, years of work experience, and department were taken into consideration. Development of Interview Outline The interview outline for this study was developed around the SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis framework. Preliminary outlines were established through literature review and discussions within the research team. Before the formal interviews, two doctors, two nurses, and two respiratory therapists who met the inclusion criteria were selected for pre-interviews to modify any issues that arose. After further discussions within the research team, the final interview outline was determined as follows: ①What advantages do you think there are in the current nurse-led shared decision-making process for weaning patients off invasive mechanical ventilation? ②What shortcomings do you think exist in the current nurse-led shared decision-making process for weaning patients off invasive mechanical ventilation? ③What factors can motivate the current shared decision-making process for weaning patients off mechanical ventilation? ④What factors can hinder the current shared decision-making process for weaning patients off mechanical ventilation? ⑤ Do you have any additional comments? Data Collection A semi-structured interview method was used to collect data, conducting one-on-one, face-to-face interviews with subjects. The researcher has systematically studied qualitative research methods and mastered semi-structured interview techniques, enabling independent conduct of interviews. Before the interviews, the researcher introduced themselves, explained the purpose, content, process, and duration of the interview, and built a trust relationship with the subjects. Research subjects signed an informed consent form. The interview location and time were chosen based on the respondents' preferences to ensure that no unrelated personnel were present during the interview, thus avoiding distractions. With the respondents' consent, audio recording was conducted throughout the interview, with the researcher flexibly asking questions based on the interview outline, refraining from interrupting or commenting on their answers to avoid leading or suggestive language. In cases where there were questions or unclear responses, the researcher confirmed through paraphrasing, follow-up questions, and counter-questions, and promptly recorded non-verbal information such as actions, expressions, and tone of voice. Each interview lasted between 20 to 40 minutes. Data Analysis Content analysis was employed to analyze the interview data. Within 24 hours after the interviews, the data were transcribed, and non-verbal information was marked at the appropriate positions in the transcript. During the data organization process, any uncertainties were promptly clarified with the interview subjects. The study used a four-level coding symbol based on the SWOT categories (Strengths, Weaknesses, Opportunities, Threats) to code the interview content. Each transcript was independently coded by two researchers with extensive experience in qualitative research, and the results were compared. Themes were refined through collaborative analysis and discussion to avoid bias.The study was reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) [ 12 ]. Ethical Considerations We strictly adhered to the ethical principles outlined in the Declaration of Helsinki.This study was conducted after approval by the Medical Ethics Committee of Shanghai Tenth People's Hospital (Approval No. 25KT67) and written permission from the implementing hospital. All participants provided verbal and written consent to the authors. This article strictly follows research norms and academic publishing ethical standards. Results Internal Advantages Theme 1. Alleviation of doctors' diagnostic pressure and decision-making pressure Most doctors and respiratory therapists indicate that the current nurse-led shared decision-making model for weaning patients from invasive mechanical ventilation reduces the clinical pressure on them by collaborating with clinical nurses. D1: "The assessment for weaning patients from invasive mechanical ventilation includes ****** and other aspects; the assessment process is complex and involves many contents. Most of the indicator parameters come from the clinical operations and observations of the nurses. The nurses inform us of the assessment results, which can save us time in obtaining information and re-evaluating, allowing us more time to provide other treatments to the patients." R4: "When making weaning decisions in the ward, facing patients who are difficult to wean puts a lot of pressure on us. It requires a lot of energy and time to identify the risk factors for unsuccessful weaning. The nurses are always by the patient's bedside, providing us with many opinions and suggestions, which saves us a considerable amount of effort." D3: "The differences in our workload and day/night shifts can affect the time we dedicate to focusing on weaning and extubating patients. Sometimes, when faced with emergencies, we may just maintain the patient’s existing respiratory support treatment plan. This implementation allows us not to worry about delaying the patient's weaning time, *****." Theme 2. Clinical nurses have the ability and willingness to implement Intensive care physicians indicate that intensive care specialized practice nurses possess extensive knowledge related to mechanical ventilation, which ensures that patients can efficiently complete the weaning process. Under the guidance of specialized nurses, junior nurses are also willing to accept the challenge and engage in shared decision-making. D2: “Senior nurses working in the ICU have a wealth of knowledge and can comprehensively grasp the assessments related to patient weaning; we feel very assured letting this part be handled by the nurses.” N11: “As a senior ICU nurse, I am quite willing to conduct patient weaning assessments; this model reflects our professional value rather than passively following medical orders, and I am still willing to accept it.” N8: “ICU specialized knowledge determines the decision-making process of nurses in clinical work. As senior nurses, we can still coordinate weaning decisions and arrangements, and we won’t panic even if a patient encounters a critical situation.” N4: “******, although relatively young and afraid of not doing this well, I am very willing to accept the challenge, as it can promote our professional technical skills improvement, ******.” Theme 3. Improving the success rate of weaning in critically ill patients Most respondents indicated that the implementation of shared decision-making can avoid the one-sidedness of any unilateral decisions made by doctors, nurses, or technicians, and can alleviate the delays in the weaning process caused by communication barriers, thereby improving the success rate of weaning in critically ill patients. D6: "ICU patients have severe conditions and require significant interventions, so doctors cannot be by every patient's side at all times. Much of the patient information comes from nursing documents and patient examination reports, which can be one-sided and delayed." N10: "In previous weaning and extubation procedures, nurses merely followed medical orders without fully utilizing their own initiative. For example, in changing the patient's ventilation mode, nurses would wait for the doctor to be informed of any changes in the patient's condition before making adjustments or would just mechanically execute the current medical orders. After the implementation of the shared decision-making model, through systematic training on weaning knowledge, nurses can match the best treatment and care measures in real time based on the patient's condition, effectively improving the extubation success rate." R5: "Previously, our department's SBT operations and extubation procedures were usually completed, but due to a shortage of staff, some patients who met the criteria for extubation still experienced delays in removing the tube. The implementation of this model has greatly reduced such occurrences." Theme 4. Enhance the recognition of patients, their families, and surgeons, increasing the department's patient loyalty Medical staff indicated that after the implementation of the shared decision-making model, the recognition of the department's clinical capabilities by patients' families and surgeons has increased, boosting the department's patient loyalty. D4: "Previously, we would receive complaints from surgeons about nurses being unfamiliar with patients' conditions, ***, but now this situation has decreased, ******." D5: "In the past, surgeons always believed that we were not timely in withdrawing machines, delaying the timing for extubation, ******. After implementing this model, doctors feel more trust in our ICU because we can provide more sufficient and reasonable explanations for whether patients can be extubated." N12: "I now have a very good relationship with the surgeons and patients' families. They consult me during visits about any ventilator-related issues, and communication with them has become easier." R3: "******, some family members have provided feedback that ICU nurses have close contact with patients, and the explanations they provide are still very trustworthy." N12: "The premise for extubation is the patient's involvement; it is necessary to establish a trusting relationship with him/her. The ICU nurses are always beside the patients and can constantly pay attention to changes in their physiological and psychological needs, providing encouragement and support." Internal Weaknesses Theme 1. Increased work pressure Some clinical nurses reported that the current shared decision-making model has increased their work pressure. N16: "The evaluation process for extubation needs to cover multiple aspects including respiratory function, circulatory function, mental status, improvement of underlying diseases, and so on. I am very afraid that something might be overlooked." N5: "Because I am not just following doctor's orders; I also need to integrate and apply my clinical experience and knowledge in the extubation and withdrawal of the ventilator. I am worried that my inadequacies could harm the patient." N14: "Sometimes when it gets busy, I can't complete the evaluations for all the patients being extubated." Theme 2. Lack of decision-making support tools Clinical nurses stated that the current extubation process is too complicated with a wide range of evaluation content, and there is a lack of decision-making support tools. N2: "We are still gradually extubating based on the extubation process document. Many steps require comprehensive evaluations. Could we invent some more intelligent tools to assist us in these evaluations?" N7: "Through literature research, I found that there are many studies on decision-making support tools for extubation, but very few are applied in clinical practice." Theme 3. Implementation process is not smooth, staffing mechanism is inactive Healthcare personnel indicated that the implementation process of the current model is unclear and lacks defined job responsibilities. D5: "Currently, there is no clear process, and the implementation is not smooth. Furthermore, there is no clear guideline on what doctors should evaluate and to what extent, which sometimes leads to incomplete evaluations." N3: "Sometimes we don't know when to use decision-making support or where to apply it, and we often need to call doctors for information, which I feel is a problem with the flow of the process." R1: "Even though team members hope for successful extubation for the patient as soon as possible, each person's attitude towards extubation can affect the execution of extubation procedures, leading to a lack of cohesion in the process, for example..." Clinical nurses stated that nurse-led standardized extubation processes are complex and need optimization in staffing arrangements to ensure that a multidisciplinary collaborative organizational structure is in place. N15: "Extubation of patients on invasive mechanical ventilation not only involves the medical plan itself, but also requires multidisciplinary collaboration and flexible staffing. When nurses are caring for patients who need extubation, this consideration might influence staffing decisions." Theme 4. Incomplete information technology Healthcare personnel unanimously expressed that improving the information technology infrastructure in critical care could enhance the smoothness of decision-making. N14: "We could incorporate procedural evaluation forms into the current information system, with doctors responsible for providing their portion of the information and nurses doing the same. This way, nurses can see what doctors see, and vice versa. It avoids incomplete information sharing and repetitive communication, improving decision-making efficiency and ensuring the evaluation process is implemented." D3: "From a global perspective, employing computer-driven extubation plans is incredibly beneficial for clinical practice, but currently, very few are implemented in clinical settings." External Opportunities Theme 1. Departmental policy and cultural support Healthcare professionals indicate that the nurse-led shared decision-making model for weaning patients from invasive mechanical ventilation aligns with departmental policies, which can improve the success rate of extubation while standardizing decision-making behaviors. D5: "The country is also promoting enhanced patient experiences now; this can be considered a means, ******." D7: "In fact, the shared decision-making in extubation by ICU nurses is influenced by various factors, some of which are related to team culture. If we provide strong support, communicate promptly when encountering obstacles, and encourage the team when families have doubts, it may lead to better implementation." Theme 2. Sufficient evidence-based basis Assessment for weaning patients from invasive mechanical ventilation has been outlined in numerous guidelines and consensus statements both domestically and internationally, hence the implementation of shared decision-making during extubation is based on solid evidence. N6: "Both domestically and internationally, many studies suggest that the extubation of patients on invasive mechanical ventilation is a patient-centered process that requires collaboration among the healthcare team; this should essentially be what shared decision-making is." N1: "The assessment standards and processes used during the implementation of shared decision-making are based on guidelines and consensus statements. Moreover, to my knowledge, researchers both domestically and internationally are exploring nurse-led extubation models, which can provide supporting evidence for our decision-making." External Threats Theme 1. Poor communication between healthcare professionals Healthcare professionals indicate that poor communication is currently the greatest barrier to the implementation of the nurse-led shared decision-making model for weaning patients from invasive mechanical ventilation. Communication is a necessary means for implementing shared decision-making. Due to the severe condition of critically ill patients, healthcare professionals face significant medical risks, and when issues arise with patients, a trust crisis may erupt. N6: "When encountering unfamiliar rotating physicians, it is inevitable that some issues will require repeated communication and confirmation, which may come off to the doctors as if nurses are shirking responsibility; ultimately, it still boils down to a lack of trust." N12: "During the entire extubation process, doctors should maintain an open attitude and share decision-making information together. This is the only way to potentially expedite the weaning process for patients, ******." D3: "I support nurses expanding their scope of responsibilities, but I hope they can report to me well-prepared beforehand and highlight key content, rather than presenting everything haphazardly." Theme 2. Cognitive differences among healthcare professionals regarding extubation Synchronized knowledge among healthcare professionals is a prerequisite for teamwork. Cognitive differences related to extubation manifest in various levels of knowledge mastery and differing degrees of emphasis on the importance of extubation. D4: "Nurses' decisions regarding extubation are often based on physiological parameters, and teamwork significantly influences this process. Although ICU nurses play an important role in planning and managing extubation." N14: "I have noticed that sometimes there are conflicting opinions, such as we prefer patients to get better rest at night and provide them with sufficient respiratory support. In those cases, doctors might believe we are delaying the patient's extubation." Theme 3. Insufficient confidence in nurse leadership As nurse prescribing rights have not yet been established in our country, execution of extubation requires medical orders from doctors. Therefore, specialized nurses in critical care express that implementing a nurse-led shared decision-making model for weaning patients from invasive mechanical ventilation feels like "competing for power" with physicians. Regardless of facing doubts from doctors or issues of patient trust, they feel disadvantaged and lack confidence. D4: "Extubation is both a medical task and a nursing intervention. The performance of some nurses may cause us to question their experience and capabilities." N13: "We will assess the patient's physical condition to decide whether to proceed with extubation. ******. However, some results might still require evaluation by doctors, such as chest X-rays or CT scans, which may still need a doctor's judgment." N2: "In our national context, nurses follow doctors' orders to execute tasks. Even though it is nurse-led, orders still need to be issued by doctors. Isn't that directing them? So once a doctor raises concerns, we will still heed their advice because if complications arise later, we can't solve those ourselves." N4: "I believe that regarding patient trust, doctors rank first, and then nurses. We have little influence, and leading the implementation is quite difficult, which also involves issues of responsibility. If extubation fails later, the nurse alone definitely cannot resolve it." Discussion Leveraging Strengths to Enhance Quality – The Importance of Nurse-Led Shared Decision-Making in Weaning Patients from Invasive Mechanical Ventilation Mechanical ventilation is a complex clinical intervention that involves multiple decision points operated by personnel with varying professional backgrounds, knowledge, and experience. The entire process may exhibit significant heterogeneity, including decision responsibility, information used for decision-making, risks, and decision thresholds [ 13 ]. Research shows that there are differences in physicians’ preferences for setting ventilator parameters, negative evaluations of adopting systems and colleagues' opinions, presenting clear heterogeneity [ 14 ]. Nurses, being the healthcare professionals most closely interacting with patients, are increasingly recognized for their value in decision-making. This study shows that intensive care unit (ICU) nurses possess solid professional knowledge, strong clinical skills, and experience in handling various situations, enabling them to effectively identify the need for weaning decisions, consistent with other research findings [ 15 ]. This study indicates that the implementation of shared decision-making can improve the success rate of weaning in critically ill patients. Enhancing the recognition of patients, families, and surgical doctors, increasing patient loyalty within the department, aligns with Blackwood’s research, which suggests that delegating weaning from mechanical ventilation to nurses has significant benefits in terms of reducing the duration of invasive mechanical ventilation (IMV) and ICU length of stay[ 16 ]. Therefore, implementing nurse-led shared decision-making for weaning patients from invasive mechanical ventilation is an effective means to promote the safe and timely weaning of patients, improving the quality of decisions and ensuring better healthcare experiences for patients. Addressing Weaknesses and Actively Responding—Establishing a Sustainable Shared Decision-Making System for Nurse-led Withdrawal of Invasive Mechanical Ventilation Patients This study indicated that the implementation of a nurse-led shared decision-making system for withdrawing invasive mechanical ventilation patients presents a greater workload for clinical nurses. Incomplete procedural systems, decision support tools, and information systems hinder the implementation of this model. Although critical care nurses are willing to implement shared decision-making, individual positive attitudes and motivations for change are insufficient to promote the operation of a sustainable development mechanism at the departmental level[ 17 ]. This suggests that healthcare institutions must prioritize this work at the managerial level, incorporate shared decision-making into routine processes, establish corresponding systems, clarify job responsibilities, and train all medical and nursing staff[ 18 ]. This will help to shift the traditional practices of all participants and promote interdisciplinary collaboration to facilitate the continuous and stable operation of nurse-led shared decision-making for withdrawing invasive mechanical ventilation patients[ 17 ]. Furthermore, research indicates that developing various forms of more intelligent decision support tools can enhance the routine implementation of shared decision-making. In addition, improving information technology infrastructure can assist in the smoother implementation of shared decision-making, such as requiring the recording of patients' social-psychological information and preferences in electronic medical records or standardizing and integrating team collaboration content into the medical record system[ 19 ]. Seizing Opportunities for Collaborative Development—Promoting Best Evidence-Based Practices for Weaning Patients from Invasive Mechanical Ventilation In the current healthcare environment, external opportunities provide a solid foundation for shared decision-making led by nurses in the weaning of patients from invasive mechanical ventilation. Firstly, the support of departmental policies and culture plays an important role in promoting shared decision-making[ 20 ]. Healthcare professionals widely recognize that the nurse-led weaning shared decision-making model not only aligns with the patient-centered care philosophy promoted by national policies but also effectively improves the success rate of weaning and standardizes weaning decision-making behaviors[ 21 ]. In this process, nurses are not only executors but also important participants in decision-making, able to make comprehensive judgments based on patients' actual conditions and team opinions. Secondly, the adequacy of evidence-based rationale provides strong theoretical support for the implementation of shared decision-making in weaning. Early studies have shown that the effectiveness of weaning plans depends on the implementation environment[ 22 , 23 ]. In this study, healthcare professionals agreed that this model aligns with clinical practices that meet policy requirements, and due to established guidelines and standards that clarify weaning decision criteria, the implementation of shared decision-making can standardize weaning behaviors. Therefore, nurse-led shared decision-making for weaning patients from invasive mechanical ventilation is an effective means of achieving best evidence-based practices for weaning patients from invasive mechanical ventilation. Perceiving Threats and Exploring Transformations — Narrowing the Cognitive Differences Among Healthcare Providers and Expanding the Scope of Nurse Decision-Making Currently, the weaning of patients from invasive mechanical ventilation is mostly dictated by treatment plans prescribed by the attending physician, with clinical doctors, nurses, and respiratory therapists in intensive care units managing the process together[ 24 ]. This model often leads to unclear responsibilities and inadequate implementation of systems. Moreover, studies have pointed out that the effective execution of weaning decisions hinges on changing the perceptions and attitudes of doctors, nurses, and technicians regarding the weaning of patients from invasive mechanical ventilation[ 25 ]. In this study, there are cognitive differences between doctors and nurses concerning the weaning of patients from invasive mechanical ventilation, which not only affects the clinical implementation of shared decision-making but also creates significant communication gaps. Nurse managers have long prioritized weaning safety as one of the key points of quality control; however, the potential benefits of effective weaning management may not be recognized by all clinical doctors. Consequently, doctors are less enthusiastic about participating in shared decision-making regarding weaning than nurses. Research indicates that when doctors have a deeper understanding of clinical nurses' weaning capabilities, they are more inclined to engage in shared decision-making with nurses[ 26 ]. Therefore, it is recommended that healthcare providers undergo joint training and collaboratively implement standards, accurately and continuously monitoring the impact of these standards to promote their thorough implementation. Additionally, in traditional medical concepts in our country, the idea that nurses execute medical orders is deeply ingrained. This study shows that critical care nurses possess extensive professional knowledge; however, due to prescription authority limitations, nurses lack the confidence to take the lead, which severely hampers their motivation. Thus, in the future, consideration could be given to appropriately broadening the scope of nursing practice, granting nurses a certain degree of autonomy. This would not only allow them to better utilize their professional knowledge and skills but also provide timely and effective services to patients, thereby enhancing their motivation and promoting the development of the nursing discipline[ 27 , 28 ]. At the same time, multidisciplinary collaboration in nurse-led weaning should not be conducted in isolation. Regular case discussions with physicians, respiratory therapists, and physical therapists can enhance coordination and decision-making capabilities[ 29 ]. Summary In conclusion, this study combines SWOT analysis with traditional qualitative research, providing insights from three different stakeholder groups: doctors, nurses, and technicians. It identifies the strengths, weaknesses, opportunities, and threats of the existing model, and proposes corresponding improvement strategies to promote the routine implementation and sustainable development of nurse-led shared decision-making in the weaning of patients from invasive mechanical ventilation. In the future, we hope to develop a standardized nurse-led shared decision-making model for weaning patients from invasive mechanical ventilation and to validate its applicability in different regions and intensive care units of various healthcare institutions, thereby providing a reference for further standardizing the decision-making model for weaning patients from invasive mechanical ventilation. Abbreviations CCM Critical Care Medicine EICU Emergency Intensive Care Unit NICU Neurosurgery Intensive Care Unit Declarations Acknowledgements We thank researchers in the study. Author contributions Study design: CQ, XZ ;Data collection: CC,YF, KZ;Data analysis: LT,CQ, KZ;Study supervision: XZ;Manuscript writing: CQ, CC,YF, KZ,XZ;Critical revisions for important intellectual content: CQ, XZ Funding This research is funded by the Shanghai Nursing Association (NO.2024MS-B21). Data availability No datasets were generated or analysed during the current study.The qualitative interview content used and/or analyzed in this study is available from the corresponding author upon reasonable request. Ethical approval We strictly adhered to the ethical principles outlined in the Declaration of Helsinki.This study was conducted after approval by the Medical Ethics Committee of Shanghai Tenth People's Hospital (Approval No. 25KT67) and written permission from the implementing hospital. All participants provided verbal and written consent to the authors. This article strictly follows research norms and academic publishing ethical standards. 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Variability of preference towardmechanical ventilator settings: a model-based behavioralanalysis. J Crit Care 2011; 26: 637.e5. 637.e12. Moussanang JA, Thery G, Marcq O, Sellam S, Jolly D, Mourvillier B, Goury A. A nurse-driven protocol for early weaning from mechanical ventilation in patients with acute respiratory failure: A pilot study. Intensive Crit Care Nurs. 2025;89:104060. Blackwood, Alderdice F, Burns K, Cardwell C, Lavery G, O'Halloran P. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. BMJ. 2011;342:c7237. Hahlweg P, Lindig A, Frerichs W, et al. Major influencing factors on routine implementation of shared decision–making in cancer care: qualitative process evaluation of a stepped–wedge cluster randomized trial. BMC Health Serv Res. 2023;23(1):840. Danner M, Geiger F, Wehkamp K, et al. Making shared decision –making (SDM) a reality: protocol of a large–scale long–term SDM implementation programme at a northern German university hospital. BMJ Open. 2020;10(10):e037575. Scholl I, Hahlweg P, Lindig A, et al. Evaluation of a program for routine implementation of shared decision–making in cancer care:results of a stepped wedge cluster randomized trial. Implement Sci. 2021;16(1):106. Balas MC, Tate J, Tan A, et al. Evaluation of the perceived barriers and facilitators to timely extubation of critically ill adults: an interprofessional survey. Worldviews Evid Based Nurs. 2021;18:201e9. Ghanbari A, Mohammad Ebrahimzadeh A, Paryad E, et al. Comparison between a nurse-led weaning protocol and a weaning protocol based on physician's clinical judgment in ICU patients. Heart Lung. 2020;49(3):296–300. Roh JH, Synn A, Lim CM, et al. A weaning protocol administered by critical care nurses for the weaning of patients from mechanical ventilation. J Crit Care. 2012;27(6):549–55. Awang S, Alias N, DeWitt D, Jamaludin KA, Abdul Rahman MN. Design of a Clinical Practice Guideline in Nurse-Led Ventilator-Weaning for Nursing Training. Front Public Health. 2021;9:726647. Sterr F, Bauernfeind L, Knop M, et al. Weaning-associated interventions for ventilated intensive care patients: A scoping review. Nurs Crit Care. 2024;29(6):1564–79. Moussanang JA, Thery G, Marcq O, et al. A nurse-driven protocol for early weaning from mechanical ventilation in patients with acute respiratory failure: A pilot study. Intensive Crit Care Nurs. 2025;89:104060. Awang S, Alias N, DeWitt D, et al. Design of a Clinical Practice Guideline in Nurse-Led Ventilator-Weaning for Nursing Training. Front Public Health. 2021;9:726647. Abuzour AS, Lewis PJ, Tully MP. Practice makes perfect:a systematic review of the expertise development of pharmacist and nurse independent prescribers in the United Kingdom. Res Social Adm Pharm. 2018;14(1):6–17. Latter S, Courtenay M. Effectiveness of nurse prescribing: a review of the literature. J Clin Nurs. 2004;13(1):26–32. Lin YC, Chang RL, Tang CC. Safety and Efficacy of Nurse-Led Weaning Protocols on ICU Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Worldviews Evid Based Nurs. 2025;22(2):e70015. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7429919","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":522486102,"identity":"f5af654c-ac09-496f-b338-1c3599c56cfb","order_by":0,"name":"Changcui Qiu","email":"","orcid":"","institution":"Tongji University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Changcui","middleName":"","lastName":"Qiu","suffix":""},{"id":522486103,"identity":"a5238db3-8b9a-4e55-81eb-4b422a7c1e1c","order_by":1,"name":"Lulu Tang","email":"","orcid":"","institution":"Tongji University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Lulu","middleName":"","lastName":"Tang","suffix":""},{"id":522486104,"identity":"adc28e33-4a9f-4e29-ba1d-408bcf52cc21","order_by":2,"name":"chunwei chi","email":"","orcid":"","institution":"Shanghai Tenth People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"chunwei","middleName":"","lastName":"chi","suffix":""},{"id":522486106,"identity":"41aa8912-e4f6-42e5-98eb-e22ae7348247","order_by":3,"name":"yating feng","email":"","orcid":"","institution":"Shanghai Tenth People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"yating","middleName":"","lastName":"feng","suffix":""},{"id":522486107,"identity":"e5fa2f08-1f93-40be-aa1b-40bad80c9605","order_by":4,"name":"kangwei zheng","email":"","orcid":"","institution":"Shanghai Tenth People’s 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12:13:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1511289,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7429919/v1/9d44de7b-a870-47e6-93b6-e2bd5d723a2e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Healthcare providers’ cognitive perception and experience of shared decision-making of nurse-led weaning of patients on invasive mechanical ventilation:a qualitative study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe process of weaning patients from mechanical ventilation in a medical setting is complex and dynamic. The timing for weaning is influenced by multiple factors, including the underlying condition, the patient's status, the mode of respiratory support, and the level of support provided[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].The guidelines recommend establishing a weaning plan at the onset of mechanical ventilation, with daily weaning assessments[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These assessments should include evaluations of the patient's clinical symptoms, signs, and respiratory function, as well as the selection of a weaning mode. The assessment process is extensive and complex.\u003c/p\u003e\u003cp\u003eThe shared decision-making model refers to the process by which both doctors and patients communicate about different treatment options and ultimately reach a consensus decision[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Research indicates that the involvement of nurses with professional expertise in shared decision-making can facilitate its effective implementation[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Previous studies have shown that nurse-led extubation can significantly shorten the duration of mechanical ventilation and reduce ICU length of stay, making it a safe and effective weaning model. It has the potential to improve ICU operational efficiency and reduce healthcare costs[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, the implementation of nurse-led shared decision-making for weaning patients from invasive mechanical ventilation has become a new practice aimed at increasing the success rate of weaning, reducing healthcare costs, and enhancing critical care capabilities.\u003c/p\u003e\u003cp\u003eThe Intensive Care Unit of Shanghai Tenth People's Hospital is implementing nurse-led shared decision-making for extubation in patients undergoing invasive mechanical ventilation. Although certain effects have been achieved, many issues have been identified during the operation process.Research reports indicate that the true feelings of healthcare professionals during the implementation process are key to promoting the improvement of shared decision-making quality [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, there has been no in-depth research on healthcare providers\u0026rsquo;understanding and experiences of this decision-making approach.\u003c/p\u003e\u003cp\u003eTherefore, this study employs qualitative research methods and SWOT analysis to clarify the views of three stakeholder groups\u0026mdash;doctors, nurses, and respiratory therapists\u0026mdash;on the advantages, disadvantages, opportunities, and threats of nurse-led shared decision-making for weaning patients from invasive mechanical ventilation[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The aim is to optimize the nurse-led shared decision-making model for weaning patients from invasive mechanical ventilation, promote the best evidence-based practices for nurse-led shared decision-making, and provide guidance and suggestions for further improvement and promotion of this decision-making approach.\u003c/p\u003e"},{"header":"Objects and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eResearch Subjects\u003c/h2\u003e\u003cp\u003eIn June to August 2025, clinical doctors, nurses, and respiratory therapists from ICU at Shanghai Tenth People's Hospital who met the criteria were selected as research subjects. Inclusion criteria for clinical doctors: ① At least 1 year of clinical work experience in ICU; ② Previous involvement in the clinical weaning of patients on invasive mechanical ventilation; ③ Received training related to shared decision-making; ④Voluntary participation in this research. Exclusion criteria: ① Doctors who were on leave or have been on leave for more than 1 year with less than 6 months of active duty; ② Interns or trainees. Inclusion criteria for clinical nurses: ① At least 2 years of clinical work experience in ICU; ② Previous involvement in the clinical weaning of patients on invasive mechanical ventilation; ③ Received training related to shared decision-making; ④ Voluntary participation in this research; ⑤ Implemented shared decision-making for weaning from invasive mechanical ventilation in \u0026ge;\u0026thinsp;20 cases. Exclusion criteria: ① Those who were on leave, away on task, or in training during the study period; ② Interns or trainees. Inclusion criteria for respiratory therapists: ① At least 1 year of clinical work experience in ICU; ② Previous involvement in the clinical weaning of patients on invasive mechanical ventilation; ③ Received training related to shared decision-making; ④ Voluntary participation in this research. Exclusion criteria: ① Doctors who were on leave or have been on leave for more than 1 year with less than 6 months of active duty; ② Interns or trainees. The sample size was determined by the saturation of interview data, specifically when the selection of research subjects exhibited maximum variability, and no new information emerged or information was repeated; at this point, the sample size reached saturation. This study included 7 doctors, numbered D1 to D7; 16 nurses, numbered N1 to N16; and 7 respiratory therapists, numbered R1 to R7. General information of the interviewed medical staff is detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e General information of interviewed medical staff\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003cp\u003e(years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eICU stay\u003c/p\u003e\u003cp\u003e(years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTitle\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDepartment\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eChief Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCCM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAttending Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCCM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAttending Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCCM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAssociate Chief Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCCM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAttending Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAttending Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAssociate Chief\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eChief Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eChief Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eChief Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCCM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCCM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCCM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCCM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eChief Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eChief Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTechnician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCCM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTechnician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEICU\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eChief Technician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCCM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTechnician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCCM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTechnician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCCM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTechnician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCCM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTechnician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCCM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSampling Method\u003c/h3\u003e\n\u003cp\u003eThis study employed purposive sampling methods, combined with a sampling strategy that maximizes the diversity of the research subjects. Factors such as the type of work of medical staff, age, gender, years of work experience, and department were taken into consideration.\u003c/p\u003e\n\u003ch3\u003eDevelopment of Interview Outline\u003c/h3\u003e\n\u003cp\u003eThe interview outline for this study was developed around the SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis framework. Preliminary outlines were established through literature review and discussions within the research team. Before the formal interviews, two doctors, two nurses, and two respiratory therapists who met the inclusion criteria were selected for pre-interviews to modify any issues that arose. After further discussions within the research team, the final interview outline was determined as follows:\u003c/p\u003e\u003cp\u003e\u003cem\u003e①What advantages do you think there are in the current nurse-led shared decision-making process for weaning patients off invasive mechanical ventilation?\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e②What shortcomings do you think exist in the current nurse-led shared decision-making process for weaning patients off invasive mechanical ventilation?\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003e③What factors can motivate the current shared decision-making process for weaning patients off mechanical ventilation?\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e④What factors can hinder the current shared decision-making process for weaning patients off mechanical ventilation?\u003c/h2\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e⑤ Do you have any additional comments?\u003c/h2\u003e\u003cdiv id=\"Sec9\" class=\"Section4\"\u003e\u003ch2\u003eData Collection\u003c/h2\u003e\u003cp\u003eA semi-structured interview method was used to collect data, conducting one-on-one, face-to-face interviews with subjects. The researcher has systematically studied qualitative research methods and mastered semi-structured interview techniques, enabling independent conduct of interviews. Before the interviews, the researcher introduced themselves, explained the purpose, content, process, and duration of the interview, and built a trust relationship with the subjects. Research subjects signed an informed consent form. The interview location and time were chosen based on the respondents' preferences to ensure that no unrelated personnel were present during the interview, thus avoiding distractions. With the respondents' consent, audio recording was conducted throughout the interview, with the researcher flexibly asking questions based on the interview outline, refraining from interrupting or commenting on their answers to avoid leading or suggestive language. In cases where there were questions or unclear responses, the researcher confirmed through paraphrasing, follow-up questions, and counter-questions, and promptly recorded non-verbal information such as actions, expressions, and tone of voice. Each interview lasted between 20 to 40 minutes.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eContent analysis was employed to analyze the interview data. Within 24 hours after the interviews, the data were transcribed, and non-verbal information was marked at the appropriate positions in the transcript. During the data organization process, any uncertainties were promptly clarified with the interview subjects. The study used a four-level coding symbol based on the SWOT categories (Strengths, Weaknesses, Opportunities, Threats) to code the interview content. Each transcript was independently coded by two researchers with extensive experience in qualitative research, and the results were compared. Themes were refined through collaborative analysis and discussion to avoid bias.The study was reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eEthical Considerations\u003c/h2\u003e\u003cp\u003e We strictly adhered to the ethical principles outlined in the Declaration of Helsinki.This study was conducted after approval by the Medical Ethics Committee of Shanghai Tenth People's Hospital (Approval No. 25KT67) and written permission from the implementing hospital. All participants provided verbal and written consent to the authors. This article strictly follows research norms and academic publishing ethical standards.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eInternal Advantages\u003c/h2\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003eTheme 1. Alleviation of doctors' diagnostic pressure and decision-making pressure\u003c/h2\u003e\u003cp\u003eMost doctors and respiratory therapists indicate that the current nurse-led shared decision-making model for weaning patients from invasive mechanical ventilation reduces the clinical pressure on them by collaborating with clinical nurses.\u003c/p\u003e\u003cp\u003e\u003cem\u003eD1: \"The assessment for weaning patients from invasive mechanical ventilation includes ****** and other aspects; the assessment process is complex and involves many contents. Most of the indicator parameters come from the clinical operations and observations of the nurses. The nurses inform us of the assessment results, which can save us time in obtaining information and re-evaluating, allowing us more time to provide other treatments to the patients.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eR4: \"When making weaning decisions in the ward, facing patients who are difficult to wean puts a lot of pressure on us. It requires a lot of energy and time to identify the risk factors for unsuccessful weaning. The nurses are always by the patient's bedside, providing us with many opinions and suggestions, which saves us a considerable amount of effort.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eD3: \"The differences in our workload and day/night shifts can affect the time we dedicate to focusing on weaning and extubating patients. Sometimes, when faced with emergencies, we may just maintain the patient\u0026rsquo;s existing respiratory support treatment plan. This implementation allows us not to worry about delaying the patient's weaning time, *****.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eTheme 2. Clinical nurses have the ability and willingness to implement\u003c/h2\u003e\u003cp\u003eIntensive care physicians indicate that intensive care specialized practice nurses possess extensive knowledge related to mechanical ventilation, which ensures that patients can efficiently complete the weaning process. Under the guidance of specialized nurses, junior nurses are also willing to accept the challenge and engage in shared decision-making.\u003c/p\u003e\u003cp\u003e\u003cem\u003eD2: \u0026ldquo;Senior nurses working in the ICU have a wealth of knowledge and can comprehensively grasp the assessments related to patient weaning; we feel very assured letting this part be handled by the nurses.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN11: \u0026ldquo;As a senior ICU nurse, I am quite willing to conduct patient weaning assessments; this model reflects our professional value rather than passively following medical orders, and I am still willing to accept it.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN8: \u0026ldquo;ICU specialized knowledge determines the decision-making process of nurses in clinical work. As senior nurses, we can still coordinate weaning decisions and arrangements, and we won\u0026rsquo;t panic even if a patient encounters a critical situation.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN4: \u0026ldquo;******, although relatively young and afraid of not doing this well, I am very willing to accept the challenge, as it can promote our professional technical skills improvement, ******.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eTheme 3. Improving the success rate of weaning in critically ill patients\u003c/h2\u003e\u003cp\u003eMost respondents indicated that the implementation of shared decision-making can avoid the one-sidedness of any unilateral decisions made by doctors, nurses, or technicians, and can alleviate the delays in the weaning process caused by communication barriers, thereby improving the success rate of weaning in critically ill patients.\u003c/p\u003e\u003cp\u003e\u003cem\u003eD6: \"ICU patients have severe conditions and require significant interventions, so doctors cannot be by every patient's side at all times. Much of the patient information comes from nursing documents and patient examination reports, which can be one-sided and delayed.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN10: \"In previous weaning and extubation procedures, nurses merely followed medical orders without fully utilizing their own initiative. For example, in changing the patient's ventilation mode, nurses would wait for the doctor to be informed of any changes in the patient's condition before making adjustments or would just mechanically execute the current medical orders. After the implementation of the shared decision-making model, through systematic training on weaning knowledge, nurses can match the best treatment and care measures in real time based on the patient's condition, effectively improving the extubation success rate.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eR5: \"Previously, our department's SBT operations and extubation procedures were usually completed, but due to a shortage of staff, some patients who met the criteria for extubation still experienced delays in removing the tube. The implementation of this model has greatly reduced such occurrences.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 4. Enhance the recognition of patients, their families, and surgeons, increasing the department's patient loyalty\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMedical staff indicated that after the implementation of the shared decision-making model, the recognition of the department's clinical capabilities by patients' families and surgeons has increased, boosting the department's patient loyalty. \u003cem\u003eD4: \"Previously, we would receive complaints from surgeons about nurses being unfamiliar with patients' conditions, ***, but now this situation has decreased, ******.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eD5: \"In the past, surgeons always believed that we were not timely in withdrawing machines, delaying the timing for extubation, ******. After implementing this model, doctors feel more trust in our ICU because we can provide more sufficient and reasonable explanations for whether patients can be extubated.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN12: \"I now have a very good relationship with the surgeons and patients' families. They consult me during visits about any ventilator-related issues, and communication with them has become easier.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eR3: \"******, some family members have provided feedback that ICU nurses have close contact with patients, and the explanations they provide are still very trustworthy.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN12: \"The premise for extubation is the patient's involvement; it is necessary to establish a trusting relationship with him/her. The ICU nurses are always beside the patients and can constantly pay attention to changes in their physiological and psychological needs, providing encouragement and support.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eInternal Weaknesses\u003c/h2\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003eTheme 1. Increased work pressure\u003c/h2\u003e\u003cp\u003eSome clinical nurses reported that the current shared decision-making model has increased their work pressure.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN16: \"The evaluation process for extubation needs to cover multiple aspects including respiratory function, circulatory function, mental status, improvement of underlying diseases, and so on. I am very afraid that something might be overlooked.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN5: \"Because I am not just following doctor's orders; I also need to integrate and apply my clinical experience and knowledge in the extubation and withdrawal of the ventilator. I am worried that my inadequacies could harm the patient.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN14: \"Sometimes when it gets busy, I can't complete the evaluations for all the patients being extubated.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eTheme 2. Lack of decision-making support tools\u003c/h2\u003e\u003cp\u003eClinical nurses stated that the current extubation process is too complicated with a wide range of evaluation content, and there is a lack of decision-making support tools.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN2: \"We are still gradually extubating based on the extubation process document. Many steps require comprehensive evaluations. Could we invent some more intelligent tools to assist us in these evaluations?\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN7: \"Through literature research, I found that there are many studies on decision-making support tools for extubation, but very few are applied in clinical practice.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eTheme 3. Implementation process is not smooth, staffing mechanism is inactive\u003c/h2\u003e\u003cp\u003eHealthcare personnel indicated that the implementation process of the current model is unclear and lacks defined job responsibilities.\u003c/p\u003e\u003cp\u003e\u003cem\u003eD5: \"Currently, there is no clear process, and the implementation is not smooth. Furthermore, there is no clear guideline on what doctors should evaluate and to what extent, which sometimes leads to incomplete evaluations.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN3: \"Sometimes we don't know when to use decision-making support or where to apply it, and we often need to call doctors for information, which I feel is a problem with the flow of the process.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eR1: \"Even though team members hope for successful extubation for the patient as soon as possible, each person's attitude towards extubation can affect the execution of extubation procedures, leading to a lack of cohesion in the process, for example...\" Clinical nurses stated that nurse-led standardized extubation processes are complex and need optimization in staffing arrangements to ensure that a multidisciplinary collaborative organizational structure is in place.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN15: \"Extubation of patients on invasive mechanical ventilation not only involves the medical plan itself, but also requires multidisciplinary collaboration and flexible staffing. When nurses are caring for patients who need extubation, this consideration might influence staffing decisions.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eTheme 4. Incomplete information technology\u003c/h2\u003e\u003cp\u003eHealthcare personnel unanimously expressed that improving the information technology infrastructure in critical care could enhance the smoothness of decision-making.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN14: \"We could incorporate procedural evaluation forms into the current information system, with doctors responsible for providing their portion of the information and nurses doing the same. This way, nurses can see what doctors see, and vice versa. It avoids incomplete information sharing and repetitive communication, improving decision-making efficiency and ensuring the evaluation process is implemented.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eD3: \"From a global perspective, employing computer-driven extubation plans is incredibly beneficial for clinical practice, but currently, very few are implemented in clinical settings.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eExternal Opportunities\u003c/h2\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eTheme 1. Departmental policy and cultural support\u003c/h2\u003e\u003cp\u003eHealthcare professionals indicate that the nurse-led shared decision-making model for weaning patients from invasive mechanical ventilation aligns with departmental policies, which can improve the success rate of extubation while standardizing decision-making behaviors.\u003c/p\u003e\u003cp\u003e\u003cem\u003eD5: \"The country is also promoting enhanced patient experiences now; this can be considered a means, ******.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eD7: \"In fact, the shared decision-making in extubation by ICU nurses is influenced by various factors, some of which are related to team culture. If we provide strong support, communicate promptly when encountering obstacles, and encourage the team when families have doubts, it may lead to better implementation.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eTheme 2. Sufficient evidence-based basis\u003c/h2\u003e\u003cp\u003e Assessment for weaning patients from invasive mechanical ventilation has been outlined in numerous guidelines and consensus statements both domestically and internationally, hence the implementation of shared decision-making during extubation is based on solid evidence.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN6: \"Both domestically and internationally, many studies suggest that the extubation of patients on invasive mechanical ventilation is a patient-centered process that requires collaboration among the healthcare team; this should essentially be what shared decision-making is.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e N1: \"The assessment standards and processes used during the implementation of shared decision-making are based on guidelines and consensus statements. Moreover, to my knowledge, researchers both domestically and internationally are exploring nurse-led extubation models, which can provide supporting evidence for our decision-making.\"\u003c/em\u003e\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eExternal Threats\u003c/h2\u003e\u003cdiv id=\"Sec26\" class=\"Section4\"\u003e\u003ch2\u003eTheme 1. Poor communication between healthcare professionals\u003c/h2\u003e\u003cp\u003eHealthcare professionals indicate that poor communication is currently the greatest barrier to the implementation of the nurse-led shared decision-making model for weaning patients from invasive mechanical ventilation. Communication is a necessary means for implementing shared decision-making. Due to the severe condition of critically ill patients, healthcare professionals face significant medical risks, and when issues arise with patients, a trust crisis may erupt.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN6: \"When encountering unfamiliar rotating physicians, it is inevitable that some issues will require repeated communication and confirmation, which may come off to the doctors as if nurses are shirking responsibility; ultimately, it still boils down to a lack of trust.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN12: \"During the entire extubation process, doctors should maintain an open attitude and share decision-making information together. This is the only way to potentially expedite the weaning process for patients, ******.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eD3: \"I support nurses expanding their scope of responsibilities, but I hope they can report to me well-prepared beforehand and highlight key content, rather than presenting everything haphazardly.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003eTheme 2. Cognitive differences among healthcare professionals regarding extubation\u003c/h2\u003e\u003cp\u003eSynchronized knowledge among healthcare professionals is a prerequisite for teamwork. Cognitive differences related to extubation manifest in various levels of knowledge mastery and differing degrees of emphasis on the importance of extubation.\u003c/p\u003e\u003cp\u003e\u003cem\u003eD4: \"Nurses' decisions regarding extubation are often based on physiological parameters, and teamwork significantly influences this process. Although ICU nurses play an important role in planning and managing extubation.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN14: \"I have noticed that sometimes there are conflicting opinions, such as we prefer patients to get better rest at night and provide them with sufficient respiratory support. In those cases, doctors might believe we are delaying the patient's extubation.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003eTheme 3. Insufficient confidence in nurse leadership\u003c/h2\u003e\u003cp\u003eAs nurse prescribing rights have not yet been established in our country, execution of extubation requires medical orders from doctors. Therefore, specialized nurses in critical care express that implementing a nurse-led shared decision-making model for weaning patients from invasive mechanical ventilation feels like \"competing for power\" with physicians. Regardless of facing doubts from doctors or issues of patient trust, they feel disadvantaged and lack confidence.\u003c/p\u003e\u003cp\u003e\u003cem\u003eD4: \"Extubation is both a medical task and a nursing intervention. The performance of some nurses may cause us to question their experience and capabilities.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN13: \"We will assess the patient's physical condition to decide whether to proceed with extubation. ******. However, some results might still require evaluation by doctors, such as chest X-rays or CT scans, which may still need a doctor's judgment.\" N2: \"In our national context, nurses follow doctors' orders to execute tasks. Even though it is nurse-led, orders still need to be issued by doctors. Isn't that directing them? So once a doctor raises concerns, we will still heed their advice because if complications arise later, we can't solve those ourselves.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN4: \"I believe that regarding patient trust, doctors rank first, and then nurses. We have little influence, and leading the implementation is quite difficult, which also involves issues of responsibility. If extubation fails later, the nurse alone definitely cannot resolve it.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cb\u003eLeveraging Strengths to Enhance Quality \u0026ndash; The Importance of Nurse-Led Shared Decision-Making in Weaning Patients from Invasive Mechanical Ventilation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMechanical ventilation is a complex clinical intervention that involves multiple decision points operated by personnel with varying professional backgrounds, knowledge, and experience. The entire process may exhibit significant heterogeneity, including decision responsibility, information used for decision-making, risks, and decision thresholds [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Research shows that there are differences in physicians\u0026rsquo; preferences for setting ventilator parameters, negative evaluations of adopting systems and colleagues' opinions, presenting clear heterogeneity [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Nurses, being the healthcare professionals most closely interacting with patients, are increasingly recognized for their value in decision-making. This study shows that intensive care unit (ICU) nurses possess solid professional knowledge, strong clinical skills, and experience in handling various situations, enabling them to effectively identify the need for weaning decisions, consistent with other research findings [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This study indicates that the implementation of shared decision-making can improve the success rate of weaning in critically ill patients. Enhancing the recognition of patients, families, and surgical doctors, increasing patient loyalty within the department, aligns with Blackwood\u0026rsquo;s research, which suggests that delegating weaning from mechanical ventilation to nurses has significant benefits in terms of reducing the duration of invasive mechanical ventilation (IMV) and ICU length of stay[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Therefore, implementing nurse-led shared decision-making for weaning patients from invasive mechanical ventilation is an effective means to promote the safe and timely weaning of patients, improving the quality of decisions and ensuring better healthcare experiences for patients.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAddressing Weaknesses and Actively Responding\u0026mdash;Establishing a Sustainable Shared Decision-Making System for Nurse-led Withdrawal of Invasive Mechanical Ventilation Patients\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study indicated that the implementation of a nurse-led shared decision-making system for withdrawing invasive mechanical ventilation patients presents a greater workload for clinical nurses. Incomplete procedural systems, decision support tools, and information systems hinder the implementation of this model. Although critical care nurses are willing to implement shared decision-making, individual positive attitudes and motivations for change are insufficient to promote the operation of a sustainable development mechanism at the departmental level[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This suggests that healthcare institutions must prioritize this work at the managerial level, incorporate shared decision-making into routine processes, establish corresponding systems, clarify job responsibilities, and train all medical and nursing staff[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This will help to shift the traditional practices of all participants and promote interdisciplinary collaboration to facilitate the continuous and stable operation of nurse-led shared decision-making for withdrawing invasive mechanical ventilation patients[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Furthermore, research indicates that developing various forms of more intelligent decision support tools can enhance the routine implementation of shared decision-making. In addition, improving information technology infrastructure can assist in the smoother implementation of shared decision-making, such as requiring the recording of patients' social-psychological information and preferences in electronic medical records or standardizing and integrating team collaboration content into the medical record system[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eSeizing Opportunities for Collaborative Development—Promoting Best Evidence-Based Practices for Weaning Patients from Invasive Mechanical Ventilation\u003c/h3\u003e\n\u003cp\u003eIn the current healthcare environment, external opportunities provide a solid foundation for shared decision-making led by nurses in the weaning of patients from invasive mechanical ventilation. Firstly, the support of departmental policies and culture plays an important role in promoting shared decision-making[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Healthcare professionals widely recognize that the nurse-led weaning shared decision-making model not only aligns with the patient-centered care philosophy promoted by national policies but also effectively improves the success rate of weaning and standardizes weaning decision-making behaviors[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In this process, nurses are not only executors but also important participants in decision-making, able to make comprehensive judgments based on patients' actual conditions and team opinions. Secondly, the adequacy of evidence-based rationale provides strong theoretical support for the implementation of shared decision-making in weaning. Early studies have shown that the effectiveness of weaning plans depends on the implementation environment[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In this study, healthcare professionals agreed that this model aligns with clinical practices that meet policy requirements, and due to established guidelines and standards that clarify weaning decision criteria, the implementation of shared decision-making can standardize weaning behaviors. Therefore, nurse-led shared decision-making for weaning patients from invasive mechanical ventilation is an effective means of achieving best evidence-based practices for weaning patients from invasive mechanical ventilation.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePerceiving Threats and Exploring Transformations \u0026mdash; Narrowing the Cognitive Differences Among Healthcare Providers and Expanding the Scope of Nurse Decision-Making\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCurrently, the weaning of patients from invasive mechanical ventilation is mostly dictated by treatment plans prescribed by the attending physician, with clinical doctors, nurses, and respiratory therapists in intensive care units managing the process together[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This model often leads to unclear responsibilities and inadequate implementation of systems. Moreover, studies have pointed out that the effective execution of weaning decisions hinges on changing the perceptions and attitudes of doctors, nurses, and technicians regarding the weaning of patients from invasive mechanical ventilation[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In this study, there are cognitive differences between doctors and nurses concerning the weaning of patients from invasive mechanical ventilation, which not only affects the clinical implementation of shared decision-making but also creates significant communication gaps. Nurse managers have long prioritized weaning safety as one of the key points of quality control; however, the potential benefits of effective weaning management may not be recognized by all clinical doctors. Consequently, doctors are less enthusiastic about participating in shared decision-making regarding weaning than nurses. Research indicates that when doctors have a deeper understanding of clinical nurses' weaning capabilities, they are more inclined to engage in shared decision-making with nurses[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Therefore, it is recommended that healthcare providers undergo joint training and collaboratively implement standards, accurately and continuously monitoring the impact of these standards to promote their thorough implementation.\u003c/p\u003e\u003cp\u003eAdditionally, in traditional medical concepts in our country, the idea that nurses execute medical orders is deeply ingrained. This study shows that critical care nurses possess extensive professional knowledge; however, due to prescription authority limitations, nurses lack the confidence to take the lead, which severely hampers their motivation. Thus, in the future, consideration could be given to appropriately broadening the scope of nursing practice, granting nurses a certain degree of autonomy. This would not only allow them to better utilize their professional knowledge and skills but also provide timely and effective services to patients, thereby enhancing their motivation and promoting the development of the nursing discipline[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. At the same time, multidisciplinary collaboration in nurse-led weaning should not be conducted in isolation. Regular case discussions with physicians, respiratory therapists, and physical therapists can enhance coordination and decision-making capabilities[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec31\" class=\"Section2\"\u003e\u003ch2\u003eSummary\u003c/h2\u003e\u003cp\u003eIn conclusion, this study combines SWOT analysis with traditional qualitative research, providing insights from three different stakeholder groups: doctors, nurses, and technicians. It identifies the strengths, weaknesses, opportunities, and threats of the existing model, and proposes corresponding improvement strategies to promote the routine implementation and sustainable development of nurse-led shared decision-making in the weaning of patients from invasive mechanical ventilation. In the future, we hope to develop a standardized nurse-led shared decision-making model for weaning patients from invasive mechanical ventilation and to validate its applicability in different regions and intensive care units of various healthcare institutions, thereby providing a reference for further standardizing the decision-making model for weaning patients from invasive mechanical ventilation.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCCM \u0026nbsp;Critical Care Medicine\u003c/p\u003e\n\u003cp\u003eEICU \u0026nbsp;Emergency Intensive Care Unit\u003c/p\u003e\n\u003cp\u003eNICU \u0026nbsp;Neurosurgery Intensive Care Unit\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank researchers in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy design: CQ, XZ ;Data collection: CC,YF, KZ;Data analysis: LT,CQ, KZ;Study supervision: XZ;Manuscript writing: CQ, CC,YF, KZ,XZ;Critical revisions for important intellectual content: CQ, XZ\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research is funded by the Shanghai Nursing Association (NO.2024MS-B21).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.The qualitative interview content used and/or analyzed in this study is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe strictly adhered to the ethical principles outlined in the Declaration of Helsinki.This study was conducted after approval by the Medical Ethics Committee of Shanghai Tenth People\u0026apos;s Hospital (Approval No. 25KT67) and written permission from the implementing hospital. All participants provided verbal and written consent to the authors. This article strictly follows research norms and academic publishing ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePreprint disclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePham T, Heunks L, Bellani G, et al. Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study. Lancet Respir Med. 2023;11(5):465\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGirard TD, Alhazzani W, Kress JP, et al. An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests[J]. Am J Respir Crit Care Med. 2017;195(1):120\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElwyn G, Frosch DL, Kobrin S. Implementing shared decision \u0026ndash; making: consider all the consequences. Implement Sci. 2016;11:114.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStacey D, Murray MA, L\u0026eacute;gar\u0026eacute; F, et al. Decision coaching to support shared decision making: a framework, evidence, and implications for nursing practice, education, and policy. Worldviews Evid Based Nurs. 2008;5(1):25\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLin YC, Chang RL, Tang CC. Safety and Efficacy of Nurse-Led Weaning Protocols on ICU Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Worldviews Evid Based Nurs. 2025;22(2):e70015.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFagoni N, Piva S, Peli E, et al. Comparison between a nurse-led weaning protocol and weaning based on physician's clinical judgment in tracheostomized critically ill patients: a pilot randomized controlled clinical trial. Ann Intensive Care. 2018;8(1):11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBateman RM, Sharpe MD, Jagger JE et al. 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15\u0026ndash;18 March 2016. Crit Care. 2016;20(Suppl 2):94.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSavelberg W, Boersma LJ, Smidt M, et al. Does lack of deeper understanding of shared decision making explains the suboptimal performance on crucial parts of it? An example from breast cancer care. Eur J Oncol Nurs. 2019;38:92\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDamschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evan Wijngaarden JD, Scholten GR, van Wijk KP. Strategic analysis for health care organizations: the suitability of the SWOT\u0026ndash;analysis. Int J Health Plann Manage. 2012;27(1):34\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eG\u0026uuml;rel E, Tat M. SWOT analysis: a theoretical review. Int J Soc Res Methodol. 2017;10(51):994\u0026ndash;10065.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups [J]. Int J Qual Health Care. 2007;19(6):349\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMurali M, Ni M, Karbing DS, Rees SE, Komorowski M, Marshall D, Ramnarayan P, Patel BV. Clinical practice, decision-making, and use of clinical decision support systems in invasive mechanical ventilation: a narrative review. Br J Anaesth. 2024;133(1):164\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAller\u0026oslash;d C, Karbing DS, Thorgaard P, Andreassen S, Kj\u0026aelig;rgaard S, Rees SE. Variability of preference towardmechanical ventilator settings: a model-based behavioralanalysis. J Crit Care 2011; 26: 637.e5. 637.e12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoussanang JA, Thery G, Marcq O, Sellam S, Jolly D, Mourvillier B, Goury A. A nurse-driven protocol for early weaning from mechanical ventilation in patients with acute respiratory failure: A pilot study. Intensive Crit Care Nurs. 2025;89:104060.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBlackwood, Alderdice F, Burns K, Cardwell C, Lavery G, O'Halloran P. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. BMJ. 2011;342:c7237.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHahlweg P, Lindig A, Frerichs W, et al. Major influencing factors on routine implementation of shared decision\u0026ndash;making in cancer care: qualitative process evaluation of a stepped\u0026ndash;wedge cluster randomized trial. BMC Health Serv Res. 2023;23(1):840.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDanner M, Geiger F, Wehkamp K, et al. Making shared decision \u0026ndash;making (SDM) a reality: protocol of a large\u0026ndash;scale long\u0026ndash;term SDM implementation programme at a northern German university hospital. BMJ Open. 2020;10(10):e037575.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eScholl I, Hahlweg P, Lindig A, et al. Evaluation of a program for routine implementation of shared decision\u0026ndash;making in cancer care:results of a stepped wedge cluster randomized trial. Implement Sci. 2021;16(1):106.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBalas MC, Tate J, Tan A, et al. Evaluation of the perceived barriers and facilitators to timely extubation of critically ill adults: an interprofessional survey. Worldviews Evid Based Nurs. 2021;18:201e9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGhanbari A, Mohammad Ebrahimzadeh A, Paryad E, et al. Comparison between a nurse-led weaning protocol and a weaning protocol based on physician's clinical judgment in ICU patients. Heart Lung. 2020;49(3):296\u0026ndash;300.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoh JH, Synn A, Lim CM, et al. A weaning protocol administered by critical care nurses for the weaning of patients from mechanical ventilation. J Crit Care. 2012;27(6):549\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAwang S, Alias N, DeWitt D, Jamaludin KA, Abdul Rahman MN. Design of a Clinical Practice Guideline in Nurse-Led Ventilator-Weaning for Nursing Training. Front Public Health. 2021;9:726647.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSterr F, Bauernfeind L, Knop M, et al. Weaning-associated interventions for ventilated intensive care patients: A scoping review. Nurs Crit Care. 2024;29(6):1564\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoussanang JA, Thery G, Marcq O, et al. A nurse-driven protocol for early weaning from mechanical ventilation in patients with acute respiratory failure: A pilot study. Intensive Crit Care Nurs. 2025;89:104060.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAwang S, Alias N, DeWitt D, et al. Design of a Clinical Practice Guideline in Nurse-Led Ventilator-Weaning for Nursing Training. Front Public Health. 2021;9:726647.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbuzour AS, Lewis PJ, Tully MP. Practice makes perfect:a systematic review of the expertise development of pharmacist and nurse independent prescribers in the United Kingdom. Res Social Adm Pharm. 2018;14(1):6\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLatter S, Courtenay M. Effectiveness of nurse prescribing: a review of the literature. J Clin Nurs. 2004;13(1):26\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLin YC, Chang RL, Tang CC. Safety and Efficacy of Nurse-Led Weaning Protocols on ICU Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Worldviews Evid Based Nurs. 2025;22(2):e70015.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Shared decision-making, invasive mechanical ventilation, weaning, SWOT analysis, qualitative study","lastPublishedDoi":"10.21203/rs.3.rs-7429919/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7429919/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e The clinical implementation of the nurse-led shared decision-making model for weaning patients from invasive mechanical ventilation has shown significant advantages. However, some issues have been revealed, and there has not yet been in-depth research on the understanding and experiences of healthcare personnel regarding this decision-making approach.\u003c/p\u003e\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e To clarify healthcare professionals' perspectives on the shared decision-making model for nurse-led weaning of patients on invasive mechanical ventilation and to determine improvement measures to promote the routine implementation of the model.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e An interview outline was developed based on the SWOT model. Using purposive sampling, seven physicians, sixteen nurses, and seven respiratory therapists working in the intensive care unit of Shanghai Tenth People's Hospital from June to August 2025 were selected for semi-structured interviews,and content analysis method was used for data analysis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e Four themes were extracted for internal advantages: alleviating the pressure on doctors in diagnosis and decision-making; clinical nurses' capability and willingness to implement; improving the success rate of weaning critically ill patients; and enhancing recognition among patients, families, and surgeons, thereby increasing the department's patient loyalty. Four themes were extracted for internal weaknesses:increased work pressure; lack of decision-support tools; smoothness of implementation processes; and ineffective human resource allocation mechanisms; and insufficient information technology. The external opportunities identified two themes: support from departmental policies and culture; and a solid evidence base. The external threats encompassed three themes: poor communication between medical staff; cognitive differences among healthcare personnel regarding weaning; and insufficient confidence in nurses taking the lead.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e The nurse-led shared decision-making for weaning patients off invasive mechanical ventilation has certain advantages. In the future, it should leverage existing opportunities, mitigate internal weaknesses, acknowledge external threats, and develop a standardized nurse-led shared decision-making model for weaning patients off invasive mechanical ventilation to promote the best evidence-based practices in this area.\u003c/p\u003e\u003cp\u003e\u003cb\u003eClinical Trial Number\u003c/b\u003e Not applicable.This research is a qualitative study.\u003c/p\u003e","manuscriptTitle":"Healthcare providers’ cognitive perception and experience of shared decision-making of nurse-led weaning of patients on invasive mechanical ventilation:a qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 15:58:59","doi":"10.21203/rs.3.rs-7429919/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a3850618-d5c8-4bb3-bb09-64da0b4ab7a4","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-04T11:26:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-30 15:58:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7429919","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7429919","identity":"rs-7429919","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}