Evidence for nurses’ viewpoints to protective lung strategies implementation—a narrative review

Background and Objective: Protective lung strategies (PLS) are known mechanical ventilation (MV) management for acute respiratory distress syndrome (ARDS) and are used for prevention of ventilation-induced lung injury (VILI). These ventilation strategies prevent atelectrauma, biotrauma, and barotrauma. Despite the potential benefits of PLS, clinical adherence is compromised at the bedside. Nurses’ clinical skills and judgment can help to deliver air volume compatible with lung capacity. However, the precise role of nurses in PLS implementation is not known. This article aims to review nurses’ perspectives and barriers to deliver PLS. Methods: The review was conducted by searching PubMed, Google Scholar, Cumulated Index to Nursing and Allied Health Literature (CINAHL), ScienceDirect, and Cochrane Library between 2015 to 2022. The reported outcomes were actual ventilation practice at the patient, practice variability from the physician’s point of view, the prognosis of the patients, and nurses’ barriers to implementing PLS. Key Content and Findings: The results were classified into three main themes, clinical audit of PLS, factors affecting adherence to practice guidelines, and nurses’ barriers to adoption of practice guidelines. The antecedents of concepts manifest as trends of nurses’ barriers to PLS use, reasons for nurses’ barriers to recommended MV management, and why it matters to understand nurses’ barriers. Conclusions: Nurses’ involvement can improve the guidelines compliance but nurses’ barriers to practice guidelines negatively affect the implementation of recommended MV. It is anticipated to re-consider nurses’ participation in MV management and identify nurses’ barriers to the implementation of PLS. Research beyond disciplinary silos is needed to implement evidence-based practice.