Validity and reliability of "Persian Weaning Tool" in mechanically ventilated patients

Document Type : Original Article


1 Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

2 Nursing and Midwifery Care Research Centre, Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Social Determinants of Health Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Biostatistics, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran


Background: "Persian Weaning Tool (PWT)" is the only specific, national protocol designed to assess patients' readiness for weaning from mechanical ventilation in Iran. This study was developed to determine the validity and reliability of this protocol.
Materials and Methods: This is a psychometric study conducted on 31 patients connected to mechanical ventilation were ready from weaning according to anesthesiologist's diagnosis and was selected through convenient sampling. The patients selected from Intensive Care Units (ICUs) of Al-Zahra Hospital in Isfahan. The sheet data collection includes demographic data, PWT; Burn's Wean Assessment Program (BWAP), and Morganroth's scale. To determine the inter-rater reliability between researcher and his partner, Pearson correlation and paired t-test were used. To assess the criterion validity of the PWT in relation to Burn's and Morganroth's weaning scales (as criteria), Pearson correlation and McNemar tests were used. To specify a minimum acceptable score of the PWT for weaning from mechanical ventilation, receiver operating characteristic curve was used.
Results: The results showed that there was statistically significant correlation between score of PWT and BWAP (r = 0.370 with P < 0.05) and there were no statistically significant differences between these tools in terms of identification of patients' readiness for weaning (P = 0.453). There was statistically significant correlation between PWT score obtained by researcher and his colleague (r = 0.928), and the reliability of this tool was approved. The PWTs cut of point was calculated as 57 (sensitivity = 0.679, specificity = 1).
Conclusions: The reliability and validity of the PWT were confirmed for this study's sample size. Consequently, the findings of this study can be used to measure the PWTs effectiveness and applicability in ICUs.


Danckers M, Grosu H, Jean R, Cruz RB, Fidellaga A, Han Q, et al. Nurse-driven, protocol-directed weaning from mechanical ventilation improves clinical outcomes and is well accepted by intensive care unit physicians. J Crit Care 2013;28:433-41.  Back to cited text no. 1
Lavelle C, Dowling M. The factors which influence nurses when weaning patients from mechanical ventilation: Findings from a qualitative study. Intensive Crit Care Nurs 2011;27:244-52.  Back to cited text no. 2
Arabi A, Tavakol KH. Respiratory Care and Mechanical Ventilation. Isfahan: University of Medical Sciences Press; 2008. p. 88-9.  Back to cited text no. 3
Irajpour A, Khodaee M, Yazdannik A, Abbasi S. Developing a readiness assessment tool for weaning patients under mechanical ventilation. Iran J Nurs Midwifery Res 2014;19:273-8.  Back to cited text no. 4
Hosseini M, Ramezani J. Evaluation of APACHE II system in prediction of the separation from mechanical ventilation. J Sci Health 2007;3:2-7.  Back to cited text no. 5
Curuvilla J. Essential of Critical Care Nursing. New Delhi: Jaypee Brother′s Medcal Publishers; 2007. p. 231.  Back to cited text no. 6
Jalalian HR, Aslani J, Panahi Z. Factors affecting the duration of mechanical ventilation device isolation of patients in intensive care units. Kowsar Med J 2009;13:163-4.  Back to cited text no. 7
Blackwood B, Alderdice F, Burns K, Cardwell C, Lavery G, O′Halloran P. Use of weaning protocols for reducing duration of mechanical ventilation incritically ill adultpatients: Cochrane systematic review and meta-analysis. Br Med J 2011;10:1-2.  Back to cited text no. 8
Tonnelier JM, Prat G, Le Gal G, Gut-Gobert C, Renault A, Boles J, et al. Impact of a nurses′ protocol-directed weaning procedure on outcomes in patients undergoing mechanical ventilation for longer than 48 hours: A prospective cohort study with a matched historical control group. Br Med J 2005;9:83-9.  Back to cited text no. 9
Sole M, Klein D, Moseley M. Introduction to Critical Care Nursing. 5 th ed. Saunders Elsevier; 2009. p. 105.  Back to cited text no. 10
Alavi M, Irajpour A, Abdoli S, SaberiZafarghandi MB. Clients as mediators of interprofessional collaboration in mental health services in Iran. J. Interprof. Care 2012;26:36-42.  Back to cited text no. 11
Irajpour A, Ghaljaei F, Alavi M. Concept of Collaboration from the Islamic Perspective: The View Points for Health Providers. J. Relig. Health 2015;54:1800-9.  Back to cited text no. 12
Yazdannik A, Salmani F, Irajpour A, Abbasi S. Application of Burn′s wean assessment program on the duration of mechanical ventilation among patients in intensive care units: A clinical trial. Iran J Nurs Midwifery Res 2012;17:520-3.  Back to cited text no. 13
McLean SE, Jensen LA, Schroeder DG, Gibney NR, Skjodt NM. Improving adherence to a mechanical ventilation weaning protocol critically ill adults: Outcomes after an implementation program. Am J Crit Care 2006;15:299.  Back to cited text no. 14
Roh JH, Synn A, Lim CM, Suh HJ, Hong SB, Huh JW, et al. A weaning protocol administered by critical care nurses for the weaning of patients from mechanical ventilation. J Crit Care 2012;27:549-55.  Back to cited text no. 15
Plang-Wan R. The Effect Providing Information and Instilling Reassurance on Uncertainty in Weaning from Mechanical Ventilation. Master Thesis of Nursing Science (Adult Nursing), Faculty of Graduate Studies, Mahidol University; 2004.  Back to cited text no. 16
Morganroth ML, Morganroth JL, Nett LM, Petty TL. Criteria for weaning from prolonged mechanical ventilation. Arch Intern Med 1984;144:1012-6.  Back to cited text no. 17
Mergoni M, Iacovelli W, Giovanelli L, Barantani D, Grattagliano C. Evaluation of traditional parameters and the Morganroth system to monitor the weaning process in patients treated with long-term mechanical ventilation. Minerva Anestesiol 1990;56:1265-7.  Back to cited text no. 18
Bagheri M, Sadrzadeh Y, Dorosti Motlagh A, Eshraghiyan M, Kazemiyan E, Agaee Negad M. The reliability and validity of body image assessment for obesity tool to measure the satisfaction of pre-pregnancy weight in pregnant women. Iran J Diabetes Lipid Disord 2013;11:400.  Back to cited text no. 19
Dalvandi A, Bahrampouri S. The validity and reliability of Iranian pre-hospital diagnosis of stroke tools. 6 th International and the First National Iranian Stroke Congress, Tabriz, University of Medical Sciences; 2013.  Back to cited text no. 20
Dehghan H, Habibi P, Meraci M, Habibi A. Validation of a Questionnaire for Heat Strain Evaluation in Women. Isfahan: School of Health, Isfahan University of Medical Sciences; 2014.  Back to cited text no. 21