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| Barriers to safe oxygen therapy | Expressions of the interviewees |
| Categories | Subcategories |
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| Lack of knowledge and awareness in the field of oxygen therapy | (i) Lack of sufficient knowledge and awareness of the personnel about the importance of correct and safe oxygen therapy and its side effects | …“The education that is given does not say everything that is needed in nursing work...” (p. 12) |
| (ii) Lack of continuous training in terms of quantity and quality | ...“Clinical training is not given; nurses mostly do not know which equipment to use for which patient...”(p. 10) |
| (iii) Absence of oxygen therapy training protocol in the hospital | …“They don’t know if they should pour distilled water or wash these oxygen containers at all...” (p. 1) |
| (iv) Lack of knowledge of some physicians about the importance of correct and safe oxygen therapy | ...“ Some nurses do not know at all what this patient’s clinical condition is and how much oxygen he should receive…” (p. 13) |
| (v) Lack of knowledge of the personnel about the indications of oxygen therapy prescription, dose, target, and duration of its use | …“When, as a nurse, I ask some physicians about the dose and equipment of oxygen therapy, they call me ignorant and say that I have no expertise in this field and just coordinate with the ICU manager...”(p. 3) |
| (vi) Lack of knowledge of personnel and services staff about the hygiene principles of infection control in oxygen therapy |
| (vii) Lack of knowledge of patient examination methods to assess oxygen saturation in the blood |
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| Defects in the correct implementation of oxygen therapy at the patient’s bedside | (i) Failure to include the oxygen therapy ordered by the attending physician in full with the type of device and required dose in the patients’ files | …“Sometimes I see nurses tape the venturi mask adapter so that more oxygen reaches the patient...” (p. 2) |
| (ii) Unnecessary oxygen administration without a physician’s order | ...“When you come to visit, you see that oxygen is given unnecessarily to a patient who does not need oxygen without an order...” (p. 7) |
| (iii) Lack of coordination between services and nurses in the field of oxygen therapy implementation | ...“Sometimes the service staff, when they change the sheets or move the patient, the mask falls off the patient’s face, and they forget to put it on...” (p. 4) |
| (iv) Failure to use oxygen therapy equipment correctly (type of equipment, dosage, length of connections) | ...“These containers that should be filled with distilled water or they don’t wash the container at all...” (p. 6) |
| (v) Failure to properly implement the protocol of the infection control unit | ...“When you look at the patient with a reservoir mask, they give oxygen, but the oxygen flow is 2 liters...” (p. 13) |
| …“Physicians either give oral orders for oxygen or do not write the dosage and the device at all...” (p. 1) |
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| Quantitative and qualitative defects of oxygen therapy devices | (i) Inconsistency and lack of attention in purchasing medical equipment | “This flowmeter gives so little oxygen that you have to take the flow to 10 liters for the nasal tube to give a little oxygen...” (p. 12) |
| (ii) Errors in the correct operation of flowmeters | “Sometimes I know that I shouldn’t reserve masks now, but we don’t have simple masks in the department, and when I call the pharmacy, they say that there are too many masks and we won’t buy masks until they run out...” (p. 5) |
| (iii) Leakage or malfunction of the flowmeter adjustment column and the ball inside the flowmeter | “These oxygen pressure alarms sounded so much sometimes, especially during the time of corona, that we had to lower the oxygen flow for the patients...” (p. 3) |
| (iv) Lack of proper oxygen generator | “This ball in the flowmeter doesn’t go up and down at all in some flowmeters, and I don’t understand how much the flow is now...” (p. 6) |
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| Lack of adequate monitoring of the oxygen therapy process | (i) Lack of head nurse supervision | …“Sometimes, when the services fill the oxygen distilled water, they raise or lower the oxygen flow themselves, and the nurses don’t pay attention at all...” (p. 5) |
| (ii) Lack of adequate monitoring of oxygen therapy by the patient’s nurse | “...ICU resident doctors or supervisors do not look at all to see if the patient has an oxygen order or not or if this device is suitable for this patient...” (p. 11) |
| (iii) Lack of supervision by the resident doctor in the ICU | ...“The infection control unit should come and collect culture samples from these containers that pour distilled water, but it cannot be done at all...” (p. 9) |
| (iv) Inadequate supervision of the infection control unit on compliance and implementation of the hygiene principles of infection control in oxygen therapy | ... “It seems that no one confirms the quality of the equipment they buy...” (p. 8) |
| (v) Lack of intraorganizational supervision at management levels on all units (clinic-medical equipment-infection control unit) | ...“There is no supervision by the people in charge of the hospital on the quality and quantity of the purchase of equipment or the work of the service department...” (p. 4) |
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