Ed.D. Dissertations

Date of Award


Document Type

Open Access Dissertation


College of Education



Degree Name

Doctorate of Education, Ed.D.

Faculty Chair

David Kluth, Ed.D.

Content Specialist

Mary Amick, Ed.D.

Content Reader

Barbara Archer, D.P.A., M.B.A.


evidence-based practice, adherence, mechanically ventilated, intubated, intubation, tracheostomy, Theoretical Domain Framework


Intubation by endotracheal or tracheostomy means is a common life-saving intervention bearing significant, yet preventable risk. Evidence-based practice (EBP), intended to mitigate risk, is often inconsistently adhered to by healthcare providers (HCPs) due to a variety of factors, leaving patients vulnerable to adverse outcomes such as ventilator-associated pneumonia or tracheostomy-related stenosis. A review of the literature identified socially related barriers resulting from overlapping roles and expectations of primary HCPs. Little research has been conducted to understand the impact of overlap on EBP adherence. Using the Theoretical Domains Framework (TDF), this case study explored HCP overlap in one critical care unit in the southeastern U.S using convenience sampling of nurses, doctors, and respiratory therapists. Data collection was performed using semistructured interviews. Manual coding and analysis were performed to identify themes among the participants noting a strong frequency of social and belief domain-related findings. This study confirmed social and belief TDF domains are highly impactful in adhering to EBP specific to MV/T patients. Conclusions recommend social and belief domains should be considered when developing strategies for increasing EBP adherence.