Experiences of intensive care nurses assessing sedation/agitation in critically ill patients

Abstract

This paper reinforces the potential benefits to patients as a direct result of implementing the SAS scoring tool and clinical guidelines. Furthermore, it highlights the reluctance of a number of staff to adhere to such guidelines and discusses the concerns regarding less experienced nurses administering sedative agents. Attention was also drawn to the educational requirements of nursing and medical staff when using the SAS scoring tool.

Nurse perception of Bispectral Index monitoring as an adjunct to sedation scale assessment in the critically ill paediatric patient

“…West (2006) has pointed out that education plays a pivotal role in preparing intensive care nurses to meet expanded responsibilities for patient assessment as their scope of practice evolves). However, the critical care nurses in both this study and that of Weir and O'Neill (2008) placed education in a much broader perspective when they recommended that education about practice innovation should extend beyond the boundaries of their own profession. These recommendations reflect nurses' recognition that adoption of practice innovations in critical care environments takes place in a context of interprofessional relationships (Robert et al, 2010) and multidisciplinary collaboration.…”

“…Participating nurses eventually recommended the delivery of enhanced BIS education to all levels of medical and nursing staff in the PICU, so that all unit personnel would fully understand the use and interpretation of this clinical innovation and its implications for patient care. Weir and O'Neill (2008) received similar feedback about education from nurses involved in implementation of an evidence-based sedation management innovation in an adult intensive care unit. Like the PICU nurses in this study, the nurses interviewed by Weir and O'Neill (2008) recognised education as a key determinant of success in implementation of evidence-based practice improvement and expressed strong opinions about its role in their practice improvement initiative.…”

“…Weir and O'Neill (2008) received similar feedback about education from nurses involved in implementation of an evidence-based sedation management innovation in an adult intensive care unit. Like the PICU nurses in this study, the nurses interviewed by Weir and O'Neill (2008) recognised education as a key determinant of success in implementation of evidence-based practice improvement and expressed strong opinions about its role in their practice improvement initiative. Comments included scattered complaints about inadequate pre-implementation education, suggestions that additional education about the innovation might improve patient outcomes, and strong recommendations that such education should be delivered to all nursing and medical staff on the unit.…”

Role of organisational structure in implementation of sedation protocols: a comparison of Canadian and French ICUs

“…For example, although nurses' perceptions are generally supportive of sedation protocols,15 variation in sedation management may be related to ethical conflicts,16 confidence and experience of individual nurses,17 18 and influence of patients' family members 19. Interestingly, access for family members to visit patients tends to be greater in North American ICUs than in French ICUs (personal communication).…”

The validity, reliability, responsiveness and applicability of observation sedation-scoring instruments for use with adult patients in the emergency department: A systematic literature review

“…19 Conversely, under-sedation can lead to increased levels of anxiety, agitation, unplanned self-extubation or violence towards staff. [20][21][22] Emergency nurses are responsible for the ongoing care of critically ill sedated patients, frequently assessing, monitoring and titrating sedation as necessary. Within the ED, the Glasgow Coma Scale (GCS) 23 is often relied upon to measure the critically ill patient's degree of consciousness whilst being sedated.…”