“Having the compass–drawing the map”: Exploring nurses’ management of pain and other discomforts during use of analgosedation in intensive care

Abstract

Aim To explore the deliberation and enactment processes of nurses in relation to pain and other discomforts in the critically ill patients after the implementation of an analgosedation protocol. Background Nurses in intensive care units (ICU) face great challenges when managing pain and other discomforts and distinguishing between patients’ needs for analgesics and sedatives. An analgosedation protocol favouring pain management, light sedation and early mobilization was implemented in a university hospital ICU in Norway in 2014. Changing sedation paradigms resulting in an increasing number of awake patients during critical illness is expected to affect nursing practice. Design Exploratory, single‐unit study in a mixed adult ICU. Methods Data collection with participant observation and semi‐structured interviews in sixteen clinical situations in 2014 and 2015. Thirteen experienced certified critical care nurses were included. Thematic content analysis was conducted. Results An overall theme “ Having the compass–drawing the map ” emerged from the analysis. The protocol or strategy of analgosedation appeared to provide a direction for treatment and care, although requiring extensive interpretation of needs and individualization of care, often in challenging situations. The overall theme was abstracted from three themes: “Interpreting a complex whole,” “Balancing conflicting goals” and “Experiencing strain from acting across ideals.” Conclusion Nurses seem to attend adequately to patient pain, but the approach to discomforts other than pain appears unsystematic and haphazard. More explicit goals of care and strategies to handle discomfort as distinct from pain are needed. More research is needed to identify effective comfort measures for ICU patients.

“Please mind the gap”: A secondary analysis of discomfort and comfort in intensive care

“…A central finding in this study was a comfort gap evident in that our ICU patients expressed a high degree of discomfort despite the endeavours of critical care nurses to alleviate these. The comfort gap correlates with findings of the critical care nurses’ perceptions that discomfort experienced by ICU patients cannot be fully eliminated (Berntzen et al, 2019). This may indicate that nurses are not capable of fulfilling all comfort needs identified.…”

“…Furthermore, transcendence may be sought by focusing on how the exercise may contribute not only to “medical” goals but also to personal goals, such as participating in a future family event or going hiking. In an earlier study, we found that nurses may experience strain from witnessing patient discomfort when trying to balance rehabilitation and comfort in their patients (Berntzen et al, 2019). To regard transcendence as one type of comfort may even reduce the nurses’ feeling of not doing their best for their patients.…”

“…Discomfort was a prominent finding in patients in the qualitative part of a combined quantitative and qualitative study where we addressed the implications of implementing a systematic approach to pain, agitation and delirium (PAD); (Berntzen, Bjørk, & Wøien, 2018, 2019). The systematic approach was supplemented by an analgosedation protocol in line with the, at that time current international recommendations (Barr et al, 2013).…”

Movements and trends in intensive care pain treatment and sedation: What matters to the patient?

“…We also aimed to explore nurses' deliberation and enactment processes in relation to pain and other discomforts in these patients after the implementation of an analgosedation protocol. The qualitative findings have been published in separate papers (Berntzen, Bjørk, & Wøien, , ).…”

Intensivsykepleieres opplevelser med langtids-intensivpasienters indre styrke og vilje til overlevelse

“…80 % er i live 30 dager etter innleggelse (1,2). Som i andre deler av helsetjenesten har det vaert en rivende utvikling og endringer i måten intensivsykepleie utøves, blant annet er innføring av protokoller for vurdering av smerter og sedasjonsnivå saerlig aktuelt med tanke på ønsket om mer våkne pasienter (3). Til tross for stor innsats fra helsepersonellet i intensivavdelinger innebaerer prosessen mot overlevelse av alvorlig sykdom/skade både lidelse og store plager (4,5).…”