Use of PADIS Assessment Tools by Critical Care Nurses: An Integrative Review

Waterfield, Denise; Barnason, Susan

doi:10.1177/0193945920973025

Cited by 3 publications

(5 citation statements)

References 75 publications

(357 reference statements)

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“…These findings are consistent with previous studies that highlight barriers to implementing practice guidelines related to nurse attitudes, beliefs, role clarity, and workload burden. [9][10][11]15 However, research has found that evidence-based care like the use of PADIS assessment tools can improve attention to patients, individualized care, and communication among team members but requires support from the entire care team. 15 PADIS care is dependent on more than 1 nurse's decision-making but encompasses moral attitude, ethical leadership, empowerment for ethical practice, and establishing and supporting a moral community.…”

Section: Discussionmentioning

confidence: 99%

“…Others do not or cannot because of many personal, environmental, and perhaps ethical reasons. 10,11,[13][14][15] Critical care nurses are typically equipped to recognize the ethical implications of higher-risk clinical situations like end-of-life decisions and the allocation of scarce resources. However, the ability to recognize moral conflict and ethical consequence (ie, ethical sensitivity) of everyday tasks included in PADIS care like mobilizing a patient or appropriate medication administration is not often recognized or discussed.…”

Section: Introductionmentioning

confidence: 99%

“…Others do not or cannot because of many personal, environmental, and perhaps ethical reasons. 10,11,13-15…”

Section: Introductionmentioning

confidence: 99%

“…14 In a previous integrative review, the researchers in this study found that personal beliefs by nurses influenced some implementation of PADIS guidelines which warranted further investigation. 15 The studies of Milliken and her colleagues 16-20 —who developed the tool used in this study—are the only studies found directly related to ethical sensitivity and critical care nursing in the literature. The purpose of this study was to develop a better understanding of nurses’ ethical awareness and ethical sensitivity of PADIS care.…”

Section: Introductionmentioning

confidence: 99%

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“It Kills Your Soul”: A Mixed Methods Study of Ethical Sensitivity of Critical Care Nurses

Waterfield,

Barnason

2024

West J Nurs Res

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Background: Critically ill patients often experience distressful and impactful symptoms and conditions that include pain, agitation/sedation, delirium, immobility, and sleep disturbances (PADIS). The presence of PADIS can affect recovery and long-term patient outcomes. An integral part of critical care nursing is PADIS prevention, assessment, and management. Ethical sensitivity of everyday nursing practice related to PADIS is an imperative part of implementing evidence-based care for patients. Objective: The first 2 aims of this study were to determine the measured level of ethical awareness as an attribute of ethical sensitivity among the critical care nurse participants and to explore the ethical sensitivity of critical care nurses related to the implementation of PADIS care. The third aim was to examine how the measured level of ethical awareness and ethical sensitivity exploration results converge, diverge, and/or relate to each other to produce a more complete understanding of PADIS ethical sensitivity by critical care nurses. Methods: This was a convergent parallel mixed methods study (QUAL + quant). Ethical sensitivity was explored by conducting an ethnography of critical care nurses. The participants were 19 critical care nurses who were observed during patient care, interviewed individually, participated in a focus group (QUAL), and were administered the Ethical Awareness Scale (quant). Findings: Despite high levels of individual ethical awareness among nurses, themes of ambiguous beneficence, heedless autonomy, and moral distress were found to be related to PADIS care. Conclusions: More effort is needed to establish moral community, ethical leadership, and individual ethical guidance for nurses to establish patient-centered decision-making and PADIS care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Others do not or cannot because of many personal, environmental, and perhaps ethical reasons. 10,11,13-15…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

“It Kills Your Soul”: A Mixed Methods Study of Ethical Sensitivity of Critical Care Nurses

Waterfield,

Barnason

2024

West J Nurs Res

Self Cite

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“…Because the patient in intensive care is not always able to communicate verbally, the CAM-ICU was adapted to screen intubated or artificially ventilated patients (Cribbin, 2018). The results of this scale are limited by the binomial approach of the evaluation of delirium, and the fact that it is a one-point-in-time assessment (Waterfield, Barnason 2021). The Neelon and Champagne (NEECHAM) Confusion Scale was developed a few years later, based on daily nursing practice: the nurses' 24-hour assessment of the level of processing information, the level of behavior, and the physiological condition rate.…”

Section: Introductionmentioning

confidence: 99%

Comparing the Confusion Assessment Method for the Intensive Care Unit and Neelon and Champagne Confusion Scale for assessing delirium in non-intubated intensive care patients

Locihová¹,

Pelikánová²

2022

Kontakt

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Introduction: There are many scales of assessment and prediction of risk of delirium, but they are little known and rarely used by professionals. Recognition of delirium by nurses continues to be limited. Design: The prospective observational study included 50 consecutive non-intubated patients staying in the ICU for more than 24 hours. Setting: Department of anesthesiology and intensive care medicine (5 beds) of AGEL Hospital in Valašské Meziříčí, between September 2020 and March 2021. Methods: Primary outcome was to compare the presence of delirium in non-intubated ICU patients with two simultaneously used assessment tools: the Neelon and Champagne (NEECHAM) Confusion Scale, and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). A secondary outcome was to verify the NEECHAM Confusion Scale reliability in the Czech ICU setting.Results: The study found that the incidence rates detected by the CAM-ICU (32%) and NEECHAM Confusion Scale (28%) were comparable. Nearly a third of CAM-ICU-negative patients were found to belong to the mild confusion or at-risk NEECHAM Confusion Scale groups. The internal consistency of the NEECHAM Confusion Scale assessed with Cronbach's α was 0.703. There was a statistically significant relationship between delirium and two of the studied patient parameters (GCS score and use of antipsychotics). Conclusions: Delirium is common in ICU patients, but it often remains undiagnosed. Various tools have been developed to help identify delirium patients. Their use has been shown to result in better outcomes. Both studied tools (the CAM-ICU and NEECHAM Confusion Scale) appear to be suitable and convenient.

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Analgosedation Management in the Intensive Care Unit: A Narrative Systematic Review

Lia,

Pucci,

Raccagna

et al. 2023

TOATJ

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Background: Intensive care unit (ICU) patients' pain and sedation management is a significant nursing challenge. Sedatives and muscle relaxants administration has been long used for improving patients' comfort and tolerance to mechanical ventilation. This practice led to an increase in adverse ICU outcomes in terms of health status, hospitalization stay, infections, and mortality. The use of appropriate ICU pain and sedation assessment tools is limited. Methods: We conducted a narrative literature systematic review (from 2010 to 2022) whose primary aims were to analyze the analgosedation definition and identify ICU patients’ pain, agitation, and sedation assessment tools; secondary aims were to explore analgesia and sedation pharmacological and non-pharmacological treatments and nurses’ perceptions and attitudes regarding analgosedation issues. Results: We retrieved 45 eligible articles. Analgosedation foresees early pain management - using pharmacological and non-pharmacological approaches and then, if necessary, implementing adequate sedation. Recommended assessment tools are the Behavioral Pain Scale (BPS) and the Critical Care Observational Tool (CPOT) for pain assessment, the Richmond Agitation Sedation Scale (RASS), and the Sedation Agitation Scale (SAS) for sedation assessment. Guidelines and specific protocols recommend both pharmacological and non-pharmacological approaches. Health professionals report mainly barriers (lack of adherence to guidelines and protocols, workload, reduced awareness, and own perceptions) to analgosedation correct application. The implementation of ICU analgosedation strategies requires continuous health professionals’ commitment and collaboration and valid assessment tools use. Conclusion: ICU analgosedation management (pain control first, and then sedation if necessary) is limited due to health professionals' knowledge gaps, inappropriate use of assessment tools, guidelines, and specific protocols. Recommended assessment tools are the BPS and CPOT for pain assessment and the RASS and SAS for sedation assessment. Interventions to improve ICU analgosedation awareness and practice include training events, the use and consultation of literature guidelines, and the use of validated assessment tools.

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Use of PADIS Assessment Tools by Critical Care Nurses: An Integrative Review

Cited by 3 publications

References 75 publications

“It Kills Your Soul”: A Mixed Methods Study of Ethical Sensitivity of Critical Care Nurses

“It Kills Your Soul”: A Mixed Methods Study of Ethical Sensitivity of Critical Care Nurses

Comparing the Confusion Assessment Method for the Intensive Care Unit and Neelon and Champagne Confusion Scale for assessing delirium in non-intubated intensive care patients

Analgosedation Management in the Intensive Care Unit: A Narrative Systematic Review

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