RT Journal Article
SR Electronic
T1 Qualitative descriptive study to explore nurses’ perceptions and experience on pain, agitation and delirium management in a community intensive care unit
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e024328
DO 10.1136/bmjopen-2018-024328
VO 9
IS 4
A1 Jennifer L Y Tsang
A1 Katie Ross
A1 Franziska Miller
A1 Ramez Maximous
A1 Priscilla Yung
A1 Carl Marshall
A1 Mercedes Camargo
A1 Dimitra Fleming
A1 Madelyn Law
YR 2019
UL http://bmjopen.bmj.com/content/9/4/e024328.abstract
AB Objectives The purpose of this study was to explore the experiences, beliefs and perceptions of intensive care unit (ICU) nurses on the management of pain, agitation and delirium (PAD) in critically ill patients.Design A qualitative descriptive study.Setting This study took place in a community hospital ICU located in a medium size Canadian city.Participants Purposeful sampling was conducted. Participants included full-time nurses working in the ICU. Forty-six ICU nurses participated.Methods A total of five focus group sessions were held to collect data. There were one to three separate groups in each focus group session, with no more than seven participants in each group. There were 10 separate groups in total. A semistructured question guide was used. Thematic analysis method was adopted to analyse the data, and to search for emergent themes and patterns.Results Three main themes emerged: (1) the professional perspectives on patient wakefulness state, (2) the professional perspectives on PAD management of critically ill patients and (3) the factors impacting PAD management. Nurses have different opinions on the optimal level of patient sedation and felt that many factors, including environmental, healthcare teams, patients and family members, can influence PAD management. This potentially leads to inconsistent PAD management in critically ill patients. The nurses also believed that PAD management requires a multidisciplinary approach including healthcare teams and patients’ families.Conclusions Many external and internal factors contribute to the complexity of PAD management including the attitudes of nursing staff towards PAD. The themes emerged from this study suggested the need of a multifaceted and multidisciplinary quality improvement programme to optimise the management of PAD in the ICU.