ABSTRACT
AIMS AND OBJECTIVES: To explore experiences of nurses implementing and using the Modified Early Warning Score (MEWS) and a Mobile Intensive Care Nurse (MICN) providing 24-hour on-call nursing support. BACKGROUND: To secure patient safety in hospital wards, nurses may increase the quality of care using a tool to detect the failure of vital functions. Possibilities for support can be provided through on-call supervision from a qualified team or nurse. DESIGN: This exploratory qualitative investigation used focus group interviews with nurses from two wards of a university hospital in Norway. METHODS: A purposive sample of seven registered nurses was interviewed in focus groups. A semi-structured guide and an inductive thematic analysis were used to identify interview themes. RESULTS: Three themes emerged: (1) experiences with the early recognition of deterioration using the MEWS, (2) supportive collaboration and knowledge transfer between nurses and (3) a "new" precise language using the score for communicating with physicians. The use of scores and support were perceived as improving care for deteriorating patients and for supporting the collaboration of nurses with other professionals. CONCLUSION: In our study, nurses described increased confidence in the recognition of deteriorating patients and in the management of such situations. The non-critical attitude, supportive communication and interactive learning according to the MICN were essential elements for success.
Subject(s)
Decision Support Systems, Clinical/standards , Nurses/psychology , Severity of Illness Index , Adult , Attitude of Health Personnel , Clinical Competence/standards , Cooperative Behavior , Female , Focus Groups , Humans , Intensive Care Units/organization & administration , Male , Middle Aged , Norway , Qualitative ResearchABSTRACT
AIMS AND OBJECTIVES: To describe intensive care nurses' perceptions and assessments of unpleasant symptoms and signs in mechanically ventilated and sedated adult intensive care patients. BACKGROUND: Mechanically ventilated patients are unable to express themselves verbally and depend upon nurses to control their symptoms by understanding their unpleasant experiences, such as pain, anxiety or delirium and interpret the relevant signs. Nurses must have enough knowledge to adjust their analgesics and sedatives appropriately and to avoid under- or oversedation. DESIGN: A cross-sectional survey design. METHODS: A study with a self-administrated questionnaire was undertaken in October 2007 to February 2008, with a convenience sample of 183 intensive care nurses in Norway. RESULTS: The questionnaire was completed by 86 (47%) nurses. Most perceived that critical illness polyneuropathy/myopathy occurred frequently. Half the nurses underestimated pain, anxiety and delirium. Signs such as a response to contact, cough reflex, wakefulness and muscle tone were considered most important in assessing oversedation. Agitation, facial grimacing, tube intolerance and wakefulness were considered most important in assessing undersedation. The Comfort Scale and Adoption of the Intensive Care Environment corresponded best to the signs identified by the nurses. CONCLUSION: The nurses underestimated unpleasant symptoms other than critical illness polyneuropathy/myopathy. A further mapping of patients' experiences should be conducted, with an emphasis on the more 'silent' distressing symptoms. Further tools to facilitate the communication of consciousness levels and the intolerance of unpleasant symptoms must be developed and implemented. RELEVANCE TO CLINICAL PRACTICE: A deeper understanding of unpleasant symptoms and signs focused in learning activities may help nurses to recognize patients' early problems and allow targeted interventions. A more active stimulus-response assessment of ICU patients is required to detect oversedation, critical illness polyneuropathy/myopathy and hypoactive delirium. Assessment tools should reflect both the patient's tolerance of various unpleasant symptoms and the level of consciousness.
Subject(s)
Conscious Sedation/methods , Critical Care Nursing/methods , Monitoring, Physiologic/nursing , Nurse-Patient Relations , Nursing Assessment , Respiration, Artificial/methods , Adult , Anxiety/diagnosis , Anxiety/nursing , Attitude of Health Personnel , Clinical Competence , Conscious Sedation/adverse effects , Critical Care/standards , Critical Care/trends , Critical Illness/nursing , Critical Illness/therapy , Cross-Sectional Studies , Delirium/diagnosis , Delirium/nursing , Female , Humans , Intensive Care Units , Male , Middle Aged , Needs Assessment , Norway , Nurse's Role , Pain/diagnosis , Pain/nursing , Perception , Reproducibility of Results , Respiration, Artificial/adverse effects , Risk Assessment , Severity of Illness Index , Surveys and Questionnaires , Treatment OutcomeABSTRACT
OBJECTIVES: To describe intensive care nurses' perceptions of unit and personal sedation practice in the context of nursing and medical treatment of adult intensive care patients sedated and ventilated for more than 24 hours. METHODS: Self-administered questionnaire. SETTING: Three general ICUs in three university hospitals in Norway. RESULTS: Eighty-six questionnaires were returned (response rate 47%). Continuous infusions of fentanyl and midazolam were perceived as most common and nurses often gave both analgesics and sedatives prior to care. Daily interruption of sedation or analgesia-based sedation was not perceived as practice in the units. MAAS was most commonly used, whilst protocols or objective scoring systems were not. Documentation of sedation levels was fairly routine, whereas documentation of patient needs was not perceived as important. Collaboration with physicians was viewed as most important, whilst no significance was assigned to collaboration with relatives. CONCLUSION: The study shows that a focus on analgesia-based sedation and continual control of the sedation level should be considered in order to decrease the risk of oversedation. Inclusion of relatives' opinions, increased collaboration between nurses and physicians, and implementation of sedation tools, may contribute to even better patient outcome and should be focus in further studies.
