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A Qualitative Study of Nurses’ Practice, Professional Preferences and Improvement Strategies on Pain, Agitation and Delirium Management in a Community ICU
Priscilla Yung1, Katie Ross2, Franziska Miller1, Carl Marshall1, Mercedes Camargo2, Gina Fleming2, Madelyn Law3, Jennifer LY Tsang1,2,4
1Niagara Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, St Catharines, Ontario, Canada, 2St Catharines Site, Niagara Health, St Catharines, Ontario, Canada, 3Department of Health Sciences, Brock University, St Catharines, Ontario, Canada, 4Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Introduction
Delirium is a common manifestation of acute brain dysfunction in critically ill patients with a prevalence of 80% in intensive care unit (ICU) patients1. It is associated with multiple complications1. In 2013, a revised version of the ICU pain, agitation, and delirium (PAD) guidelines was published2. However, its dissemination is suboptimal. More importantly, nurses play an integral part in PAD management and their perspectives should inform the development of a multifaceted and multidisciplinary quality improvement (QI) program to improve PAD management.
Objectives
This qualitative study explored the views of ICU nurses regarding PAD management in order to inform the subsequent development of a multifaceted and multidisciplinary quality improvement (QI) program with the aim to improve PAD management in a community ICU.
Methods
Focus groups (1-hour) with nurses were conducted using a structured interview guide containing six questions designed to explore themes related to nursing practice, professional preferences and improvement strategies around PAD management. Transcripts were analyzed using a constant comparative approach to identify themes that emerged from the data. Responses for each question were analyzed individually and then compared across sessions to examine similarities or differences across the responses.
Results
Forty-five out of sixty-eight nurses attended 1 of 5 focus group sessions. Themes that developed from the analysis outlined differences in nurse perceptions of optimal sedation and physical restraint use, but there was alignment in their perception regarding the impact of environmental factors on delirium development. Differences were found related to physical restraint use as some nurses felt that they contribute to delirium while some felt that they are necessary for safety. Some nurses preferred deep sedation to avoid awareness of traumatic experience, whereas others preferred wakefulness facilitating participation in their medical care. Most nurses agreed that noise, lights, medications, disjointed care and physical restraint use contribute to delirium development. They agreed that consistencies among healthcare professionals in the form of an algorithm, individual patient-tailored non-pharmacological therapy involving input from family members and education for staff and family members would aid in PAD management.
Conclusion
The results of this study will guide subsequent interventions as part of our multifaceted and multidisciplinary PAD QI program. Core to this project is the nurse engagement in the development of these interventions which in turn will impact improvements for PAD management in the ICU.
A Qualitative Study of Nurses’ Practice, Professional Preferences and Improvement Strategies on Pain, Agitation and Delirium Management in a Community ICU
Priscilla Yung1, Katie Ross2, Franziska Miller1, Carl Marshall1, Mercedes Camargo2, Gina Fleming2, Madelyn Law3, Jennifer LY Tsang1,2,4
1Niagara Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, St Catharines, Ontario, Canada, 2St Catharines Site, Niagara Health, St Catharines, Ontario, Canada, 3Department of Health Sciences, Brock University, St Catharines, Ontario, Canada, 4Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Introduction
Delirium is a common manifestation of acute brain dysfunction in critically ill patients with a prevalence of 80% in intensive care unit (ICU) patients1. It is associated with multiple complications1. In 2013, a revised version of the ICU pain, agitation, and delirium (PAD) guidelines was published2. However, its dissemination is suboptimal. More importantly, nurses play an integral part in PAD management and their perspectives should inform the development of a multifaceted and multidisciplinary quality improvement (QI) program to improve PAD management.
Objectives
This qualitative study explored the views of ICU nurses regarding PAD management in order to inform the subsequent development of a multifaceted and multidisciplinary quality improvement (QI) program with the aim to improve PAD management in a community ICU.
Methods
Focus groups (1-hour) with nurses were conducted using a structured interview guide containing six questions designed to explore themes related to nursing practice, professional preferences and improvement strategies around PAD management. Transcripts were analyzed using a constant comparative approach to identify themes that emerged from the data. Responses for each question were analyzed individually and then compared across sessions to examine similarities or differences across the responses.
Results
Forty-five out of sixty-eight nurses attended 1 of 5 focus group sessions. Themes that developed from the analysis outlined differences in nurse perceptions of optimal sedation and physical restraint use, but there was alignment in their perception regarding the impact of environmental factors on delirium development. Differences were found related to physical restraint use as some nurses felt that they contribute to delirium while some felt that they are necessary for safety. Some nurses preferred deep sedation to avoid awareness of traumatic experience, whereas others preferred wakefulness facilitating participation in their medical care. Most nurses agreed that noise, lights, medications, disjointed care and physical restraint use contribute to delirium development. They agreed that consistencies among healthcare professionals in the form of an algorithm, individual patient-tailored non-pharmacological therapy involving input from family members and education for staff and family members would aid in PAD management.
Conclusion
The results of this study will guide subsequent interventions as part of our multifaceted and multidisciplinary PAD QI program. Core to this project is the nurse engagement in the development of these interventions which in turn will impact improvements for PAD management in the ICU.
A Qualitative Study of Nurses’ Practice, Professional Preferences and Improvement Strategies on Pain, Agitation and Delirium Management in a Community ICU
Priscilla Yung1, Katie Ross2, Franziska Miller1, Carl Marshall1, Mercedes Camargo2, Gina Fleming2, Madelyn Law3, Jennifer LY Tsang1,2,4
1Niagara Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, St Catharines, Ontario, Canada, 2St Catharines Site, Niagara Health, St Catharines, Ontario, Canada, 3Department of Health Sciences, Brock University, St Catharines, Ontario, Canada, 4Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Introduction
Delirium is a common manifestation of acute brain dysfunction in critically ill patients with a prevalence of 80% in intensive care unit (ICU) patients1. It is associated with multiple complications1. In 2013, a revised version of the ICU pain, agitation, and delirium (PAD) guidelines was published2. However, its dissemination is suboptimal. More importantly, nurses play an integral part in PAD management and their perspectives should inform the development of a multifaceted and multidisciplinary quality improvement (QI) program to improve PAD management.
Objectives
This qualitative study explored the views of ICU nurses regarding PAD management in order to inform the subsequent development of a multifaceted and multidisciplinary quality improvement (QI) program with the aim to improve PAD management in a community ICU.
Methods
Focus groups (1-hour) with nurses were conducted using a structured interview guide containing six questions designed to explore themes related to nursing practice, professional preferences and improvement strategies around PAD management. Transcripts were analyzed using a constant comparative approach to identify themes that emerged from the data. Responses for each question were analyzed individually and then compared across sessions to examine similarities or differences across the responses.
Results
Forty-five out of sixty-eight nurses attended 1 of 5 focus group sessions. Themes that developed from the analysis outlined differences in nurse perceptions of optimal sedation and physical restraint use, but there was alignment in their perception regarding the impact of environmental factors on delirium development. Differences were found related to physical restraint use as some nurses felt that they contribute to delirium while some felt that they are necessary for safety. Some nurses preferred deep sedation to avoid awareness of traumatic experience, whereas others preferred wakefulness facilitating participation in their medical care. Most nurses agreed that noise, lights, medications, disjointed care and physical restraint use contribute to delirium development. They agreed that consistencies among healthcare professionals in the form of an algorithm, individual patient-tailored non-pharmacological therapy involving input from family members and education for staff and family members would aid in PAD management.
Conclusion
The results of this study will guide subsequent interventions as part of our multifaceted and multidisciplinary PAD QI program. Core to this project is the nurse engagement in the development of these interventions which in turn will impact improvements for PAD management in the ICU.
A Qualitative Study of Nurses’ Practice, Professional Preferences and Improvement Strategies on Pain, Agitation and Delirium Management in a Community ICU
Priscilla Yung1, Katie Ross2, Franziska Miller1, Carl Marshall1, Mercedes Camargo2, Gina Fleming2, Madelyn Law3, Jennifer LY Tsang1,2,4
1Niagara Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, St Catharines, Ontario, Canada, 2St Catharines Site, Niagara Health, St Catharines, Ontario, Canada, 3Department of Health Sciences, Brock University, St Catharines, Ontario, Canada, 4Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Introduction
Delirium is a common manifestation of acute brain dysfunction in critically ill patients with a prevalence of 80% in intensive care unit (ICU) patients1. It is associated with multiple complications1. In 2013, a revised version of the ICU pain, agitation, and delirium (PAD) guidelines was published2. However, its dissemination is suboptimal. More importantly, nurses play an integral part in PAD management and their perspectives should inform the development of a multifaceted and multidisciplinary quality improvement (QI) program to improve PAD management.
Objectives
This qualitative study explored the views of ICU nurses regarding PAD management in order to inform the subsequent development of a multifaceted and multidisciplinary quality improvement (QI) program with the aim to improve PAD management in a community ICU.
Methods
Focus groups (1-hour) with nurses were conducted using a structured interview guide containing six questions designed to explore themes related to nursing practice, professional preferences and improvement strategies around PAD management. Transcripts were analyzed using a constant comparative approach to identify themes that emerged from the data. Responses for each question were analyzed individually and then compared across sessions to examine similarities or differences across the responses.
Results
Forty-five out of sixty-eight nurses attended 1 of 5 focus group sessions. Themes that developed from the analysis outlined differences in nurse perceptions of optimal sedation and physical restraint use, but there was alignment in their perception regarding the impact of environmental factors on delirium development. Differences were found related to physical restraint use as some nurses felt that they contribute to delirium while some felt that they are necessary for safety. Some nurses preferred deep sedation to avoid awareness of traumatic experience, whereas others preferred wakefulness facilitating participation in their medical care. Most nurses agreed that noise, lights, medications, disjointed care and physical restraint use contribute to delirium development. They agreed that consistencies among healthcare professionals in the form of an algorithm, individual patient-tailored non-pharmacological therapy involving input from family members and education for staff and family members would aid in PAD management.
Conclusion
The results of this study will guide subsequent interventions as part of our multifaceted and multidisciplinary PAD QI program. Core to this project is the nurse engagement in the development of these interventions which in turn will impact improvements for PAD management in the ICU.
