Nurses' perceptions of their role in the management of sedation in intensive care units
Date
2018
Authors
Tshibha, Noluvuyo
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Abstract
Background: Sedation is regarded as a common and essential part of treatment for intensive care patients. Clinicians frequently sedate critically ill patients to aid the following: patient-ventilation synchrony, relief of anxiety, promotes sleep or rest, prevent patient self-harm, induce amnesia, alleviate agitation, promote hemodynamic instability, and reduce intracranial pressure. Sedation should be administered with the aim of reaching predetermined end results, because both unsatisfactory and over sedation can lead to negative consequences for patients. The current sedation practice in intensive care has changed, hence the need to explore nurses’ role.
Setting: The study was conducted in the adult ICUs (n=5) of a 1,200 bedded universityaffiliated, public sector hospital, and tertiary/quaternary level institution in Johannesburg. These ICUs included: trauma, cardiothoracic, coronary care, neurosurgery and multidisciplinary unit.
Purpose of the Study: The purpose of this study was to explore nurses’ perceptions of their role in the management of sedation in the intensive care units of a major public sector hospital in Johannesburg, with an intention of making recommendations for clinical practice and education of intensive care nurses.
Methods: A non-experimental, quantitative, descriptive and cross-sectional design was utilised to achieve the study objectives. A sample size of 80 (n=80) nurses participated in the study. The questionnaire used in the study was developed by Walker and Gillen (2006). It comprised of 29 items with a combination of multiple responses which included dichotomous responses, a 5-point Likert Scale and open ended questions. Descriptive and inferential statistics were used to analyse the data. Statistical tests included the Proportions test, univariate and multivariate regressions and Chi-squared tests. Testing was done on the 0.05 (p=0.05) level of significance.
Results: The findings of the study showed that nurses have a high (>97%) percentage of agreement that they have a major role in sedation management for the care of critically ill patients. An equal (56.3%) percent of nurses agreed that sedation scoring is used in the assessment of the sedation level and that, sedation is titrated by the nurse in collaboration with medical personnel to a pre-determined target level. Most (58.7%) of the nurses rated themselves (out of 10) with a high confidence level (M = 7.45). However, a statistically (p<0.05) significantly difference in nurse’s perceptions of this role depends on age >50 years (OR = 38.98, 95% CI = 0.99-1.535.79; p=0.051) experience >6 to 10 years (OR = 0.26, 95% CI = 0.07-0.99, p = 0.048) and contribution of this nurse as knowledge and skills are required in order to provide effective sedation for patients.
Recommendations from this study are to incorporate a multi-disciplinary team approach within a locally developed sedation protocol. This should be supported by an education programme aiming to improve decision-making about sedation management for all nurses at the bedside.
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Nursing, Johannesburg, 2018
Keywords
Sedation