"Having the compass-drawing the map": Exploring nurses' management of pain and other discomforts during use of analgosedation in intensive care.
Helene Berntzen, Ida Torunn Bjørk, Hilde Wøien
PMID 30918696WHAT IT FOUND
ICU nurses used an analgosedation protocol as a guide, but still had to interpret pain and discomfort.
Discomfort was often treated as mild pain, and there was no systematic assessment beyond pain.
Key findings
01The analgosedation protocol gave direction for pain and discomfort care, but nurses seldom explicitly referred to it and still needed extensive interpretation of patient needs.
02There was no systematic assessment of discomforts other than pain; nurses often described discomfort as mild pain or a precursor to pain that led to an enactment.
03Nurses sometimes withheld analgesics or sedatives to achieve rehabilitation goals such as waking, ventilator weaning, spontaneous breathing or mobilization, and sometimes cancelled physiotherapy or mobilization to let patients rest.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It was done in one Norwegian ICU with a nurse to patient ratio of 1:1, so it may not fit units with different staffing or care models. Only 13 nurses were included, and all were female, so it does not show how other nurse groups decide. The data collector was an experienced ICU nurse, which may have shaped what was noticed and how it was interpreted. The study did not aim to evaluate positive or negative implications of the analgosedation protocol, so it does not show whether it improved patient pain or comfort.
The easy way to misread this
Do not conclude that analgosedation reduced pain or improved comfort. The study explored nurses' reasoning and actions, not patient outcomes, and the protocol was seldom explicitly mentioned.