ARTICLE REVIEW

Whilst sedation is often considered an integral aspect of care for patients requiring mechanical ventilation, over recent years, the trend, as noted by the authors of a recent paper, has been towards lighter or no sedation, resulting in improved cerebral monitoring, significantly shorter length of hospital stay and no risk of increase in adverse psychological sequelae.  

This paper published in ICCN reports on a qualitative study designed to explore nurses’ experiences and attitudes towards caring for non-sedated, awake, critically ill mechanically ventilated patients.  Conducted in two adult ICUs in Demark, this study used participant observation and interviews to gather data.  A total of 70 nurses were observed providing care to non-sedated mechanically ventilated patients, and in-depth individual semi-structured interviews were conducted with a further 16 experienced ICU nurses.

The overarching theme to come from the data was ‘demanding but rewarding’ describing the ambiguity of the need for increased surveillance and constant awareness of the patient’s condition, actions and needs; balanced with the advantage of being able to interact with the patient and for the patient to convey their wishes and contribute to care decisions.  Nurses reported valuing the resultant style of interactive nursing care that facilitated patient involvement, acknowledging that it was more person-centred.  However participants stressed that this was best achieved by ensuring continuity in nursing care where possible, highlighting the benefits of knowing the patient.  

Where other studies have challenged the notion of being able to meet the personal and psychological needs of the awake critically ill and ventilated patient, the findings of this study demonstrated that nurses felt they were able to manage the technical and physical care requirements at the same time as providing person-centred care and the opportunity to engage with the patient.

The nurse’s constant presence at the patient’s bedside and physical and emotional closeness that developed as a result of caring for a non-sedated ventilated patient enabled nurses to pay closer attention and offer reassurance to the patient, resulting in them viewing the patient as a unique individual with a life and history, rather than just their diagnosis.

In summary, this study found that whilst there are challenges to caring for the non-sedated ventilated patients, nurses found it rewarding because it offered a more patient-centred approach to care where patient preferences can be considered and integrated in to care routines.  In their conclusion, the authors caution that implementing a protocol of no sedation must only be undertaken in an environment with adequate consideration for a multidisciplinary approach, adequate staffing with specific education.

This article review was submitted by ESICM Journal Review Club member Melissa Bloomer on behalf of the N&AHP Committee.

Reference

Laerknew, E., Egerod, I., Hansen, H.P. (2015). Nurses’ experiences of caring for critically ill, non-sedated, mechanically ventilated patients in the Intensive Care Unit: A qualitative study. Intensive and Critical Care Nursing, 31, 196-204