Challenges and barriers to optimising sedation in intensive care: a qualitative study in eight Scottish intensive care units
| العنوان: | Challenges and barriers to optimising sedation in intensive care: a qualitative study in eight Scottish intensive care units |
|---|---|
| المؤلفون: | Jean Antonelli, Guro Huby, Timothy S. Walsh, Kalliopi Kydonaki, Janet Hanley |
| المصدر: | BMJ Open 2019, ' Challenges and barriers to optimising sedation in intensive care : a qualitative study in eight Scottish intensive care units ', BMJ Open, vol. 9, no. 5, 024549 . https://doi.org/10.1136/bmjopen-2018-024549Test |
| بيانات النشر: | BMJ Publishing Group, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | PROTOCOL, MECHANICALLY VENTILATED PATIENTS, Quality management, Critical Care, Sedation, Exploratory research, Conscious Sedation, Critical Care Nursing, ANALGESIA, 03 medical and health sciences, 0302 clinical medicine, Nursing, Intensive care, Physicians, medicine, Humans, 030212 general & internal medicine, INTERRUPTION, Research ethics, business.industry, Research, Intensive Care, General Medicine, Focus Groups, SLEEP, Focus group, Quality Improvement, Physical Therapists, Intensive Care Units, Scotland, Health, quality In health care, Thematic analysis, medicine.symptom, DELIRIUM, business, CRITICALLY-ILL PATIENTS, 030217 neurology & neurosurgery, qualitative research, Qualitative research |
| الوصف: | ObjectivesVarious strategies to promote light sedation are highly recommended in recent guidelines, as deep sedation is associated with suboptimum patient outcomes. Yet, the challenges met by clinicians in delivering high-quality analgosedation is rarely addressed. As part of the evaluation of a cluster-randomised quality improvement trial in eight Scottish intensive care units (ICUs), we aimed to understand the challenges to optimising sedation in the Scottish ICU settings prior to the trial. This article reports on the findings.DesignA qualitative exploratory design: We conducted focus groups (FG) with clinicians during the preintervention period.Setting and participants: Eight Scottish ICUs. Nurses, physiotherapists and doctors working in each ICU volunteered to participate. FG were recorded and verbatim transcribed and inserted in NVivo V.10 for analysis. Qualitative thematic analysis was undertaken to develop emergent themes from the patterns identified in relation to sedation practice. Ethical approval was secured by Scotland A Research ethics committee.ResultsThree themes emerged from the inductive analysis: (a) a recent shift in sedation practice, (b) uncertainty in decision-making and (c) system-level factors including the ICU environment, organisational factors and educational gaps. Clinicians were challenged daily to manage agitated or difficult-to-sedate patients in the era of a progressive mantra of ‘just sedate less’ imposed by the pain–agitation–delirium guidelines.ConclusionsThe current implementation of guidelines does not support behaviour change strategies to allow a patient-focused approach to sedation management, which obstructs optimum sedation–analgesia management. Recognition of the various challenges when mandating less sedation needs to be considered and novel sedation–analgesia strategies should allow a system-level approach to improve sedation–analgesia quality.DESIST registration numberNCT01634451 |
| وصف الملف: | PDF; application/pdf |
| اللغة: | English |
| تدمد: | 2044-6055 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1370b0e03a90e98a62d2c32c34401cdfTest http://europepmc.org/articles/PMC6538047Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....1370b0e03a90e98a62d2c32c34401cdf |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 20446055 |
|---|