More than half of the respondents to a recent survey of critical care nurses indicated that they believe sedation is needed to minimize patient discomfort and distress, even though clinical guidelines call for limiting sedation while a patient in the intesive care unit (ICU) receives mechanical ventilation.

“Nurses’ Attitudes and Practices Related to Sedation: A National Survey” reports the results from a 2016 survey of critical care nurses and compares them with results from a similar survey conducted in 2005. The study is published in the July 2019 issue of American Journal of Critical Care.

The results support previous findings that lack of support from nursing staff is a barrier to implementing sedation protocols and highlight the need to consider nurses’ attitudes when seeking to change sedation practices.

Co-author Jill Guttormson, PhD, RN, is an associate professor at the Marquette University College of Nursing, Milwaukee, WI. The research team also included nurse researchers from the University of Minnesota School of Nursing, Mayo Clinic, and the University of Nebraska Medical Center College of Nursing. The study was supported by Mayo Clinic Research Funds.

“Nurses’ attitudes related to sedating patients during mechanical ventilation influence their sedation practices at the bedside,” she said. “Nurses may be reluctant to reduce sedation if they believe that doing so may affect patients’ comfort or increase stress.”

The results of the 2016 survey show that attitudes have evolved in the past decade, with fewer nurses believing that all patients receiving mechanical ventilation should be sedated. However, despite a decrease from 81% in 2005, a majority of nurse respondents (>65%) still indicated that sedation is needed for patient comfort.

According to the researchers, growing awareness of the potential negative consequences of routine administration of sedative medications likely contributed to the shift in attitudes. Sedation has been associated with adverse outcomes, including delirium, increased duration of mechanical ventilation, and post-intensive care syndrome.

Respondents with more experience, older age, or CCRN certification had a lower propensity to administer sedative medications and a less positive evaluation of the medications’ effectiveness in minimizing distress. Respondents working in Magnet-designated hospitals also expressed a less positive evaluation of the effectiveness of sedative medications and were less likely to agree that they intended to sedate all patients receiving mechanical ventilation.

A total of 177 respondents completed the 28-item Nurse Sedation Practices Scale, which measures nurses’ self-reported sedation practices and factors that affect them.

The American Association of Critical-Care Nurses (AACN), which publishes AJCC, has an extensive collection of resources related to pain, agitation, delirium, and other behavioral or psychosocial issues that may impact patient outcomes. Its library of clinical resources includes AACN Practice Alerts for assessing pain and managing delirium. AACN Practice Alerts are available as free downloads on the AACN website, www.aacn.org/practicealerts, after signing in.

To access the article and full-text PDF, visit the AJCC website at www.ajcconline.org.