Nurse decision making regarding the use of analgesics and sedatives in the pediatric cardiac ICU.

Authors:

Sandra L Staveski Patricia A Lincoln Lori D Fineman Lisa A Asaro David Wypij Martha A Q Curley

Pediatr Crit Care Med 2014 Oct;15(8):691-7

1Department of Nursing, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA. 2Cardiovascular and Critical Care Program, Boston Children's Hospital, Boston, MA. 3Department of Nursing, UCSF Benioff Children's Hospital, San Francisco, CA. 4Department of Cardiology, Boston Children's Hospital, Boston, MA. 5Department of Biostatistics, Harvard School of Public Health, Boston, MA. 6Department of Pediatrics, Harvard Medical School, Boston, MA. 7Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA. 8Department of Anesthesia and Critical Care, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Objective: To describe nurse decision making and patient responses associated with the administration of analgesics and sedatives in the pediatric cardiac ICU.

Design: Prospective nonexperimental mixed methods study of pediatric cardiac ICU nursing practice.

Setting: Three tertiary academic pediatric heart centers in the United States.

Subjects: Pediatric cardiac ICU nurses caring for 217 patients completed 1,330 surveys.

Interventions: Four-item open-ended nurse survey completed each time an as needed dose of an analgesic or sedative was administered, an analgesic or sedative infusion/dose was titrated, and/or a new analgesic or sedative was administered.

Measurements And Main Results: Responses to survey questions were entered verbatim and then collapsed using a consensus process. Collapsing of the data continued until there was a working set of "symptoms," "changes," and "clinical situation managed" categories. Nurses identified 28 symptoms managed with analgesia and sedation. The most frequent symptoms included hypertension, tachycardia, crying, pain, and agitation. Nurses identified 20 patient changes that resulted from their interventions. The most prevalent changes included improved hemodynamics, calm state, sleep, comfort, and relaxed state. Nurses identified 22 clinical situations that they were attempting to manage. The most frequent clinical situations included pain, hemodynamics, procedures, hypertension, and agitation. Nurses responded that 22% of their interventions were influenced by others.

Conclusions: Pediatric cardiac ICU nurses use many nonspecific indicators to describe patient level of comfort collectively. Decisions for managing patient comfort were influenced by their patients' overall hemodynamic stability.