Sedation scoring and managing abilities of intensive care nurses post educational intervention

Ramoo V 1 , Abdullah KL 1 , Tan PS 2 , Wong LP 3 , Chua YP 4 , Tang LY 1

Affiliations 

  • 1 Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
  • 2 Intensive Care Unit, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 3 Department of Social and Preventive Medicine, Faculty of Medicine, 50603, University of Malaya, Kuala Lumpur, Malaysia
  • 4 Institute of Educational Leadership & Unit for the Enhancement of Academic Performance (ULPA), 50603, University of Malaya, Kuala Lumpur, Malaysia
Nurs Crit Care, 2017 May;22(3):141-149.
PMID: 25913373 DOI: 10.1111/nicc.12180

Abstract

BACKGROUND: Inappropriate sedation assessment can jeopardize patient comfort and safety. Therefore, nurses' abilities in assessing and managing sedation are vital for effective care of mechanically ventilated patients.

AIMS AND OBJECTIVES: This study assessed nurses' sedation scoring and management abilities as primary outcomes following educational interventions. Nurses' perceived self-confidence and barriers to effective sedation management were assessed as secondary outcomes.

DESIGN: A post-test-only quasi-experimental design was used. Data were collected at 3 and 9 months post-intervention.

METHODS: A total of 66 nurses from a 14-bed intensive care unit of a Malaysian teaching hospital participated. The educational interventions included theoretical sessions, hands-on sedation assessment practice using the Richmond Agitation Sedation Scale, and a brief sedation assessment tool. Nurses' sedation scoring and management abilities and perceived self-confidence level were assessed at both time points using self-administered questionnaires with case scenarios. Sedation assessment and management barriers were assessed once at 9 months post-intervention.

RESULTS: Median scores for overall accurate sedation scoring (9 months: 4·00; 3 months: 2·00, p = 0·0001) and overall sedation management (9 months: 14·0; 3 months: 7·0, p = 0·0001) were significantly higher at 9 months compared to 3 months post-intervention. There were no significant differences in the perceived self-confidence level for rating sedation level. Overall perceived barrier scores were low (M = 27·78, SD = 6·26, possible range = 11·0-55·0). Patient conditions (M = 3·68, SD = 1·13) and nurses' workload (M = 3·54, SD = 0·95) were the greatest barriers to effective sedation assessment and management. Demographic variables did not affect sedation scoring or management abilities.

CONCLUSIONS: Positive changes in nurses' sedation assessment and management abilities were observed, indicating that adequate hands-on clinical practice following educational interventions can improve nurses' knowledge and skills.

RELEVANCE TO CLINICAL PRACTICE: Educational initiatives are necessary to improve ICU practice, particularly in ICUs with inexperienced nurses.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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