Sedating critically ill patients: factors affecting nurses' delivery of sedative therapy.
Sedating critically ill patients: factors affecting nurses' delivery of sedative therapy.
复制标题
危重病人镇静：影响护士镇静治疗的因素。
DOI：
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发表时间：
2001
影响因子：
2.7
通讯作者：
C. Gross
中科院分区：
文献类型：
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作者：
C. Weinert;L. Chlan;C. Gross
背景
重症监护护士在管理接受机械通气的患者的镇静治疗时通常有广泛的自由裁量权。对于影响镇静实践的因素和过程知之甚少。
目标
确定护士对危重疾病的个人信念和态度以及镇静目标是否影响护士的镇静实践，发现社会因素是否影响镇静治疗，并描述护士评估患者镇静治疗需求的过程。
方法
来自 2 家医院的 5 组 34 名经验丰富的内外科重症监护室护士的焦点小组访谈录音被逐字转录。两名研究人员独立分析了逐字文本，并且参与者样本验证了类别摘要和解释。
结果
患者的家庭成员可以直接或间接影响镇静实践，而对有效护理的需求也可以影响镇静治疗。镇静的主要适应症包括患者的舒适度和遗忘以及预防患者的自残行为。当缺乏明确且共同的镇静目标时，医生和护士之间就会出现冲突。参与者指出，许多因素阻碍了镇静方案的常规使用，尽管使用方案可以改善沟通并促进镇静实践的一致性。
结论
社会、个人和职业因素影响镇静治疗。未来的研究应该确定这些因素的相对重要性，并确定实施镇静方案时它们的影响是否会减弱。
BACKGROUND
Critical care nurses often have wide discretion in managing the sedative therapy of patients receiving mechanical ventilation. Little is known about the factors and processes that influence sedative practice.
OBJECTIVES
To determine if nurses' personal beliefs about and attitudes toward critical illness and their goals for sedation influence the nurses' sedative practice, to discover whether social factors influence sedative therapy, and to describe the processes that nurses use to assess patients' need for sedative therapy.
METHODS
Audiotapes of focus group interviews with 5 groups of 34 experienced medical and surgical intensive care unit nurses from 2 hospitals were transcribed verbatim. Two investigators independently analyzed the verbatim text, and a sample of the participants validated the category summaries and interpretations.
RESULTS
Patients' family members can affect sedative practice directly or indirectly, and demands for efficient delivery of care can influence sedative therapy. Primary indications for sedation included patients' comfort and amnesia and prevention of patients' self-injurious behaviors. Conflicts between physicians and nurses arose when explicit and shared goals for sedation were lacking. Participants noted that numerous factors impede routine use of sedation protocols even though use of the protocols may improve communication and promote uniformity of sedative practice.
CONCLUSION
Social, personal, and professional factors influence sedative therapy. Future research should establish the relative importance of these factors and determine whether their impact is attenuated when sedation protocols are implemented.