Towards a Standardized Approach for Critical Care Nursing Practices: Development of Evidence Based Analgo-Sedation Guidelines for Adult Mechanically Ventilated Patients (original) (raw)
2016, IOSR Journal of Nursing and Health Science
Background: The judicious and appropriate use of analgesic/sedative medications is an essential goal of providing safe and effective nursing management for mechanically ventilated patients. One method of achieving this goal is the use of evidence based guidelines. Although numerous researches have been conducted to explore the clinical benefits of nurse managed-sedation protocol/guidelines, none of them was conducted in Egypt. Aim: This study aimed to develop evidence based analgo-sedation guidelines for adult mechanically ventilated patients. Methods: A methodological research design was utilized according to the Scottish Intercollegiate Guidelines Network (SIGN) process of guidelines development. The present study was conducted on three phases i.e. observation phase, developing guidelines phase and guidelines appraisal phase. The observation phase was conducted on forty patients to better understand how routine analgesia/sedation practices provided by critical care nurses (CCNs) influenced patients' clinical outcomes. Also, the results of this phase were served as a basis for the elaboration of the intended analgo-sedation guidelines. The study was conducted at trauma adult ICU of Emergency Hospital of Mansoura University, Egypt. Two tools were used for data collection: Analgesia/sedation assessment record and Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument that was used for appraising the developed guidelines. Results: Unsatisfactory nursing analgesia/sedation practices were found during the observational phase which had negative effects on patients' clinical outcomes. In response to these findings, the authors developed analgosedation guidelines that included fifty recommendations. The overall quality of intended guidelines was relatively good. The majority of academic nursing appraisers as well as two thirds of academic medical appraisers recommended the current analgo-sedation guidelines to be used in practice without modifications. Conclusions: The observational phase findings of the current study provide additional rationale for the application of standardized approach in analgesia/sedation management for mechanically ventilated patients. The developed guidelines may be a first step in a patient-safety initiative for sedating mechanically ventilated patients in Egypt. It was strongly recommended by the appraisers to incorporate these guidelines in clinical practice as a routine of unit care.
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