Patient experiences and nurses’ management of pain and discomfort in intensive care during a strategy of analgosedation: An exploratory study

Abstract

Patients report both pain and discomfort in relation to treatment in intensive care units (ICU). Traditionally, patients were kept sedated on mechanical ventilation (MV) in the ICU, but currently it is well recognized that minimizing sedation to keep patients awake and able to communicate and mobilise, reduce complication rates and length of stay on MV and in the ICU. In this thesis, Helene Berntzen and colleagues used a qualitative design with semi-structured interviews and participant observation to generate and analyse data from eighteen patients and thirteen critical care nurses. Following the implementation of a protocol for analgosedation, a strategy of treating pain first and providing sedation only when necessary to reduce anxiety and agitation, the authors found that discomfort other than pain seemed to dominate the patients’ experience. Moreover, the nurses appeared systematic in managing pain according to the protocol by using assessment tools and by assessing and treating pain before assessing the need for sedation. Discomfort other than pain was treated less systematically, largely based on the nurses’ individual or personal perception and interpretation of what was beneficial to the patient. When investigating the discomfort in ICU more in-depth, the phenomenon could be characterised as being deprived of a functioning body, a functioning mind and of integrity, all parts of a complex and inter-woven ICU experience. Moreover, discomfort in the ICU appeared to some extent inevitable. The discomfort pertaining to the mind, i.e. the brain dysfunction frequently accompanying critical illness and resulting in cognitive impairment, confusion and delirium, appeared to be the most difficult to alleviate. By focusing specifically and more systematically on the different aspects of discomfort and on patient comfort as a goal of care, health care personnel may further individualise and structure the care to make the intensive care stay better for the patients.