Background

Managing pain and agitation among patients is a major nursing challenge. In the Intensive Care Unit (ICU) the goal is to minimize any physical and psychological discomfort for the patient [1]. For many years, the administration of sedatives and muscle relaxants medications was considered the best practice to improve patients’ comfort [2]. However, literature shows that this practice has increased adverse outcomes in terms of health status, length of hospital stay, development of infections and mortality of patients admitted to the ICU [3]. Subsequent studies have explored the concept of analgosedation to improve pain and agitation management and prevention in patients admitted to the ICU [4], [5].

Method

The goal of this work is dual. First of all, a literature review was undertaken to define the analgosedation concept. Secondly, an exploratory survey was carried out with a custom developed questionnaire, to highlight the perceptions, points of view and awareness of intensive care nurses about analgosedation in patients admitted to the ICU.

Results

The articles analyzed have led to define the concept of analgosedation, the main evaluation scales and the various pharmacological and non-pharmacological approaches applicable. As for nurses' perceptions and attitudes, facilitating factors and barriers to the correct application of analgosedation have been identified. The questionnaire administered to nursing staff allowed to investigate the following areas: the concept of analgosedation and knowledge regarding the categories of drugs used, the use of scales and protocols, the perception of the importance of analgosedation in the ICU, the identification of signs of pain and sedation and the previous training of health professionals in this context.

Discussion

The implementation of strategies for the analgosedation requires continuous commitment and collaboration between health professionals and, at the same time, valid and effective assessment tools. Unfortunately, however, the lack of adherence by health professionals to the guidelines, related to a reduced awareness of the problem and the suggestion of one's own perceptions, leads to underestimating the patient's needs [6], [7], [8], [9], [10]. Data emerged from the survey highlight a lack of knowledge and a lack of compliance to the literature’s recommendations by nurses, especially regarding the evaluation of analgesia and sedation, and the use of suitable tools.

Conclusion

Analgosedation is critical in ICU but the knowledge, the interventions and the use of tools by healthcare professionals are still limited. Improvement interventions such as training events about this topic, about the use and consultation of the present guidelines, and about the use of validated scales and tools to guide practice appear to be a first starting point for the implementation of the analgosedation practice in the ICU. Secondly, the inclusion of these tools in the intensive care units would improve the management of analgosedation by guiding healthcare personnel to make conscious choices and to implement effective and targeted care interventions.

References

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[2] M.J. Grap, C.L. Munro, P.A. Wetzel, A.M. Best, J.M. Ketchum, V.A. Hamilton, N.Y. Arief, R. Pickler, C.N. Sessler, «Sedation in adults receiving mechanical ventilation: physiological and comfort outcomes», Am J Crit Care, vol. 21, fasc. 3, pp. e53-63, may 2012, doi: 10.4037/ajcc2012301.

[3] K. M. Garrett, «Best Practices for Managing Pain, Sedation, and Delirium in the Mechanically Ventilated Patient», Crit. Care Nurs. Clin. North Am., vol. 28, fasc. 4, pp. 437–450, dic. 2016, doi: 10.1016/j.cnc.2016.07.004.

[4] J. W. Devlin et al., «Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU»:, Crit. Care Med., vol. 46, fasc. 9, pp. e825–e873, set. 2018, doi: 10.1097/CCM.0000000000003299.

[5] C.-T. Wang, Y. Mao, L. Zhao, e B. Ma, «The impact of analgosedation on mortality and delirium in critically ill patients: A systematic review and meta-analysis», Intensive Crit. Care Nurs., vol. 54, pp. 7–14, ott. 2019, doi: 10.1016/j.iccn.2019.06.004.

[6] H.-L. Wang e Y.-F. Tsai, «Nurses’ knowledge and barriers regarding pain management in intensive care units: ICU nurses and pain management», J. Clin. Nurs., vol. 19, fasc. 21–22, pp. 3188–3196, nov. 2010, doi: 10.1111/j.1365-2702.2010.03226.x.

[7] K. M. Hamdan, A. M. Shaheen, e M. S. Abdalrahim, «Barriers and enablers of intensive care unit nurses’ assessment and management of patients’ pain», Nurs. Crit. Care, vol. 27, fasc. 4, pp. 567–575, lug. 2022, doi: 10.1111/nicc.12624.

[8] J. L. Y. Tsang et al., «Qualitative descriptive study to explore nurses’ perceptions and experience on pain, agitation and delirium management in a community intensive care unit», BMJ Open, vol. 9, fasc. 4, p. e024328, apr. 2019, doi: 10.1136/bmjopen-2018-024328.