Barriers and enablers in nurses implementing light sedation in intubated and ventilated children: A qualitative exploratory descriptive study.

OBJECTIVE

To explore barriers and enablers in nurses implementing light sedation in mechanically ventilated children.

DESIGN

A qualitative exploratory descriptive study.

SETTING

The study was conducted in a quaternary paediatric intensive care unit in Queensland, Australia.

METHODS

Focus groups (n = 4) were conducted with nurses (n = 32) caring for children requiring mechanical ventilation and sedation. The Capability, Opportunity and Motivation model of Behaviour change (COM-B) provided the conceptual framework for this study. Qualitative data were thematically analysed.

FINDINGS: Nurse reported challenges in balancing sedation needs with patient safety. Knowledge and experience with sedation management in mechanically ventilated children, and continuity of care, positively influenced light sedation. Resources in both the physical and social environment, including family engagement, play a positive role in enhancing the practice of light sedation. Light sedation in the younger paediatric population, and those with delirium, was identified as challenging. Nonpharmacological measures facilitated management of lightly sedated patients whereas inconsistent practice among physicians and lack of nursing autonomy were identified as barriers.

CONCLUSIONS

The practice of light sedation is most effectively promoted when it is prioritized at the organisational level. Ensuring adequate human resources, modifying the physical environment, and fostering collaboration among multidisciplinary teams, including family, are all likely to enhance its implementation. Nurses' knowledge and experience in sedation management, alongside continuity of care and utilising nonpharmacological interventions, can further promote its practice. However, factors such as nurses' concerns for their own professional and patient safety, high acuity levels in the unit, and a lack of support may hinder the adoption of light sedation practices.

IMPLICATIONS FOR CLINICAL PRACTICE: The findings from this study suggest engaging multidisciplinary team to support light sedation practice. Likewise, training and skill development of nurses in the assessment and management of sedation may help implement light sedation. Continuity of care, adequate staffing, patient visibility and minimising stimulation should be considered to support the same. Nurses need to be empowered to practice light sedation, and sedation protocols may be helpful in this regard.