Australian critical care : official journal of the Confederation of Australian Critical Care Nurses · 2026
"A little bit of propofol, a little bit of fentanyl does wonders for everyone": Understanding the sedation practices of healthcare professionals when caring for mechanically ventilated intensive care unit (ICU) patients-A qualitative study.
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Varga Sarah, Moore Tracey, Seymour Jane, Mills Gary, Ryan Tony
Аннотация
INTRODUCTION: Sedation is commonly used in intensive care units (ICUs), but there is limited evidence about how staff members make sense of their sedation practice or what influences their use of sedation.
OBJECTIVE: The aim of this study was to report qualitative case study findings that compare ICU sedation practice and staff perspectives in Australia and the UK, with the aim of informing international practice and policy.
METHODS: A qualitative case study approach was applied in one general ICU in Australia and one in the UK. Between November 2021 and February 2023, nurses, doctors, and allied health professionals were recruited. Data were collected through focus groups, participant observation, clinical notes review, and semistructured interviews. A cross-case analysis was completed using reflexive thematic analysis.
FINDINGS: In Australia, 43 ICU staff members participated; in the UK, 91 ICU staff members participated. Twenty-four patients were observed, and their notes were reviewed. Two focus groups, 18 interviews, and over 300 observation hours were completed. The cross-case analysis identified similarities and differences in sedation practice between the ICUs. Each unit had differences in sedation reduction and contrasting daily routines influencing sedation use. In both units, key drivers of decision-making were similar, namely the physical layout, perceptions of moral distress, and safety concerns.
CONCLUSIONS: This paper presents an in-depth exploration of the sedation practices and perspectives of healthcare professionals working in an ICU in Australia and a similar ICU in the UK. Through the cross-case analysis, we have shown the importance of attending to the physical layout of ICUs and understanding the concerns of staff about safety and the moral dimensions of their practice when aspiring to implement best sedation practice. Furthermore, we have revealed that similar ICUs in different countries take different approaches to sedation reduction, highlighting the need for greater international exchange on this crucial area of ICU practice.
OBJECTIVE: The aim of this study was to report qualitative case study findings that compare ICU sedation practice and staff perspectives in Australia and the UK, with the aim of informing international practice and policy.
METHODS: A qualitative case study approach was applied in one general ICU in Australia and one in the UK. Between November 2021 and February 2023, nurses, doctors, and allied health professionals were recruited. Data were collected through focus groups, participant observation, clinical notes review, and semistructured interviews. A cross-case analysis was completed using reflexive thematic analysis.
FINDINGS: In Australia, 43 ICU staff members participated; in the UK, 91 ICU staff members participated. Twenty-four patients were observed, and their notes were reviewed. Two focus groups, 18 interviews, and over 300 observation hours were completed. The cross-case analysis identified similarities and differences in sedation practice between the ICUs. Each unit had differences in sedation reduction and contrasting daily routines influencing sedation use. In both units, key drivers of decision-making were similar, namely the physical layout, perceptions of moral distress, and safety concerns.
CONCLUSIONS: This paper presents an in-depth exploration of the sedation practices and perspectives of healthcare professionals working in an ICU in Australia and a similar ICU in the UK. Through the cross-case analysis, we have shown the importance of attending to the physical layout of ICUs and understanding the concerns of staff about safety and the moral dimensions of their practice when aspiring to implement best sedation practice. Furthermore, we have revealed that similar ICUs in different countries take different approaches to sedation reduction, highlighting the need for greater international exchange on this crucial area of ICU practice.