Abstract：
BACKGROUND: Pain, delirium, and sedation should be assessed routinely using validated assessment scales. Inappropriately managed pain, delirium, and sedation in critically ill patients can have serious consequences regarding mortality, morbidity, and increased healthcare costs. Despite the benefits of a bundled approach to pain, delirium, and sedation assessments, few studies have explored nurses\' perceptions of using validated scales for such assessments. Furthermore, no studies have examined nurses\' perceptions of undertaking these assessments as a bundled approach.
OBJECTIVE: The objective of this study was to explore nurses\' knowledge, perceptions, attitudes, and experiences regarding the use of validated pain, delirium, and sedation assessment tools as a bundled approach in the intensive care unit (ICU).
METHODS: A qualitative exploratory descriptive design was adopted. We conducted four focus groups and 10 individual interviews with 23 nurses from a 26-bed adult ICU at an Australian metropolitan tertiary teaching hospital. Data were analysed using thematic analysis techniques.
RESULTS: Four themes were identified: (i) factors impacting nurses\' ability to undertake pain, delirium, and sedation assessments in the ICU; (ii) use, misuse, and nonuse of tools and use of alternative strategies to assess pain, delirium, and sedation; (iii) implementing assessment tools; and (iv) consequences of suboptimal pain, delirium, and sedation assessments. A gap was found in nurses\' use of validated scales to assess pain, delirium, and sedation as a bundled approach, and they were not familiar with using a bundled approach to assessment.
CONCLUSIONS: The practice gap could be addressed using a carefully planned implementation strategy. Strategies could include a policy and protocol for assessing pain, delirium, and sedation in the ICU, engagement of change champions to facilitate uptake of the strategy, reminder and feedback systems, further in-service education, and ongoing workplace training for nurses.
OBJECTIVE: The objective of this study was to explore nurses\' knowledge, perceptions, attitudes, and experiences regarding the use of validated pain, delirium, and sedation assessment tools as a bundled approach in the intensive care unit (ICU).
METHODS: A qualitative exploratory descriptive design was adopted. We conducted four focus groups and 10 individual interviews with 23 nurses from a 26-bed adult ICU at an Australian metropolitan tertiary teaching hospital. Data were analysed using thematic analysis techniques.
RESULTS: Four themes were identified: (i) factors impacting nurses\' ability to undertake pain, delirium, and sedation assessments in the ICU; (ii) use, misuse, and nonuse of tools and use of alternative strategies to assess pain, delirium, and sedation; (iii) implementing assessment tools; and (iv) consequences of suboptimal pain, delirium, and sedation assessments. A gap was found in nurses\' use of validated scales to assess pain, delirium, and sedation as a bundled approach, and they were not familiar with using a bundled approach to assessment.
CONCLUSIONS: The practice gap could be addressed using a carefully planned implementation strategy. Strategies could include a policy and protocol for assessing pain, delirium, and sedation in the ICU, engagement of change champions to facilitate uptake of the strategy, reminder and feedback systems, further in-service education, and ongoing workplace training for nurses.
摘要：
背景：疼痛，谵妄,应使用经过验证的评估量表对镇静进行常规评估.疼痛管理不当，谵妄,危重病人的镇静可能会对死亡率产生严重后果，发病率，增加医疗费用。尽管捆绑治疗疼痛的方法有好处，谵妄,和镇静评估，很少有研究探讨护士对使用经过验证的量表进行此类评估的看法。此外，没有研究检查护士对将这些评估作为一种捆绑方法进行评估的看法。
目的：本研究的目的是探索护士的知识，感知，态度，以及使用经过验证的疼痛的经验，谵妄,和镇静评估工具作为重症监护病房（ICU）的捆绑方法。
方法：采用定性探索性描述性设计。我们在澳大利亚都市三级教学医院对来自26张病床的成人ICU的23名护士进行了四个焦点小组和10次个人访谈。使用专题分析技术对数据进行了分析。
结果：确定了四个主题：（i）影响护士承担疼痛能力的因素，谵妄,和ICU中的镇静评估；(Ii)使用，误用，以及不使用工具和使用替代策略来评估疼痛，谵妄,和镇静；(iii)实施评估工具；和(iv)欠佳疼痛的后果，谵妄,和镇静评估。在护士使用经过验证的量表评估疼痛方面发现了差距，谵妄,镇静作为一种捆绑的方法，他们不熟悉使用捆绑方法进行评估。
结论：可以使用精心计划的实施策略来解决实践差距。策略可以包括评估疼痛的政策和协议，谵妄,在ICU中镇静,变革倡导者的参与，以促进战略的采纳，提醒和反馈系统，进一步在职教育，以及正在进行的护士工作场所培训。
目的：本研究的目的是探索护士的知识，感知，态度，以及使用经过验证的疼痛的经验，谵妄,和镇静评估工具作为重症监护病房（ICU）的捆绑方法。
方法：采用定性探索性描述性设计。我们在澳大利亚都市三级教学医院对来自26张病床的成人ICU的23名护士进行了四个焦点小组和10次个人访谈。使用专题分析技术对数据进行了分析。
结果：确定了四个主题：（i）影响护士承担疼痛能力的因素，谵妄,和ICU中的镇静评估；(Ii)使用，误用，以及不使用工具和使用替代策略来评估疼痛，谵妄,和镇静；(iii)实施评估工具；和(iv)欠佳疼痛的后果，谵妄,和镇静评估。在护士使用经过验证的量表评估疼痛方面发现了差距，谵妄,镇静作为一种捆绑的方法，他们不熟悉使用捆绑方法进行评估。
结论：可以使用精心计划的实施策略来解决实践差距。策略可以包括评估疼痛的政策和协议，谵妄,在ICU中镇静,变革倡导者的参与，以促进战略的采纳，提醒和反馈系统，进一步在职教育，以及正在进行的护士工作场所培训。
