Texas Tech University Health Sciences Center
In partial fulfillment of the requirements for NURS 5391
December 9, 2012
Table of Contents
Chapter 1: Introduction to the Study2
Background and Significance to Nursing3
Statement of the Problem3
Chapter 2: Review of the Literature7
Relevant Literature for each Study Variable7
Relevant Literature for Selected Framework8
Synthesis of Findings9
Chapter 3: Methods10
Population & Sample11
Data Collection Procedures11
Statistical Analysis/Coding Procedures12
Protection of Human Subjects12
Purpose: The purpose of this study is to determine if the Nursing Instrument for the Communication of Sedation (NICS) yield more accurate or appropriate sedation assessment than individual nursing judgment in an effort to build support for its use as a sedation assessment tool among adults in general medical ICU’s that are mechanically ventilated. Accuracy of the NICS on Sedation Assessment Design: Quasi experimental
Setting: Level II Trauma center
Population: Adult general Medical ICU patients
Methods/Measurements: Spearman’s Rho (rs)
Chapter 1: Introduction to the Study
Many times patients in general medical intensive care units (ICU) need mechanical ventilation support. The 2002 clinical practice guidelines of the Society of Critical Care Medicine (SCCM) for the sustained use of analgesics and sedatives are geared toward the preservation of optimal comfort for critically ill patients by concentrating on pain and anxiety. In order to achieve alleviation of pain and anxiety, the SCCM recommends use of protocols to titrate medications to a defined endpoint such as pain free, calm and alert. This endorsement is based on evidence from admirable outcome investigations and is best accomplished by means of validated pain assessment and sedation scales (Pun, Gordon, Peterson, & al, 2005). Unfortunately not all medical facilities have implemented these recommendations and many patients continue to be over and under sedated related to not instituting a standardized sedation assessment scale.
The purpose of this study is to determine if the Nursing Instrument for the Communication of Sedation (NICS) yield more accurate or appropriate sedation assessment than individual nursing judgment in an effort to build support for its use as a sedation assessment tool among adults in general medical ICU’s that are mechanically ventilated.
Background and Significance to Nursing
Many adult critical care patients require mechanical ventilation to combat many disease processes and traumatic injuries. Most patients requiring mechanical ventilation are treated with sedative mediations such as opiates, benzodiazepines and propofol. These are given for a wide range of indications that is best summarized as reducing the physiological and psychological stress of the disease process that warrants mechanical ventilation and to improve the tolerance of the invasive life support itself. Some studies have demonstrated the use of sedation assessment scales and protocols to minimize sedative exposure and maximize sedation accuracy (Weinert & Calvin, 2006). Nursing is the dominant executions of such protocols as well as the administrating clinicians of the sedative medications. In the time before use of standardized sedations scales and still in some facilities today, nurses drew from their own individual judgment to determine the amount of sedative to give.
Statement of the Problem...