Abstract Rationale Increased nocturnal sedation in mechanically ventilated patients decreases the chances of passing a spontaneous breathing trial, delays extubation, and increases the risk of delirium and coma. Given that titration of sedation is common to nursing practice, we sought to determine if factors that influence sedation administration differ between day and night-shift nursing staff. Methods This is a single-center cross-sectional study at the University of Chicago. The Nurse Sedation Practices Scale was used to measure nurses’ self-reported sedation practices and factors influencing sedative administration. The instrument has 5 subscales: attitudes toward sedation, subjective norms, sedation orders and goals, perceived behavioral control, and sedation practices. For each subscale, higher scores indicate the following: 1) belief in the effectiveness of sedative in minimizing distress (attitudes); 2) sedation practice strongly influenced by others (subjective norms); 3) greater perceived independence in managing sedative medications (sedation orders and goals); 4) minimal influence of external factors on sedation administration (perceived behavioral control); 5) higher propensity to administer sedative medications (sedation practices). Subscales were reported if sufficiently reliable (Chronbach α 0.7). Additional questions regarding analgesia use were added to the survey. Nursing staff completed the surveys on REDCap. Descriptive statistics and t-tests were performed. Results Of 81 eligible nurses, 43 (53%) completed the survey (22 day, 21 night). There was limited reliability of the subscales scores except for the sedation practices subscale (Table 1). Night-shift nurses reported a potentially greater influence from colleagues (47.6% agree/strongly agree vs. 18.2% day-shift nurses, P = 0.055). In contrast, night-shift nurses were significantly less likely to agree that there was clear communication from physicians about sedation goals (38.1% vs. 68.2% in day shift, P = 0.048). Night-shift nurses were more likely to disagree with intending to sedate all mechanically ventilated patients (66.7% vs 36.4% day-shift, P = 0.047). Differences in analgesia practices were also observed: 57.1% of night-shift nurses disagreed/strongly disagreed with a fentanyl bolus prior to increasing the fentanyl infusion rate, compared with only 13.6% of day-shift nurses (P = 0.004). Conclusions Overall, this survey did not elucidate large consistent differences in sedation practices by day and night shift nurses. Potential interventions that could guard against deep nocturnal sedation include improving physician communication for nocturnal sedation and education on light sedation approaches. Limitations include single-center design and modest survey response rate. Future efforts will expand data collection to include nurses in other ICUs to understand contextual factors that influence nursing sedation practices. This abstract is funded by: Healthcare Delivery Science and Innovation Grant
Pena et al. (Fri,) studied this question.