• Tsang Jennifer L Y JLY 0000-0002-1809-0505 Department of Medicine, McMaster University, Hamilton, Ontario, Canada. , Katie Ross, Franziska Miller, Ramez Maximous, Priscilla Yung, Carl Marshall, Mercedes Camargo, Dimitra Fleming, and Madelyn Law.
• Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
• BMJ Open. 2019 Apr 4; 9 (4): e024328.

ObjectivesThe purpose of this study was to explore the experiences, beliefs and perceptions of intensive care unit (ICU) nurses on the management of pain, agitation and delirium (PAD) in critically ill patients.DesignA qualitative descriptive study.SettingThis study took place in a community hospital ICU located in a medium size Canadian city.ParticipantsPurposeful sampling was conducted. Participants included full-time nurses working in the ICU. Forty-six ICU nurses participated.MethodsA total of five focus group sessions were held to collect data. There were one to three separate groups in each focus group session, with no more than seven participants in each group. There were 10 separate groups in total. A semistructured question guide was used. Thematic analysis method was adopted to analyse the data, and to search for emergent themes and patterns.ResultsThree main themes emerged: (1) the professional perspectives on patient wakefulness state, (2) the professional perspectives on PAD management of critically ill patients and (3) the factors impacting PAD management. Nurses have different opinions on the optimal level of patient sedation and felt that many factors, including environmental, healthcare teams, patients and family members, can influence PAD management. This potentially leads to inconsistent PAD management in critically ill patients. The nurses also believed that PAD management requires a multidisciplinary approach including healthcare teams and patients' families.ConclusionsMany external and internal factors contribute to the complexity of PAD management including the attitudes of nursing staff towards PAD. The themes emerged from this study suggested the need of a multifaceted and multidisciplinary quality improvement programme to optimise the management of PAD in the ICU.© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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