Intensive Care Unit, Department of Anesthesiology, Zealand University Hospital, Koege, Lykkebaekvej 1, 4600 Koege, Denmark.
Intensive Care Unit 4131, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Intensive Crit Care Nurs. 2019 Jun;52:35-41. doi: 10.1016/j.iccn.2019.01.004. Epub 2019 Feb 5.
Sedation practice has evolved from deep to lighter or no sedation in mechanically ventilated patients in the intensive care unit (ICU). The care of conscious intubated patients constitutes a change in the nurse-patient interaction.
We aimed to compare the perspectives of expert and competent nurses regarding their interaction with non-sedated mechanically ventilated ICU patients.
The study had a qualitative comparative design applying semi-structured dyadic interviews. We interviewed five pairs of expert and competent ICU nurses with respectively >8 and 2-3 years of ICU experience and performed qualitative content analysis to explore the two perspectives.
We identified four main categories illustrating complexities of nurse-patient interaction: Managing frustration, Attempting dialogue, Negotiating reality and Alleviating discomfort. Expert nurses expressed more frustration and ambivalence towards light sedation than competent nurses, who took awake patients for granted. All nurses experienced communication issues, demanding patients, and inability to provide adequate patient comfort.
Our study added to the knowledge of nurse-patient interaction by describing issues of frustration, ambivalence and insecurity in a contemporary context of minimal sedation. Expert nurses were mere concerned by awake patients than competent nurses. Lighter sedation in ICU requires better staffing and improved communication tools.
在重症监护病房（ICU）中，接受机械通气的患者的镇静实践已经从深度镇静转变为轻度镇静或无镇静。对有意识的插管患者的护理构成了护士-患者互动的改变。
我们旨在比较专家和有能力的护士对非镇静机械通气 ICU 患者的护理的观点。
该研究采用定性比较设计，应用半结构式对偶访谈。我们采访了五对具有> 8 年和 2-3 年 ICU 经验的专家和有能力的 ICU 护士，并进行了定性内容分析，以探讨这两种观点。
我们确定了四个主要类别，说明了护士-患者互动的复杂性：管理挫折感、尝试对话、协商现实和缓解不适。与有能力的护士相比，专家护士对轻度镇静表现出更多的挫折感和矛盾心理，而有能力的护士则认为清醒的患者是理所当然的。所有护士都经历了沟通问题、要求过高的患者和无法提供足够的患者舒适度的问题。
我们的研究通过在当代轻度镇静的背景下描述挫折感、矛盾心理和不安全感等问题，增加了护士-患者互动的知识。专家护士比有能力的护士更关注清醒的患者。ICU 中的轻度镇静需要更好的人员配备和改进的沟通工具。
