Dimens Crit Care Nurs. 2021;40(5):280-287. doi: 10.1097/DCC.0000000000000491.
Pediatric intensive care unit (PICU) nurses may consider additional factors beyond validated tools when managing pain and sedation of children. However, these other factors and related beliefs, practices, and decision-making for analgesia and sedation have not been well described.
This study describes nurses' beliefs, practices, and decision-making related to sedation and analgesia for mechanically ventilated children on a PICU and a pediatric cardiovascular ICU at a tertiary academic children's medical center in the United States.
A 35-item web-based survey tool was developed to more fully identify nurses' pain, sedation, comfort, and analgesia beliefs, decisions, planning, and procedures for children who were mechanically ventilated in the ICU. It was distributed to 102 nurses in the PICU, pediatric cardiovascular ICU, and pediatric critical care float pool.
Twenty-six nurses (25%) responded; a majority worked the night shift and had 5 years or less of ICU experience. While participants believed intubated pediatric patients required moderate to deep sedation, approximately only half reported patients were adequately sedated. They reported that they were more likely to manage pain and sedation using specific behaviors and changes in vital signs than scores on a standardized scale. Nurses also reported routinely incorporating nonpharmacologic comfort measures. Premedication was more common for invasive procedures than for routine nursing care.
Pediatric ICU nurses in this study considered factors beyond standardized scales when evaluating and managing pain and sedation of ventilated children. Nurses prioritized children's specific behaviors, vital signs, and their own nursing judgment above standardized scales. Research is needed to describe nurses' practices beyond this small study and to define and validate additional assessment parameters to incorporate into decision-making to improve management and care outcomes.
儿科重症监护病房（PICU）护士在管理儿童疼痛和镇静时，可能会考虑验证工具之外的其他因素。然而，这些其他因素以及与镇痛和镇静相关的信念、实践和决策尚未得到很好的描述。
本研究描述了美国一家三级学术儿童医院的 PICU 和儿科心血管 ICU 护士在管理机械通气儿童镇静和镇痛方面的信念、实践和决策。
开发了一个包含 35 个项目的网络调查工具，以更全面地了解护士对 ICU 中机械通气儿童的疼痛、镇静、舒适度和镇痛的信念、决策、计划和程序。它分发给了 PICU、儿科心血管 ICU 和儿科重症监护病房的 102 名护士。
26 名护士（25%）做出了回应；大多数人上夜班，ICU 工作经验在 5 年或以下。尽管参与者认为接受插管的儿科患者需要中度至深度镇静，但只有约一半的人报告患者得到了充分的镇静。他们报告说，与使用标准化量表评分相比，他们更有可能通过特定行为和生命体征的变化来管理疼痛和镇静。护士还报告说，他们经常常规纳入非药物性舒适措施。与常规护理相比，术前用药在侵入性操作中更为常见。
本研究中的儿科 ICU 护士在评估和管理机械通气儿童的疼痛和镇静时，考虑了标准化量表之外的因素。护士将儿童的特定行为、生命体征和他们自己的护理判断置于标准化量表之上。需要进行研究以描述超出这项小型研究的护士实践，并定义和验证其他评估参数，以纳入决策制定中，以改善管理和护理结果。
