None listed
Conditions
Brief summary
It is estimated that 60% of patients admitted to intensive care units receive vasoactive medication to support patient blood pressure and/or heart function. Patients presenting with infection, shock, injury, drug overdose or heart failure are prescribed vasoactive medications by doctors, and nurses are responsible for many aspects of management including preparation, administration, adjustment of doses and weaning. These medications are fast acting and need careful management to prevent harms including stroke and heart attack. Possible problems include rapid administration of the vasoactive medication or incorrect dose adjustments. There has been little research on how nurses manage vasoactive medications and many of the guidelines in current use are not based on research evidence. The aims of this study are to identify the frequency and types of decisions that nurses make in managing vasoactive medications, the immediate impact of these decisions on patients and the underlying decision-making processes in use. The project objectives are to observe how nurses manage vasoactive medications and the decision-making processes they use to assess patients, prepare, initiate and administer the medication and the decisions that prompt dose-adjustments, such as titration and weaning. A systematic review completed by the researcher and PhD supervisors identified few published studies of nurses’ management of vasoactive medications and this lack of attention, coupled with anecdotal clinical experiences, prompted the conceptualisation of this study (Hunter, Manias, & Considine, 2018). These medications are ubiquitous in intensive care settings all over the world and are managed by nurses with little or no evidence based support. The potential for risk associated with the use of vasoactive medications highlights that nurse decision making is fundamental to the safe management of vasoactive medications (Hunter et al., 2018).
Interventions
A purposive sample of 25 intensive care nurses looking after 25 patients admitted to the intensive care unit for haemodynamic support and needing vasoactive medications, will be observed for a 2-4 hour period during a rostered shift. Recruitment will begin in August 2019 and conclude when the sample size has been reached. Rate of recruitment will be dictated by the number of nurses and patient dyads who meet all inclusion and no exclusion criteria and will explore the decision making processes n
A purposive sample of 25 intensive care nurses looking after 25 patients admitted to the intensive care unit for haemodynamic support and needing vasoactive medications, will be observed for a 2-4 hour period during a rostered shift. Recruitment will begin in August 2019 and conclude when the sample size has been reached. Rate of recruitment will be dictated by the number of nurses and patient dyads who meet all inclusion and no exclusion criteria and will explore the decision making processes nurses use to prepare, initiate, administer, titrate and wean vasoactive medications. Ten nurse/patient dyads who have consented to participate in observation sessions will also be asked to allow audiovisual recording of the 2-4 hour session. The nurses from audiovisual sessions will be approached to participate in individual semi structured interviews that will take place as soon as possible after their observational session. It is anticipated that interviews will take between 20 and 40 minutes. Focus groups will be conducted from January to March 2020 and will consist of 2 groups of intensive care nurses from each study site, with 5 to 7 nurses recruited into each of the 4 focus groups (up to 28 nurses in total). The 2 groups at each site will be designated as Expert or Intermediate to allow more junior nurses to speak freely about their experiences without embarrassment or repercussion. The focus groups will last approximately 30 to 60 minutes each, depending on group engagement with the topic.
Sponsors
Eastern Health
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Nurse inclusion criteria: Nurses who are employed on a permanent full time or part time basis by the intensive care unit Patient inclusion criteria: Patients who have been admitted to the ICU Patient has been allocated a nurse who has previously provided written consent to participate in either video or empirical data collection Patients who are assessed by the ICU medical team as likely to need vasoactive support for the next 12 hours Patients who have a functional arterial line in situ and Patients who have a central venous catheter is in situ or insertion is imminent
Exclusion criteria
Nurse exclusion criteria: Nurses who have previously participated in this study Nurses who do not have direct patient care responsibilities Patient exclusion criteria: Patients who are aged less than 18 years Patients who will be out of the intensive care unit (ICU) for (i.e. for transport to Medical Imaging or Operating Theatre) for the observation period Patients who are assessed by the ICU treating team as unlikely to need vasoactive support for the four-hour data collection period. Patients who have been transitioned to palliative care Patients or their Medical Treatment Decision Makers are visibly distressed The medical team or bedside nurse considers that it is an inappropriate time to approach the patient or Medical Treatment Decision Maker with information about the study.
Outcome results
None listed