title: Intensive care pain treatment and sedation: nurses' experiences of the conflict between clinical judgement and standardised care: an explorative study.
abstract: OBJECTIVE
  To examine nurses' experiences of performing clinical judgements of patient pain and sedative requirements after implementation of assessment tools, and how the tools influenced these judgements.
  
  
  BACKGROUND
  Clinical judgement in ICU pain and sedation management is complex. There appears to be a gap between knowledge, attitudes and practice, reflecting an overall lack of adherence among nurses to standardised care.
  
  
  METHODS
  Exploratory qualitative investigation based on principles from Tanner's Clinical Judgment Model, using focus group interviews.
  
  
  METHODS
  Fourteen ICU nurses were included in two focus groups and interviewed twice during the implementation period. The interviews reflected central themes on the use of assessment tools related to the nurses' clinical experience in ICU pain treatment and sedation, and were interpreted through a systematic classification process of coding and identification of themes and patterns.
  
  
  RESULTS
  Four themes emerged as central: (1) balancing clinical judgement and the use of tools; (2) improvement of collaboration, documentation and goal achievement; (3) enhanced evaluation of the patient's response and (4) emphasis on the ICU patient's characteristics.
  
  
  CONCLUSIONS
  The use of tools was perceived to improve the quality of pain control and sedation, and supported nurses in their decision-making. Great importance was attached to personal knowledge and experience.
authors.affiliation: Division of Emergencies and Critical Care, Oslo University Hospital, Norway. hilde.woien@ous-hf.no
authors.forename: Hilde
authors.initials: H
authors.lastname: Wøien
authors.forename: Ida Torunn
authors.initials: IT
authors.lastname: Bjørk
mesh_terms: D000328:Adult; D002983:Clinical Competence; D016292:Procedural Sedation; D003657:Decision Making; D017144:Focus Groups; D006801:Humans; D008875:Middle Aged; D009732:Nursing Care / Q000592:standards*; D059408:Pain Management; D010147:Pain Measurement