title: Nurses' perceptions of unpleasant symptoms and signs in ventilated and sedated patients.
abstract: OBJECTIVE
  To describe intensive care nurses' perceptions and assessments of unpleasant symptoms and signs in mechanically ventilated and sedated adult intensive care patients.
  
  
  BACKGROUND
  Mechanically ventilated patients are unable to express themselves verbally and depend upon nurses to control their symptoms by understanding their unpleasant experiences, such as pain, anxiety or delirium and interpret the relevant signs. Nurses must have enough knowledge to adjust their analgesics and sedatives appropriately and to avoid under- or oversedation.
  
  
  METHODS
  A cross-sectional survey design.
  
  
  METHODS
  A study with a self-administrated questionnaire was undertaken in October 2007 to February 2008, with a convenience sample of 183 intensive care nurses in Norway.
  
  
  RESULTS
  The questionnaire was completed by 86 (47%) nurses. Most perceived that critical illness polyneuropathy/myopathy occurred frequently. Half the nurses underestimated pain, anxiety and delirium. Signs such as a response to contact, cough reflex, wakefulness and muscle tone were considered most important in assessing oversedation. Agitation, facial grimacing, tube intolerance and wakefulness were considered most important in assessing undersedation. The Comfort Scale and Adoption of the Intensive Care Environment corresponded best to the signs identified by the nurses.
  
  
  CONCLUSIONS
  The nurses underestimated unpleasant symptoms other than critical illness polyneuropathy/myopathy. A further mapping of patients' experiences should be conducted, with an emphasis on the more 'silent' distressing symptoms. Further tools to facilitate the communication of consciousness levels and the intolerance of unpleasant symptoms must be developed and implemented.
  
  
  CONCLUSIONS
  A deeper understanding of unpleasant symptoms and signs focused in learning activities may help nurses to recognize patients' early problems and allow targeted interventions. A more active stimulus-response assessment of ICU patients is required to detect oversedation, critical illness polyneuropathy/myopathy and hypoactive delirium. Assessment tools should reflect both the patient's tolerance of various unpleasant symptoms and the level of consciousness.
authors.affiliation: Department of Intensive Care Nursing, Lovisenberg Deaconal University College, Oslo, Norway. irene.randen@ldh.no
authors.forename: Irene
authors.initials: I
authors.lastname: Randen
authors.forename: Anners
authors.initials: A
authors.lastname: Lerdal
authors.forename: Ida T
authors.initials: IT
authors.lastname: Bjørk
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000451:nursing; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D003422:Critical Care / Q000592:standards / Q000639:trends; D064648:Critical Care Nursing / Q000379:methods*; D016638:Critical Illness / Q000451:nursing / Q000628:therapy; D003430:Cross-Sectional Studies; D003693:Delirium / Q000175:diagnosis / Q000451:nursing; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000451:nursing*; D020380:Needs Assessment; D009664:Norway; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009730:Nursing Assessment; D010146:Pain / Q000175:diagnosis / Q000451:nursing; D010465:Perception; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome