Discovery of unexpected pain in intubated and sedated patients.
BACKGROUND
The perceptions of patients who are restrained and sedated while being treated with mechanical ventilation in the intensive care unit are not well understood. The effectiveness of sedation used to aid in recovery and enhance comfort during intubation is unknown.


OBJECTIVE
To explore the perceptions of patients who were intubated and receiving pain medication while sedated and restrained in the intensive care unit, in particular, their experience and their memories of the experience.


METHODS
In a phenomenological study, 14 patients who were intubated and receiving pain medication while sedated and restrained were interviewed at the bedside. A semistructured interview guide was used. Data were analyzed by using an inductive method consistent with qualitative research.


RESULTS
Three major themes were identified from the data: lack of memory of being restrained; a perception of being intubated as horrific; nursing behaviors that were helpful and comforting. An unexpected discovery was that sedation may be interfering with pain assessment and management.


CONCLUSIONS
Being intubated can be painful and traumatic despite administration of sedatives and analgesics. Sedation may mask uncontrolled pain for intubated patients and prevent them from communicating this condition to a nurse. Nurses may need to evaluate current interventions in order to provide maximum comfort and promote optimal positive outcomes for intensive care patients who are intubated.
Lory Clukey is an associate professor, University of Northern Colorado, Greeley, Colorado. Ruth A. Weyant is a staff nurse in the cardiac intensive care unit, Melanie Roberts is a critical care clinical nurse specialist, and Ann Henderson is an education nurse specialist, Medical Center of the Rockies, Loveland, Colorado.
Lory
L
Clukey
Ruth A
RA
Weyant
Melanie
M
Roberts
Ann
A
Henderson
D000328:Adult; D000368:Aged; D064646:Cardiovascular Nursing / Q000379:methods; D064648:Critical Care Nursing / Q000379:methods; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use; D007440:Intubation / Q000009:adverse effects* / Q000451:nursing; D008297:Male; D008569:Memory Disorders; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology* / Q000451:nursing; D058748:Pain Perception; D012149:Restraint, Physical / Q000009:adverse effects* / Q000523:psychology
D006993:Hypnotics and Sedatives