title: Nurse decision making regarding the use of analgesics and sedatives in the pediatric cardiac ICU.
abstract: OBJECTIVE
  To describe nurse decision making and patient responses associated with the administration of analgesics and sedatives in the pediatric cardiac ICU.
  
  
  METHODS
  Prospective nonexperimental mixed methods study of pediatric cardiac ICU nursing practice.
  
  
  METHODS
  Three tertiary academic pediatric heart centers in the United States.
  
  
  METHODS
  Pediatric cardiac ICU nurses caring for 217 patients completed 1,330 surveys.
  
  
  METHODS
  Four-item open-ended nurse survey completed each time an as needed dose of an analgesic or sedative was administered, an analgesic or sedative infusion/dose was titrated, and/or a new analgesic or sedative was administered.
  
  
  RESULTS
  Responses to survey questions were entered verbatim and then collapsed using a consensus process. Collapsing of the data continued until there was a working set of "symptoms," "changes," and "clinical situation managed" categories. Nurses identified 28 symptoms managed with analgesia and sedation. The most frequent symptoms included hypertension, tachycardia, crying, pain, and agitation. Nurses identified 20 patient changes that resulted from their interventions. The most prevalent changes included improved hemodynamics, calm state, sleep, comfort, and relaxed state. Nurses identified 22 clinical situations that they were attempting to manage. The most frequent clinical situations included pain, hemodynamics, procedures, hypertension, and agitation. Nurses responded that 22% of their interventions were influenced by others.
  
  
  CONCLUSIONS
  Pediatric cardiac ICU nurses use many nonspecific indicators to describe patient level of comfort collectively. Decisions for managing patient comfort were influenced by their patients' overall hemodynamic stability.
authors: 1Department of Nursing, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA. 2Cardiovascular and Critical Care Program, Boston Children's Hospital, Boston, MA. 3Department of Nursing, UCSF Benioff Children's Hospital, San Francisco, CA. 4Department of Cardiology, Boston Children's Hospital, Boston, MA. 5Department of Biostatistics, Harvard School of Public Health, Boston, MA. 6Department of Pediatrics, Harvard Medical School, Boston, MA. 7Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA. 8Department of Anesthesia and Critical Care, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors: Sandra L
authors: SL
authors: Staveski
authors: Patricia A
authors: PA
authors: Lincoln
authors: Lori D
authors: LD
authors: Fineman
authors: Lisa A
authors: LA
authors: Asaro
authors: David
authors: D
authors: Wypij
authors: Martha A Q
authors: MA
authors: Curley
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use*; D002300:Cardiac Care Facilities; D002648:Child; D002675:Child, Preschool; D003448:Crying; D003657:Decision Making; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000451:nursing; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D024802:Nurse's Role; D010146:Pain / Q000188:drug therapy / Q000451:nursing; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000451:nursing; D011795:Surveys and Questionnaires; D013610:Tachycardia / Q000188:drug therapy / Q000451:nursing; D014481:United States; D055815:Young Adult
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives