What Factors Influence Nurses' Adherence to the Implementation of Daily Sedation Holds; a Key Component of the Ventilator Care Bundle

Abstract

Background: Critically ill patients in intensive care usually require invasive mechanical ventilation as part of their treatment and as such are often administered sedatives to increase their tolerance of invasive mechanical ventilation so as to promote their comfort and safety (Kress et al 2003, Arroliga 2005, Weinert & Calvin 2007). Nurses are primarily responsible for the titration and administration of sedatives. Over-sedation can increase the duration of mechanical ventilation which can in-turn impact on the risk of patients developing Ventilator-Associated Pneumonia (VAP) (Ibrahim, Tracy, Hill, Fraser, & Kollef, 2001, Schweickert et al., 2004, Grap, 2009, Sedwick et al., 2012). Therefore an optimal level of sedation is often endorsed however achieving this level of sedation can be quite difficult and challenging (Berry et al 2010). Hence, the use of ventilator care bundle which has daily sedation holds as one of it key component has been recommended. Daily sedation holds has proven to reduce the risk of over-sedation and consequently the duration of mechanical ventilation (Kress et al 1996, 2000, 2007; Mehta et al 2008, Gammon et al 2005). Nurses' adherence to the implementation of daily sedation hold is therefore very crucial. Aim: The purpose of this research proposal is to explore the factors that influence the adherence of nurses to daily sedation hold; a component of the ventilator care b