Discovery of Unexpected Pain in Intubated and Sedated Patients

Lory Clukey, RN, PhD, PsyD, CNS; Ruth A. Weyant, RN, MSN, CCRN-CMC; Melanie Roberts, MS, APRN, CCRN, CCNS; Ann Henderson, PhD, APRN, CNS

Disclosures

Am J Crit Care. 2014;23(3):216-220. 

In This Article

Abstract and Introduction

Abstract

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.

Conclusion. 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.

Introduction

Patients are often sedated and restrained during intubation in the intensive care unit (ICU). The perceptions and experiences of these patients are not fully known. The purpose of this phenomenological study was to explore the experience of patients and patients' families in the ICU when the patients were physically restrained and sedated for treatment with mechanical ventilation. In this article, we present the patients' perceptions. The results related to the families' perceptions will be presented in a separate article.

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