Nurses' Attitudes, Practices, and Barriers to Assessing Symptoms of Discomfort in Mechanically Ventilated Patients: A Cross-Sectional Study

Tomohiko Takahashi; Yusuke Oyama; Hideaki Sakuramoto; Mitsuhiro Tamoto; Tomoo Sato; Yuko Nanjo; Sayaka Hosoi; Takeshi Unoki

doi:10.1177/23779608241245209

Nurses' Attitudes, Practices, and Barriers to Assessing Symptoms of Discomfort in Mechanically Ventilated Patients: A Cross-Sectional Study

SAGE Open Nurs. 2024 Apr 7:10:23779608241245209. doi: 10.1177/23779608241245209. eCollection 2024 Jan-Dec.

Authors

Tomohiko Takahashi¹, Yusuke Oyama², Hideaki Sakuramoto³, Mitsuhiro Tamoto⁴, Tomoo Sato⁵, Yuko Nanjo⁶, Sayaka Hosoi⁷, Takeshi Unoki⁸

Affiliations

¹ Intensive Care Unit, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan.
² Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
³ Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Fukuoka, Japan.
⁴ Department of Nursing, Kyoto University Hospital, Kyoto, Kyoto, Japan.
⁵ Acute Care Nursing Division, Kobe City College of Nursing, Kobe, Hyogo, Japan.
⁶ Department of Fundamental Nursing, Faculty of Nursing, Ishikawa Prefectural Nursing University, Kahoku, Ishikawa, Japan.
⁷ Department of Coronary Care Unit, Hitachi General Hospital, Ibaraki, Japan.
⁸ Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan.

Abstract

Introduction: Critically ill patients experience various stressful symptoms of discomfort, including dyspnea, pain, and sleep disruption. Notably, ventilated patients have difficulty self-reporting discomfort symptoms. Nurses need to assess discomfort symptoms to alleviate them, but limited research exists on discomfort symptom assessment and management in critically ill patients.

Objective: To identify the practices, attitudes, and barriers among nurses related to the assessment of discomfort symptoms in mechanically ventilated patients.

Methods: Using a cross-sectional, descriptive study design, a web-based survey was conducted between May and June 2022 with critical care nurses sampled through Japanese academic societies and social networking services. The survey contained questions relative to the above-stated objective. Descriptive statistical analysis was performed without sample size calculation because of the descriptive and exploratory nature of this study.

Results: There were 267 respondents to the questionnaire. The discomfort symptoms that nurses perceived as important to assess were pain (median 100 [interquartile range, IQR 90-100]), insomnia (99 [80-100]), and dyspnea (96.5 [75-100]). Most participants (89.8%) routinely assessed pain in mechanically ventilated patients using a scale; however, other discomfort symptoms were assessed by less than 40% (dyspnea [28.4%], fatigue [8.1%], thirst [13.1%], insomnia [37.3%], and anxiety [13.6%]). Two major barriers to assessing discomfort symptoms were lack of assessment culture within the intensive care unit and lack of knowledge of the relevant evaluation scales.

Conclusions: Nurses were aware of the importance of using scales to assess the discomfort symptoms experienced by mechanically ventilated patients. However, except for pain, most nurses did not routinely use scales to assess discomfort symptoms. Barriers to routine discomfort symptom assessment included the lack of an assessment culture and the lack of knowledge of the assessment scales. Clinicians should be educated regarding the existence of validated rating scales and develop additional rating scales utilizable for minor discomforts in mechanically ventilated patients.

Keywords: Discomfort symptoms; attitudes; barriers; mechanically ventilated patients; practices.