(795) Supporting the Patient's Transition From Sedated to Awake During Mechanical Ventilation

Introduction: Clinical guidelines recommend a light level or even no routine sedation during mechanical ventilation in the intensive care unit (ICU). However, nurses experience that the patient’s transition from being sedated to being awake during mechanical ventilation can be difficult, because the patient can be restless, agitated, confused or fearful in the situation. The aim of the study is to investigate experienced critical care nurses perspective on how to support the patient’s transition from being sedated to awake during mechanical ventilation.

Methods: To gain insight into experienced nurses’ perspective, the study was conducted within the qualitative, inductive methodology of Intepretive Description (ID).
The study was carried out in three mixed medical/surgical adult ICUs at a Danish University Hospital with 20 ICU beds. These units were selected purposefully as the context of the study, since they had implemented a strategy of using less sedation during mechanical ventilation.
As participants, we purposively selected 10 special educated critical care nurses, who had considerable knowledge and experience in caring for patients through the process of wake up from sedation.
Data was collected through individual, semi-structured interviews and subsequently thematically analysed in concordance with the methodological framework of ID.

Results: Four themes emerged in the analysis: a) Carefully planning the wake up b) Guiding awakening c) Succeeding wake up and d) Collaborating care to support wakefulness.

Conclusions: The nurses highlighted the importance of being close to the patient, calm and patient in the process of wake up. They drew on their clinical wisdom to support the patients in the transition from sedated to being awake during mechanical ventilation. Knowing the patient as a person as well as their medical history was important to plan, guide, support and collaborate with the patient to achieve successful wake up. The nurses’ clinical leadership, communication, close collaboration with other health professionals and vigilant attention towards the patient’s signs and actions were crucial aspects to succeed wake up and support patient’s continued alertness during mechanical ventilation.