Abstract
Aims
The aim of the study was to evaluate
registered children’s nurses’ approach to
the assessment and management of
withdrawal syndrome in children.
Background
Assessment of withdrawal syndrome is
undertaken following critical illness when
the child’s condition may be unstable with
competing differential diagnoses.
Assessment tools aim to standardise and
improve recognition of withdrawal
syndrome. Making the right decisions in
complex clinical situations requires a
degree of mental effort and it is not known
how nurses make decisions when
undertaking withdrawal assessments.
Design
Cognitive interviews using with clinical
vignettes.
Methods
Interviews were undertaken with 12
nurses to explore the cognitive processes
they utilised when assessing children using
the Sedation Withdrawal Score (SWS) tool.
Interviews took place in Autumn 2013.
Findings
Each stage of decision-making – noticing,
interpreting and responding – presented
cognitive challenges for nurses. When
defining withdrawal behaviours nurses
tended to blur the boundaries between
SWS signs. Challenges in interpreting
behaviours arose from not knowing if the
patient’s behaviour was a result of
withdrawal or other co-morbidities. Nurses
gave a range of diagnoses when
interpreting the vignettes, despite being
provided with identical information.
Treatment responses corresponded to
definite withdrawal diagnoses, but varied
when nurses were unsure of the diagnosis.
Conclusion
Cognitive interviews with vignettes
provided insight into nurses’ judgement
and decision-making. The SWS does not
standardise the assessment of withdrawal
due to the complexity of the context within
which assessments take place and the
difficulties of determining the cause of
equivocal behaviours in children recovering
from critical illness.
Original language | English |
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Journal | Journal of Advanced Nursing |
Early online date | 22 Mar 2017 |
DOIs | |
Publication status | Published - 3 May 2017 |