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Abstract

Introduction: Nursing perceptions of systematic evaluations of analgesia, sedation level, and delirium features in the neurologically critically ill are unknown, and may influence whether and how these assessments are performed. Hypothesis: Bedside nurses would find pain and sedation assessments feasible, and delirium assessments more challenging, using structured instruments; years of nursing experience might influence nursing perceptions. Methods: Bedside ICU nurses in adult Neurological and Neurosurgical-trauma intensive care units from 3 hospitals (2 in Canada and 1 in the USA) were surveyed from November 2011 to April 2012.Systematic assessments were assessed for ease of use, applicability to Neurosurgical ICCU patients, adequacy of training for these assessments and physician response to the nursing assessments. Instruments assessed were the Numeric rating scale (NRS) or Behaviour Pain Scale (BPS), the Richmond Agitation-Sedation Scale (RASS), and delirium features with the Intensive Care Delirium Screening Checklist (ICDSC). Results: Nurses found the scales generally easy to use and applicable to neurologically ill patients. Agreement across assessment categories and for ease of use was significantly higher in nurses with more than 10 years’ ICU experience.When comparing all nurses from the study, all responders: 1. strongly agreed that they are familiar with interventions to manage delirium. 2. moderately agreed that physicians are receptive told ‘my patient is delirious’. 3. strongly agree with interventions to manage over-sedation and agitation. When comparing STICU to NSICU there was:1. little agreement as to whether pain, sedation and agitation are difficult to assess. 2. moderate agreement that delirium is difficult to assess. 3. moderate agreement that they are familiar with interventions to manage delirium.4. moderate disagreement that it is time consuming to assess for pain, sedation and delirium. Conclusions: Nursing staff find pain, sedation and delirium assessment in neurocritically ill patients feasible to perform but challenging to communicate to physicians. Experienced nurses were more consistent in their comfort level and opinions with applying these scales to the neurologically critically ill.