Julie Hall, Senior Staff Nurse at North Bristol NHS Trust has just completed a research scholarship for her Masters with The Florence Nightingale Foundation, sponsored by NHS Professionals. Julie’s research is entitled, ‘Introducing a work based project into the intensive care unit: improving the assessment and management of pain in the sedated patient’.
What made you decide to apply for a scholarship with the Florence Nightingale Foundation?
The lead of my Masters programme (a senior lecturer at the University of the West of England) was also a Florence Nightingale Scholar. She suggested that I apply to the Florence Nightingale Foundation for funding to allow me to finish my studies.
Why did you choose to research assessment and management of pain in sedated patients in the intensive care unit?
Prior to this final module, I undertook a module called ‘The nature of pain and its management’ as part of my Masters. Pain assessment and management in sedated patients was one of the areas I examined as part of this module, and I realised that so much work could be done in this area to improve patient care and quality. As part of the module was a change management project, the topic became more justifiable as the time and work invested would be evident within my workplace.
What were your main findings?
Firstly, a pain tool is paramount in ensuring adequate pain assessment – observing facial expressions, body movements, and toleration of the ventilator. My research also highlighted the consequences of unrelieved pain. There are a number of detrimental physiological effects of pain (cardiac instability, an increase in oxygen requirements and poor sleep quality) for example. Patients essentially require ventilator support for longer, so the intensive care unit (ICU) stay is prolonged resulting in a higher risk of infection and post-traumatic stress disorder.
What were your key recommendations?
Utilising a pain tool was recommended as essential. The research recommends the Behavioural Pain Scale.
It is also recommended setting a sedation score for each patient on the first ward round of the day to ensure patients are not over-sedated. If a patient is over-sedated they will not be able to express their pain. Whilst on the ward round, clinicians should make sure each patient has adequate analgesia prescribed.
Procedural pain – for example, if a patient needs to have a line inserted, needs to be anticipated and analgesia given prior to the intervention.
Education – making sure that all members of the multidisciplinary team are educated on this topic so that it raises awareness and informed decisions can be made.
How is your Trust planning to take these recommendations forward?
The pain project will be rolled out at the Frenchay site of North Bristol NHS Trust (NBT) in the near future and when we move to our new hospital in May 2014, pain assessment and management in sedated patients will be fully incorporated into our ICU practice.
We will be forming an ICU pain team as recommended by the Royal College of Anaesthetists. They state a multidisciplinary team is essential to promote good pain management. It’s something we did not include at the Southmead site due to time constraints but will be incorporating at Frenchay. The team will also act as a focus group so we can share ideas and not only focus on pain, but also any other areas that arise that we can improve upon.
I have been allocated space on the Trust intranet that will be used to share information, learning tools, descriptions of the pain tool, and quizzes for example.
How has conducting this research impacted on you and your role?
There has been an increase in job satisfaction due to newly acquired knowledge and the opportunity to improve nursing practice. It has improved my confidence and I have developed my skills in leadership and change management. It’s made me more analytical, critical and inquisitive, and furthermore given me the confidence to challenge current practice and improve patient care.
I am very grateful to the Florence Nightingale Foundation and NHS Professionals for funding this research.