Anxiety and agitation are experienced by critically ill patients frequently and produce management challenges for clinicians. The purpose of this study was to describe critically ill patients’ behaviors classified as “anxious or agitated”, clinician interpretation of these behavioral cues, and choice of interventions based on those interpretations. This qualitative secondary analysis used existing longitudinal data (observations, interviews, and medical records) from an ethnographic study of 30 critically ill patients who were weaning from prolonged mechanical ventilation, patient families and clinicians who cared for them. Each event of anxiety or agitation was analyzed using dimensional analysis techniques.
Exploration of relationships of resulting themes and patterns using graphic displays led to development of the Anxiety-Agitation in Critical Illness Model which describes patient physiological, behavioral and psychological responses to stimuli of anxiety and agitation; clinician assessment of symptoms of anxiety and agitation, and management strategies chosen by clinicians. Interaction was identified as the core process in which patients appraised the threat of stimuli. Clinician assessment of patient interaction guided assessment and management of anxiety and agitation. Clinicians observed and interpreted patient responses to stimuli using “knowing the patient” and attributions about anxiety and agitation. Two opposing or dialectic attributions were revealed: discrimination vs. generalization and anxiety as an expected response vs. a character flaw.
Interventions were designed to modify the stimulus of anxiety or agitation and included physical comfort measures, distraction, supportive verbal strategies, and music. Withholding presence and withholding information was described by clinicians as strategies used when patient anxiety was associated with ventilator weaning. These interventions were called “out of sight, out of mind” and “sneaking the wean”. These were new and unexpected psychosocial interactions not described previously in the literature. Sedation was used to modify appraisal of or response to the stimulus. Sedation management was inconsistent and variable especially when anxiety was associated with ventilator weaning.
This study provides a foundation for practice improvement by offering a comprehensive model and alternative considerations for interpretation and management of symptoms in the ICU. It suggests areas for additional study, specifically, social support, sedation and withholding information or presence.
|Advisor:||Happ, Mary Beth|
|School:||University of Pittsburgh|
|School Location:||United States -- Pennsylvania|
|Source:||DAI-B 72/01, Dissertation Abstracts International|
|Keywords:||Agitation, Anxiety, Critical care, Mechanical ventilation|
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