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Nursing judgement and decision-making using the Sedation Withdrawal Score (SWS) in children
Jennie Craske1,2, Bernie Carter3,4,5, Ian H Jarman6
1Department of Anaesthetics, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
Journal of Advanced Nursing
|March 23, 2017
Summary
Registered children
Area of Science:
- Pediatric critical care nursing
- Clinical decision-making in pediatric nursing
- Childhood withdrawal syndrome assessment
Background:
- Assessing withdrawal syndrome in critically ill children presents challenges due to unstable conditions and differential diagnoses.
- Standardized assessment tools are crucial for recognizing withdrawal syndrome, but nurses' decision-making processes in these complex situations are not well understood.
- Cognitive effort is required for accurate assessment and management of withdrawal syndrome in pediatric patients.
Purpose of the Study:
- To evaluate how registered children's nurses approach the assessment and management of withdrawal syndrome in pediatric patients.
- To explore the cognitive processes nurses employ when using the Sedation Withdrawal Score (SWS) tool.
- To understand the decision-making challenges faced by nurses during withdrawal assessments in critical care settings.
Main Methods:
- Qualitative study employing cognitive interviews with 12 registered children's nurses.
- Utilized clinical vignettes to explore nurses' decision-making processes when assessing withdrawal.
- Interviews focused on the application of the Sedation Withdrawal Score (SWS) tool in pediatric critical care.
Main Results:
- Nurses experienced cognitive challenges at all decision-making stages: noticing, interpreting, and responding to withdrawal signs.
- Difficulty in distinguishing between Sedation Withdrawal Score (SWS) signs and attributing behaviors to withdrawal versus comorbidities was common.
- Variability in diagnoses and treatment responses occurred, particularly when nurses were uncertain about the cause of a child's behavior.
Conclusions:
- Cognitive interviews revealed insights into nurses' judgment and decision-making complexities in pediatric withdrawal assessment.
- The Sedation Withdrawal Score (SWS) may not fully standardize assessment due to contextual complexities and difficulties in determining the cause of ambiguous behaviors.
- Further research is needed to improve standardized assessment and management of withdrawal syndrome in critically ill children.
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