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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
PubMed

Insights

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.
Abstract

Keywords:
cognitive errorscognitive interviewingcritical carenursing assessmentpaediatric

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