Definition and management of anxiety, agitation, and confusion in ICUs

Critically ill patients require continuous assessment of their need for sedation and pain management. The purpose of this study was to develop a consistent categorization of patient's symptoms and to identify actions that yield effective patient outcomes. Nurses in this study described patients with sedation problems as those who were disoriented or aggressively acting out, fearful and restless, or manifesting changes in orientation, memory loss, or mental status. Twenty-seven medical intensive care unit (MICU) nurses volunteered to complete a questionnaire about their assessment process in determining patient's sedation needs, interventions, and evaluation criteria for patient outcomes. Fifty-five patient questionnaires were completed by the nurses. Nurses identified separate subjective and objective cues for patients' anxiety, agitation, and confusion. The most frequently identified nursing actions were assessment to differentiate between pain, anxiety, agitation, and confusion; personal reassurances, relaxation and other physical comfort techniques; administer prescribed medication; collaborate with a physician to identify cause; and give additional prescribed medication. Effective outcome measures included stable vital signs, normal oxygen saturation, progression with ventilator weaning if appropriate, return to normal level of orientation, and a quiet yet arousable state.