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Issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory: a qualitative study

Authors

  • Aaron Conway RN, BN,

    PhD Candidate, Corresponding author
    1. School of Nursing, Midwifery and Paramedicine (QLD), Australian Catholic University, Banyo, Qld, Australia
    2. Cardiac Catheter Theatres, The Wesley Hospital, Auchenflower, Qld, Australia
    • Correspondence: Aaron Conway, PhD Candidate, School of Nursing & Midwifery (QLD)

      Australian Catholic University, Banyo, Qld, Australia. Telephone: +61 423124421.

      E-mail: awconw001@myacu.edu.au

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  • John Rolley PhD, RN, BN,

    Research Fellow
    1. Cardiology Investigation Unit, St Vincent's Hospital, Melbourne, Vic., Australia
    2. The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, Vic., Australia
    3. University of Melbourne, Melbourne, Vic., Australia
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  • Karen Page RN, DN,

    Manager of Clinical Care Engagement
    1. Heart Foundation, Melbourne, Vic., Australia
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  • Paul Fulbrook PhD, RN

    Professor of Nursing and Deputy Director
    1. National Centre for Clinical Outcomes Research, School of Nursing, Midwifery & Paramedicine (QLD), Australian Catholic University, Banyo, Qld, Australia
    2. Nursing Research and Practice Development Unit, The Prince Charles Hospital, Chermside, Qld, Australia
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Abstract

Aims and objectives

To explore issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory from the perspectives of senior nurses.

Background

Nurses play an important part in managing sedation because the prescription is usually given verbally directly from the cardiologist who is performing the procedure and typically, an anaesthetist is not present.

Design

A qualitative exploratory design was employed.

Methods

Semi-structured interviews with 23 nurses from 16 cardiac catheterisation laboratories across four states in Australia and also New Zealand were conducted. Data analysis followed the guide developed by Braun and Clark to identify the main themes.

Results

Major themes emerged from analysis regarding the lack of access to anaesthetists, the limitations of sedative medications, the barriers to effective patient monitoring and the impact that the increasing complexity of procedures has on patients' sedation requirements.

Conclusions

The most critical issue identified in this study is that current guidelines, which are meant to apply regardless of the clinical setting, are not practical for the cardiac catheterisation laboratory due to a lack of access to anaesthetists. Furthermore, this study has demonstrated that nurses hold concerns about the legitimacy of their practice in situations when they are required to perform tasks outside of clinical practice guidelines. To address nurses' concerns, it is proposed that new guidelines could be developed, which address the unique circumstances in which sedation is used in the cardiac catheterisation laboratory.

Relevance to clinical practice

Nurses need to possess advanced knowledge and skills in monitoring for the adverse effects of sedation. Several challenges impact on nurses' ability to monitor patients during procedural sedation and analgesia. Preprocedural patient education about what to expect from sedation is essential.

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