The information needs of patients receiving procedural sedation in a hospital emergency department

https://doi.org/10.1016/j.ienj.2016.12.006Get rights and content

Highlights

  • Patients had difficulty separating sedation information from their ED experience.

  • Patients reported the need to feel safe and to trust the staff providing their care.

  • Staff competence and efficiency needed to be demonstrated by all team members.

  • Specific information in a written format was not found to be valued by patients.

  • Patients valued ongoing and repeated information relevant to their circumstances.

Abstract

This research investigated the information needs of patients receiving ED procedural sedation to determine the best format to consistently deliver key information in a way acceptable to all involved. Of particular interest was the question concerning patients’ need for receiving written information. A descriptive exploratory study gathered qualitative data through face-to-face interviews and focus groups involving patients, nurses and medical staff. Individual interviews were conducted with eight adult patients following procedural sedation. They identified very few gaps in terms of specific information they needed pertaining to procedural sedation and rejected the need for receiving information in a written format. Their information needs related to a central concern for safety and trust. Focus groups, reflecting on the findings from patients, were conducted with five ED nurses and four emergency medicine consultants/registrars who regularly provided procedural sedation. Themes that emerged from the analysis of data from all three groups identified the issues concerning patient information needs as being: competence and efficiency of staff; explanations of procedures and progress; support person presence; and medico-legal issues. The research confirms that the quality of the patient’s ED experience, specifically related to procedural sedation, is enhanced by ED staff, especially nurses, providing them with ongoing and repeated verbal information relevant to their circumstances.

Introduction

It is often necessary to perform procedures that can cause pain to patients in hospital and in recent years it has become common place to provide procedural sedation in these situations within the Emergency Department (ED) setting [1]. Procedural sedation, alternatively known as conscious sedation, is acknowledged as being on a sedation/anaesthesia continuum, with the level of sedation dependant on the choice of agent and on the individual patient’s response. The American College of Emergency Physicians (ACEP) [2] define procedural sedation as “the technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function” (p. 178). The safety and efficacy of providing procedural sedation in the ED setting by suitably skilled practitioners following recognised standards of monitoring is well documented by researchers, key stakeholder collegiate consensus and policy statements [2], [3], [4], [1], [5].

Providing hospital patients with high quality, comprehensible and consistently accurate information is a requirement of the New Zealand Health and Disability Commission Act Code of Rights [6]. This Code recognises quality healthcare and is an integral step towards achieving legal and ethical partnership between healthcare providers and patients. However, the quality of information provided to patients can vary widely in its delivery, content and usefulness. Mills and Sullivan [7] review of information given to newly diagnosed cancer patients cited four reasons for variability in the quality of this information. These were the extent of the health care professional’s knowledge, the patient’s perceived level of understanding, a lack of appreciation for what the patient actually wanted to know, and time pressures. Whilst overall patient satisfaction around procedural sedation in ED has been noted [5], factors influencing satisfaction were not investigated and it is recognised that effective pain relief, success of the procedure or length of ED visit may impact on satisfaction levels when communicated information may have been less than adequate.

The aim of this research was to investigate the information needs of patients receiving ED procedural sedation to determine the best format for health care workers to consistently meet these needs in a way acceptable to all. Of particular interest was the question concerning patients’ need for receiving written information. It was not current practice in the ED setting of the research to provide written information about sedation and the research sought to identify the extent to which this was a failing.

Section snippets

Design and setting

The descriptive exploratory study gathered qualitative data through face-to-face interviews with patients, and focus group discussions involving nurses and medical staff. The research sought to understand health and nursing care in its natural setting.

The research was conducted in 2012 in an ED in a tertiary care hospital of a regional District Health Board (DHB) of New Zealand. The ED treats an average of 43,000 patients annually and preforms an annual average of 190 procedural sedations. The

Safety and trust

What became clear from interviews with patients who had undergone procedural sedation was that specific information about sedation was not their main concern. Instead, they viewed the whole ED experience as one integral journey and described how they sought regular information and explanation along the way. Patients found it difficult to separate the sedation from the presentation problem and were more concerned with getting the problem fixed than with the sedation itself.

The eight patients

Discussion

Based on an identified lack of clarity about what it is, exactly, that patients want to know regarding procedural sedation in ED, this research aimed to identify the preferred content and format of that information. It was hoped that, as a result of interviews with patients, the research would identify a convenient, succinct list of information points that could be reproduced in writing and subsequently used for informing future patients receiving procedural sedation in ED. This did not

Conclusions

This research has provided an insight into the information needs of adult patients receiving procedural sedation within the ED setting. The analysis of results from patient interviews showed that the information they sought was to satisfy their need to feel safe and to trust the staff providing their care. To achieve this, staff competence and efficiency needed to be demonstrated by all ED staff members, but preferably from within a cohesive and effective team environment. Including the patient

References (23)

  • Ministry of Health. Population of Hawke’s Bay District Health Board....
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