Registered nurses in interventional radiology deliver moderate sedation under the direction of the medical expert doing the treatment (IR). The nurses understood that there was a need for more standardized instruction and training that addressed clinical subjects, including capnography, distress, and airway management. Because of advancements in IR techniques and the development of nurse-administered moderate sedation, nurses will need considerable continuing education to ensure safe and successful patient care.
During a drug-induced state of moderate drowsiness, the patient consciously reacts to verbal directions alone or in conjunction with light tactile stimulation (Cravero, 2015). Spontaneous breathing is sufficient and cardiovascular function is preserved without intervention to maintain a patent airway.
Nurses administer most of the sedatives used in interventional radiology at our clinic—more than 80% of them (IR). To provide moderate sedation, more than 20 nurses and ten specially trained practitioners collaborate across departments. Using capable non-anaesthesia professionals for moderate sedation is a cost-effective strategy that allows IR nurses a rare chance to use their critical care talents regularly. The IR nurses have long given the majority of the moderate sedation at our facility. The ability to provide critical care is a skill that any nurse working in IR must possess.
Despite this endorsement of nurses’ abilities, worries about the nurses’ different levels of comfort when delivering moderate sedation were raised. During a conversation about care delivery at the monthly shared governance meeting, the nurses brought up the matter. The in-person IR director concurred and said that the radiologists were also uneasy about some of the nurses’ confidence. Upon further research by the nurse manager, it became increasingly obvious that the differences between nurses and doctors regarding the administration of moderate sedation were the only factors contributing to the drop in nursing satisfaction as it pertained to RN-MD interactions. This study aimed to examine interventions that would improve the knowledge, confidence, competence, and satisfaction of IR nurses who provide moderate sedation.
Nonanesthetist sedation rules are hazy and unequal in terms of personnel preparation and training (McCoy et al., 2013). There isn’t a lot of widely accepted training available for medical professionals who utilize or incorporate moderate sedation into their procedures. For sedation services offered by non-anesthesia providers, there are no readily available quality indicators or benchmarks. Each facility must establish evidence-based guidelines to ensure patient safety as the number of procedures requiring moderate sedation keeps rising (Caperelli-White & Urman, 2014). The literature suggests that systematic education and training, together with qualifications, can boost sedating nurses’ confidence and competence. Confidence levels can fluctuate based on the circumstance, subject, and surrounding environment. It has been discovered that negative effects on confidence can result from personal views or self-doubt of efficacy as determined by particular surroundings.
A study was conducted to assess how important, competent, confident, and satisfied IR nurses felt about implementing a mild sedation regimen. The study was authorized after being thoroughly reviewed by the institutional review board. Prior to executing the interventions, the protocol, including the goal of the study, was communicated with the individuals in accordance with the Health Insurance Portability and Accountability Act rule. To protect their anonymity and confidentiality, the subjects were given a code. Potential participants had the choice to decline the study without having the educational intervention suffer. The subjects (24 IR nurses) completed surveys before and after educational interventions to gauge their perceptions of the importance, competence, satisfaction, and results associated with the administration of moderate sedation.
One of the alternatives was a competency-based, flexible, and customized online sedation certification program provided by AAMSN in the form of 10-hour instructional modules, which was accredited by the American Nurses Credentialing Center (2018). The second intervention involved an airway management practicum with a provider of anesthesia (8 hr.).
The nurses’ assessment of their own competence significantly increased after completing the 10-hour online didactic program, which resulted in a significant boost in knowledge. The majority of nurses concurred that it was critical and really satisfying to realize how practical the material from the AAMSN online certification course was to their day-to-day duties. Just by virtue of this, they felt more assured in their practice.
The 8-hour practicum with the anesthesia doctor, according to the nurses, gave them the most confidence to properly manage the sedated patient’s airway. The opportunity to practice rescue techniques with experts and demonstrate airway methods led to a discernible improvement in skill when managing airway emergencies. The degree of nursing satisfaction significantly increased. The program’s overall didactic hands-on sedation practicum and medication delivery refresher were to blame for the increased satisfaction. These findings suggest reorganizing nurses’ orientation and training in IR. When nurses have received formal education through certification and airway practicums with anesthetic professionals, it has been shown to boost nurses’ subjective satisfaction, confidence, and proficiency when using a moderate sedation technique on patients in the IR department.
My own experience indicates that community nurses need to be educated and trained in the field of IR and IR drain care. In the community, nurses are crucial to the health and safety of patients who have IR drains. The knowledge base of community nurses may be expanded, and the right guidelines can be provided, enabling them to confidently and professionally deliver high-quality care. To introduce and keep in place, effective leadership is required at all levels. In general, nurses with more expertise tend to be more wary, even resistive, of sedation, whereas nurses with less experience in palliative care tend to be more comfortable with the procedure. Therefore, even among experienced nurses, education and training are still necessary.
When caring for patients who receive sedative drugs, we nurses must take into account a variety of issues. The possibility of abrupt or significant changes in sedative or anesthetic depth during sedation cannot always be predicted. Short-acting hypnotics like Etomidate and Propofol (used for sedation) need to be administered with the same level of caution as profound sedation. Other factors to take into account when caring for a sedated patient are the competency and availability of the practitioner who is skilled in advanced life support and airway management to remedy the negative physiological effects that result from a deeper level of sedation than anticipated.
Conclusion
The success of the program’s execution relied heavily on the nursing leadership’s provision of resources and support. No matter how many years of expertise our nursing team had with moderate sedation, the online instruction and airway practical were definitely beneficial.
Within IR, examining labor quality presents challenges. However, difficult patient care, including the administration of moderate sedation, is routinely carried out in these settings despite the lack of evidence supporting the training, experience, or skills that should be required of the caregivers. Because it is used more frequently outside of the operating room, it is critical now more than ever that practitioners are appropriately trained to administer moderate sedation.
References
Caperelli-White, L., & Urman, R. D. (2014). Developing a moderate sedation policy: essential elements and evidence-based considerations. AORN journal, 99(3), 416-430.
Cravero, J. P. (2015). Sedation Policies, Recommendations, and Guidelines Across the Specialties and Continents. In Pediatric Sedation Outside of the Operating Room (pp. 17-31). Springer, New York, NY.
McCoy, S., Wakai, A., Blackburn, C., Barrett, M., Murphy, A., Brenner, M., … & O’Sullivan, R. (2013). Structured sedation programs in the emergency department, hospital and other acute settings: protocol for systematic review of effects and events. Systematic reviews, 2(1), 1-7.
Tuck, P., Riley, E., Krenzischek, D., & MacDonald, R. (2018). Evaluation of perceived importance, competence, confidence, and satisfaction in the implementation of moderate sedation by interventional radiology nurses. Journal of Radiology Nursing, 37(2), 85-89.
write