Background Nurses are fundamental to the implementation of sedation protocols for patients receiving mechanical ventilation. A 2005 survey showed that nurses’ attitudes toward sedation affected their sedation practices. Since then, updated guidelines on managing pain, agitation, and delirium have been published. Objective To explore nurses’ self-reported attitudes and practices related to sedation and determine whether they have changed in the past decade. Methods Members of the American Association of Critical-Care Nurses were invited to complete the Nurse Sedation Practices Scale, which measures nurses’ self-reported sedation practices and factors that affect them. Item and subscale responses were analyzed, and differences in item responses by respondent characteristics were determined. Results Respondents (N = 177) were mostly staff nurses (68%) with a bachelor’s degree in nursing (63%). Nurses’ attitudes toward the effectiveness of sedation in relieving patients’ distress during mechanical ventilation correlated positively with their intention to administer sedatives ( r s = 0.65). Sixty-six percent of nurses agreed that sedation was necessary for patients’ comfort, and 34% agreed that limiting patients’ recall was a desired outcome of sedation. Respondents with more experience or CCRN certification had a less positive evaluation of the effectiveness of sedation in minimizing distress. Conclusions Nurses’ attitudes toward sedating patients receiving mechanical ventilation have shifted in the past decade, with fewer nurses now believing that all patients should be sedated. However, more than half of nurses still agree that sedation is needed for patients’ comfort, highlighting the need to consider nurses’ attitudes when seeking to optimize sedation practices during mechanical ventilation.

Background Intensive care unit–acquired weakness is a frequent complication of critical illness because of patients’ immobility and prolonged use of mechanical ventilation. Objectives To describe daily measurements of peripheral muscle strength in patients receiving mechanical ventilation and explore relationships among factors that influence intensive care unit–acquired weakness. Methods Peripheral muscle strength of 120 critically ill patients receiving mechanical ventilation was measured daily by using a standardized handgrip dynamometry protocol. Three grip measurements for each hand were recorded in pounds-force; the mean of these 3 assessments was used in the analysis. Correlates of intensive care unit–acquired weakness (age, sex, illness severity, duration of mechanical ventilation, medications) were analyzed by using mixed models to explore the relationship to grip strength. Results Median baseline grip strength was variable yet diminished (7.7 pounds-force), with either a pattern of diminishing grip strength or maintenance of the baseline low grip strength over time. With controls for days of measurement, female sex (β = −10.4; P < .001), age (β = −0.24; P = .004), and days receiving mechanical ventilation (β = −0.34; P = .005) explained a significant amount of variance in grip strength over time. Conclusions Patients receiving prolonged mechanical ventilation had marked decrements in grip strength, measured by hand dynamometry, a marker for peripheral muscle strength. Hand dynamometry is a reliable method for measuring muscle strength in cooperative critically ill patients and can be used to develop interventions to prevent intensive care unit–acquired weakness.

Although enrolling a sufficient number of participants is a challenge for any multisite clinical trial, recruiting patients who are critically ill and receiving mechanical ventilatory support presents additional challenges because of the severity of the patients’ illness and the impediments to their communication. Recruitment challenges related to the research sites, nursing staff, and research participants faced in the first 2 years of a 4-year multisite clinical trial of a patient-directed music intervention for managing anxiety in the intensive care unit were determined. Strategies to overcome these challenges, and thereby increase enrollment, were devised. Individual strategies, such as timing of screening on a unit, were tailored to each participating site to enhance recruitment for this trial. Other strategies, such as obtaining a waiver for a participant’s signature, were instituted across all participating sites. Through implementation of these various strategies, the mean monthly enrollment of participants increased by 50%. Investigators are advised to plan well in advance of starting recruitment for a clinical trial based in an intensive care unit, anticipate peaks and valleys in recruitment, and be proactive in addressing issues creatively as the issues arise.

• Background Demand for complementary and alternative therapies is increasing and is affecting all healthcare settings, including critical care. • Methods A random sample of members of the American Association of Critical-Care Nurses was surveyed to determine the members’ attitudes, knowledge, perspectives, and use of complementary and alternative therapies. • Results Most of the 726 respondents were using one or more complementary and alternative therapies in practice. The most common therapies used were diet, exercise, relaxation techniques, and prayer. A majority of the nurses had some knowledge of more than half of the 28 therapies listed on the survey, and a majority desired additional training for 25 therapies. Respondents generally required more evidence judged as essential to use or recommend conventional therapy than to use or recommend complementary and alternative therapies. Nurses viewed complementary and alternative therapies positively overall, were open to use of the therapies, and perceived them as legitimate and beneficial to patients. Nurses judged the therapies helpful for treatment of a variety of symptoms. A majority of nurses desired an increase in the availability of the therapies for patients, patients’ families, and nursing staff. Nurses’ professional use of the therapies was related to having more knowledge of them, perceiving benefits of them, total number of therapies they recommended to patients, personal use, and affiliation with a mainstream religion. • Conclusions Educational programs that provide information about use of complementary and alternative therapies and the underlying evidence base most likely will increase the appropriate use of the therapies to achieve desired outcomes.