Navigating non-pharmacological strategies for agitation management in the ICU


Within intensive care units (ICUs), where patients frequently confront daunting conditions, managing agitation proves to be a significant obstacle for healthcare providers. When patients exhibit behaviours, such as restlessness, pulling on lines and tube or attempting to get out of bed, nurses face a dilemma: how to address these behaviours without resorting to physical restraints or excessive medication.

Caring Futures Institute’s Dr Anne Mette Adams, an experienced Critical Care Nurse, aims to address this pressing issue by developing clinical practice guidelines that empower nurses to effectively manage agitation without solely relying on medication or physical restraints.

Dr Anne Mette Adams

Mette’s interest in improving care in ICUs comes from an extensive nursing background spanning various countries. Observing the diverse practices in agitation management sparked her curiosity and drove her explore existing research which, identified a significant gap: although current guidelines mostly prioritise medication-based interventions, there’s a noticeable absence of evidence-based strategies for non-drug management highlighting the pressing need for clear guidance in this critical area.

In collaboration with patients, their families, and various healthcare professionals, including physicians, nurses, physiotherapists, and occupational therapists, Dr Adams  Australia. Her success in obtaining the prestigious Erik Elgaard Sørensen Scholarship has enabled her to conduct research across both countries, providing her with invaluable cross-cultural insights.

Further, while presenting her study in Denmark, Mette was contacted by the Centre for Clinical Practice Guidelines who have expressed interest in translating, contextualising, and publishing the guidelines in Danish.

“It has been a rewarding experience working with experts in the field to go through this final step of guideline development. In Australia we will replicate the process and contextualise and publish the guidelines for an Australian audience.”

Recognising the necessity of co-design for successful implementation, Mette emphasises the importance of involving stakeholders throughout the process.

“An inclusive approach aims to create consensus on effective non-pharmacological interventions despite the limited evidence. The study’s inclusivity ensures that diverse perspectives will be incorporated into the guidelines, resulting in recommendations that resonate across borders. Additionally, this collaborative approach sets a strong foundation for successful implementation efforts in the future.”

It is important to emphasise that the project does not advocate for the complete exclusion of medication in managing agitation. Medication plays a vital role in addressing various causes of agitation in the intensive care unit and ensuring patient and staff safety. However, the aim of the project is to highlight the importance of considering non-pharmacological strategies alongside medication.

“By increasing staff awareness of these alternative approaches, our aim is to promote a more holistic and patient-centred approach to managing agitation. The ultimate goal is to equip staff with a wide range of options, enabling them to customise their interventions to suit each patient’s unique needs.”

“Our findings so far underscore the critical need for supporting staff members in implementing non-pharmacological strategies effectively. It’s clear that clinicians require assistance and resources to successfully employ these approaches in their practice.”

Dr Adams’ continued efforts, supported by funding from the Australian College of Critical Care Nurses and a Flinders University Impact Seeding grant underscores her commitment to improving ICU care practices.

So far, Mette says the feedback has been overwhelmingly positive, “We were pleasantly surprised by the remarkable support from clinicians, patients, and family members, which has exceeded our expectations from the outset. Notably, our Delphi study witnessed an unusually low dropout rate among participants, contrary to the typically high rates observed in similar studies. This exceptional level of engagement and minimal dropout is indicative of the genuine interest, enthusiasm, and motivation among stakeholders in crafting these guidelines. It highlights the urgent demand for such resources and the shared commitment to tackling the complexities of agitation management in intensive care environments.”

Dr Adams’ research exemplifies innovation and collaboration, presenting a fresh approach to enhancing ICU care. Mette is shaping a future where patients receive comprehensive, patient-centred care, minimising reliance on medication and alleviating agitation. As she persists in her efforts to refine healthcare practices, Mette is making a lasting impact on critical care nursing.

Posted in
Fundamentals of Care