Patient agitation in an Intensive Care Unit (ICU) can be addressed by more than pharmaceutical interventions or physical restraints – but clear guidelines are needed.
Dr Anne Mette Adams, from the Caring Futures Institute at Flinders University, has been conducting research of clinical practices in both Denmark and Australia, to establish guidelines for the non-pharmacological management of patient agitation in the ICU.
Dr Adams commenced this research after receiving the Erik Elgaard Sørensen scholarship in 2020, to travel to Denmark and work in collaboration with Danish researchers. The result is a series of guidelines developed for two countries, designed from the outset through consulting stakeholders to ensure the accuracy and viability of the guidelines.
“The triggers for agitation in ICU are complex and there are multiple causes – from critical illness, fear and anxiety to mental health conditions and the effects of unprescribed drugs,” explains Dr Adams.
“While situations can escalate in ICU settings, and pharmaceutical interventions or physical restraints may be required to ensure staff safety – there are other options available that are often the best solution.”
Dr Adams embarked on this research after finding that existing literature on this specific matter was lacking, and that ICU staff consequently find themselves in difficult situations without a range of possible solutions.
“Through developing guidelines simultaneously in two countries, it became clear what was needed in both places – and that it was necessary to respond to each country’s requirements separately.”
The researchers conducted a Delphi study, where participants from both countries sat in a panel to achieve consensus on guideline recommendations – and this provided very specific contexts for the guidelines in both countries.
The recommendations, with key aspects focusing on fundamental care of agitated patients in ICU, underscore the vital role of relationship-centred, holistic fundamental care for critically unwell patients.
The guidelines include involving relatives to assist with calming patients, the mobilisation of patients, reducing stimuli, attending more to patient comfort, reassuring their safety – and also recommendations to organisations, to ensure that ICU staff are provided with adequate time to properly attend to agitated patients.
“It’s known that most patients will become agitated at some stage during their stay in an Intensive Care Unit – and we know there are long-term ramifications on patients subdued with physical restraints or pharmaceutical interventions, so we really want to help healthcare professionals work through difficult situations with more confidence and a wide set of alternative interventions to provide necessary help,” says Dr Adams.
“The guidelines show the full range of appropriate care options available to ICU staff, so that they can make considered choice about what is the best course of action, to get results that work best for the patient in ICU as well as the staff.”
Dr Adams is now completing final consultation with ICU stakeholders, with the research ready for publication in Australia, and nearing completion in Denmark.
This extensive project has reached fruition through receiving additional funding from the Australian College of Critical Care Nurses, which is keen for the guidelines to be implemented.
Dr Adams says the guidelines project also received a recent grant from the Flinders Foundation, to implement the guidelines in practice. This will be achieved through co-designing the implementation process with a multi-disciplinary group comprising ICU clinicians from the Flinders Medical Centre, along with patients. This work will commence this year and be crucial to the effective rollout of the guidelines nationally.
These guidelines are likely to receive international acceptance – beyond Denmark – with Dr Adams and team presenting their findings at conferences in New Zealand, Switzerland and Italy in 2025.
“Because we have developed these guidelines over two countries, it is recognised that they are likely to also be applicable in other countries. Through the collaborative way we developed these guidelines, it means that we have saved a lot of resources and time.”
This work stands as a fitting tribute to honour the late Professor Sørensen, a revered nursing professor at Aalborg University in Denmark who dedicated his career to elevating the delivery of high-quality fundamental care and nursing education.
The Erik Elgaard Sørensen PhD scholarship was established by Flinders University and Aalborg University to facilitate joint-supervision of students between the two institutions, fostering cross-cultural research and collaboration in nursing.
Dr Adams says the scholarship allowed her academic pursuits to be enriched through being about to work and travel between two countries.
“My research journey, involving an overseas trip to Denmark, gave me important insights into international collaboration and how we can learn from each other to produce research at an international level and with a global impact.”