A qualitative study of emergency nurses’ perspectives on intranasal ketamine for procedural sedation in children
Bibliographic record
Abstract
ABSTRACT Purpose There is mounting evidence supporting a role for intranasal (IN) ketamine for procedural sedation in children due to its less invasive delivery. Drug administration and monitoring is largely performed by nurses and clinical uptake requires understanding their perceptions. We explored nursing perspectives of IN ketamine for procedural sedation in children to understand facilitators and barriers and inform institutional guidelines. Design and Methods From January to February, 2018, we conducted 2 focus groups with 8 registered nurses in a Canadian tertiary care paediatric ED. Following professional transcription, data were analyzed using an inductive qualitative approach. Results Seven of 8 participants had experience administering IN ketamine to children for procedural sedation. Nurses perceived that IN ketamine had the potential to reduce children’s distress and improve nursing resource use. Perceived barriers included: 1) uncertainty regarding sedation effectiveness and incorporation into institutional sedation protocols, 2) perceptions that IN ketamine produced a relatively lighter, slower-onset, and less titratable sedation, and 3) healthcare providers’ lack of familiarity with IN ketamine and reluctance to change their current approach to sedation. Conclusions We identified barriers to adoption of IN ketamine such as uncertainty regarding its pharmacodynamic properties, safety, and impact on workflow, along with facilitators such as fewer adverse events and nursing resources, and less procedural distress for children. Practice Implications Provider education should focus on IN ketamine’s pharmacodynamic properties and development of institutional sedation guidelines that define indications for use, support engagement of child life specialists, and operationalize the type and duration of monitoring requirements. CLINICIAN’S CAPSULE What is known about the topic? Intranasal ketamine is an emerging agent for procedural sedation and analgesia in the emergency department due to ease of administration. What did this study ask? What are paediatric nurses’ perspectives on intranasal ketamine for procedural sedation among children in the emergency department? What did this study find? Nurses identified advantages to intranasal ketamine but expressed considerable uncertainty regarding its pharmacodynamic properties and its incorporation into clinical practice. Why does this study matter to clinicians? Provider education may overcome some uncertainty and should focus on intranasal ketamine’s pharmacodynamic properties and incorporation into institutional sedation protocols. Meetings Pediatric Academic Societies (Baltimore, Maryland, April 30, 2019); Canadian Association of Emergency Physicians (Halifax, Nova Scotia, May 29, 2019); Canadian Paediatric Society (Toronto, Ontario, June 7, 2019)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.032 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.009 | 0.008 |
| Scholarly communication | 0.004 | 0.005 |
| Open science | 0.002 | 0.006 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".