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A Study of Anxiety and Agitation Events in Mechanically Ventilated Patients

Tate, Judith Ann (2010) A Study of Anxiety and Agitation Events in Mechanically Ventilated Patients. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Anxiety and agitation are experienced by critically ill patients frequently and produce management challenges for clinicians. The purpose of this study was to describe critically ill patients' behaviors classified as "anxious or agitated", clinician interpretation of these behavioral cues, and choice of interventions based on those interpretations. This qualitative secondary analysis used existing longitudinal data (observations, interviews, and medical records) from an ethnographic study of 30 critically ill patients who were weaning from prolonged mechanical ventilation, patient families and clinicians who cared for them. Each event of anxiety or agitation was analyzed using dimensional analysis techniques. Exploration of relationships of resulting themes and patterns using graphic displays led to development of the Anxiety -Agitation in Critical Illness Model which describes patient physiological, behavioral and psychological responses to stimuli of anxiety and agitation; clinician assessment of symptoms of anxiety and agitation, and management strategies chosen by clinicians. Interaction was identified as the core process in which patients appraised the threat of stimuli. Clinician assessment of patient interaction guided assessment and management of anxiety and agitation. Clinicians observed and interpreted patient responses to stimuli using "knowing the patient" and attributions about anxiety and agitation. Two opposing or dialectic attributions were revealed: discrimination vs. generalization and anxiety as an expected response vs. a character flaw. Interventions were designed to modify the stimulus of anxiety or agitation and included physical comfort measures, distraction, supportive verbal strategies, and music. Withholding presence and withholding information was described by clinicians as strategies used when patient anxiety was associated with ventilator weaning. These interventions were called "out of sight, out of mind" and "sneaking the wean". These were new and unexpected psychosocial interactions not described previously in the literature. Sedation was used to modify appraisal of or response to the stimulus. Sedation management was inconsistent and variable especially when anxiety was associated with ventilator weaning. This study provides a foundation for practice improvement by offering a comprehensive model and alternative considerations for interpretation and management of symptoms in the ICU. It suggests areas for additional study, specifically, social support, sedation and withholding information or presence.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Tate, Judith Annjta100@pitt.eduJTA100
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairHapp, Mary Bethmhapp@pitt.eduMHAPP
Committee MemberDabbs, Annette Devitoajdst42@pitt.eduAJDST42
Committee MemberMilbrandt, Ericmilbeb@UPMC.EDU
Committee MemberHoffman, Leslielhof@pitt.eduLHOF
Date: 29 August 2010
Date Type: Completion
Defense Date: 8 July 2010
Approval Date: 29 August 2010
Submission Date: 5 August 2010
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: School of Nursing > Nursing
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: critical illness; event analysis; mechanical ventilation; qualitative; secondary analysis; ventilator weaning
Other ID:, etd-08052010-120123
Date Deposited: 10 Nov 2011 19:57
Last Modified: 15 Nov 2016 13:48


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