Nurses' Decision-Making and Confidence With Titration of Vasoactive Medication.

Abstract

Background: Critical care nurses are responsible for titration of intravenous vasoactive medications. Before the 2017 publication of The Joint Commission standards requiring nurses to titrate medications within specific protocols, nurses mostly titrated medications autonomously according to clinical judgment. Little is known about how nurses make decisions when titrating vasoactive medications. Additional research on this area of nursing practice is needed to optimize patient outcomes.

Objectives: To better understand critical care nurses' practices, perceptions, and decision-making processes when titrating vasoactive medications.

Methods: The study used a prospective, single-site, convergent mixed-methods, descriptive design. Nurse surveys using the Clinical Decision-Making in Nursing Scale and the Confidence Scale provided data for quantitative analysis. Semistructured interviews provided results for thematic, qualitative analysis.

Results: Nurses' scores for decision-making and confidence when titrating vasoactive medications did not differ significantly between demographic groups. Survey saturation was achieved after 10 interviews, resulting in 4 themes: using the protocol, using knowledge and critical thinking, considering patient history, and collaborating professionally.

Conclusions: Titration protocols are valued but have limitations based on patients' responses and medical history. Vasoactive medication titration requires a robust knowledge base, experience, and collaboration with physicians and coworkers. Similar confidence levels despite different years of experience may be attributed to a strong unit support system or accelerated experiences during the COVID-19 pandemic, when nurses were exposed to more patients receiving vasoactive medications.