A Qualitative Study of Nurses’ Perceptions of Narcotic Administration after Subarachnoid Hemorrhage

Background: Nearly every patient admitted to a neuroscience intensive care unit (ICU) will experience pain and nurses are tasked with analgesic administration. Within the setting of the ongoing opioid epidemic it is not well understood how nurses meet the need to alleviate pain while individualizing analgesic administration. Aims: This qualitative study used a phenomenological approach to determine nurses’ perceptions in pain management of patientswith subarachnoid hemorrhage (SAH). Design: Prospective qualitative inquiry using phenomenology Setting: The study was conducted in a neuroscience intensive care unit at a university hospital. Participants: Nine neuroscience intensive care unit nurses were enrolled using snowball sampling. Methods: Saturation was reached after nine individual nurse interviews. Hermeneutic cycling analysis was used throughout interviews and codes and themes were developed throughout the interview process. Rigor was established using triangulation, rich and thick descriptions, and member checks. Results: Emerging themes included discernment and hesitation. Discernment is supported by codes such as: “nursing judgement” and “follow the orders.” Hesitation is supported by codes such as “clouded exam” and “over sedation.” Eight nurses made references to hesitation of administering opioids due to the perception that it would cause a poorer neurological exam. All nurses described a reliance on education, experience, or intuition to guide their decision to administer opioids along with using approved pain scales. Themes were confirmed by member checks, which prompted slight modifications to coding. Conclusions: Results of this study support that nurses do express apprehension in administering opioids to patients with (SAH). This apprehension leads to hesitation to administer the medication and a thought out discernment process.