What is the inter-rater reliability of the RASS by monitoring palliative sedation by community nurses?
ID
Source
Brief title
Condition
- Other condition
Synonym
Health condition
Het onderzoek betreft terminale patienten die gesedeerd worden (levenverwachting korter dan twee weken)
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Intraclass Correlation Coefficient (ICC)
Secondary outcome
inapplicable
Background summary
Palliative sedation is defined as the intentional lowering of consciousness of
a patient in the last stage of life. The patient is dying and experiences
unbearable suffering. (Royal Dutch Society for the Advancement of Medicine
[KNMG], 2009).
When a palliative sedation takes place within the home of the patient,
community nurses have an explicit role in identifying, observing, measuring and
reporting the course of the sedation. (KNMG, 2011). In order to describe the
depth of sedation, the nurse can use a sedation score (KNMG, 2009). There is no
golden standard for monitoring the depth of a palliative sedation (Arévalo,
Brinkkemper, van der Heide, Rietjens, Ribbe, Deliens, Lure, Zuurmond & Pérez,
2012).
Arévalo et al. studied four sedation scales in 2012. These scales were
validated within an ICU setting. This study showed that the Richmond Agitation
Sedation Scale (RASS) is the most reliable and valid instrument to monitor
sedation in the palliative setting. The RASS was also the least time consuming
scale. But this study was done in a clinical setting.
Problem
There is no validated scale for monitoring sedation within a homecare setting.
The study of Arévalo et al. (2012) took place in a clinical setting, being
hospices and nursing homes. However, the everyday practice of palliative care
in the homecare setting differs from the practice in the clinical setting.
The frequency of monitoring sedation in the homecare setting is lower compared
to the clinical setting. A community is a generalist and works on her own. To
improve the quality of monitoring palliative sedation, it is important to study
the RASS in a homecare setting. It should be demonstrated that the inter-rater
reliability is sufficient. Based on the research results, the RASS could be
implemented within the homecare.
Study objective
What is the inter-rater reliability of the RASS by monitoring palliative
sedation by community nurses?
Study design
Prospective observational study
Study burden and risks
This study will show no risks for the patients and/or his or her representative
that are included. During this study no interventions or invasive tests will be
performed.
The burden for the patient and/or his/her representative will be the
occasionally administering of a physical stimulus (shaking the shoulder or
rubbing the sternum). This stimulus will only be administered if a reduced
consciousness is observed. The burden for the patient and/or their
representative is best described as a daily extra nurse in their home for about
ten minutes.
This study will include the legally incapable, i.e. patients who are legally
incapable as result of delirium or unconsciousness caused by progression of the
disease. Given the purpose of the study and the nature of the care being
delivered, the measurement of the level of consciousness, it is desirable that
these clients are included within the studies population. The observational
nature of the study prevents unnecessary burden in this vulnerable population.
Reinier Postlaan 2
Nijmegen 6525 GC
NL
Reinier Postlaan 2
Nijmegen 6525 GC
NL
Listed location countries
Age
Inclusion criteria
•The indication for palliative sedation is determined by a general practionar in accordance with the national guidelines for sedation from the Royal Dutch Medical Association;
• The patient is 18 year or older;
• The sedation takes place in the home of the patient;
• The patient receives homecare from the community nurses from the ZZG Zorggroep. This care includes the assesment op the palliative sedation within the study period;
• The general practionar agrees that the patient and/or his representative will be approaced for participation in the study;
•The patient and/or his representative agrees with participation in the study and has signed the informed consent.
Exclusion criteria
No exclusion criteria
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL44376.091.13 |