Factors influencing the outcome of nurse delivered procedural sedation and analgesia during atrial fibrillation ablation: a mixed methods study

Barker, Stuart John (2021) Factors influencing the outcome of nurse delivered procedural sedation and analgesia during atrial fibrillation ablation: a mixed methods study. Doctoral thesis, Northumbria University.

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Abstract

Despite continual rising demand for atrial fibrillation ablation, numbers of cases performed have plateaued. One reason for this is a shortage of appropriately skilled sedationists. Administration of sedation by nurses using a protocol is a potential solution, but virtually no research exists on the impact of this on the quality of patient care.

This project aimed to evaluate the use of such a protocol in a single NHS Trust in terms of safety and patient experience. By doing so, it was intended that it should ascertain the feasibility of protocol-based sedation by nurses, and identify areas in the practice studied requiring alteration in order to optimise patient outcomes.

A two-stage mixed methods project was undertaken. An initial survey phase provided statistical data that allowed comparison between the safety of protocolised nurse-led sedation and other sedation practices. Fuzzy set Qualitative Comparative Analysis (QCA) of the survey data allowed for exploration of patterns of complexity between components determining patient experience, a possibility identified within existing theories of pain such as the 'Gate Control Theory'. Subsequently pathways leading to positive experiences were modelled. These pathways were then tested using a series of case studies to ascertain the existence of causal links between the identified factors and positive outcomes as well as the extent to which protocol-adherence facilitated positive outcomes.

This thesis presents findings from both stages. These include the conclusion that nurse-delivered sedation is at least as safe as other methods. It establishes more than one pathway to positive patient experiences may exist, but finds strongest evidence that effective management of patient anxiety leads to a positive outcome. However, it also concludes that creating this outcome depends on the clinical judgement of the individual nurse, and identifies alterations in the status of the protocol and its content to facilitate optimal outcomes.

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