In whose best interests? Nurses' experiences of the administration of sedation in general medical wards in England: An application of the critical incident technique

Background: Despite concern expressed in recent government documents in the UK about the inappropriate use of sedation when a patient is agitated or confused and cannot consent, there is little nursing literature on the topic. The general legal and ethical principles apply that a patient who is unable to consent should be given care that is in his or her 'best interests'. Aim: The aim of this paper is to report on qualitative data concerning nurses' use of sedation which were obtained as part of a larger study to explore the way in which nurses obtain consent prior to nursing care procedures. Method: A purposive sample of 30 qualified nurses in two teaching hospitals in England was obtained. One hundred critical incidents were collected through 30 in-depth interviews as a means of focusing on specific incidents concerning informed consent prior to nursing care procedures in clinical practice. Findings: The administration of sedation to patients who cannot consent was a major theme to emerge. Sedation was sometimes given in the interests of other patients or staff rather than the patient and before alternative strategies had been considered. Nurses were uneasy about the use of sedation in such circumstances, and lacked knowledge as to when it may be appropriate to do so. Conclusions: Nurses need to be familiar with the relevant ethical and legal principles and professional guidance in their own countries for caring for people who cannot consent, and need to be confident in their understanding and application of these principles to ensure that sedation is administered appropriately. (c) 2005 Elsevier Ltd. All rights reserved.