Actionable companion · Leadership practice and organizational learning

From leadership research to district action: Barriers to Changing Sedation Practice for Patients Undergoing Mechanical Ventilation on the Intensive Care Unit: A Qualitative Interview Study of Clinical Staff

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

ABSTRACT Background Medical sedation is a requirement for mechanical ventilation for most patients admitted to the intensive care unit (ICU). Sedation can help minimise patient discomfort, pain and distress, but can lead to hypotension, bradycardia, prolonged ventilation and delirium. Improving sedation practice is key to improving sedation‐related patient outcomes. Aim This study aims to explore ICU staff experience with sedation practices and identify potential areas for improvement and innovation. Study Design Semi‐structured interview study exploring views, experiences and clinical decision‐making of ICU medical and nursing staff from two NHS adult ICUs in Yorkshire, England. Interviews were recorded to enable anonymous transcript production. Transcripts were coded using reflexive thematic analysis guided by Braun and Clarke's six‐stage method. Findings We interviewed 18 members of ICU medical and nursing staff and using thematic analysis four interrelated themes were identified. First, staff perception of sedation, including understanding and reasoning around sedation goals. Second, the impact that ICU culture has on sedation practices. Third, sedation education and training for clinical staff. Finally, motivation to change, aspects impacting the delivery of sedation practices on ICU and key considerations for innovating change. Conclusions Sedation practices in ICU are shaped by complex interactions between clinical framing, cultural norms, education and training and organisational pressures. Optimising sedation and implementing innovation require prioritisation of sedation as an active, goal‐directed treatment, supported by structured education and leadership engagement. Relevance to Clinical Practice This analysis offers novel insights into barriers and facilitators to innovating sedation practices for mechanically ventilated patients, highlighting under‐prioritisation in clinical practice and training, cultural barriers and external influencers like staff retention and workload. Impact Statements What is known about the topic ○ Current international guidance suggests employing a multimodal, multidisciplinary approach to tailor analgesia and sedation to individual patient needs. ○ The adverse effects associated with sedation can significantly impact both patients and the NHS. ○ There is a lack of work investigating barriers to implementing sedation interventions, the majority of which have not considered the multidisciplinary approach to sedation, have not investigated barriers to new sedative agents and were conducted outside of the UK context. What this paper adds ○ This analysis illustrates how sedation is under‐prioritised in daily practice as well as in education and training. Staff perception, combined with ICU culture, not only limits individualisation of care and impedes innovation but also functions as a safety mechanism. ○ Improving sedation practice requires a complex intervention that addresses cultural barriers and the under‐prioritisation of sedation in current practice, while increasing sedation education and training and considering external influencers like staff retention and workload.

A 90-day district inquiry

1. Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
2. Days 16–30 · Design. Choose one recurring leadership practice described in the source. Map its participants, incentives and constraints to a district setting, then design a small reversible staff pilot with an accountable owner. Agree participation, privacy protections, baseline and stopping rules before starting.
3. Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
4. Days 61–90 · Decide. Record implementation fidelity, staff review time, task quality and unintended burdens against a baseline. Use a comparison team where feasible and document alternative explanations before expanding. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Nicholas D. Richards; Hilary L. Bekker; Simon J. Howell. Barriers to Changing Sedation Practice for Patients Undergoing Mechanical Ventilation on the Intensive Care Unit: A Qualitative Interview Study of Clinical Staff. Nursing in Critical Care (2026-01-01). https://doi.org/10.1111/nicc.70348

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.