Sedation scales: Do they capture the concept of opioid-induced sedation?

Aim: The purpose of this study was to explore the concept of opioid-induced sedation and how nurses define and measure sedation in the hospital setting.

Background: Opioid medications are the primary treatment for acute pain in the postoperative setting. One of the most serious side effects of opioid therapy is excessive sedation and respiratory depression. Nurses have the responsibility of providing effective pain management, while keeping the patient safe from adverse sedation and respiratory depression. Thus, the assessment of sedation becomes an integral part of the nurses' responsibilities.

Review Method: A review of the literature on the concept of opioid-induced sedation, and how it is measured by nurses in the hospital setting was performed using the Walker and Avant's (2011) framework.

Results: Sedation is an ambiguous concept that challenges nurse's critical thinking skills. The linear sedation scales can assist with the measurement of sedation, but may lack sensitivity and specificity in detecting the small changes on the continuum of levels of consciousness. Additionally, the scales may not capture the entire aspects of the concept of sedation.

Conclusions: Sedation, as defined by the linear sedation scales is limiting nurses' appreciation of the small changes in level of cognition as well as consciousness that occurs as an adverse and potentially dangerous side effect of opioid medications used for acute pain management. Through developing a better understanding of sedation as a clinical concept, nurses may enhance their clinical skillset in safer postoperative pain management. Additionally, linear sedation scales could be further developed to better capture all aspects of sedation.