The Sedation Gap: Knowledge, Attitudes, and Real-World Practices of ICU Nurses in Public and Private Hospitals of Punjab: A Cross-Sectional Study

Abstract

Background: Sedation management is a critical component of intensive care practice, directly influencing patient safety, mechanical ventilation outcomes, and ICU morbidity. Despite its importance, inconsistencies in knowledge and clinical implementation persist among ICU nurses. Objective: To assess ICU nurses’ knowledge, attitudes, and real-world practices regarding sedation management and to identify barriers affecting optimal care in public and private hospitals of Punjab, Pakistan. Methods: A cross-sectional descriptive study was conducted among 151 ICU nurses selected through convenience sampling. Data were collected using a structured questionnaire assessing knowledge, practices, and perceived barriers. Descriptive statistics were computed using SPSS version 27. Results: Moderate knowledge was observed in 47.0% of participants, with a mean score of 5.8 ± 1.9, while only 30.5% demonstrated good knowledge. Key gaps included sedation scale identification (41.7%) and appropriate assessment frequency (38.4%). Practice inconsistencies were evident, with only 38.4% consistently documenting sedation levels and 42.4% always assessing sedation before administration. Major barriers included inadequate staffing (89.4%), high workload (86.8%), lack of training (78.8%), and absence of standardized protocols. Conclusion: A significant gap exists between knowledge and practice of sedation management among ICU nurses, primarily driven by systemic and organizational constraints. Targeted training, protocol implementation, and workforce strengthening are essential to improve critical care outcomes