{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T16:07:59Z","timestamp":1793376479510,"version":"4.5.0"},"reference-count":26,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["HTA 16\/93\/01"],"award-info":[{"award-number":["HTA 16\/93\/01"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of the Intensive Care Society"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>This process evaluation explored delivery of a complex sedation intervention within the Alpha-2 Agonists for Sedation to Produce Better Outcomes from Critical Illness (A2B) trial, which compared dexmedetomidine- and clonidine-based sedation with propofol (usual care). All groups targeted lighter sedation levels. The objective was to understand bedside nurses\u2019 experiences delivering the interventions and identify factors influencing protocol adherence and implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A qualitative study using semi-structured interviews was conducted with intensive care unit (ICU) staff (consultants, bedside and research nurses) from A2B trial sites. Thematic analysis explored how participants experienced and delivered trial interventions, with particular focus on bedside nurses\u2019 abilities to manage sedation in line with the protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Nurses with greater ICU experience described more confidence and adaptability in using alpha-2 agonists, while less experienced staff required support due to limited familiarity with lighter sedation. Hesitancy to up-titrate alpha-2 agonists was common, driven by concerns about bradycardia and hypotension. Reluctance to down-titrate propofol was shaped by fears of agitation and self-extubation. Deep sedation norms, especially amongst nurses trained during the COVID-19 pandemic, further hindered protocol adherence. Research nurses were instrumental in supporting implementation and bridging knowledge gaps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Despite all three trial groups targeting lighter sedation, nurse confidence, safety concerns, and ingrained cultural practices limited adherence to alpha-2 agonist-based protocols. Addressing these barriers through training, support, and cultural change will be essential for future trials and practice shifts involving lighter sedation strategies in ICU.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number:<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov NCT03653832\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT03653832\">https:\/\/clinicaltrials.gov\/study\/NCT03653832<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17511437251381951","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T05:24:17Z","timestamp":1762493057000},"page":"145-154","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["The experiences of bedside nurses delivering an intensive care sedation study: A process evaluation within the A2B trial"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4250-5758","authenticated-orcid":false,"given":"Lydia M.","family":"Emerson","sequence":"first","affiliation":[{"name":"School of Health &amp; Medical Sciences, City St George\u2019s, University of London, UK"},{"name":"The Medical School, University of Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bronagh","family":"Blackwood","sequence":"additional","affiliation":[{"name":"School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalliopi","family":"Kydonaki","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, National and Kapodistrian, University of Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5190-9711","authenticated-orcid":false,"given":"Cathrine","family":"McKenzie","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Southampton, NIHR Biomedical Research Centre Southampton, Perioperative and Critical Care Theme, Department of Pharmacy and Critical Care, University Hospital Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3590-8540","authenticated-orcid":false,"given":"Timothy S.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Dept of Anaesthesia, Critical Care and Pain Medicine, Usher Institute, University of Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5722-9090","authenticated-orcid":false,"given":"Leanne M.","family":"Aitken","sequence":"additional","affiliation":[{"name":"School of Health &amp; Medical Sciences, City St George\u2019s, University of London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnsa.2021.100060"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000882"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc8956"},{"issue":"3","key":"e_1_3_2_5_2","article-title":"A focused update to the clinical practice guidelines for the prevention and management of pain, anxiety, agitation\/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU","volume":"53","author":"Lewis K","year":"2025","unstructured":"Lewis K, Balas MC, Stollings JL, et al A focused update to the clinical practice guidelines for the prevention and management of pain, anxiety, agitation\/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. 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