Increasing Emergency Nurses' Knowledge of Awareness with Paralysis

Background: AWP is a frightening complication of medications used to facilitate endotracheal intubation and mechanical ventilation and occurs when patient is given neuromuscular blocking agent (NMBA) and conscious enough to perceive sensory input but cannot move or breathe. Terror, helplessness, pain, feelings of suffocation, and sensations of profound isolation and imminent death have been reported by survivors and volunteer research subjects. AWP can be a life-changing event and survivors may develop anxiety, depression, and post-traumatic stress disorder (PTSD). Several recent ED trials have documented an AWP incidence of 2.6 – 7.4% in patients receiving NMBAs, which represents nearly 3600% increase when compared to surgical patients. Purpose: Purpose of this quality improvement (QI) project was increased emergency department (ED) nurse knowledge of awareness with paralysis (AWP), risk factors and ED practices believed to increase its incidence, and suggested mitigation strategies and best practices. Methods: This QI project used pretest/posttest design to determine effectiveness of an education intervention aimed at increasing ED nurse knowledge regarding risk factors and ED practices thought to increase incidence of AWP, and suggested mitigation strategies and best practices. Participants were contacted by email, given hyperlink, and asked to take pre-intervention survey, view narrated slide presentation, and complete post-intervention survey. Results: After intervention, participating ED nurses had statistically significant improvements in survey scores which evaluated their knowledge of AWP, ED specific risk factors, and sedation best practices, t(11) = 5.30, p < 0.001, g = 1.42. Participants also had statistically significant (p = 0.004) increases in their self-reported familiarity with AWP and associated mitigation strategies, as well as increased confidence in discussing rapid sequence intubation and post-intubation sedation plan with physician team. Conclusions: QI project found a single intervention, delivered as video presentation, increased participating ED nurses’ knowledge about AWP and positively affected attitudes regarding understanding of complication, sedation best practices highlighted in education, and confidence in working collaboratively with physicians in pre-intubation period.

Name thesis:degree_name

D.N.P.

Level thesis:degree_level

doctoral

Discipline thesis:degree_discipline

Graduate College

Grantor dc:publisher

The University of Arizona.

Year dc:date.issued

2026

Author dc:creator

• Tredici, John

Advisor dc:contributor.advisor

• DeBoe, Joseph C.

Committee members dc:contributor.committeemember

• Carlisle, Heather L.
• Edwards, Christopher

Statement dc:rights

• Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction, presentation (such as public display or performance) of protected items is prohibited except with permission of the author.

Licence dc:rights.uri

• http://rightsstatements.org/vocab/InC/1.0/

Language dc:language.iso

en

Handle dc:identifier.uri

http://hdl.handle.net/10150/680220

OAI identifier oai:identifier

oai:repository.arizona.edu:10150/680220