Skip to main content

Research Repository

Advanced Search

Nursing judgement and decision-making using the Sedation Withdrawal Score (SWS) in children

Jarman, Ian H.; Craske, Jennie; Carter, Bernie; Tume, Lyvonne N


Ian H. Jarman

Jennie Craske

Bernie Carter

Lyvonne N Tume


© 2017 John Wiley & Sons Ltd Aims: The aim of the study was to evaluate registered children's nurses’ approaches to the assessment and management of withdrawal syndrome in children. Background: Assessment of withdrawal syndrome is undertaken following critical illness when the child's condition may be unstable with competing differential diagnoses. Assessment tools aim to standardize and improve recognition of withdrawal syndrome. Making the right decisions in complex clinical situations requires a degree of mental effort and it is not known how nurses make decisions when undertaking withdrawal assessments. Design: Cognitive interviews with clinical vignettes. Methods: Interviews were undertaken with 12 nurses to explore the cognitive processes they used when assessing children using the Sedation Withdrawal Score (SWS) tool. Interviews took place in Autumn 2013. Findings: Each stage of decision-making—noticing, interpreting and responding—presented cognitive challenges for nurses. When defining withdrawal behaviours nurses tended to blur the boundaries between Sedation Withdrawal Score signs. Challenges in interpreting behaviours arose from not knowing if the patient's behaviour was a result of withdrawal or other co-morbidities. Nurses gave a range of diagnoses when interpreting the vignettes, despite being provided with identical information. Treatment responses corresponded to definite withdrawal diagnoses, but varied when nurses were unsure of the diagnosis. Conclusion: Cognitive interviews with vignettes provided insight into nurses’ judgement and decision-making. The SWS does not standardize the assessment of withdrawal due to the complexity of the context where assessments take place and the difficulties of determining the cause of equivocal behaviours in children recovering from critical illness.


Tume, L. N., Jarman, I. H., Craske, J., Carter, B., Jarman, I., & Tume, L. N. (2017). Nursing judgement and decision-making using the Sedation Withdrawal Score (SWS) in children. Journal of Advanced Nursing, 73(10), 2327-2338.

Journal Article Type Article
Acceptance Date Feb 16, 2017
Online Publication Date May 3, 2017
Publication Date Oct 1, 2017
Journal Journal of Advanced Nursing
Print ISSN 0309-2402
Electronic ISSN 1365-2648
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 73
Issue 10
Pages 2327-2338
Keywords child, sedation withdrawal, nurse decision-making, cognitive interviews
Public URL
Publisher URL
Additional Information Additional Information : This is the peer reviewed version of the following article: Craske, J., Carter, B., Jarman, I. and Tume, L. N. (2017) Nursing judgement and decision-making using the Sedation Withdrawal Score (SWS) in children. Journal of Advanced nursing. ISSN 0309-2402 Available from:, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.


You might also like

Downloadable Citations