Table 3.

Themes and representative quotations from study participants

Themes		Representative quotations
The professional perspectives on patient wakefulness state	When to worry?	‘If a patient is agitated, we can fix it.’ (FG3) ‘If the patient is comatose, we are more worried, you may not be able to do anything to help them.’ (FG3) ‘Agitated patients are more call to action, annoying and keeping you busy.’ (FG2) ‘Trying to get out of bed when they are not supposed to.’ (FG2)
	The optimal patient wakefulness state	‘I don’t want to remember anything because of fear of PTSD.’ (FG5) ‘Better when they are able to communicate with nurses and follow instructions.’ (FG2) ‘I want to be able to know everything about the current situation and to make decisions on healthcare management.’ (FG4)
The professional perspectives on pain, agitation and delirium (PAD) management of critically ill patients	Clinical conditions of patients	‘Patient coming in with previous dementia or Alzheimer makes delirium management difficult.’ (FG3) ‘Fentanyl is good for pain unless patient has already developed tolerance.’ (FG1) ‘Propofol is great if not hemodynamically compromised.’ (FG1)
	Preferences of healthcare providers	‘Some doctors take a more conservative treatment while others use multiple drugs.’ (FG2) ‘Night nurses heavily sedate patients for easier management—takes longer for day staff to assess patients since it takes time to wean patient off sedation.’ (FG2)
The factors impacting PAD management	Interprofessional dynamics	‘The nurses like to work together, like a team, which will make a difference, but it depends on the staff.’ (FG1) ‘Nurses don’t explain to patients what they are doing.’ (FG3) ‘Talk to patient like they are, they can hear us, be gentle.’ (FG3) ‘Patient should be told what’s going on.’ (FG3) ‘Don’t approach patient too abruptly.’ (FG4)
	Environmental factors	‘Overhead announcements and monitors with constant beeping are distracting and preventing good quality of sleep.’ (FG1) ‘Very bright light—difficult to regulate sleep patterns. ’ (FG2) ‘Loss of day night cycle if the patient is not facing the window.’ (FG1) ‘Line insertions, intubations, chest tube insertion, X-ray, blood work at 6 am disrupt sleep.’ (FG2)
	Family Input	‘Do not want family splitting the team or pitting nurses against each other.’ (FG2) ‘Family induces stress in patient, agitating patient, talking at patient, and not allowing patient to rest. ’ (FG3) ‘Educational material available to families might eliminate inconsistent practices such as different nurses telling patient families different things.’ (FG3) ‘Educational pamphlets to family to teach them how to manage from non-pharmacological side would help.’ (FG5) ‘It would be helpful if the family knew what patients’ wishes are, whether they want to be completely sedated or conscious/aware.’ (FG2)