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Thank you for your responses. I work in the MICU, but since no one has received proper education on RASS, it's easy for us to get confused or for our evaluation to be influenced by the patient's level of consciousness. I would greatly appreciate any past experiences with RASS that you could share! We are currently hoping to promote correct assessment by nurses, but as we are not in an English-speaking country, we are still figuring things out together! Anyway, thank you all for addressing my question.

My colleague and I have encountered patients who are able to open their eyes on their own, engage in activities that might not be fully conscious, and seem to follow their own routine(sleep and awake), yet they do not respond to voice. It appears as though they are living in their own little world, disconnected from external engagement. The challenge we face is determining the appropriate RASS score for such patients. Would they be classified as -3, indicating a lack of eye contact, or as 0, which suggests a patient is alert and oriented? We have this argument cause none of us were trained for RASS accuracy. Help someone could help us to clarify.