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Perelló-Campaner C, González-Trujillo A, Alorda-Terrassa C, González-Gascúe M, Pérez-Castelló JA, Morales-Asencio JM, Molina-Mula J. Determinants of Communication Failure in Intubated Critically Ill Patients: A Qualitative Phenomenological Study from the Perspective of Critical Care Nurses. Healthcare (Basel) 2023; 11:2645. [PMID: 37830682 PMCID: PMC10572283 DOI: 10.3390/healthcare11192645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
AIM To explore what factors determine communication with awake intubated critically ill patients from the point of view of critical care nursing professionals. BACKGROUND Impaired communication frequently affects mechanically ventilated patients with artificial airways in the intensive care unit. Consequences of communication breaches comprise emotional and ethical aspects as well as clinical safety, affecting both patients and their conversation partners. Identification of determining factors in communication with awake intubated patients is needed to design effective action strategies. DESIGN A qualitative phenomenological approach was used. METHODS Semi-structured interviews were used as the data collection method. A total of 11 participants from three intensive care units of three Majorcan public hospitals, selected by purposive sampling, were interviewed. FINDINGS Three major themes regarding the communication determinants of the awake intubated critically ill patients were identified from the interviewees' statements: factors related to the patient (physical and cognitive functionality to communicate, their relational and communicative style and their personal circumstances), to the context (family presence, ICU characteristics, workload, availability/adequacy of communication aids, features of the messages and communication situations) and, finally, those related to the professionals themselves (professional experience and person-centredness). CONCLUSIONS The present study reveals determinants that influence communication with the awake intubated patient, as there are attitudes and professional beliefs. RELEVANCE TO CLINICAL PRACTICE The discovery of relations between different kinds of determinants (of patient, context or professionals) provides a multi-factor perspective on the communicative problem which should be considered in the design of new approaches to improve communicative effectiveness. This study is reported according to the COREQ checklist.
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Affiliation(s)
- Catalina Perelló-Campaner
- Emergency Care Service 061, 07011 Palma, Spain
- SATSE CIDEFIB, c/Antoni Marques, 4. Bjs izqda, 07003 Palma, Spain
| | - Antonio González-Trujillo
- SATSE CIDEFIB, c/Antoni Marques, 4. Bjs izqda, 07003 Palma, Spain
- Emergency Hospital Care Service, Hospital de Manacor, 07500 Manacor, Spain
| | - Carme Alorda-Terrassa
- Nursing and Physiotherapy Department, University of Balearic Islands, 07122 Palma, Spain (J.M.-M.)
| | | | | | - José Miguel Morales-Asencio
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Instituto de Investigación Biomédica de Málaga (IBIMA-Bionand), 29016 Málaga, Spain
| | - Jesús Molina-Mula
- Nursing and Physiotherapy Department, University of Balearic Islands, 07122 Palma, Spain (J.M.-M.)
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Communication with Chronic Patients Weaning from Mechanical Ventilation: A Qualitative Study on Iranian ICU Caregivers. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2020. [DOI: 10.52547/pcnm.10.3.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Patient and Family Centered Actionable Processes of Care and Performance Measures for Persistent and Chronic Critical Illness: A Systematic Review. Crit Care Explor 2019; 1:e0005. [PMID: 32166252 PMCID: PMC7063874 DOI: 10.1097/cce.0000000000000005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Supplemental Digital Content is available in the text. To identify actionable processes of care, quality indicators, or performance measures and their evidence base relevant to patients with persistent or chronic critical illness and their family members including themes relating to patient/family experience.
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The work undertaken by mechanically ventilated patients in Intensive Care: A qualitative meta-ethnography of survivors’ experiences. Int J Nurs Stud 2018; 86:60-73. [DOI: 10.1016/j.ijnurstu.2018.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 02/02/2023]
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Freeman-Sanderson AL, Togher L, Elkins M, Kenny B. Quality of life improves for tracheostomy patients with return of voice: A mixed methods evaluation of the patient experience across the care continuum. Intensive Crit Care Nurs 2018; 46:10-16. [PMID: 29551223 DOI: 10.1016/j.iccn.2018.02.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 02/01/2018] [Accepted: 02/06/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES A tracheostomy tube can profoundly impact ability to communicate. The impact of this on patients' self-esteem and quality of life in the care continuum from the intensive care unit to after decannulation has not been reported. Therefore, the aim was to investigate the patient-reported experience regarding change in communication function, communication-related self-esteem and quality of life. RESEARCH DESIGN A mixed methods approach was utilised. Quantitative data were obtained using validated measures of self-esteem related to communication-related quality of life and general health. Data were measured before return of voice, within 48 hours of voice return and six months after tracheostomy decannulation. Qualitative data were collected through structured interviews six months after tracheostomy. RESULTS Seventeen participants completed the study. Four themes emerged from the interviews: It's hard communicating without a voice; What is happening to me?; A storm of dark emotions and More than a response…it's participating and recovering. Significant positive change occurred in six items of self-esteem related to communication from baseline to return of voice. Overall, positive changes in quality of life scores were observed. CONCLUSIONS Voice loss with tracheostomy significantly affected participants' abilities to effectively communicate their care and comfort needs. Restoration of voice occurred in conjunction with patient-reported improved mood, outlook and sense of recovery.
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Affiliation(s)
- Amy L Freeman-Sanderson
- Royal Prince Alfred Hospital, Australia; Faculty of Health Sciences University of Sydney, Australia.
| | - Leanne Togher
- Faculty of Health Sciences University of Sydney, Australia
| | - Mark Elkins
- Sydney Medical School, University of Sydney, Australia; Centre for Education & Workforce Development, Sydney Local Health District, Australia
| | - Belinda Kenny
- Faculty of Health Sciences University of Sydney, Australia
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Wermström J, Ryrlén E, Axelsson ÅB. From powerlessness to striving for control - experiences of invasive treatment while awake. J Clin Nurs 2017; 26:1066-1073. [DOI: 10.1111/jocn.13440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Johanna Wermström
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
- Institute of Health and Care Science; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Eva Ryrlén
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
- Institute of Health and Care Science; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Åsa B Axelsson
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
- Institute of Health and Care Science; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Abstract
The purpose of this qualitative inquiry was to examine the meaning of prolonged mechanical ventilation from the perspective of the patient with a diagnosis of chronic obstructive pulmonary disease (COPD). Interviews were conducted with four individuals with a diagnosis of COPD who had experienced long-term ventilator dependence. Participants were asked to reflect on their experiences while they were ventilator dependent, and their narratives were utilized as text for hermeneutical analysis. The study's findings describe three distinct phases experienced by the participants, beginning with intubation and lasting until well after discharge from the hospital. The support of nurses was an important aspect of maintaining hope for the participants. The study revealed that prolonged mechanical ventilation had a profound impact on COPD patients and their sense of self. Postdischarge psychological support and follow-up with survivors of this experience is warranted.
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Yang R. Dependency in Critically Ill Patients: A Meta-Synthesis. Glob Qual Nurs Res 2016; 3:2333393616631677. [PMID: 28462328 PMCID: PMC5342646 DOI: 10.1177/2333393616631677] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 01/04/2016] [Accepted: 01/07/2016] [Indexed: 12/23/2022] Open
Abstract
By necessity, critically ill patients admitted to intensive care units (ICUs) have a high level of dependency, which is linked to a variety of negative feelings, such as powerlessness. However, the term dependency is not well defined in the critically ill patients. The concept of “dependency” in critically ill patients was analyzed using a meta-synthesis approach. An inductive process described by Deborah Finfgeld-Connett was used to analyze the data. Overarching themes emerged that reflected critically ill patients’ experience and meaning of being in dependency were (a) antecedents: dependency in critically ill patients was a powerless and vulnerable state, triggered by a life-threatening crisis; (b) attributes: the characteristic of losing “self” was featured by dehumanization and disembodiment, which can be alleviated by a “self”-restoring process; and (c) outcomes: living with dependency and coping with dependency. The conceptual model explicated here may provide a framework for understanding dependency in critically ill patients.
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Affiliation(s)
- Rumei Yang
- University of Utah, Salt Lake City, UT, USA
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Laurent A, Magalie B, Ansel D, Aubert L, Mellier D, Quenot JP, Capellier G. Les professionnels de réanimation à l’épreuve de la relation avec le patient. EVOLUTION PSYCHIATRIQUE 2015. [DOI: 10.1016/j.evopsy.2014.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
BACKGROUND In the 21st century, we are starting to discover and understand the longer term sequelae of critical illness from both patient's and family members' perspectives. The consequential effects on physical and psychological function and the social landscape are being slowing realized. We are beginning to understand the long-term legacy of critical care, with survivorship possibly the greatest challenge within the critical care setting. AIM To draw together research that has appraised the experience of surviving critical illness from the holistic, triadic perspectives of survivor, relative and critical care nurse. In doing so, knowledge of the complexities of the critical care trajectory is enhanced. SEARCH STRATEGY Using Medline; Assia; CINAHL Plus; SCOPUS; Web of knowledge searches from 2000 to 2015 were conducted utilizing the terms 'critical care'; 'intensive care', ITU; patient*; relative*; family member*; experience*; nurse*, and trajectory. Relevant exclusion criteria were applied to provide a generalist adult critical care perspective. RESULTS Following a process of constant comparative analysis of the literature and thematic synthesis, seven themes were highlighted. Facing mortality, critical junctures, physiological sequelae, psychological sequelae, family presence, beyond meeting the needs of family members and technology versus humanity were all emergent themes. CONCLUSION As humans, we do not live an isolated life; we are interdependent upon each other. This inclusive review of literature has highlighted the lacunae and areas of dissonance both in the literature and in clinical practice in relation to the critical care trajectory as experienced by survivors of critical illness and their families. RELEVANCE TO CLINICAL PRACTICE Critical care nurses can and should play a role in preparing and supporting patients and families beyond the critical care unit. In turn, Registered Nurses needed to be supported to fulfil this important role in enabling the process of moving patients and their families from surviving to thriving (survivorship).
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Stayt LC, Seers K, Tutton E. Patients' experiences of technology and care in adult intensive care. J Adv Nurs 2015; 71:2051-61. [PMID: 25868064 DOI: 10.1111/jan.12664] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 01/12/2023]
Abstract
AIMS To investigate patients' experiences of technology in an adult intensive care unit. BACKGROUND Technology is fundamental to support physical recovery from critical illness in Intensive Care Units. As well as physical corollaries, psychological disturbances are reported in critically ill patients at all stages of their illness and recovery. Nurses play a key role in the physical and psychological care of patients;, however, there is a suggestion in the literature that the presence of technology may dehumanise patient care and distract the nurse from attending to patients psychosocial needs. Little attention has been paid to patients' perceptions of receiving care in a technological environment. DESIGN This study was informed by Heideggerian phenomenology. METHODS The research took place in 2009-2011 in a university hospital in England. Nineteen participants who had been patients in ICU were interviewed guided by an interview topic prompt list. Interviews were transcribed verbatim and analysed using Van Manen's framework. FINDINGS Participants described technology and care as inseparable and presented their experiences as a unified encounter. The theme 'Getting on with it' described how participants endured technology by 'Being Good' and 'Being Invisible'. 'Getting over it' described why participants endured technology by 'Bowing to Authority' and viewing invasive technologies as a 'Necessary Evil'. CONCLUSION Patients experienced technology and care as a series of paradoxical relationships: alienating yet reassuring, uncomfortable yet comforting, impersonal yet personal. By maintaining a close and supportive presence and providing personal comfort and care nurses may minimize the invasive and isolating potential of technology.
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Affiliation(s)
| | - Kate Seers
- Royal College of Nursing Research Institute, University of Warwick, Coventry, UK
| | - Elizabeth Tutton
- Royal College of Nursing Research Institute, University of Warwick, Coventry, UK
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Jakimowicz S, Perry L. A concept analysis of patient-centred nursing in the intensive care unit. J Adv Nurs 2015; 71:1499-517. [PMID: 25720454 DOI: 10.1111/jan.12644] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2015] [Indexed: 11/28/2022]
Abstract
AIM To report an analysis of the concept of patient-centred nursing in the context of intensive care. BACKGROUND Clarification of patient-centred nursing in the intensive care unit is important because consensus definition of this concept is lacking. The severely compromised physiological state of these people and the sequelae of this differentiate patient-centred nursing in intensive care from that occurring in other hospital settings. While the broad concept has been analysed, it has not been examined in the context of intensive care. DESIGN Concept analysis. DATA SOURCES CINAHL, PsycINFO, Medline and PubMed databases (2000-2014) were searched. Peer-reviewed papers were identified and reference lists of relevant articles searched. METHODS Walker and Avant's eight-stage approach was used. RESULTS Patient-centred nursing in the intensive care unit incorporates antecedents of a physiologically compromised patient requiring biomedical intervention, a professional and competent nurse and organizational support. The concept's defining attributes entail maintenance of patient identity by a compassionate and professional nurse exercising biomedical expertise. Consequences include patient satisfaction, positive patient experience, nurse job satisfaction and better nurse workforce retention. CONCLUSION Patient-centred nursing in intensive care is differentiated from other healthcare areas by the particular characteristics of critically ill patients, the critical care environment and the challenging bio-psycho-social demands made on intensive care nurses. Effective patient-centred nursing in this environment promotes beneficial outcomes for patients, nurses and healthcare service. Decision-makers and policymakers should support critical care nurses in this challenging role, to maintain delivery of patient-centred nursing and grow an effective nursing workforce.
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Affiliation(s)
- Samantha Jakimowicz
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Lin Perry
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
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Tsay SF, Mu PF, Lin S, Wang KWK, Chen YC. The experiences of adult ventilator-dependent patients: A meta-synthesis review. Nurs Health Sci 2013; 15:525-33. [DOI: 10.1111/nhs.12049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/13/2013] [Accepted: 01/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Shwu-Feng Tsay
- R. O.C., Health Bureau; Taichung City Government; Taichung Taiwan
- Department of Health Service Administration; China Medical University; Taichung Taiwan
| | - Pei-Fan Mu
- Institute of Clinical and Community Health Nursing; National Yang-Ming University; Taipei Taiwan
| | - Shirling Lin
- Nursing Department; Taipei Veterans General Hospital; Taipei Taiwan
| | | | - Yu-Chih Chen
- Nursing Department; Taipei Veterans General Hospital; Taipei Taiwan
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Tingsvik C, Bexell E, Andersson AC, Henricson M. Meeting the challenge: ICU-nurses' experiences of lightly sedated patients. Aust Crit Care 2013; 26:124-9. [PMID: 23369717 DOI: 10.1016/j.aucc.2012.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 12/27/2012] [Accepted: 12/30/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Sedation of intensive care patients is necessary for comfort and to implement appropriate treatment. The trend of sedation has gone from deep to light sedation. The topic is of interest to intensive care nursing because patients are generally more awake, which requires a different clinical approach than caring for deeply sedated patients. PURPOSE The aim of this study was to describe intensive care unit (ICU) nurses experiences of caring for patients who are lightly sedated during mechanical ventilation. METHODS A qualitative approach was used. Semi-structured interviews with nine intensive care nurses were conducted. The interview texts were subjected to qualitative content analysis, resulting in the formulation of one main category and six sub-categories. FINDINGS The nurses' experience of lightly sedated patients was described as a challenge requiring knowledge and experience. The ability to communicate with the lightly sedated patient is perceived as important for ICU nurses. Individualised nursing care respecting the patients' integrity, involvement and participation are goals in intensive care, but might be easier to achieve when the patients are lightly sedated. CONCLUSION The results reinforce the importance of communication in nursing care. It is difficult however to create an inter-personal relationship, encourage patient involvement, and maintain communication with deeply sedated patients. When patients are lightly sedated, the nurses are able to communicate, establish a relationship and provide individualised care. This is a challenge requiring expertise and patience from the nurses. Accomplishing this increases the nurses satisfaction with their care. The positive outcome for the patients is that their experience of their stay in the ICU might become less traumatic.
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Affiliation(s)
- Catarina Tingsvik
- Operations and Intensive Care Unit, Ryhov County Hospital, SE 551 85 Jönköping, Sweden; School of Health Sciences, Jönköping University, Box 1026, SE-551 11 Jönköping, Sweden
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Karlsson V, Bergbom I, Forsberg A. The lived experiences of adult intensive care patients who were conscious during mechanical ventilation: A phenomenological-hermeneutic study. Intensive Crit Care Nurs 2012; 28:6-15. [DOI: 10.1016/j.iccn.2011.11.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 11/08/2011] [Accepted: 11/12/2011] [Indexed: 10/14/2022]
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Zeilani R, Seymour JE. Muslim women's narratives about bodily change and care during critical illness: a qualitative study. J Nurs Scholarsh 2011; 44:99-107. [PMID: 22141404 DOI: 10.1111/j.1547-5069.2011.01427.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To explore experiences of Jordanian Muslim women in relation to bodily change during critical illness. DESIGN A longitudinal narrative approach was used. A purposive sample of 16 Jordanian women who had spent a minimum of 48 hr in intensive care participated in one to three interviews over a 6-month period. FINDINGS Three main categories emerged from the analysis: the dependent body reflects changes in the women's bodily strength and performance, as they moved from being care providers into those in need of care; this was associated with experiences of a sense of paralysis, shame, and burden. The social body reflects the essential contribution that family help or nurses' support (as a proxy for family) made to women's adjustment to bodily change and their ability to make sense of their illness. The cultural body reflects the effect of cultural norms and Islamic beliefs on the women's interpretation of their experiences and relates to the women's understandings of bodily modesty. CONCLUSIONS This study illustrates, by in-depth focus on Muslim women's narratives, the complex interrelationship between religious beliefs, cultural norms, and the experiences and meanings of bodily changes during critical illness. CLINICAL RELEVANCE This article provides insights into vital aspects of Muslim women's needs and preferences for nursing care. It highlights the importance of including an assessment of culture and spiritual aspects when nursing critically ill patients.
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Affiliation(s)
- Ruqayya Zeilani
- The University of Jordan, Faculty of Nursing, Amman, Jordan.
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Crocker C, Scholes J. The importance of knowing the patient in weaning from mechanical ventilation. Nurs Crit Care 2011; 14:289-96. [PMID: 19840275 DOI: 10.1111/j.1478-5153.2009.00355.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of the research was to understand how nurses used technology to wean patients from mechanical ventilation. BACKGROUND The literature concerned with the development of critical care centres on the role of technology with little emphasis on the nursing contribution. DESIGN An ethnographic approach was used to understand how nurses used technology to wean patients from mechanical ventilation. METHODS Data were gathered by participant observation and interviewing over a 6-month period. In total, 250 h of field notes were recorded. RESULTS Data were analysed by the content analysis method. Knowing the patient was a central theme identified. Three sub-themes were identified: ways of knowing, continuity of care and the role of the patient in the weaning trajectory. CONCLUSION 'Knowing the patient' was implied during the interviews as essential to the delivery of patient-centred care. There were two main factors that needed to be present in order for nurses to know their patients: continuity of care and expertise. 'Ways of knowing' was reliant on gaining information about the patient. The role of the patient was a passive recipient of treatment. IMPLICATIONS FOR PRACTICE Knowing the patient has been defined as a characteristic of expert nursing. To be truly patient-centred nursing needs to address the barriers that prevent nurses from getting to 'know' their patients.
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Affiliation(s)
- Cheryl Crocker
- Critical Care, Nottingham University Hospitals, Hucknall Road, Nottingham NG5 1PB, UK.
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Muslim women's experiences of suffering in Jordanian intensive care units: a narrative study. Intensive Crit Care Nurs 2010; 26:175-84. [PMID: 20434344 DOI: 10.1016/j.iccn.2010.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 02/08/2010] [Accepted: 02/09/2010] [Indexed: 11/20/2022]
Abstract
This paper explores Muslim women's experiences of suffering in Jordanian intensive care units. A narrative approach was employed to access women's stories of their critical illness. Sixteen women who had spent at least 48 hours in intensive care were recruited from two hospitals in a Jordanian city and took part in between one and three interviews over a six-month period. Women's accounts of suffering were pervaded with physical, social, spiritual and technological themes. Pain was a central strand in the women's accounts and was experienced often as severe, overwhelming and disturbing to their sleep. The sudden onset of illness, the unfamiliar ICU environment and feeling of uncertainty made it difficult for the women to interpret their experiences. Religious beliefs and cultural norms helped the women make sense of their suffering. Social support, especially from the family, was reported by the women to be essential: a lack of social support was seen as a symbol of death. This study emphasises the importance of looking at a patient who is critically ill as a whole person within the context of their cultural, spiritual and biographical milieu.
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Mu PF, Wang KWK, Chen YC, Tsay SF. A systematic review of the experiences of adult ventilator-dependent patients. ACTA ACUST UNITED AC 2010. [DOI: 10.11124/jbisrir-2010-117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Briscoe WP, Woodgate RL. Sustaining self: the lived experience of transition to long-term ventilation. QUALITATIVE HEALTH RESEARCH 2010; 20:57-67. [PMID: 20019349 DOI: 10.1177/1049732309356096] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Long-term mechanical ventilation (LTMV) is used to support growing numbers of children and adults who develop chronic respiratory failure. The purpose of this hermeneutic phenomenological study was to explore the subjective meaning of the experience of transition from spontaneous breathing to reliance on LTMV. In-depth, audiorecorded interviews of 11 ventilated individuals living in a western Canadian province were transcribed and analyzed. The transition journey was revealed to be a time of psychological, physical, and spiritual challenge. "Sustaining self " was revealed as the essence of ventilator users' transition experience. Findings underscore the complex nature of transition to technological reliance, illuminating the need for increased health professional knowledge and understanding of the symptom experience and management options for individuals living with chronic respiratory failure. Strategies to support individuals' sense of self as they journey to a life reliant on LTMV are required.
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Affiliation(s)
- Winnifred P Briscoe
- Red River College of Applied Arts, Science and Technology, Winnipeg, Manitoba, Canada.
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Mu PF, Wang KWK, Chen YC, Tsay SF. A systematic review of the experiences of adult ventilator-dependent patients. ACTA ACUST UNITED AC 2010; 8:344-381. [PMID: 27820005 DOI: 10.11124/01938924-201008080-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The objective of this meta-synthesis study was to describe the nature of the experience of adult ventilator-dependent patients. INCLUSION CRITERIA This review considered studies utilized qualitative methods to examine the experience of adult with ventilator. The phenomena of interest were experiences of patients who were treated with ventilator for both short term and long term in ICU settings or home settings. The research was limited to studies published in Chinese or in English language. SEARCH STRATEGY The searching strategy sought to find both published and unpublished studies. The CINAHL, PubMed, MEDLINE, Cochrane Library, Chinese Periodicals Index and JIB website were used to search the articles. The preliminary keywords were drawn from the natural language terms of the topic, in the title, abstract and subject descriptors. METHODOLOGICAL QUALITY Each paper was assessed independently by two reviewers for methodological quality. The Joanna Briggs Institute's Qualitative Assessment and Review Instrument were used to appraisal the methodological quality of the articles. Any disagreements that arose between the reviewers were resolved through discussion with a third reviewer. DATA SYNTHESIS Qualitative research findings were pooled and the data analysis process involved synthesizing findings to generate a set of statements that represent the nature of the experiences of ventilator-dependent adult patients. The categories and themes/meta-syntheses were emerged from the analysis process. RESULTS A total of 997 papers were identified from various database and hand searches. Nineteen papers were critically appraised and 15 met inclusion criteria. Four papers were excluded because they did not meet the inclusion criteria. Five themes/meta-syntheses emerged from the analysis: 1). The feelings of fear due to being dependent on ventilator and the loss of control of life, 2). Disconnection with reality, 3). Impaired embodiment (body image and body boundary), 4). Construction of coping patterns, 5). Trust and caring relationship. CONCLUSION The five themes/meta-syntheses derived from the review represent the patients' experiences in regarding the threatening of the integrity of self, self-other and self-environment relationships, the coping patterns and resilient resources to maintain their self-identify and the meaning of life. These findings also illustrate the resiliency factors for those patients to cope with this stressful situation.The implications to practice include enhancing the trust relationship with health professionals, as well as the nursing actions prior to suction, during the suction procedure and post suction in related to release their psychological distress and empower their resilience factors was suggested.Furthermore, the further research could focus on the development and implementation of support programs for the patients, families, and health professionals, as well as the research regarding the reduction of psychological distress and empower the coping patterns.
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Affiliation(s)
- Pei-Fan Mu
- 1. Taiwan Joanna Briggs Institute Collaborating Centre, Taiwan. 2. School of Nursing, National Yang-Ming University, Taipei, Taiwan, R. O. C. 3. Director of Department of Nursing, Veteran General Hospital, Taipei, Taiwan R. O. C. 4. Deputy Director of Bureau of Nursing and Health Services Development, R. O. C
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Foster A. More than nothing: the lived experience of tracheostomy while acutely ill. Intensive Crit Care Nurs 2009; 26:33-43. [PMID: 19910195 DOI: 10.1016/j.iccn.2009.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 09/20/2009] [Accepted: 09/23/2009] [Indexed: 11/27/2022]
Abstract
While the physical sensations surrounding tracheostomy tube insertion have been reported within nursing and allied healthcare literature, the lived experience of these sensations is poorly described. This appears relevant given the imminent results of the Tracman study (2008). A purposive sample of three participants who had tracheostomy tubes previously within a critical care area or still in situ were recruited. They described their experiences in a face-to-face semi-structured interview that were audio taped. The interviews were transcribed verbatim and analysed using Giorgi's 5 concrete steps of the human scientific phenomenological method (1997). Findings revealed themes that drew attention to the fundamental aspects of the experience. These were: Practical recommendations draw attention to the organisational support required for staff expected to care for these patients in the ward environment. This involves the introduction of evidence based guidelines and competency based care to promote the acquisition of skills required to perform those essential tasks such as suction and stoma care to a high standard. Protected, formalised skills based teaching is seen as fundamental in this process. Patients' felt confident in nursing staff that were able to demonstrate proficiency with such tasks and this is seen as crucial when one considers that the tracheostomy tube is a new experience for patients.
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Affiliation(s)
- Andrew Foster
- Critical Care Outreach Team, Princess Alexandra Hospital, Essex, United Kingdom.
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24
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Abstract
Weaning from mechanical ventilation has attracted a growing interest recently in the medical and nursing press. Attempts have been made to determine a patient's readiness to wean, define criteria for successful weaning and enhance the weaning process through the developments of protocols. Key to this work is the role of the critical care nurse. Transferring the role and the responsibility of weaning from the traditional perspective of the intensivist to the nurse is not without challenges. Inherent is the need for skill and expertise and the willingness to accept this level of responsibility, not questioned in the medical role, but worthy of consideration when transferred to nurses. Key to successful weaning and weaning is redefined for the purposes of this paper, is continuity of care, knowing the patient and the development of patient-centred, individualized weaning plans. Critical care nurses have an important role to play. This is particularly so when the patient experience is to be understood. There is relatively little research conducted in this area, yet this is an important consideration if we are to fully understand and embrace the role of patients in their weaning. Weaning in the context of critical care can be challenging. To wean the difficult-to-wean or the long-term-weaning patient requires great skill and expertise. Expertise in this context has not been fully explored, yet research suggests that these patients are not allocated expert nurses to care for them because they are not seen as critically ill. It may be that this group of patients would benefit from a transfer to a weaning centre as suggested by the Modernisation Agency in 2002. This would greatly challenge the way we, as critical care nurses, perceive weaning in critical care.
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Affiliation(s)
- Cheryl Crocker
- Critical Care, Nottingham University Hospitals, Hucknall Road, Nottingham, UK.
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25
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Olsen KD, Dysvik E, Hansen BS. The meaning of family members' presence during intensive care stay: a qualitative study. Intensive Crit Care Nurs 2009; 25:190-8. [PMID: 19497746 DOI: 10.1016/j.iccn.2009.04.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 04/14/2009] [Accepted: 04/15/2009] [Indexed: 10/20/2022]
Abstract
The aim of this study was to investigate what the presence of family members meant to patients in intensive care units. The study employed a qualitative approach with semi-structured interviews and qualitative content analysis. Eleven intensive care patients were interviewed at a university hospital in Norway. The results of the study indicated that the patients desired some limitation of visitors' presence and preferred visits only from those who were closest in daily life. Visits had a variety of functions for intensive care patients, including promoting support for patients and families. However, visits also caused stress for patients and worries about creating stress for family members. The patients' requirements for information differed. The findings suggest that information to the families is important for the patients need for reality orientation. Visits in intensive care units and information to the families have mutual importance for the patients and their families. The study supports prior claims that flexible visiting routines are challenging for ICU nurses. A dialogue with the families is recommended in order to find a balance between the social support and the stress caused by visits. This puts the families in a better position to give support to the patients during recovery.
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Affiliation(s)
- Kristin Dahle Olsen
- Acute Clinic of Intensive Care, Stavanger University Hospital, Box 8100, N-4068 Stavanger, Norway.
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26
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Meijers KE, Gustafsson B. Patient's self-determination in intensive care-from an action- and confirmation theoretical perspective. The intensive care nurse view. Intensive Crit Care Nurs 2008; 24:222-32. [PMID: 18403204 DOI: 10.1016/j.iccn.2008.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Revised: 12/25/2007] [Accepted: 01/14/2008] [Indexed: 11/28/2022]
Abstract
When becoming an intensive care patient life changes dramatically. In order to save life, different actions are performed by the caregivers and the patient's ability to exercise self-determination is non-existent. After the acute phase the patient is more awake and the possibilities for self-determination change. The purpose of this study was to describe intensive care nurses' (ICNs) views of patient's self-determination in an intensive care unit and to systematize ICNs' nursing actions for supporting patient's self-determination from an action- and confirmation-theoretic perspective. In order to answer these questions, 17 interviews with ICNs were conducted by the use of the Critical Incident Technique (CIT). The transcripts were then analysed using a hermeneutic analysis method and structured by the SAUC model for confirming nursing. The main findings were that the ICN thought that the ICU patient's self-determination was low and restricted. It was more common that the ICN acted to strengthen the patient's self-determination in nursing care, but there were no specific nursing goals for patient's self-determination. The most common actions for supporting self-determination were supplying the patient with information and engaging the patient in making a day plan. The nursing implications are that the ICN's view of human being as an acting subject is important for the ICN's awareness to recognise the patient's own personal resources to handle the critically ill situation and that the ICN's competence to manifest qualified nursing is necessary for strengthening patient's self-determination.
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Affiliation(s)
- Katarina E Meijers
- Intensive Care Unit, South Stockholm General Hospital, Stockholm, Sweden.
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27
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A qualitative study into the lived experience of post-CABG patients during mechanical ventilator weaning. Intensive Crit Care Nurs 2008; 24:171-9. [PMID: 18280735 DOI: 10.1016/j.iccn.2007.12.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Revised: 12/13/2007] [Accepted: 12/28/2007] [Indexed: 11/23/2022]
Abstract
AIM Research into mechanical ventilator weaning has predominantly been devoted to analysis and evaluation of predictors of weaning success. Few studies have examined the patient experience of weaning. The aim of this study was to provide a contemporary description of the patient experience of weaning, in order to up-date this aspect of knowledge in the context of newer modalities of mechanical ventilation and sedation. METHODOLOGY The study had a descriptive qualitative design focusing on the lived experience of post-CABG (coronary artery bypass graft) patients ventilated > or = 24h (n=10). Data were generated using semi-structured depth interviews conducted 2-5 months after hospital discharge. A hermeneutic phenomenological approach was used to analyze the data. RESULTS The article presents selected themes that emerged during the process of analysis. The main findings relate to general phenomena such as discomfort and impaired communication, psychological phenomena such as loss of control and loneliness, and existential phenomena such as temporality and human interaction. CONCLUSION Newer modalities of sedation and mechanical ventilation have not entirely eliminated the discomforts of critical illness; the human aspects of suffering remain. In order to address some of the general, psychological, and existential patient experiences, care should be taken to acknowledge the patient and to respect the patient domain and individual time frames. In nurse-patient communication, it is recommended that caregivers give accurate and unambiguous information.
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Karlsson V, Forsberg A. Health is yearning--experiences of being conscious during ventilator treatment in a critical care unit. Intensive Crit Care Nurs 2007; 24:41-50. [PMID: 17689082 DOI: 10.1016/j.iccn.2007.06.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 04/18/2007] [Accepted: 06/01/2007] [Indexed: 11/20/2022]
Abstract
The aim of this study was to investigate experiences of being conscious during ventilator treatment in the ICU from a patient perspective. Hermeneutic, phenomenological methods were used. Eight patients who had received ventilator treatment were interviewed. The time on a ventilator varied from 1 day to several months. Some patients had been more heavily sedated during the acute phase while some were only lightly sedated and others had no sedation at all. The motor activity assessment scale was used to rate the sedation level. The patients had been sufficiently conscious to communicate with the help of the alphabet board, by means of facial expression or by nodding or shaking their head. The results show that the experience of care by patients who were conscious during ventilator treatment was described under the headings of: memories, mastering the situation and individual consequences. Health in the ICU is associated with yearning. The patient undergoes different stages of yearning as part of his or her recovery process. The patient who is conscious during ventilator treatment views him/herself and his/her worth on the basis of the attitude and behaviour of the caregivers, where the value of caring consists of the holistic confirmation of individual suffering.
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Affiliation(s)
- Veronika Karlsson
- Department of Intensive Care Unit, SkaS, Kärnsjukhuset, Skövde, Sweden.
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29
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Johnson P, St John W, Moyle W. Long-term mechanical ventilation in a critical care unit: existing in an uneveryday world. J Adv Nurs 2006; 53:551-8. [PMID: 16499676 DOI: 10.1111/j.1365-2648.2006.03757.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper reports a study to describe and interpret the meaning of being on long-term mechanical ventilation. BACKGROUND Patients who require mechanical ventilation in a critical care unit for prolonged periods of time are typically sicker than those who are ventilated for shorter periods. Despite advances in treatment modalities for critically ill patients, many still require long-term mechanical ventilation for 7 days or more. Therefore, caring for a long-term ventilated patient is often an everyday occurrence for critical care nurses; however, there is insufficient evidence of the meaning of this experience from a patient perspective. METHOD We used an ontological phenomenological approach informed by the ideas of Heidegger. Data were collected using unstructured audio-taped interviews with nine former patients from critical care units unit in Queensland, Australia. The data were collected between January 2000 and December 2001 and analysed thematically using the method developed by van Manen. FINDINGS Thematic analysis revealed four themes. This paper presents the findings from the theme titled 'existing in an uneveryday world', which revealed what it meant for participants to exist, live through and survive the many physiological and psychological effects arising from their critical illness episode. For the most part, this was an unpleasant and frightening experience that involved bizarre nightmares and inability to distinguish time, place and the familiar body; disagreeable effects from the technology used and patient care activities; and reliance on external agents for survival. In addition, participants reported how they questioned their chances of surviving the critical illness ordeal. CONCLUSION There is a need for further research in the areas of sedative and analgesic management in critically ill patients, methods of communicating with intubated and mechanically ventilated patients, and debriefing and follow-up support services for survivors.
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Affiliation(s)
- Patricia Johnson
- Faculty of Nursing and Health, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia.
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30
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Taylor F. A comparative study examining the decision-making processes of medical and nursing staff in weaning patients from mechanical ventilation. Intensive Crit Care Nurs 2006; 22:253-63. [PMID: 16406785 DOI: 10.1016/j.iccn.2005.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Revised: 10/08/2005] [Accepted: 11/11/2005] [Indexed: 11/16/2022]
Abstract
A prolonged period of mechanical ventilation is costly for both the patient, in terms of the risk of complications such as ventilator-acquired pneumonia, and to the health service due to the high cost of maintaining a patient in intensive care. The recognition of the role nurses can play in the weaning process and the desire to try and reduce weaning times led to the introduction of nurse-managed weaning on the intensive care unit which is the focus of this study. This means that both doctors and nurses are now responsible for making decisions about weaning. Flexible guidelines for weaning were devised which still require a large element of individual, clinical decision-making during the process. At every stage in the weaning process clinicians are required to make judgments about patient responses, using these judgments as the basis for their decision-making. This study examined the ways doctors and nurses make these decisions. Semi-structured interviews were conducted with doctors and senior nurses. A grounded theory approach was used to analyse the results and the key themes of Treatment, Balance, Making Progress and The Individual were identified which were found to be linked with particular methods of decision-making.
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Affiliation(s)
- Fran Taylor
- Intensive Care Unit, Bassetlaw District General Hospital, 19 George St., Worksop, Notts S80 1QJ, UK.
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