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Dağcan N, Özden D, Gürol Arslan G. Pain perception of patients in intensive care unit after cardiac surgery: A qualitative study using Roy's Adaptation Model. Nurs Crit Care 2024; 29:512-520. [PMID: 37527978 DOI: 10.1111/nicc.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/24/2023] [Accepted: 07/14/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Although research on postoperative pain has increased, postoperative pain management is still a problem today. Most patients experience moderate to severe pain after cardiac surgery. As a result of pain, patients show inefficient adaptation behaviour in physiologic, role function, self-concept, and interdependence modes. AIM This study was conducted to examine the pain perceptions of intensive care patients after cardiac surgery according to Roy's Adaptation Model (RAM). STUDY DESIGN A qualitative design with a phenomenological approach was used in the study. The research data were collected by using a "descriptive information form", a "semi-structured interview form", and the "numerical rating scale" through the "in-depth interview method". The study sample consisted of 16 patients who were aged 18 years or older, had undergone cardiac surgery, experienced pain post-operatively in the intensive care unit at least once, and had intensive care experience. Patients with neuropathic or chronic pain or neurological or psychiatric disorders were not included in the study. Data were classified into physiologic, self-concept, and interdependence modes according to RAM. RESULTS The themes and sub-themes that emerged included physiologic modes (pain responses), self-concept modes (pain self-management), role-function modes (effects of pain), and interdependence modes (support systems in pain). CONCLUSIONS The results of our study can enable patients and nurses to communicate effectively about pain. In future studies, the effect of model-based pain management programs on cardiac surgery patients can be investigated. RELEVANCE TO CLINICAL PRACTICE Examining the pain perceptions of intensive care patients after cardiac surgery according to RAM will guide the improvement and development of pain management. It is thought that the model addresses intensive care patients experiencing pain holistically.
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Affiliation(s)
- Necibe Dağcan
- Nursing Department, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Dilek Özden
- Fundamentals of Nursing Department, Nursing Faculty, Dokuz Eylul University, Izmir, Turkey
| | - Gülşah Gürol Arslan
- Fundamentals of Nursing Department, Nursing Faculty, Dokuz Eylul University, Izmir, Turkey
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Dağcan Şahin N, Gürol Arslan G. Perspectives of patients, families and nurses on pain after cardiac surgery: A qualitative study. Nurs Crit Care 2024; 29:501-511. [PMID: 37970732 DOI: 10.1111/nicc.13000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Post-cardiac surgery pain affects patients, family caregivers and nurses. The pain experiences of patients, caregivers and nurses remain largely unknown. Therefore, it is important to examine the experiences of patients, caregivers and nurses in depth to ensure effective pain management. AIM The aim of this study is to examine post-cardiac surgery pain from the perspectives of patients, caregivers and nurses. STUDY DESIGN A descriptive qualitative research design was used. The study was carried out in the cardiovascular surgery ward of a tertiary hospital in Türkiye between June and December 2022. The data-driven triangulation method was used in the research. The study sample consisted of eight patients who had undergone cardiac surgery in the tertiary hospital, eight family caregivers and nine nurses who provided care for these individuals. A 'semi-structured interview form' was used to collect data through face-to-face and in-depth interviews. The data were analysed using the thematic analysis method. The COREQ checklist was used for reporting the study. RESULTS As a result of the interviews, six themes were elicited from the data. These themes were 'explaining pain', 'assessment of pain', 'responses to pain', 'effect of pain on activities of daily living', 'expectations in painful situations' and 'pain management'. CONCLUSIONS This study revealed the differences between pain perceptions and coping processes of patients who experienced pain after cardiac surgery, their caregivers and nurses. RELEVANCE TO CLINICAL PRACTICE Considering the experiences of patients, caregivers and nurses in pain management after cardiac surgery, applications that will ensure joint participation in care practices should be planned.
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Affiliation(s)
- Necibe Dağcan Şahin
- Fundamentals of Nursing Department, The Institute of Health Sciences, Dokuz Eylül University, Izmir, Türkiye
| | - Gülşah Gürol Arslan
- Fundamentals of Nursing Department, Nursing Faculty, Dokuz Eylül University, Izmir, Türkiye
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Shahid A, Johnstone C, Sept BG, Kupsch S, Soo A, Fiest KM, Stelfox HT. Family coaching during Spontaneous Awakening Trials and Spontaneous Breathing Trials (FamCAB): pilot study protocol. BMJ Open 2023; 13:e068770. [PMID: 36806132 PMCID: PMC9943692 DOI: 10.1136/bmjopen-2022-068770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION Many patients in the intensive care unit (ICU) require weaning from deep sedation (Spontaneous Awakening Trials, SATs) and mechanical ventilation (Spontaneous Breathing Trials, SBTs) in their journey to recovery. These procedures can be distressing for patients and their families. The presence of family members as 'coaches' during SATs/SBTs could provide patients with reassurance, reduce stress for patients and families and potentially improve procedural success rates. METHODS AND ANALYSIS This study will be executed in two phases:Development of a coaching module: a working group including patient partners (i.e., former ICU patients or family members of former ICU patients), researchers, and ICU clinicians will develop an educational module on family coaching during SATs/SBTs (FamCAB). This module will provide families of critically ill patients basic information about SATs/SBTs as well as coaching guidance.Pilot testing: family members of ICU patients will complete the FamCAB module and provide information on: (1) demographics, (2) anxiety and (3) satisfaction with care in the ICU. Family members will then coach the patient through the next clinically indicated SATs and/or SBTs. Information around duration of time and success rates of SATs and/or SBTs (ability to conduct a complete assessment) alongside feedback will be collected. ICU clinical staff (including physicians and nurses) will be asked for feedback on practicality and perceived benefits or drawbacks of family coaching during these procedures. Feasibility and acceptability of family coaching in SATs/SBTs will be determined. DISCUSSION The results of this work will inform whether a larger study to explore family coaching during SATs/SBTs is warranted. ETHICS AND DISSEMINATION This study has received ethical approval from the University of Calgary Conjoint Health Research Ethics Board. Results from this pilot study will be made available via peer-reviewed journals and presented at critical care conferences on completion.
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Corson Johnstone
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
- Department of Psychiatry, Hotchkiss Brain Institute, and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Henry Thomas Stelfox
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Salmani F, Moghimian M, Jouzi M. The effect of planned presence of the family at the time of weaning on the length of weaning from mechanical ventilation in patients with brain injury admitted to intensive care units. BMC Nurs 2022; 21:328. [PMCID: PMC9703410 DOI: 10.1186/s12912-022-01098-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Weaning the patient from mechanical ventilation (MV) is one of the common treatments in intensive care units (ICU). Among the factors that can complicate the weaning process are psychological problems caused by a lack of family visits.
Objective
This study aimed to evaluate the effect of scheduled visiting on weaning from mechanical ventilation in patients with brain injury admitted to ICUs.
Methods
This quasi-experimental study was performed on 60 patients with brain injury referred to one of the hospitals in Central Province, Iran in 2020. The selection of samples based on inclusion criteria and random allocation to the two groups of intervention and control by permuted block randomization was done. The first-degree relatives of the patients at the time of weaning in the intervention group were present at the patient’s bedside twice a day at 10:00 AM and 3:00 PM for 30–45 min and performed what they had been trained to do. Participants in the control group visited patients from the area outside the patient room. Length of weaning, length of mechanical ventilation, and length of stay in the ICU were recorded and measured using a researcher-conducted checklist. The results were analyzed using descriptive and inferential statistics and chi-square and independent t-tests in SPSS16.
Results
The study results showed that the number of patients weaned from mechanical ventilation in the intervention group was significantly higher than that of the control group (P ≤ 0.05). The mean length of weaning in the intervention and control groups was not statistically significant, but it was clinically significant in the intervention group (P > 0.05). In addition, the length of mechanical ventilation and the length of stay of the intervention group in the ICU were significantly shorter than that of the control group (P ≤ 0.05).
Conclusion
According to the study results, scheduled visiting resulted in faster weaning from mechanical ventilation. As a result, nurse managers are suggested to make arrangements for family members to be present at the patient’s bedside in order for patients to be weaned off the mechanical ventilator more easily.
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Tolotti A, Cadorin L, Bonetti L, Valcarenghi D, Pagnucci N. Communication experiences of tracheostomy patients with nurses in the ICU: A scoping review. J Clin Nurs 2022; 32:2361-2370. [PMID: 35343019 DOI: 10.1111/jocn.16296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/31/2022] [Accepted: 02/24/2022] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The quality of care for tracheostomy and mechanically ventilated patients in intensive care units (ICUs) has improved considerably. However, the communication barrier attributable to these procedures generates many problems for patients, as they are unable to communicate effectively with family members and ICU healthcare professionals, especially nurses. AIMS To describe (1) tracheostomy patients' needs, emotions and difficulties when communicating with ICU nurses and (2) which strategies nurses and patients have adopted to improve their communication. METHODS A scoping review was completed using the Joanna Briggs Institute method and following the PRISMA-ScR Checklist. The research question was developed using the Population, Concept and Context framework. Five databases were searched. After screening, two researchers independently analysed the 75 papers, and finally, 19 studies were included in this review. RESULTS All studies used a qualitative design. Seven adopted a phenomenological and two a hermeneutic approach, involving a total of 265 patients. Two main themes and four subthemes were identified: (1) the tracheostomy patients' needs, emotions and difficulties communicating with ICU nurses (patients' emotions, communication needs, and their content and difficulties) and (2) strategies that nurses and patients adopted to improve communication (communication strategies). CONCLUSIONS It is essential to develop effective communication with tracheostomy patients to ensure they feel relieved, safe and considered. Communication content should focus on information relating to the person's personal condition and active involvement in care. RELEVANCE TO CLINICAL PRACTICE It is important to prioritise the communication process in tracheostomised patients and create the organisational conditions that foster effective communication processes. Developing training programmes for new or practising nurses is essential to instil greater awareness about this crucial fundamental need.
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Affiliation(s)
- Angela Tolotti
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Lucia Cadorin
- Continuing Education Office, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Loris Bonetti
- Nursing Research Competence Centre, Nursing Direction Department, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland.,Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Dario Valcarenghi
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Nicola Pagnucci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Cardiovascular disease and meaning in life: A systematic literature review and conceptual model. Palliat Support Care 2021; 19:367-376. [PMID: 33960285 DOI: 10.1017/s1478951520001261] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Previous studies have shown that psychological stress and mental health problems increase the risk for cardiovascular disease (CVD) events, such as heart attack or stroke. Furthermore, after CVD events, the majority of patients report large stress. However, psychological treatments have only modest effects in CVD patients. Therefore, it has been argued that new conceptual models are needed to understand the aetiology of stress and mental health problems in CVD patients. Therefore, this study included a systematic literature review and a conceptual model on the role of meaning in life for psychological stress, mental health, and CVD risks. METHODS A systematic literature review was conducted on relationships between CVD and meaning in life. PRISMA/MOOSE review guidelines were followed. These findings were used to build a conceptual model. RESULTS The literature review included 113 studies on meaning and CVD. The included studies described meaning as a predictor of cardiovascular risks and health, meaning-centered needs of patients in conversations with medical staff, meaning-centered changes after CVD events, meaning-centered coping with CVD, meaning as motivator of CVD-related lifestyle changes, and meaning as an element in psychological treatments of CVD patients. In sum, the literature showed that a central clinical concern for patients is their question how to live a meaningful life despite CVD. Meaning-centered concerns seem to lead to lower motivation to make lifestyle changes, more psychological stress, lower quality-of-life, worse physical well-being, and increased CVD risk. The ability to live a meaningful life after CVD events is related with lower stress, better mental health, and several biomarkers. SIGNIFICANCE OF RESULTS An evidence-based conceptual framework was developed for the relationship between meaning and CVD. It may be hypothesized CVD patients may benefit from psychological therapies focused on meaning.
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Gilder E, Jull A, Slark J, Parke RL. Patient's experiences of endotracheal tubes and suction following cardiac surgery. Nurs Crit Care 2021; 27:187-194. [PMID: 33586305 DOI: 10.1111/nicc.12604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 12/27/2020] [Accepted: 01/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a growing body of evidence addressing the patient experience of intensive care, including patient reports that the presence of an endotracheal tube is bothersome and distressing, and that endotracheal suction is moderately to extremely painful. Yet there remains little information about the patient experience of the endotracheal tube and suction in those patients receiving planned short-term mechanical ventilation. AIMS AND OBJECTIVES This study aimed to describe the patient experience of the endotracheal tube and suction, following mechanical ventilation in post-operative cardiac surgical patients. DESIGN This qualitative study used inductive thematic analysis. Participants having planned cardiac surgery, anticipated to receive less than 12-hours mechanical ventilation, were approached pre-operatively and written consent provided. METHODS Ten participants were recruited using purposive sampling. Semi-structured interviews were conducted between days four and six post-operatively. One researcher interviewed all participants; two researchers independently read, coded, and agreed themes. FINDINGS None of the participants recalled endotracheal suction, while half had no recollection of the endotracheal tube. Three themes were identified; the experience of the endotracheal tube and extubation, the experience of emerging from sedation, and participants concerns about the future. The presence of the endotracheal tube was described as bothersome, whilst breathing through the tube and extubation were described as 'weird' and 'strange' but not painful. CONCLUSIONS Knowledge of the patient experience can help inform nursing practice by improving pre and post-operative care planning. RELEVANCE TO CLINICAL PRACTICE This study adds to the body of knowledge about the patient experience of the endotracheal tube and extubation. TRIAL REGISTRATION Prospective registration with the Australian New Zealand Clinical Trials Registry. www.anzctr.org.au (ACTRN12616001515482).
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Affiliation(s)
- Eileen Gilder
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrew Jull
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Julia Slark
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rachael L Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Australian and New Zealand Intensive Care Research Centre, Melbourne, Victoria, Australia
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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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Implementing a Weaning Protocol for Cardiac Surgery Patients Using Simulation: A Quality Improvement Project. Dimens Crit Care Nurs 2019; 38:248-255. [PMID: 31369444 DOI: 10.1097/dcc.0000000000000373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Mechanical ventilation is the standard of care after cardiac surgery, but it imposes physiologic and psychological stress on patients. The Society of Thoracic Surgery recommends 6 hours as the goal for extubation, but 60% of our patients were not meeting this metric. OBJECTIVES The objectives of this project were to decrease cardiac surgery patients' ventilation hours and intensive care unit length of stay using a ventilator weaning protocol. METHODS An evidence-based ventilator weaning protocol was developed, and nurses were prepared for its implementation using a simulation education program. RESULTS Ventilator hours were reduced from 7.74 to 6.27 (t = 2.5, P = .012). The percentage of patients extubated in 6 hours increased from 40% to 63.5% (χ = 7.757, P = .005). There was no statistically significant decrease in cardiovascular intensive care unit length of stay (17.15 to 15.99, t = 0.619, P = .537). Nurses' scores on a knowledge test increased significantly from pre (6.11) to post (7.79) (t = -5.04, P < .001). Their perception of confidence increased in weaning from pre (median, 4; IQR, 4,4) to post (median, 4; interquartile range [IQR], 4,5), z = -2.71, P = .007, and also in using the protocol from pre (median, 4; IQR, 3,4) to post (median, 4; IQR, 4,5) (z = -3.17, P = .002). DISCUSSION Using a nurse-led ventilator weaning protocol resulted in decreased ventilator hours for patients and increased knowledge and confidence for nurses.
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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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Tingsvik C, Hammarskjöld F, Mårtensson J, Henricson M. Patients’ lived experience of intensive care when being on mechanical ventilation during the weaning process: A hermeneutic phenomenological study. Intensive Crit Care Nurs 2018; 47:46-53. [DOI: 10.1016/j.iccn.2018.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/14/2018] [Accepted: 03/24/2018] [Indexed: 02/06/2023]
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Hetland B, Lindquist R, Weinert CR, Peden-McAlpine C, Savik K, Chlan L. Predictive Associations of Music, Anxiety, and Sedative Exposure on Mechanical Ventilation Weaning Trials. Am J Crit Care 2017; 26:210-220. [PMID: 28461543 DOI: 10.4037/ajcc2017468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Weaning from mechanical ventilation requires increased respiratory effort, which can heighten anxiety and later prolong the need for mechanical ventilation. OBJECTIVES To examine the predictive associations of music intervention, anxiety, sedative exposure, and patients' characteristics on time to initiation and duration of weaning trials of patients receiving mechanical ventilation. METHODS A descriptive, correlational design was used for a secondary analysis of data from a randomized trial. Music listening was defined as self-initiated, patient-directed music via headphones. Anxiety was measured daily with a visual analog scale. Sedative exposure was operationalized as a daily sedation intensity score and a sedative dose frequency. Analyses consisted of descriptive statistics, graphing, survival analysis, Cox proportional hazards regression, and linear regression. RESULTS Of 307 patients, 52% were women and 86% were white. Mean age was 59.3 (SD, 14.4) years, mean Acute Physiology and Chronic Health Evaluation III score was 62.9 (SD, 21.6), mean duration of ventilatory support was 8 (range, 1-52) days, and mean stay in the intensive care unit was 18 (range, 2-71) days. Music listening, anxiety levels, and sedative exposure did not influence time to initial weaning trial or duration of trials. Clinical factors of illness severity, days of weaning trials, and tracheostomy placement influenced weaning patterns in this sample. CONCLUSIONS Prospective studies of music intervention and other psychophysiological factors during weaning from mechanical ventilation are needed to better understand factors that promote successful weaning.
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Affiliation(s)
- Breanna Hetland
- Breanna Hetland is a postdoctoral fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Ruth Lindquist is a professor, Cynthia Peden-McAlpine is an associate professor, and Kay Savik is senior statistician, School of Nursing, University of Minnesota, Minneapolis, Minnesota. Craig R. Weinert is an associate professor, School of Medicine, University of Minnesota. Linda Chlan is associate dean for nursing research, Mayo Clinic, Rochester, Minnesota
| | - Ruth Lindquist
- Breanna Hetland is a postdoctoral fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Ruth Lindquist is a professor, Cynthia Peden-McAlpine is an associate professor, and Kay Savik is senior statistician, School of Nursing, University of Minnesota, Minneapolis, Minnesota. Craig R. Weinert is an associate professor, School of Medicine, University of Minnesota. Linda Chlan is associate dean for nursing research, Mayo Clinic, Rochester, Minnesota
| | - Craig R. Weinert
- Breanna Hetland is a postdoctoral fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Ruth Lindquist is a professor, Cynthia Peden-McAlpine is an associate professor, and Kay Savik is senior statistician, School of Nursing, University of Minnesota, Minneapolis, Minnesota. Craig R. Weinert is an associate professor, School of Medicine, University of Minnesota. Linda Chlan is associate dean for nursing research, Mayo Clinic, Rochester, Minnesota
| | - Cynthia Peden-McAlpine
- Breanna Hetland is a postdoctoral fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Ruth Lindquist is a professor, Cynthia Peden-McAlpine is an associate professor, and Kay Savik is senior statistician, School of Nursing, University of Minnesota, Minneapolis, Minnesota. Craig R. Weinert is an associate professor, School of Medicine, University of Minnesota. Linda Chlan is associate dean for nursing research, Mayo Clinic, Rochester, Minnesota
| | - Kay Savik
- Breanna Hetland is a postdoctoral fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Ruth Lindquist is a professor, Cynthia Peden-McAlpine is an associate professor, and Kay Savik is senior statistician, School of Nursing, University of Minnesota, Minneapolis, Minnesota. Craig R. Weinert is an associate professor, School of Medicine, University of Minnesota. Linda Chlan is associate dean for nursing research, Mayo Clinic, Rochester, Minnesota
| | - Linda Chlan
- Breanna Hetland is a postdoctoral fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Ruth Lindquist is a professor, Cynthia Peden-McAlpine is an associate professor, and Kay Savik is senior statistician, School of Nursing, University of Minnesota, Minneapolis, Minnesota. Craig R. Weinert is an associate professor, School of Medicine, University of Minnesota. Linda Chlan is associate dean for nursing research, Mayo Clinic, Rochester, Minnesota
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Merchán-Tahvanainen ME, Romero-Belmonte C, Cundín-Laguna M, Basterra-Brun P, San Miguel-Aguirre A, Regaira-Martínez E. Patients' experience during weaning of invasive mechanical ventilation: A review of the literature. ENFERMERIA INTENSIVA 2017; 28:64-79. [PMID: 28131790 DOI: 10.1016/j.enfi.2016.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 10/31/2016] [Accepted: 11/12/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Weaning from invasive mechanical ventilation (IMV) is influenced by physiological and psychological factors, the latter being the least studied. The aim was to identify, through the literature, patients' experiences during weaning from IMV and report its influencing factors. METHOD The literature search was conducted using the Pubmed, CINAHL and PsycINFO databases. The search terms were: "patient", "experience" and "ventilator weaning". The research limits were: age (>19years) and language (English, Spanish and Finnish). RESULTS Fifteen publications were analysed. The main results were grouped into three main categories according to patient's perceptions, feelings and experiences, influence of professionals' attention and determinants for successful weaning. Patients remember IMV weaning as a stressful process where they experience anxiety, frustration, despair or uncertainty. Nurses have a key role in improving communication with patients and foreseeing their needs. Family support and the care provided by the caregivers were shown as essential during the process. The patient's self-determination, self-motivation and confidence are identified as important factors to achieve successful IMV weaning. CONCLUSIONS Psychological care, in addition to physical and technical care, is important at providing holistic care. Interventional studies are needed to improve the care during the weaning experience.
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Affiliation(s)
| | - C Romero-Belmonte
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España
| | - M Cundín-Laguna
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España
| | - P Basterra-Brun
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España
| | | | - E Regaira-Martínez
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España
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Karhe L, Kaunonen M, Koivisto AM. Loneliness in Professional Caring Relationships, Health, and Recovery. Clin Nurs Res 2016; 27:213-234. [PMID: 27836936 DOI: 10.1177/1054773816676580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study investigated patients' experiences of loneliness in professional caring relationships and their associations with perceived recovery, health, psychological distress, and general loneliness in life. The sample consisted of 406 patients who had undergone breast cancer or heart surgery 6 months earlier. The data were collected in May 2014-March 2015 using a postal survey including the Caring Loneliness Scale (CARLOS), questions concerning perceived health and recovery, 12-item General Health Questionnaire (GHQ-12), and a question concerning perceived general loneliness in life. Data analysis was done using Mann-Whitney U test and Kruskal-Wallis test. The variables showing a statistically significant association with professional caring loneliness were perceived health, recovery, psychological distress, and general loneliness in life. It is necessary for health care professionals to identify the phenomenon of this dimension of loneliness because it is bound to affect patients' experiences. Further studies with different patient groups are required.
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Affiliation(s)
- Liisa Karhe
- 1 University of Tampere, Finland.,2 Tampere University Hospital, Finland
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Khalafi A, Elahi N, Ahmadi F. Holistic Care for Patients During Weaning from Mechanical Ventilation: A Qualitative Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e33682. [PMID: 28191345 PMCID: PMC5292725 DOI: 10.5812/ircmj.33682] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/22/2015] [Accepted: 12/04/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Weaning patients from mechanical ventilation is a complex and highly challenging process. It requires continuity of care, the overall assessment of patients, and a focus on all aspects of patients' needs by critical care nurses. OBJECTIVES The aim of the present study was to explore holistic care while patients are being weaned from mechanical ventilation from the perspective of the critical care nurses. METHODS The study was carried out in the intensive care units (ICUs) of six hospitals in Ahvaz, Iran, from 2014 to 2015. In this qualitative study, 25 ICU staff including nurses, nurse managers, and nurse educators were selected by means of purposive sampling. Semi-structured interviews were used for data collection. The interview transcripts were then analyzed using qualitative content analysis. RESULTS The four main themes that emerged to explain nurses' experiences of holistic care when weaning patients from mechanical ventilation include continuous care, a holistic overview of the patient, promoting human dignity, and the overall development of well-being. CONCLUSIONS It was found that avoiding routine pivotal expertise, increasing consciousness of the nonphysical aspects of patients while providing treatment and presenting exclusive care, utilizing experienced ICU nurses, and placing more emphasis on effective communication with patients in order to honor them as human beings can all enhance the holistic quality of care.
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Affiliation(s)
- Ali Khalafi
- Nursing Care Research Center in Chronic Diseases, Department of Nursing, Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Nasrin Elahi
- Nursing Care Research Center in Chronic Diseases, Department of Nursing, Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
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Khalafi A, Elahi N, Ahmadi F. Continuous care and patients' basic needs during weaning from mechanical ventilation: A qualitative study. Intensive Crit Care Nurs 2016; 37:37-45. [PMID: 27503771 DOI: 10.1016/j.iccn.2016.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 05/09/2016] [Accepted: 05/30/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mechanical ventilation is associated with a number of risks and complications. Thus, rapid and safe weaning from mechanical ventilation is of great importance. Weaning is a complex and challenging process, requiring continuous care and knowledge of the patient. AIMS The aim of the present study was to describe the continuous care process during weaning as well as to analyse the facilitators and obstacles to the weaning process from start to finish from the perspective of intensive care unit (ICU) staff, particularly nurses. RESEARCH DESIGN Twenty-two ICU staff members, including nurses and physicians, and three patients hospitalised in the ICU were enrolled in this qualitative study. Semi-structured interviews were used for data collection and the transcripts were analysed using qualitative content analysis. FINDINGS 'Continuous care' was found to be the patients' basic need during weaning from mechanical ventilation. Uninterrupted, stable, comprehensive and dynamic care and monitoring with immediate response to all physiological and psychological changes were features of continuous care. The three main themes identified by this study were time spent with the patient, comprehensive supervision and maintenance of the quality of care during shifts. CONCLUSION Continuous and constant care should be provided during the weaning process. Such care will help to provide health care staff with a deeper understanding of the patient and his or her continuous changes, leading to a timely and favourable response during weaning. To achieve this goal, skill, communication and organisational changes are essential.
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Affiliation(s)
- Ali Khalafi
- Department of Nursing, Faculty of Nursing and Midwifery, Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nasrin Elahi
- Department of Nursing, Faculty of Nursing and Midwifery, Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Ball K, Swallow V. Patient experiences of cardiac surgery and nursing care: a narrative review. ACTA ACUST UNITED AC 2016. [DOI: 10.12968/bjca.2016.11.7.348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Katie Ball
- Clinical Research Nurse, Central Manchester University Hospital Foundation Trust, Manchester (Formerly Staff Nurse, Cardiothoracic Critical Care at time of writing)
| | - Veronica Swallow
- Professor in Child and Family Health, School of Healthcare, University of Leeds, Leeds
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Aslan Ö, Tosun B. Cardiovascular Surgery Patients: Intensive Care Experiences and Associated Factors. Asian Nurs Res (Korean Soc Nurs Sci) 2015; 9:336-41. [PMID: 26724243 DOI: 10.1016/j.anr.2015.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 11/19/2014] [Accepted: 10/02/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the intensive care unit (ICU) experiences of cardiovascular surgery (CS) patients and to define the associations between their ICU experiences and related factors. METHODS The study used a descriptive design. In total, 106 CS patients were interviewed at least 24 hours after discharge from an ICU in an educational research hospital in Ankara, Turkey between January and July 2012. Data were collected using the Intensive Care Experience Scale (ICES), a sociodemographic and clinical characteristics data form and two open-ended questions inquiring about smells and light. Statistical analyses were conducted using SPSS 15.0. RESULTS The patients were moderately aware of their ICU environments, partly recalled their ICU experiences, highly recollected frightening experiences, and expressed good satisfaction with care. Age, education, marital status, and pain were associated with ICU experiences. Patients who sensed smell had higher scores of frightening experiences than those who did not. Patients who were annoyed with excessive light reported less satisfaction with care than those who were not. CONCLUSIONS The results suggest that measuring the patients' characteristics and environmental factors may be beneficial for healthcare teams to improve the recovery of CS patients in the ICU.
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Affiliation(s)
- Özlem Aslan
- Department of Fundamentals of Nursing, School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey.
| | - Betül Tosun
- Department of Fundamentals of Nursing, School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey
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Abstract
Loneliness is a painful experience for patients. To clarity the concept of patient loneliness, this study undertook an evolutionary concept analysis based on a literature search in the main relevant databases. We identified 7 dimensions in adult patients' experiences of loneliness. These dimensions of loneliness have different causes and theoretical foundations, which have different implications for patient care. Patients may be lonely in their different relationships, including those with nurses and doctors. Loneliness in relation to health care professionals is a new application of the concept of loneliness that provides a useful starting point for future research.
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Egerod I, Bergbom I, Lindahl B, Henricson M, Granberg-Axell A, Storli SL. The patient experience of intensive care: A meta-synthesis of Nordic studies. Int J Nurs Stud 2015; 52:1354-61. [DOI: 10.1016/j.ijnurstu.2015.04.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 04/01/2015] [Accepted: 04/28/2015] [Indexed: 01/30/2023]
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Moen EK, Nåden D. Intensive care patients' perceptions of how their dignity is maintained: A phenomenological study. Intensive Crit Care Nurs 2015; 31:285-93. [PMID: 25963294 DOI: 10.1016/j.iccn.2015.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 03/02/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
Abstract
AIM The aim of the study was to acquire knowledge of what contributes to maintaining and promoting the dignity of intensive care patients. METHOD The study takes a phenomenological approach, and the method of data collection is qualitative research interviews. The participants consist of seven former intensive care patients. The analysis was carried out by means of Giorgi's phenomenological analysis strategy. FINDINGS Being seen and heard and having one's wishes and needs attended to are parts of dignified care. Personal and individual nursing was essential, as well as the extra involvement beyond what was expected. Being helpless and having to be cared for was unpleasant and degrading. The experience of being unable to speak could cause demeaning situations. Being met with respect was the essence of having one's dignity maintained and promoted. The sense of being treated as an object was the essence of experiences that inhibited dignity. CONCLUSION The findings indicate that the intensive care patients' experience of having their dignity maintained in an intensive care unit is good, despite a high-tech, busy environment. There is also potential for improvement in several areas. Awareness, moral integrity and demeanour are central to dignified patient care from the perspective of intensive care patients.
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Affiliation(s)
- Ellen Klavestad Moen
- Østfold Hospital Trust, Research and Innovation, Box 16, N-1603 Fredrikstad, Norway.
| | - Dagfinn Nåden
- Department of Nursing, Faculty of Health, Oslo and Akershus University College of Applied Sciences, Box 4, St. Olavs Plass, 0130 Oslo, Norway.
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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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Flinterud SI, Andershed B. Transitions in the communication experiences of tracheostomised patients in intensive care: a qualitative descriptive study. J Clin Nurs 2015; 24:2295-304. [PMID: 25850361 DOI: 10.1111/jocn.12826] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe how tracheostomised patients in intensive care experience acts of communication and to better understand their experiences in the context of the transitions theory. BACKGROUND Waking up in an intensive care unit unable to speak because of mechanical ventilation can be challenging. Communication aids are available, but patients still report difficulties communicating. Investigating how mechanically ventilated patients experience communication in the context of the transitions theory might elucidate new ways of supporting them during their transitions while being ventilated. DESIGN A qualitative, descriptive design. METHODS Eleven patients who had previously been tracheostomised in an intensive care unit were included in this quality improvement project conducted in a university hospital in Norway. Participants were tracheostomised from 3-27 days. Semistructured interviews were conducted from June 2013-August 2013, 3-18 months after hospital discharge. Transcripts were analysed using inductive content analysis. RESULTS Participants reported a great diversity of emotions and experiences attempting to communicate while being tracheostomised. One overarching theme emerging from the analysis was the 'Experience of caring and understanding despite having uncomfortable feelings due to troublesome communication.' The theme consists of three categories. The category 'Emotionally challenging' shows that patients struggled initially. With time, their coping improved, as revealed in the category 'The experience changes with time.' Despite difficulties, participants described positive experiences, as shown in the category 'Successful communication.' CONCLUSION The importance of patients experiencing caring and understanding despite their difficult situation constitutes the core finding. The findings suggest that participants went through different transitions. Some reached the end of their transition, experiencing increased stability. RELEVANCE TO CLINICAL PRACTICE Despite challenges with communication, participants reported that caring and safety provided by health care professionals were significant experiences. They viewed nonverbal communication as being very important.
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Affiliation(s)
- Stine Irene Flinterud
- Haukeland University Hospital, Bergen, Norway.,Haraldsplass Deaconess University College, Bergen, Norway
| | - Birgitta Andershed
- Department of Nursing, Gjøvik University College, Gjøvik, Norway.,Department of Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden
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24
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Yang PH, Hung CH, Chen YC. The impact of three nursing staffing models on nursing outcomes. J Adv Nurs 2015; 71:1847-56. [DOI: 10.1111/jan.12643] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Pei-Hsuan Yang
- Department of Nursing; Kaohsiung Medical University Hospital; Taiwan
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Nydahl P, Hermes C, Dubb R, Kaltwasser A, Schuchhardt D. [Tolerance of endotracheal tubes in patients on mechanical ventilation]. Med Klin Intensivmed Notfmed 2014; 110:68-76. [PMID: 25527237 DOI: 10.1007/s00063-014-0449-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/25/2014] [Accepted: 11/27/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Modern concepts for sedation and analgesia and guidelines recommend light analgesia and sedation, so that patients on mechanically ventilation are more awake, compared to previous concepts. Hence, these patients are more alert and able to experience their situation on the ventilator and their endotracheal tube (ETT). PROBLEM There is currently no convincing evidence of how patients tolerate the tube under present conditions, which interventions could help them, or whether they want to be sedated deeper because of the tube. Based upon our own observations, a broad range of reactions are possible. PURPOSE The tolerance of the ETT in intensive care patients was explored. METHOD A systematic literature research without time constraints in the databases PubMed and CINAHL was performed. Included were quantitative and qualitative studies written in German or English that investigated tolerance of the ETT in adult intensive care patients. Excluded were anesthetic studies including in- and extubation immediately before and after operations. RESULTS Of the 2348 hits, 14 studies were included, including 4 qualitative studies about the experience of intensive care, 8 quantitative studies including 2 randomized controlled studies, and 2 studies with a mixed approach. Within the studies different aspects could be identified, which may in- or decrease the tolerance of an ETT. Aspects like breathlessness, pain during endotracheal suctioning and inability to speak decrease the tolerance. Information, the presence of relatives and early mobilization appear to increase the tolerance. CONCLUSION Tolerance of the ETT is a complex phenomenon. A reflected and critical evaluation of the behavior of the patient with an ETT is recommended. Interventions that increase the tolerance of the ETT should be adapted to the situation of the patient and should be evaluated daily.
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Affiliation(s)
- P Nydahl
- Pflegeforschung, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Haus 31, Brunswiker Str. 10, 24105, Kiel, Deutschland,
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Baumgarten M, Poulsen I. Patients' experiences of being mechanically ventilated in an ICU: a qualitative metasynthesis. Scand J Caring Sci 2014; 29:205-14. [DOI: 10.1111/scs.12177] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 07/23/2014] [Indexed: 01/01/2023]
Affiliation(s)
- Mette Baumgarten
- Department of Anaesthesiology; Intensive Care Unit; Copenhagen University Hospital; Hvidovre Denmark
| | - Ingrid Poulsen
- Department of Neurorehabilitation; TBI Unit; Copenhagen University Hospital; Glostrup (Satellite Department on Hvidovre Hospital); Hvidovre Denmark
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Lykkegaard K, Delmar C. A threat to the understanding of oneself: intensive care patients' experiences of dependency. Int J Qual Stud Health Well-being 2013; 8:20934. [PMID: 23809023 PMCID: PMC3697396 DOI: 10.3402/qhw.v8i0.20934] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2013] [Indexed: 11/29/2022] Open
Abstract
This study examines the meaning of dependency on care as experienced by intensive care patients. Literature on the subject is sparse, but research from nonintensive settings shows that dependency is often experienced negatively. The study is based on in-depth qualitative semistructured interviews with three former patients characterized as narratives. The analysis is inspired by a phenomenological hermeneutical method. The study has found that dependency is experienced as difficult and that the experience seems to be attached to the relationship to oneself. Patients feel powerless and experience shame, their understanding of self is threatened, and they fight for independence in the course after intensive care. The findings might be influenced by the study being conducted in a Western country setting, where independence is valued. They can be used as means of reflection on nursing practice and matters such as communication and patient participation.
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28
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Locsin RC, Kongsuwan W. Lived experience of patients being cared for in ICUs in Southern Thailand. Nurs Crit Care 2013; 18:200-11. [PMID: 23782114 DOI: 10.1111/nicc.12025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 03/16/2013] [Accepted: 03/19/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Technologies in ICUs are increasingly saving human lives. The challenge for nursing in ICUs is to use technologies competently in order to know patients more fully within the harmonized view of technology, nursing and human care. PURPOSE The purpose of this study was to describe the meaning of the experiences of patients who were dependent on technologies while being cared for in ICUs. METHOD A hermeneutic phenomenological approach was used to describe the experiences of 10 participants who were discharged from adult ICU units in Southern Thailand. Lincoln and Guba's criteria for trustworthiness was used to establish the rigour of the study. FINDINGS Four thematic categories structured the meaning of the participants' experiences: Living suffering; Harmonizing living; Being in trust and security; and Transitioning to a better life. These thematic categories were reflective of the four lived worlds of corporeality, relationality, spatiality and temporality. CONCLUSION The description of being cared for was based on the narratives of patients who were discharged from ICUs in Southern Thailand. In conclusion, the lived experience of being cared for with technologies in ICU was described as living suffering within trust and security, and harmonizing living while transitioning to a better life. RELEVANCE TO CLINICAL PRACTICE The findings of the study could be used to design innovative nursing strategies and interventions to enhance understanding of human health and well-being while maintaining and advancing competencies in the use of technologies for human care.
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Affiliation(s)
- Rozzano C Locsin
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL 33431, USA.
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29
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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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Pettersson S, Melaniuk-Bose M, Edell-Gustafsson U. Anaesthetists' perceptions of facilitative weaning strategies from mechanical ventilator in the intensive care unit (ICU): a qualitative interview study. Intensive Crit Care Nurs 2012; 28:168-75. [PMID: 22227354 DOI: 10.1016/j.iccn.2011.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 12/06/2011] [Accepted: 12/10/2011] [Indexed: 11/26/2022]
Abstract
AIM This study aimed to examine anaesthetists' perceptions of facilitative weaning from the mechanical ventilator in the intensive care unit (ICU). METHODS Explorative qualitative interviews in a phenomenographic reference frame with a purposive sample of 14 eligible anaesthetists from four different ICUs with at least one year of clinical experience of ICU and of ventilator weaning. FINDINGS Four categories of anaesthetists' perceptions of facilitative decision-making strategies for ventilator weaning were identified. These were the instrumental, the interacting, the process-oriented and the structural strategies" for ventilator weaning. The findings refer to a supportive multidisciplinary holistic ICU quality of care. Choice of strategy for ventilator weaning was flexible and individually tailored to the patients'. CONCLUSIONS Choice of strategy was flexible and individually adjustable. Introduction of evidence-based guidelines from ventilator weaning is necessary in the ICU. The guidelines should also cover the responsibilities of various professional groups. Regular evaluations of methods and strategies used in practice need to be implemented. This may facilitate decision-making strategies for ventilator weaning in practice at the ICU. Greater attention needs to focus on family members' experiences. The strategies should be an integral part of continuous staff training.
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Affiliation(s)
- Sara Pettersson
- Department of Medicine and Health, Division of Nursing Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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31
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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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Karlsson V, Lindahl B, Bergbom I. Patients’ statements and experiences concerning receiving mechanical ventilation: a prospective video-recorded study. Nurs Inq 2011; 19:247-58. [DOI: 10.1111/j.1440-1800.2011.00576.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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Palacios-Ceña D, Corral Liria I. [The basics and development of a phenomenological research protocol in nursing]. ENFERMERIA INTENSIVA 2010; 21:68-73. [PMID: 20447587 DOI: 10.1016/j.enfi.2009.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 11/11/2009] [Indexed: 10/19/2022]
Abstract
UNLABELLED The use of qualitative methodology has been increasing over recent years. The application of different theoretical and methodological qualitative approaches makes it necessary to identify the characteristics of qualitative designs when developing research protocols and projects. OBJECTIVES To show the steps for the development of a phenomenological research protocol. METHOD AND CONCLUSIONS Developing a phenomenological research protocol entails a series of steps and elements that must be consistent, this mainly being the development of the research question with an adequate qualitative proposal. This methodological approach will determine the data, the method of collection and analysis. The phenomenological studies are aimed at studying the experience of the patient regarding a disease or circumstance.
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Affiliation(s)
- D Palacios-Ceña
- Departamento de Ciencias de la Salud II, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España.
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35
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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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36
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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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Lapum J, Angus JE, Peter E, Watt-Watson J. Patients' narrative accounts of open-heart surgery and recovery: authorial voice of technology. Soc Sci Med 2009; 70:754-62. [PMID: 20042262 DOI: 10.1016/j.socscimed.2009.11.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 10/25/2009] [Accepted: 11/13/2009] [Indexed: 11/28/2022]
Abstract
In this narrative inquiry, we examined patients' experiential accounts of technology in open-heart surgery and recovery. A convenience sample of sixteen individuals was recruited from a preoperative clinic at a regional centre for cardiac services in Canada. Each participated in two interviews following transfer from cardiovascular intensive care and 4-6 weeks post discharge from the hospital. Participants also documented their experiences in journals during the first 3-4 weeks following discharge. The focal point of the study's theoretical foundations was narrative emplotment, which directs attention to the active processes of plot construction and shaping forces of stories. In our narrative analysis, we used narrative mapping to document the temporal flow of events. We found that technology acted as the authorial voice, or controlling influence, over how participants' narratives were shaped and unfolded. Key were the ways in which technology as the authorial voice was linked with participants becoming background characters and surrendering agency. Problematic and important to health care professionals is ensuring that authorial voice shifts back to patients so that they become active in shaping their own course of recovery. This study underscores the benefits of using literary techniques such as narrative analysis in health science research. Examining the narrative structures and forces that shape patients' stories sheds light on how health care professionals and their technologically-driven practices of care strongly affect the stories' content and how they unfold. By focusing on how stories unfolded, we revealed ways in which cardiac surgery practices and patients' course of recovery could be enhanced.
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Affiliation(s)
- Jennifer Lapum
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada.
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Bench S, Day T. The user experience of critical care discharge: a meta-synthesis of qualitative research. Int J Nurs Stud 2009; 47:487-99. [PMID: 20004396 DOI: 10.1016/j.ijnurstu.2009.11.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 10/14/2009] [Accepted: 11/15/2009] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This review identifies the most significant factors, which impact upon the user experience of progress and recovery from critical illness during the first month after discharge from critical care, and discusses these in relation to the development of effective critical care discharge support strategies. DESIGN Meta-synthesis of qualitative primary research. DATA SOURCES Qualitative research published in English between 1990 and 2009 was identified using online databases: CINAHL, MEDLINE, EMBASE, British Nursing Index, CDSR, ACP Journal Club, Cochrane library, Social Policy and Practice and PsycInfo. Studies of adult patients, relatives/carers/significant others, which focused on experiences after discharge from an intensive care or high dependency unit to a general ward were retrieved. REVIEW METHODS Following screening against inclusion/exclusion criteria, methodological appraisal of studies was conducted using a published framework. Ten studies met the criteria for inclusion. RESULTS Five key themes emerged from the meta-synthesis: physical and psychological symptoms; making progress; the need to know; and safety and security. CONCLUSIONS Findings from this meta-synthesis and other related literature supports the existence of physical and psychological problems in the immediate period following discharge from critical care to the ward, and suggests that patients and their families have a desire for more control over their recovery. However, this desire is countered by a need to feel safe and protected, culminating in an expression of dependence on healthcare staff. Any effective support strategy needs to take account of these findings.
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Affiliation(s)
- Suzanne Bench
- Florence Nightingale School of Nursing and Midwifery, King's College, James Clerk Maxwell Building, London SE1 8WA, United Kingdom.
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Egerod I, Christensen D. Analysis of patient diaries in Danish ICUs: A narrative approach. Intensive Crit Care Nurs 2009; 25:268-77. [DOI: 10.1016/j.iccn.2009.06.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Revised: 06/16/2009] [Accepted: 06/21/2009] [Indexed: 10/20/2022]
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Nurses' conceptions of facilitative strategies of weaning patients from mechanical ventilation--a phenomenographic study. Intensive Crit Care Nurs 2009; 25:225-32. [PMID: 19695878 DOI: 10.1016/j.iccn.2009.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Revised: 06/11/2009] [Accepted: 06/23/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND Mechanical ventilator withdrawal can amount up to 40% of total ventilator time. Being on a mechanical ventilator is associated with risk of anxiety, post-traumatic stress syndrome, nosocomial pneumonia and premature mortality. PURPOSE The purpose of the present study was to describe different conceptions of nurses' facilitating decision-making strategies regarding weaning patients from mechanical ventilations cared for in intensive care unit (ICU). METHOD Semi-structured interviews were analysed within the phenomenographic framework. Twenty ICU nurses were interviewed. FINDINGS The findings revealed three main categories of nurses' facilitating decision-making strategies: "The intuitive and interpretative strategy" featured nurses' pre-understandings. "The instrumental strategy" involved analysis and assessment of technological and physiological parameters. "The cooperative strategy" was characterised by interpersonal relationships in the work situation. Absence of a common strategy and lack of understanding of others' strategies were a source of frustration. The main goals were to end mechanical ventilator support, create a sense of security, and avoid further complications. CONCLUSION Although these findings need to be confirmed by further studies we suggest that nurses' variable use of individual strategies more likely complicate an efficient and safe weaning process of the patients from mechanical ventilation.
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Abstract
The aim of this study was to explore physicians' views and perceptions of sedation, and offer a new approach to the understanding of issues of sedation. I used a qualitative, descriptive, and explorative multicenter design. Data were generated by seven key-informant interviews using a semistructured interview guide. One experienced doctor was selected at each of the seven largest intensive care units in Denmark. Interpretational analysis was performed by comprehensive overview, individual case analysis, cross-case analysis, and integrated thematic analysis and identification of emerging themes. The following themes emerged: a paradigm shift from sedated to more awake and comfortable patients, cultural changes toward intracollegial openness, increased interdisciplinary and staff/patient/family collaboration, patient and environmental normalization, and humanization. The study findings provide an understanding of contextual issues of sedation, safety, and comfort, and suggest that a cultural change in sedation strategies might reduce the duration of sedation and mechanical ventilation while containing cost and improving the well-being of the patients.
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