Intensive care patients' perceptions of how their dignity is maintained: A phenomenological study

Patients' lived body experiences in the intensive care unit and beyond - a meta-ethnographic synthesis

INTRODUCTION

Physical therapists supporting patients in intensive care unit (ICU) rehabilitation can improve their clinical practice with insight in patients' lived body experiences.

OBJECTIVE

To gain insight in patients' lived body experiences during ICU stay and in recovery from critical illness.

METHODS

Through a comprehensive systematic literature search, 45 empirical phenomenological studies were identified. Patients' lived body experiences were extracted from these studies and synthesized following the seven-phase interpretative approach as described by Noblit and Hare.

RESULTS

Three lines of argument were illuminated: 1) "recovery from critical illness starts from a situation in which patients experience the lived body as unable;" 2) "patients experience progress in recovery from critical illness when the lived body is empowered;" and 3) "recovery from critical illness results in a lived body changed for life." Eleven third-order constructs were formulated as different kinds of bodies: 1) "an intolerable body;" 2) "an alienated body;" 3) "a powerless body;" 4) "a dependent body;" 5) "a restricted body;" 6) "a muted body;" 7) "a touched body;" 8) "a transforming body;" 9) "a re-discovering body;" 10) "an unhomelike body;" and 11) "a remembering body."

CONCLUSION

Patients' lived body experiences during ICU stay and in recovery from critical illness have richly been described in phenomenological studies and were synthesized in this meta-ethnography.

"I am Here"-The Importance of Caring Touch in Intensive Care. A Qualitative Observation and Interview Study

Purpose: The purpose of the study was to illuminate the experience of caring touch in intensive care from the perspectives of patients, next-of-kin, and healthcare professionals. Design and Method: This study was explorative, and data were collected through qualitative observations (n = 9) with subsequent interviews (n = 27) at two general intensive care units. An inductive approach was embraced to be open-minded to the participants' experiences. Findings: The results are presented in one generic category-caring touch creates presence-which generated five subcategories: to touch and be touched with respect, touch as guidance and communication, touch causes suffering, touch creates compassion, and touch creates security. Conclusion: When the ability to communicate with words is lost, it is body language that reveals what a person is trying to express. Nurses create a way of being present with the patients by touching them, to communicate I am here for you. Caring touch is a tool to show compassion and respect and to protect the integrity of the lived body. The caring touch is soothing and comforting for the patient and next-of-kin and creates security. It also helps to awaken the motivation to get healthy, which is needed in an environment that is foreign.

The meaning of respect and dignity for intensive care unit patients: A meta-synthesis of qualitative research

AIM

To synthesize qualitative research on perspectives and understandings of Intensive Care Unit (ICU) patients, family members, and staff regarding respect and dignity in ICU, in order to explore the connotations and meanings of respect and dignity in ICU.

DESIGN

A qualitative meta-synthesis.

METHODS

The Chinese and English databases were systematically searched, including PubMed, Web of Science, CINAHL, Embase, Cochrane Library, CNKI, Wangfang Data, VIP, and CBM from each database's inception to July 22, 2023. Studies were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Qualitative data were extracted, summarized, and meta-synthesized. (PROSPERO: CRD42023447218).

RESULTS

A total of 9 studies from 6 countries were included in the meta-synthesis. Thirty-six main themes and 67 sub-themes were extracted, which were eventually integrated into 9 categories and 4 themes: (1) integrity of humanity; (2) autonomy; (3) equality; (4) environmental support.

CONCLUSION

To maintain patient dignity, it is necessary to create an environment of respect within the ICU where healthcare professionals uphold the concept of preserving human integrity and respect patients' autonomy and equality. Healthcare professionals need to value the dignity of ICU patients and treat them as unique individuals during treatment and care. Hospital managers should also strive to create a respectful environment to provide environmental support for dignity care implementation.

The perception of dignity in the hospitalized patient: a meta-synthesis

Dignity is a value inherent to all human beings, guaranteed to every individual from birth, and influenced by culture and society. It is protected by various laws and declarations, and represents one of the fundamental human rights. Preserving human dignity is an essential aspect of nursing practice and a central element of care. Dignity is a highly subjective and personal concept; there may be variations in the way that patients perceive it and in the ways that nurses can guarantee it. A systematic review of the qualitative literature was conducted to obtain a comprehensive understanding of adult patients' perceptions of dignity in a hospital setting. This review adhered to the PRISMA Statement for reporting systematic reviews, and the results were reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Major databases (PubMed, CINAHL, Scopus, and PsycINFO) were consulted and resulted in the inclusion of 21 studies. Methodological quality was assessed using the Critical Appraisal Skills Program (CASP) Checklist for Qualitative Studies. Six main themes emerged from the data analysis: (1) The concept of dignity and its various dimensions; (2) The significance of maintaining one's own privacy and confidentiality; (3) The hospital environment's influence on patients' dignity; (4) Healthcare professionals' characteristics and behaviours that affect dignity; (5) The role of communication and the relationship with healthcare providers; and (6) The patient's ability to make choices and be involved actively in their care. These findings underscore the importance of understanding caregivers' perspectives on dignity to ensure that they provide respectful and dignified care and treatment that prioritizes the patient's mental and physical needs.

Cross-cultural adaptation of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to Brazilian Portuguese and its psychometric properties-A multicenter cross-sectional study

OBJECTIVE

To adapt the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to the Brazilian language and culture and to assess its psychometric properties.

RESULTS

The scale was evaluated by 15 experts, and 239 patients from three tertiary hospitals in Rio de Janeiro. All participants signed a consent form. Data have shown adequacy of the model (KMO=0.839, Bartlett's test of sphericity: χ2(171) = 2241.3, p = 0.000010), good adjusted content validity (CVCa ≥ 0.90), internal consistency and reliability, such as α = 0.927.

DISCUSSION

CuPDPH is a rating scale on observable professional attitudes. Illnesses change lives and impose adaptation to a new situation, perceived as depersonalization, leading patients to try to regain control of their lives. Patients expressed "ill will" to fill out the scale. Psychiatric patients' scale filling time was higher than others. A sample from three Rio de Janeiro third-level hospitals may not reflect the country's population; also, this adaptation may not comprise all linguistic variations of Brazilian Portuguese and Portuguese-speaking countries.

CONCLUSION

The Portuguese version of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH), a 19-item, six-component version is a reliable instrument to measure the perception of internal medicine, surgical, and psychiatric patients on the maintenance of their dignity in Rio de Janeiro, Brazil. This knowledge could be used in advancing research on patients' perception of dignity, as well as professional ethical competencies, staff-patient relationship skills, and leadership development in medical and other healthcare professional education.

A Heideggerian analysis of good care in an acute hospital setting: Insights from healthcare workers, patients and families

This study articulates the relational constituents of good care beyond techno-rational competence. Neoliberal healthcare means that notions of care are readily commodified and reduced to quantifiable assessments and checklists. This novel research investigated accounts of good care provided by nursing, medical, allied and auxiliary staff. The Heideggerian phenomenological study was undertaken in acute medical-surgical wards, investigating the contextual, communicative nature of care. The study involved interviews with 17 participants: 3 previous patients, 3 family members and 11 staff. Data were analysed iteratively, dwelling with stories and writing and rewriting to surface the phenomenality of good care. The data set highlighted the following essential constituents: authentic care: caring encompassing solicitude (fürsorge); impromptu care: caring beyond role category; sustained care: caring beyond specialist parameters; attuned care: caring encompassing family and culture; and insightful care: caring beyond assessment and diagnosis. The findings are clinically significant because they indicate the importance of nurse leaders and educators harnessing the potential capacity of all healthcare workers to participate in good care. Healthcare workers reported that participating in or witnessing good care was uplifting and added meaning to their work, contributing to a sense of shared humanity.

The relationship between futile medical care and respect for patient dignity: a cross-sectional study

BACKGROUND

Various technologies and interventions at intensive care units can lead to futile medical care for critically ill patients. Futile medical care increases patients' suffering and costs, reduces nurses' attention to patients, and thus affects patients' dignity. This study aimed to investigate the relationship between futile medical care and respect for patient dignity from the perspective of nurses working in intensive care units of medical centers.

METHODS

We conducted this cross-sectional study on 160 nurses working in intensive care units in Kerman. We measured nurses' perceptions of futile care and respect for patient dignity using futile care and patients' dignity questionnaire. We used linear regression model to investigate the effect of futile care on the patient dignity.

RESULTS

The mean severity and frequency of futile care in the intensive care unit were 57.2 ± 14.3 and 54.1 ± 19, respectively. Respect for patient privacy and respectful communication were desirable, while patients' autonomy was not desirable. We found a significant direct relationship (p = 0.006) between the severity of futile care and respect for patient dignity, with every unit increase in futile care, a 0.01 unit increase was available in patient dignity. We observed no significant association between frequency of futile care and dignity.

CONCLUSION

Our results indicated the effect of futile care on nurses' respect for patient dignity. Nurses must raise their awareness through participating in training classes and specialized workshops to improve the level of care, the quality of care, and respect for patient dignity.

Individual factors in dignified care: a cross-sectional study of critical care nurses

AIM

To determine the level of dignified care provided by critical care nurses and to explore the associated individual factors.

BACKGROUND

Dignity is a fundamental right of human beings. Critically ill patients are dependent on nurses. Their need for respect and dignity is liable to be neglected in intensive care unit settings. Both critically ill survivors and dying patients suffer mental anguish due to loss of dignity.

METHOD

This was a cross-sectional study of 526 critical care nurses working at intensive care units for adults in Zhejiang Province, China. Data were collected from February 2021 to May 2021 using the Intensive Care Unit Dignified Care Questionnaire, Wong and Law Emotional Intelligence Scale, Jefferson Scale of Empathy-Health Professional, Nurses Professional Values Scale-Revised.

RESULTS

The total score of dignified care was 67.37 (8.83), with the standard score as 74.07 (12.99). Participants who performed poorly in absolute and relative dignity accounted for 8.4% and 31.2% of the total sample, respectively. Emotional intelligence (β = 0.379, p < .001), empathy (β = 0.319, p < .001), professional values (β = 0.147, p < .001), age (β = 0.075, p = .003), and training in dignified care (β = 0.074, p = .010) were associated with dignified care, explaining 67.6% of the variance.

CONCLUSION

The average level of participants' behaviors of maintaining patient dignity was medium. Critical care nurses need to improve their ability to maintain relative dignity of patients. Emotional intelligence, empathy, professional values, age level, and training in dignified care were predictors of dignified care.

IMPLICATIONS FOR NURSING MANAGEMENT

Improving emotional intelligence, empathy, and professional values of critical care nurses and training them (especially less experienced nurses) will enhance their ability in dignified care. This study provides a novel perspective to help nursing managers develop interventions to promote humanized care in the intensive care unit.

The core qualities and competencies of the intensive and critical care nurse, a meta-ethnography

AIM

To develop a conceptual framework of the core qualities and competencies of the intensive and critical care nurse based on the experiences of intensive care patients, their relatives and the intensive and critical care nurses.

DESIGN

Meta-ethnography.

DATA SOURCES

A comprehensive, systematic search in seven databases supplemented with hand, citation and reference search. Sources published from 2007 to 2019 were included.

REVIEW METHODS

Noblit and Hare's understanding of meta-ethnography and the work of the eMERGE project have directed the synthesis.

RESULTS

Nineteen studies were included and synthesized into a conceptual framework. Overarching theme: 'feeling safe and being safe', subtheme: 'creating confidence and motivation' and conceptual categories (CCs): 'technical skills and biophysical knowledge'; 'inter/intra professional teamwork skills'; 'communication skills (with patients and their relatives)'; 'constant and attentive bedside presence'; 'creating participative care'; 'creating confidence through daily care'; 'creating a good atmosphere and having a supportive and encouraging attitude'; and 'building relationship to maintain self-esteem'.

CONCLUSION

By including the perspectives of intensive care patients, their relatives and intensive and critical care nurses, the core qualities and competencies comprise elements of both patient safety and the feeling of safety. The framework outlines concepts necessary to ensure person-centred and safe intensive care. Further research should involve each perspective to validate and strengthen the findings.

IMPACT

The development of standards and competence guidelines expressing the learning outcomes and qualification of intensive and critical care nurses should be based on input from intensive care patients, their relatives and intensive and critical care nurses. A variety of core qualities and competencies are necessary to create confidence and motivation, and to make the patient feel safe and be safe. This conceptual framework might form a basis for development of a program or assessment tool to facilitate excellence in education and practice in intensive care.

Exploring the perceptions of dignity among patients and nurses in hospital and community settings: an integrative review

Background

Patients have a right to be treated with dignity. However, reports have continually identified concerns regarding the quality of care and dignity in hospitals. Undignified care can have unfavourable impact on the patient’s recovery such as leading to depression and loss of will to live. The aim of this study was to explore dignity as perceived by patients and nurses within hospital and community environments.

Methods

An integrative review methodological approach was adopted. Nine databases including Medline, CINAHL plus with full text, Web of Science, Embase, Pubmed, Psycinfo, Scopus, Nursing and Allied Health Source, and Science Direct were systematically searched for relevant articles using a predetermined set of inclusion criteria. Articles were included if they were primary empirical studies, peer reviewed, published between 2008–2019, assessing patients’ or nurses’ perception of dignity outside the end-of-life context, conducted in one of the European countries and written in English. Included papers were analysed using constant comparative analysis. The preferred reporting system for systematic review and meta-analysis (Prisma) flow diagram was used for quality appraisal and review.

Results

Fourteen relevant articles were included in this review. Four overarching themes and 10 subthemes were identified as impacting on patient dignity. Overarching themes include autonomy, healthcare delivery factors, organisational factors and the meaning of dignity, whilst subthemes include dependence/independence, choice, staff attitudes, communication, privacy, structure of services, staff shortages, physical environment, respect and person-centred care.

Conclusion

There are a wide range of factors impacting on patient dignity. Adopting evidence-based interventions supported by adequate theoretical backing can help to enhance patient dignity in hospital and community settings.

The meaning of caring touch for healthcare professionals in an intensive care unit: A qualitative interview study

BACKGROUND

The way health care professionals touch patients and relatives in the intensive care unit plays a significant role. A negative feeling can be caused by being touched in the wrong way, this is why a holistic approach with respect for the patient is important for the ability to make the patient and their relatives feel secure, avoiding unnecessary suffering.

AIM

The aim of the study was to describe the meaning of caring touch that is given in the ICU from the health care professionals perspective.

METHOD

Qualitative interview study with health care professionals in the intensive care unit, analysed using inductive content analysis, resulting in two themes and four main categories.

FINDINGS

Two themes emerged: Imperative touch and emotional touch and four main categories: touch as a natural tool, create a prerequisite for touch, empathetic touch and conversant touch.

CONCLUSION

Caring touch can be used as a natural tool in the daily work in order to bring comfort and calm to the patient in the intensive care unit.

Patients' experiences of well-being when being cared for in the intensive care unit-An integrative review

OBJECTIVE

The aim of this integrative review was to identify facilitators and barriers to patients' well-being when being cared for in an ICU setting, from the perspective of the patients.

BACKGROUND

To become critically ill and hospitalised in an ICU is a stressful, chaotic event due to the life-threatening condition itself, as well as therapeutic treatments and the environment. A growing body of evidence has revealed that patients often suffer from physical, psychological and cognitive problems after an ICU stay. Several strategies, such as sedation and pain management, are used to reduce stress and increase well-being during ICU hospitalisation, but the ICU experience nevertheless affects the body and mind. DESIGN; METHODS: Since research exploring patients' sense of well-being in an ICU setting is limited, an integrative review approach was selected. Searches were performed in CINAHL, Medline, Psych Info, Eric and EMBASE. After reviewing 66 studies, 12 studies were included in the integrative review. Thematic analysis was used to analyse the studies. The PRISMA checklist for systematic reviews was used.

RESULTS

The results are presented under one main theme, 'Well-being as a multidimensional experience-interwoven in barriers and facilitators' and six sub-themes representing barriers to and facilitators of well-being in an ICU. Barriers identified were physical stressors, emotional stressors, environmental disturbances and insecurity relating to time and space. Facilitators were meeting physical needs and activities that included dimensions of a caring and relational environment.

CONCLUSION

Our main findings were that experiences of well-being were multidimensional and included physical, emotional, relational and environmental aspects, and they were more often described through barriers than facilitators of well-being.

RELEVANCE FOR CLINICAL PRACTICE

This integrative review has shown that it is necessary to adopt an individual focus on patient well-being in an ICU setting since physical, emotional, relational and environmental stressors might impact each patient differently.

Nurses' perceptions about the dignity of intubated patients

BACKGROUND

The intensive and critical care units are high-dependency areas, with patients requiring complex care. The intubated status of the intensive and critical care patients makes them dependent on healthcare providers not only for acute care, but also for intimate care, imposing a threat to their dignity. Nurses, being the central care providers, become the stakeholders for dignity promotion. The incorporation of dignity in patient care improves the quality of care, and promotes the health and well-being of intubated patients.

OBJECTIVE

The purpose of the study was to explore nurses' perceptions about the dignity of intubated patients in the intensive and critical care units.

RESEARCH DESIGN

A qualitative descriptive exploratory study design was used to explore the nurses' perceptions about the dignity of intubated patients.

PARTICIPANTS AND RESEARCH CONTEXT

The intensive and critical care nurses of a tertiary care hospital were recruited using the purposive sampling technique. The data were collected through in-depth individual interviews, using a semi-structured interview guide. The findings were manually analyzed into themes and categories through content analysis.

ETHICAL CONSIDERATION

The study was conducted after the approval from the Ethical Review Committee of the Aga Khan University.

FINDINGS

Four major themes emerged from the data analysis: (1) two sides of the contemporary nursing practice; (2) benefits of dignified nursing care; (3) challenges to the dignity of intubated patients; and (4) strategies for promoting the dignity of intubated patients.

DISCUSSION

Dignity incorporates both the science and the art of nursing. The provision of dignified care is the core component of the quality nursing care and patient well-being in the high-dependency units.

CONCLUSION

This is the first exploratory and descriptive study conducted in Pakistan that explored the nurses' perceptions about the dignity of intubated patients, and also generated contextual understanding about the phenomenon.

Integrity at end of life in the intensive care unit: a qualitative study of nurses' views

BACKGROUND

Integrity is a core value for delivering ethical health care. However, there is a lack of precision in defining what integrity is and how nurses understand it. In the setting of nurses caring for critically ill and dying patients in intensive care units (ICUs), integrity has not received much attention. Therefore, the aim of this study was to explore how nurses perceive and maintain the integrity of patients during end-of-life care in the ICU setting.

METHODS

This study had a qualitative descriptive design. Data were collected using individual semi-structured interviews with 16 intensive care nurses working at ICUs in four Swedish hospitals. The data were analysed by applying qualitative content analysis.

RESULTS

Five overall categories were explored: seeing the unique individual; sensitive to patient vulnerability; observant of patients' physical and mental sphere; perceptive of patients' religion and culture; and being respectful during patient encounters. Many nurses found it difficult to define integrity and to explain what respecting integrity entails in the daily care of dying patients. They often used notions associated with respect and patient-centred attitudes, such as listening and being sensitive or by trying to describe good care. Integrity was nonetheless seen as a central value for their clinical work and a precondition for ethical nursing practice. Some nurses were concerned about patient integrity, which is at risk of being "wiped out" due to the patient's illness/injury, unfamiliarity with the ICU environment and utter dependence on others for care. Protecting patients from harm and reducing patient vulnerability were also seen as important and a way to maintain the integrity of patients.

CONCLUSIONS

The study results show that even though integrity is a fundamental ethical concept and a core value in nursing, ethical codes and guidelines are not always helpful in clinical situations in the end-of-life care of ICU patients. Hence, opportunities must regularly be made available for ICU nurses to reflect on and discuss ethical issues in terms of their decision-making and behaviour.

The Patient's Situation During Interhospital Intensive Care Unit-to-Unit Transfers: A Hermeneutical Observational Study

Interhospital intensive care unit-to-unit transfers are an increasing phenomenon, earlier mainly studied from a patient safety perspective. Using data from video recordings and participant observations, the aim was to explore and interpret the observed nature of the patient's situation during interhospital intensive care unit-to-unit transfers. Data collection from eight transfers resulted in over 7 hours of video material and field notes. Using a hermeneutical approach, three themes emerged: being visible and invisible; being in a constantly changing space; and being a fettered body in constant motion. The patient's situation can be viewed as an involuntary journey, one where the patient exists in a constantly changing space drifting in and out of the health personnel's attention and where movements from the journey become part of the patient's body. Interhospital transfers of vulnerable patients emerge as a complex task, challenging the health personnel's ability to maintain a caring atmosphere around these patients.

Nurse Perspectives of Maintaining Patient Dignity in Indonesian Clinical Care Settings: A Multicenter Qualitative Study

PURPOSE

Nurses have a professional obligation to maintain patient dignity when providing nursing care. The concept of dignity, however, is dependent on cultural context. The aim of this study was to elicit nurses' perspectives for maintaining patient dignity in Indonesian clinical care settings.

DESIGN

A qualitative descriptive study was performed.

METHODS

A total of 40 clinical nurse participants were recruited by purposive sampling from six general public hospitals in Eastern Java, Indonesia, including six medical and six surgical units. Data were collected in 2017 using individual face-to-face semistructured interviews. Inductive content analysis was employed.

FINDINGS

The interview data revealed nurses considered three main elements were necessary to maintain patient dignity in clinical care: personalized care, which included prioritizing patients and treating as individuals; compassionate care, which included empathizing and providing emotional support; and patient care advocacy, which included protecting patient rights and being a representative for the patient.

CONCLUSIONS

This study provided knowledge on how to maintain patient dignity from the cultural perspective of clinical nurses in Indonesia. Our findings highlight the importance of providing dignified care in a manner that is congruent with culture. The nurses in our study considered compassion and beneficence necessary values for providing dignified patient-centered care, which might be qualities that are culturally sensitive for an Indonesian population.

CLINICAL RELEVANCE

Strategies should be developed to improve dignity of care for hospitalized patients in Indonesia as well as other cultural settings, which could be incorporated into patient care. These should include improving patients' health literacy to increase patient-centered communication, eliminating mixed-gender wards to enhance patient privacy, and involving family members as partners in health care.

Beyond Pain: Nurses' Assessment of Patient Suffering, Dignity, and Dying in the Intensive Care Unit

CONTEXT

Deaths in the intensive care unit (ICU) are increasingly common in the U.S., yet little is known about patients' experiences at the end of life in the ICU.

OBJECTIVES

The objective of this study was to determine nurse assessment of symptoms experienced, and care received by ICU patients in their final week, and their associations with nurse-perceived suffering and dignity.

METHODS

From September 2015 to March 2017, nurses who cared for 200 ICU patients who died were interviewed about physical and psychosocial dimensions of patients' experiences. Medical chart abstraction was used to document baseline patient characteristics and care.

RESULTS

The patient sample was 61% males, 70.2% whites, and on average 66.9 (SD 15.1) years old. Nurses reported that 40.9% of patients suffered severely and 33.1% experienced severe loss of dignity. The most common symptoms perceived to contribute to suffering and loss of dignity included trouble breathing (44.0%), edema (41.9%), and loss of control of limbs (36.1%). Most (n = 9) remained significantly (P < 0.05) associated with suffering, after adjusting for physical pain, including fever/chills, fatigue, and edema. Most patients received vasopressors and mechanical ventilation. Renal replacement therapy was significantly (<0.05) associated with severe suffering (adjusted odds ratio [AOR] 2.53) and loss of dignity (AOR 3.15). Use of feeding tube was associated with severe loss of dignity (AOR 3.12).

CONCLUSION

Dying ICU patients are perceived by nurses to experience extreme indignities and suffer beyond physical pain. Attention to symptoms such as dyspnea and edema may improve the quality of death in the ICU.

He survived thanks to a non-sedation protocol: Nurses' reflections about caring for critically ill, non-sedated and mechanically ventilated patients

OBJECTIVE

The objective was to explore ICU nurses' experiences of caring for non-sedated, critically ill mechanically ventilated patients, when following a study protocol as part of a clinical trial.

DESIGN

The study had a qualitative design with twelve nurses participating in two focus groups. The interviews were analysed using a thematic approach.

FINDINGS

One overall theme emerged, "Cautious optimism", which suggests positive experiences but with a negative undertone. The most remarkable experiences were related to caring for the patient, but there were some disappointments with regard to the interprofessional teamwork. Three subthemes were identified: 1) Excitement and uncertainty 2) Inspiring but demanding nurse-patient relationship, and 3) Teamwork or working against the tide?

CONCLUSION

The main findings reflect the remarkable and positive aspects of caring for awake and involved mechanically ventilated ICU patients, but also how nurses found it demanding to follow a weakly implemented study protocol that sometimes resulted in deviations from their nursing ethical standards of care. A more strategic implementation plan for the study and improved interprofessional teamwork might have improved their experiences.

Mental well-being of patients from ethnic minority groups during critical care: a qualitative ethnographic study

OBJECTIVES

To investigate the state of the mental well-being of patients from ethnic minority groups and possible related risk factors for the development of mental health problems among these patients during critical medical situations in hospital.

DESIGN

Qualitative ethnographic design.

SETTING

Oneintensive care unit (ICU) of a multiethnic urban hospital in Belgium.

PARTICIPANTS

84 ICU staff members, 10 patients from ethnic-minority groups and their visiting family members.

RESULTS

Patients had several human basic needs for which they could not sufficiently turn to anybody, neither to their healthcare professionals, nor to their relatives nor to other patients. These needs included the need for social contact, the need to increase comfort and alleviate pain, the need to express desperation and participate in end-of-life decision making. Three interrelated risk factors for the development of mental health problems among the patients included were identified: First, healthcare professionals' mainly biomedical care approach (eg, focus on curing the patient, limited psychosocial support), second, the ICU context (eg, time pressure, uncertainty, regulatory frameworks) and third, patients' different ethnocultural background (eg, religious and phenotypical differences).

CONCLUSIONS

The mental state of patients from ethnic minority groups during critical care is characterised by extreme emotional loneliness. It is important that staff should identify and meet patients' unique basic needs in good time with regard to their mental well-being, taking into account important threats related to their own mainly biomedical approach to care, the ICU's structural context as well as the patients' different ethnocultural background.

Patient's dignity in intensive care unit: A critical ethnography

BACKGROUND

Maintaining patient's dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units.

OBJECTIVES

The aim of this study was to uncover the cultural factors that impeded maintaining patients' dignity in the cardiac surgery intensive care unit.

RESEARCH DESIGN

The study was conducted using a critical ethnographic method proposed by Carspecken.

PARTICIPANTS AND RESEARCH CONTEXT

Participants included all physicians, nurses and staffs working in the study setting (two cardiac surgery intensive care units). Data collection methods included participant observations, formal and informal interviews, and documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace.

ETHICAL CONSIDERATION

Ethical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained.

FINDINGS

The findings of the study fell into the following main themes: "Presence: the guarantee for giving enough attention to patients' self-esteem", "Instrumental and objectified attitudes", "Adherence to the human equality principle: value-action gap", "Paternalistic conduct", "Improper language", and "Non-interactive communication". The final assertion was "Reductionism as a major barrier to the maintaining of patient's dignity".

DISCUSSION

The prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches.

CONCLUSION

Changing an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships.

Dignity realization of patients with stroke in hospital care: A grounded theory

Background:

Dignity is seen as an important but complex concept in the healthcare context. In this context, the discussion of dignity includes concepts of other ethical principles such as autonomy and privacy. Patients consider dignity to cover individuality, patient’s feelings, communication, and the behavior of healthcare personnel. However, there is a lack of knowledge concerning the realization of patients’ dignity in hospital care and the focus of the study is therefore on the realization of dignity of the vulnerable group of patients with stroke.

Aim:

The aim of the study was to create a theoretical construct to describe the dignity realization of patients with stroke in hospital care.

Research design and participants:

Patients with stroke (n = 16) were interviewed in 2015 using a semi-structured interview containing open questions concerning dignity. The data were analyzed using constant comparison of Grounded Theory.

Ethical considerations:

Ethical approval for the research was obtained from the Ethics Committee of the University. The permission for the research was given by the hospital. Informed consent was obtained from participants.

Findings:

The “Theory of Dignity Realization of Patients with Stroke in Hospital Care” consists of a core category including generic elements of the new situation and dignity realization types. The core category was identified as “Dignity in a new situation” and the generic elements as health history, life history, individuality and stroke. Dignity of patients with stroke is realized through specific types of realization: person-related dignity type, control-related dignity type, independence-related dignity type, social-related dignity type, and care-related dignity type.

Discussion:

The theory has similar elements with the previous literature but the whole construct is new. The theory reveals possible special characteristics in dignity realization of patients with stroke.

Conclusion:

For healthcare personnel, the theory provides a frame for a better understanding and recognition of how dignity of patients with stroke is realized.

Intensive care nursing students' perceptions of simulation for learning confirming communication skills: A descriptive qualitative study

AIM

The aim of this study was to explore intensive care nursing students experiences with confirming communication skills training in a simulation-based environment.

RESEARCH METHODOLOGY

The study has a qualitative, exploratory and descriptive design. The participants were students in a post-graduate program in intensive care nursing, that had attended a one day confirming communication course. Three focus group interviews lasting between 60 and 80min were conducted with 14 participants. The interviews were transcribed verbatim. Thematic analysis was performed, using Braun & Clark's seven steps.

FINDINGS

The analysis resulted in three main themes: "awareness", "ice-breaker" and "challenging learning environment". The participants felt that it was a challenge to see themselves on the video-recordings afterwards, however receiving feedback resulted in better self-confidence in mastering complex communication.

CONCLUSION

The main finding of the study is that the students reported improved communication skills after the confirming communication course. However; it is uncertain how these skills can be transferred to clinical practice improving patient outcomes.