1
|
Karlsen MMW, Heyn LG, Heggdal K. Being a patient in the intensive care unit: a narrative approach to understanding patients' experiences of being awake and on mechanical ventilation. Int J Qual Stud Health Well-being 2024; 19:2322174. [PMID: 38431874 PMCID: PMC10911109 DOI: 10.1080/17482631.2024.2322174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
PURPOSE Intensive care patients often struggle to communicate due to the technical equipment used for mechanical ventilation and their critical illness. The aim of the study was to achieve a deeper understanding of how mechanically ventilated intensive care patients construct meaning in the unpredictable trajectory of critical illness. METHODS The study was a part of a larger study in which ten patients were video recorded while being in the intensive care. Five patients engaged in interviews about their experiences from the intensive care stay after being discharged and were offered the possibility to see themselves in the video recordings. A narrative, thematic analysis was applied to categorize the patients' experiences from the intensive care. RESULTS A pattern of shared experiences among intensive care patients were identified. Three main themes capture the patient's experiences: 1) perceiving the intensive care stay as a life-changing turning point, 2) being dependent on and cared for by others, and 3) living with negative and positive ICU experiences. CONCLUSION The patients' narratives revealed how being critically ill affected them, and how they understood their experiences in relation to themselves and their surroundings. The results can be used to pose important questions about our current clinical practice.
Collapse
Affiliation(s)
| | - Lena Günterberg Heyn
- Department of postgraduate and master studies, University of South-Eastern Norway, Kongsberg, Norway
| | - Kristin Heggdal
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
| |
Collapse
|
2
|
Brodsky MB, Friedman LA, Colantuoni E, Pandian V, Vertigan AE, Needham DM, Chan KS. Instrument adaptation and preliminary validation study of the Laryngeal Hypersensitivity Questionnaire used for assessment of laryngeal symptoms in patients with artificial airways. Aust Crit Care 2024; 37:138-143. [PMID: 38135588 PMCID: PMC10842835 DOI: 10.1016/j.aucc.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 01/22/2023] [Accepted: 09/05/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) was developed to measure abnormal laryngeal sensation and was originally validated in a patient sample from otolaryngologic and respiratory outpatient clinics. Modification is needed for patients who are mechanically ventilated via an endotracheal tube or a tracheostomy tube. OBJECTIVES We sought to adapt and preliminarily validate a modified version of the LHQ appropriate for nurses and other clinicians to administer in acute hospital settings called the LHQ-Acute (LHQ-A). METHODS Internal consistency and construct validity analyses using secondary data from patients at a tertiary teaching hospital who presented with symptoms of laryngeal irritability/hypersensitivity between September 2012 and October 2013 were performed. RESULTS A total of 131 patients, most complaining of coughing and dysphonia, with a median age of 58 (interquartile range: 48, 66) years and 29 healthy participants with a median age of 62 (interquartile range: 50, 66) years were analysed. The original LHQ was reduced from 14 questions with responses on a 7-point scale to the LHQ-A containing 13 questions with responses on a 4-point scale. Correlations between items of the LHQ and LHQ-A were similar, and internal consistency was excellent and highly comparable, with Cronbach's alpha = 0.906 and 0.902, respectively. CONCLUSIONS The LHQ-A, which has been adapted for nurses and other clinicians to administer to a critically ill patient population, demonstrated comparable reliability and validity to the original LHQ. Validation of the LHQ-A in independent patient populations from acute settings is necessary to better understand norms and changes during recovery from acute illness.
Collapse
Affiliation(s)
- Martin B Brodsky
- Speech-Language Pathology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA.
| | - Lisa Aronson Friedman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA.
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Vinciya Pandian
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA; Center for Immersive Learning and Digital Innovation, Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Anne E Vertigan
- Speech Pathology Department, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
| | - Dale M Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA; Center for Immersive Learning and Digital Innovation, Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Kitty S Chan
- MedStar-Georgetown Surgical Outcomes Research, Hyattsville, MD, USA.
| |
Collapse
|
3
|
Lehmkuhl L, Dreyer P, Laerkner E, Tanghus Olsen H, Jespersen E, Juel Rothmann M. Getting the body back on track - Understanding the phenomenon of mobilisation when conscious and mechanically ventilated patients are mobilised in the intensive care unit. Intensive Crit Care Nurs 2023; 78:103450. [PMID: 37172466 DOI: 10.1016/j.iccn.2023.103450] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/24/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To gain an in-depth understanding of the phenomenon of mobilisation when conscious and mechanically ventilated patients are mobilised in the intensive care unit. DESIGN A qualitative study with a phenomenological-hermeneutic approach. Data were generated in three intensive care units from September 2019 to March 2020. Participant observations of twelve conscious mechanically ventilated patients, thirty-five nurses and four physiotherapists were performed. Furthermore, seven semi-structured patient interviews were conducted, both on the ward and after discharge. FINDINGS Mobilisation during mechanical ventilation in the intensive care unit followed a trajectory from a failing body to a growing sense of independence in getting the body back on track. Three themes were revealed: 'Challenging to move a failing body', 'Ambiguity of both resistance and willingness in the process of strengthen the body', and 'An ongoing effort in getting the body back on track'. CONCLUSIONS Mobilisation when conscious and mechanically ventilated included support of the living body by physical prompts and ongoing bodily guidance. Resistance and willingness regarding mobilisation were found to be a way of coping with bodily reactions of comfort or discomfort, embedded in a need to feel bodily control. The trajectory of mobilisation promoted a sense of agency, as mobilisation activities at different stages during the intensive care unit stay supported the patients in becoming more active collaborators in getting the body back on track. IMPLICATIONS FOR CLINICAL PRACTICE Ongoing bodily guidance provided by healthcare professionals can promote bodily control and support conscious and mechanically ventilated patients in active participation in mobilisation. Furthermore, understanding the ambiguity of patients' reactions caused by loss of bodily control provides a potential to prepare mechanically ventilated patients for and assist them with mobilisation. In particular, the first mobilisation in the intensive care unit seems to influence the success of future mobilisation, as the body remembers negative experiences.
Collapse
Affiliation(s)
- Lene Lehmkuhl
- Department of Anaesthesiology and Intensive Care, OUH Svendborg Hospital, Baagøes Alle 15, 5700 Svendborg, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark.
| | - Pia Dreyer
- Department of Public Health, Aarhus University, Bartholin's Alle 2, 8000 Aarhus C, Denmark; Department of Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Eva Laerkner
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark; Department of Anaesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Hanne Tanghus Olsen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Eva Jespersen
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark; Department of Oncology, Odense University Hospital, Kløvervænget 8D, 5000 Odense C, Denmark.
| | - Mette Juel Rothmann
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark; Steno Diabetes Center Odense, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; Centre for Innovative Medical Technology, Odense University Hospital, Kløvervænget 8C, 5000 Odense, Denmark; Department of Endocrinology, Odense University Hospital, J. B. Winsløws Vej 9a, 5000 Odense, Denmark.
| |
Collapse
|
4
|
Jensen JF, Ramos J, Ørom ML, Naver KB, Shiv L, Bunkenborg G, Kodal AM, Skram U. Improving patient's intensive care admission through multidisciplinary simulation-based crisis resource management: A qualitative study. J Clin Nurs 2023; 32:7530-7542. [PMID: 37458172 DOI: 10.1111/jocn.16821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
AIM To explore nurses' and physicians' experiences of simulation-based training in a crisis resource management quality improvement intervention on intensive care admission. BACKGROUND Quantitative studies have documented that staffs' non-technical skills are improved after simulation-based training in crisis resource management interventions. Experienced-based consensus led to development of a quality improvement intervention based on principles of crisis resource management and tested in simulation-based training to enhance staffs' non-technical skills. However, the impact on staff is unexplored, leaving little understanding of the relationship between simulation-based training in crisis resource management interventions and changes in non-technical skills. DESIGN A qualitative study with a hermeneutical approach. METHODS Data consisted of semi-structured interviews with physicians (n = 5) and nurses (n = 15) with maximum variation in work experience. Data were collected 3 months after implementation and analysed using thematic analysis. The COREQ guideline was applied. RESULTS The analysis revealed three themes: prioritising core clinical activities and patient centredness; transition into practice; and reflection on patient safety. These themes reflected staff's experiences of the intervention and implementation process, which evolved through prioritising core clinical activities that facilitated the transition into clinical practice and staff's reflection on patient safety. CONCLUSIONS Prioritising core clinical activities were facilitated by clear communication, predefined roles and better teamwork. Transition into practice stimulated professional growth through feedback. Reflection on patient safety created a new understanding on how a new structure of intensive care admission could be implemented. Collectively, this indicated a joint understanding of admissions. IMPLICATIONS FOR PRACTICE Findings enables health care professionals to understand how the intervention can contribute to improve quality of care in management of intensive care admission. Improving non-technical skills are vital in high-quality admissions, which supported a structured process and a collaborative professional standard of admissions. PATIENT AND PUBLIC CONTRIBUTION None.
Collapse
Affiliation(s)
- Janet F Jensen
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark
- Department of Anesthesiology, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Joanna Ramos
- Department of Anesthesiology, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Thoracic Anaesthesiology, Rigshospital, Copenhagen, Denmark
| | - Marie-Louise Ørom
- Department of Anesthesiology, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten B Naver
- Department of Anesthesiology, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Louise Shiv
- Department of Anesthesiology, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Bunkenborg
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- Department of Anesthesiology, Holbaek Hospital, Holbaek, Denmark
| | - Anne Marie Kodal
- Department of Anesthesiology, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Skram
- Department of Anesthesiology, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
van Oorsouw R, Oerlemans A, van Oorsouw G, van den Boogaard M, van der Wees P, Koenders N. Patients' lived body experiences in the intensive care unit and beyond - a meta-ethnographic synthesis. Physiother Theory Pract 2023:1-33. [PMID: 37498170 DOI: 10.1080/09593985.2023.2239903] [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: 03/20/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023]
Abstract
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.
Collapse
Affiliation(s)
- Roel van Oorsouw
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anke Oerlemans
- IQ healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gijs van Oorsouw
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Philip van der Wees
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
- IQ healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Niek Koenders
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
6
|
Vahedian-Azimi A, Salesi M, Hssain AA, Baghernezhad F, Miller AC. Impact of spirituality on patient memories of intensive care unit stays: A nationwide cross-sectional study. Int J Crit Illn Inj Sci 2023; 13:66-72. [PMID: 37547189 PMCID: PMC10401560 DOI: 10.4103/ijciis.ijciis_10_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 08/08/2023] Open
Abstract
Background Absent or delusional memories are experienced by many patients following an intensive care unit (ICU) stay. Up to 70% may have delusional or hallucinatory intrusive memories, which may persist long term. This study aims to investigate how spiritual health (SH) impacts ICU patients' memories and quality of communication (QoC) between patients and physicians (PP) or nurses (PN). Methods This cross-sectional study was conducted across the country on ICU patients discharged from 45 medical centers in 31 provinces of Iran, to evaluate the direct and indirect effects of SH and ICU characteristics on patients' memory. Two valid and standard ICU memory tools (ICU-MT) and SH questionnaires were administered to patients 1 day post-ICU discharge used. Results No significant direct effect of SH scores on ICU-MT items was observed. No significant correlation was observed between PP-QoC and PN-QoC variables and primary items of the ICU-MT. Female sex positively correlated with the development of delusional memories (odds ratio [OR]: 1.730, 95% confidence interval [CI]: 1.025-2.915, P < 0.05). Subjects admitted to the medical ICU were less likely to remember being in the ICU (OR: 0.398, 95% CI: 0.159-0.996, P < 0.05), and were less likely to report intrusive memories from their time in the hospital or events that led to their admission (OR: 0.19, 95% CI: 0.086-0.419, P < 0.001). Conclusions The results of this study indicate that the spiritual health indirectly increased coping with intrusive memories, however, no direct effect was observed on ICU-MT items. The quality of communication between patients and physicians and nurses significantly mediated development of intrusive memories.
Collapse
Affiliation(s)
- Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali A. Hssain
- Department of Internal Medicine, Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Farzaneh Baghernezhad
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Andrew C. Miller
- Department of Emergency Medicine, Memorial Hospital of Belleville, BJC Healthcare, Belleville, Illinois, USA
| |
Collapse
|
7
|
Maagaard CA, Laerkner E. Writing a diary for ”you” —Intensive care nurses' narrative practices in diaries for patients: A qualitative study. Int J Nurs Stud 2022; 136:104363. [DOI: 10.1016/j.ijnurstu.2022.104363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/08/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022]
|
8
|
Opportunities for Interactive Communication in Mechanically Ventilated Critically Ill Patients: A Video-Based Observational Study. Nurs Res Pract 2022; 2022:1885938. [PMID: 35873203 PMCID: PMC9303512 DOI: 10.1155/2022/1885938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/14/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Mechanically ventilated critically ill patients need the opportunity to communicate their physical and psychosocial concerns to nurses. However, these patients face the unique problem of lacking even the opportunity to communicate. Aims The study aimed to describe the characteristics of communication opportunities for critically ill mechanically ventilated patients. Methods The study was designed as a video-based descriptive observational study. Participants included seven mechanically ventilated critically ill patients at the intensive care unit, coronary care unit, or high care unit who were conscious and seven registered nurses (seven pairs). Videos were recorded continuously from 8 am to 4 pm, and the footage was then descriptively analyzed. Data collection took place between July 2019 and June 2020. Results The total recording time was 668.0 minutes. Of these 668.0 minutes, nurses stayed in the Conversation Area of the Patient for 279.6 minutes, and of these 279.6 minutes, two-way face-to-face communication between nurse and patient occurred for 78.0 minutes. Of these 78.0 minutes, communications were started by nurses for 47.2 minutes (174 scenes) and by patients for 24.2 minutes (36 scenes). The patient-started two-way communication scenes included 37 instances of Patient-Intentional-Action that triggered the start of communication. Actions using the upper limbs were observed in 20 instances and represented the most frequently used body part. The head/face, lower limbs, or trunk were also used in some of the actions. Gestures were the most commonly used action type (14 instances). Other types included lip movement, grimace, leg flex/extension, and cough. Conclusions We found that nurses tended to start communication more frequently than patients did and that patients demonstrated Patient-Intentional-Action with a variety of actions using various body parts. Communication opportunities for patients were created when nurses took the initiative to start communication or when they noticed and responded to the Patient-Intentional-Action. Our findings demonstrate that nurses need to recognize and always respond to Patient-Intentional-Action and to take the initiative in communicating rather than waiting for the patient to do so.
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Freeman S, Yorke J, Dark P. The patient and their family's perspectives on agitation and its management in adult critical care: A qualitative study. Intensive Crit Care Nurs 2021; 69:103163. [PMID: 34893394 DOI: 10.1016/j.iccn.2021.103163] [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: 03/08/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Agitation is frequently experienced by patients during critical illness, this is distressing for both the patient and their family. In addition, an acute episode of agitation can create management dilemmas for clinical teams. What is not understood is the patient and family's perspective of agitation and any subsequent management strategies employed. OBJECTIVE To understand the perspectives of patients and family members on the experience of agitation in adult critical care. METHOD An interpretive qualitative study using semi-structured interviews was undertaken with 13 participants, patient participants (n = 7) with the mean critical care length of stay 59 days (±70.88 days). Family members (n = 6) all opted to be interviewed with the patient present. FINDINGS Three themes generated from the data: 1) The recollection of sensations and delusions. 2) Communication and its impact. 3) Managing agitation, what helped and what did not. CONCLUSION The presence of family members has a positive effect on the patient during episodes of agitation. Their involvement in care requires promotion.
Collapse
|
11
|
babaie S, torki A, Keivanfar M. Efficacy of fentanyl on pain relief during tracheal suctioning in ventilated children: A randomized clinical trial. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.1016/j.tacc.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
12
|
Henriksen KF, Hansen BS, Wøien H, Tønnessen S. The core qualities and competencies of the intensive and critical care nurse, a meta-ethnography. J Adv Nurs 2021; 77:4693-4710. [PMID: 34532876 DOI: 10.1111/jan.15044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 08/18/2021] [Accepted: 09/05/2021] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- Kjersti Forbech Henriksen
- Faculty of Health and Social Sciences, Department of Nursing and Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Britt Saetre Hansen
- Faculty of Health and Social Sciences, Department of Nursing and Health Sciences, University of South-Eastern Norway, Kongsberg, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Hilde Wøien
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Nursing Science, University of Oslo, Oslo, Norway
| | - Siri Tønnessen
- Faculty of Health and Social Sciences, Department of Nursing and Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
| |
Collapse
|
13
|
Albaiceta GM, Brochard L, Dos Santos CC, Fernández R, Georgopoulos D, Girard T, Jubran A, López-Aguilar J, Mancebo J, Pelosi P, Skrobik Y, Thille AW, Wilcox ME, Blanch L. The central nervous system during lung injury and mechanical ventilation: a narrative review. Br J Anaesth 2021; 127:648-659. [PMID: 34340836 DOI: 10.1016/j.bja.2021.05.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/03/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
Mechanical ventilation induces a number of systemic responses for which the brain plays an essential role. During the last decade, substantial evidence has emerged showing that the brain modifies pulmonary responses to physical and biological stimuli by various mechanisms, including the modulation of neuroinflammatory reflexes and the onset of abnormal breathing patterns. Afferent signals and circulating factors from injured peripheral tissues, including the lung, can induce neuronal reprogramming, potentially contributing to neurocognitive dysfunction and psychological alterations seen in critically ill patients. These impairments are ubiquitous in the presence of positive pressure ventilation. This narrative review summarises current evidence of lung-brain crosstalk in patients receiving mechanical ventilation and describes the clinical implications of this crosstalk. Further, it proposes directions for future research ranging from identifying mechanisms of multiorgan failure to mitigating long-term sequelae after critical illness.
Collapse
Affiliation(s)
- Guillermo M Albaiceta
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Oviedo, Spain; Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBER)-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Laurent Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Claudia C Dos Santos
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Rafael Fernández
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBER)-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Critical Care Department, Althaia Xarxa Assistencial Universitaria de Manresa, Universitat Internacional de Catalunya, Manresa, Spain
| | - Dimitris Georgopoulos
- Intensive Care Medicine Department, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Timothy Girard
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Amal Jubran
- Division of Pulmonary and Critical Care Medicine, Hines VA Hospital, Hines, IL, USA; Loyola University of Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Josefina López-Aguilar
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBER)-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Jordi Mancebo
- Servei Medicina Intensiva, University Hospital Sant Pau, Barcelona, Spain
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Yoanna Skrobik
- Department of Medicine, McGill University, Regroupement de Soins Critiques Respiratoires, Réseau de Soins Respiratoires FRQS, Montreal, QC, Canada
| | - Arnaud W Thille
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France; INSERM CIC 1402 ALIVE, Université de Poitiers, Poitiers, France
| | - Mary E Wilcox
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Respirology (Critical Care Medicine), University Health Network, Toronto, ON, Canada
| | - Lluis Blanch
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBER)-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| |
Collapse
|
14
|
Ellingsen S, Moi AL, Gjengedal E, Flinterud SI, Natvik E, Råheim M, Sviland R, Sekse RJT. "Finding oneself after critical illness": voices from the remission society. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:35-44. [PMID: 33029693 DOI: 10.1007/s11019-020-09979-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
The number of people who survive critical illness is increasing. In parallel, a growing body of literature reveals a broad range of side-effects following intensive care treatment. Today, more attention is needed to improve the quality of survival. Based on nine individual stories of illness experiences given by participants in two focus groups and one individual interview, this paper elaborates how former critically ill patients craft and recraft their personal stories throughout their illness trajectory. The analysis was conducted from a phenomenological perspective and led to the meaning structure; a quest to find oneself after critical illness. In this structure, illness represented a breakdown of the participants' lives, forcing them to develop a new understanding of themselves. Despite acute illness, they felt safe in hospital. Coming home, however, meant a constant balancing between health and illness, and being either in or out of control. To gain a deeper understanding of the participants' narratives of survival, the meaning structure was developed from a phenomenological life world perspective, Heidegger's concept of homelikeness and Arthur Frank's typologies of illness narratives. In conclusion listening to and acknowledging the patients' lived experiences of critical illness may support the patient efforts to establish the newly defined self and hence be vital for recovery. Phenomenology is one approach facilitating care tailored to the patients' lived experience of critical illness and its aftermaths.
Collapse
Affiliation(s)
- S Ellingsen
- Faculty of Health Studies, VID Specialized University, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - A L Moi
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, Bergen, Norway
| | - E Gjengedal
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - S I Flinterud
- Centre of Diaconia and Professional Practice, VID Specialized University, Bergen, Norway
| | - E Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- The Centre for Health Research, District General Hospital of Førde, Førde, Norway
| | - M Råheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - R Sviland
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - R J T Sekse
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| |
Collapse
|
15
|
Maartmann-Moe CC, Solberg MT, Larsen MH, Steindal SA. Patients' memories from intensive care unit: A qualitative systematic review. Nurs Open 2021; 8:2221-2234. [PMID: 33611859 PMCID: PMC8363378 DOI: 10.1002/nop2.804] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/11/2020] [Accepted: 01/29/2021] [Indexed: 11/05/2022] Open
Abstract
AIM To identify and synthesize the evidence regarding adult patients' memories from their stay in the intensive care unit. DESIGN A qualitative systematic review and meta-synthesis. PROSPERO # CRD42020164928. The review employed the guideline of Bettany-Saltikov and McSherry and the Enhancing transparency in reporting the synthesis of qualitative research guidelines. METHODS Systematic search for qualitative studies published between January 2000 and December 2019 in Cumulative Index to Nursing and Allied Health, Medical Literature Analysis and Retrieval System Online, PsycINFO, and Excerpta Medica Database. Pairs of authors independently assessed eligibility, appraised methodological quality using Joanna Briggs's quality appraisal tool and extracted data. The analysis followed the principles of interpretative synthesis. RESULTS Sixteen papers from 15 studies were included in the review. Three themes emerged: (a) memories of surreal dreams and delusions, (b) care memories from sanctuary to alienation and (c) memories of being vulnerable and close to death.
Collapse
Affiliation(s)
- Charlotte C Maartmann-Moe
- Lovisenberg Diaconal University College, Oslo, Norway.,Emergency Department, Oslo University Hospital, Oslo, Norway
| | | | | | | |
Collapse
|
16
|
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).
Collapse
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
| |
Collapse
|
17
|
Karlsen MMW, Happ MB, Finset A, Heggdal K, Heyn LG. Patient involvement in micro-decisions in intensive care. PATIENT EDUCATION AND COUNSELING 2020; 103:2252-2259. [PMID: 32493611 DOI: 10.1016/j.pec.2020.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The objective of this study was to explore how bedside micro-decisions were made between conscious patients on mechanical ventilation in intensive care and their healthcare providers. METHODS Using video recordings to collect data, we explored micro-decisions between 10 mechanically ventilated patients and 60 providers in interactions at the bedside. We first identified the types of micro-decisions before using an interpretative approach to analyze the decision-making processes and create prominent themes. RESULTS We identified six types of bedside micro-decisions; non-invited, substituted, guided, invited, shared and self-determined decisions. Three themes were identified in the decision-making processes: 1) being an observer versus a participant in treatment and care, 2) negotiating decisions about individualized care (such as tracheal suctioning or medication),and 3) balancing empowering activities with the need for energy restoration. CONCLUSION This study revealed that bedside decision-making processes in intensive care were characterized by a high degree of variability between and within patients. Communication barriers influenced patients' ability to express their preferences. An increased understanding of how micro-decisions occur with non-vocal patients is needed to strengthen patient participation. PRACTICE IMPLICATIONS We advise providers to make an effort to solicit patients' preferences when caring for critically ill patients.
Collapse
Affiliation(s)
- Marte Marie Wallander Karlsen
- Lovisenberg Diaconal University College, Lovisenberggt 15b, 0456 Oslo, Norway; Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Postboks 1100 Blindern, 0137 Oslo, Norway; Department of Emergencies and Critical Care, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway.
| | - Mary Beth Happ
- The Ohio State University, College of Nursing, 352 Newton Hall, 1585 Neil Avenue Columbus, OH 43210 USA.
| | - Arnstein Finset
- Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Postboks 1100 Blindern, 0137 Oslo, Norway.
| | - Kristin Heggdal
- Lovisenberg Diaconal University College, Lovisenberggt 15b, 0456 Oslo, Norway.
| | | |
Collapse
|
18
|
Oxland P, Foster N, Fiest KM, Skrobik Y. Engaging Patients and Families to Help Research Inform and Advance Patient and Family-Centered Care in Critical Care Medicine. Crit Care Nurs Clin North Am 2020; 32:211-226. [PMID: 32402317 DOI: 10.1016/j.cnc.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Intensive care unit (ICU) patient, and family member engagement is evolving in both critical care medicine practice and research. The results of two qualitative critical care research projects led by ICU survivors and family members show how patient-partner research training can inform the critical care community of meaningful priorities in the traumatic ICU context. The resulting creation of a prioritized list of critical care research topics builds further on the construct of patient-centered care.
Collapse
Affiliation(s)
- Peter Oxland
- Alberta Health Services, Critical Care, Patient & Community Engagement Researcher (PaCER), Department of Critical Care Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive Northwest, Calgary T2N5A1, Canada
| | - Nadine Foster
- Alberta Health Services, Critical Care, Department of Critical Care Medicine, Ground Floor, McCaig Tower, 3134 Hospital Drive Northwest, Calgary T2N5A1, Canada. https://twitter.com/nkwfoster
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive Northwest, Calgary T2N5A1, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive Northwest, Calgary T2N5A1, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive Northwest, Calgary T2N5A1, Canada.
| | - Yoanna Skrobik
- Department of Medicine, McGill University, 1650 Cedar Avenue, Room D6.237, Montreal, Quebec H3G 1A4, Canada. https://twitter.com/YoannaSkrobik
| |
Collapse
|
19
|
Noguchi A, Hosokawa K, Amaya F, Yokota I. Factors related to memory absence and delusional memories in patients in intensive care units managed with light sedation. Intensive Crit Care Nurs 2020; 59:102830. [PMID: 32217019 DOI: 10.1016/j.iccn.2020.102830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Currently, light sedation is typically given to patients in intensive care units and studies have not extensively examined the factors related to absences or abnormalities of their memories. We, therefore, analysed the factors related to the absence/abnormalities of patients' memories in intensive care units. RESEARCH METHODOLOGY A secondary analysis of previously collected survey data examining patients' experiences in an intensive care unit was undertaken (n = 405; women = 38%; median age = 70 years). To observe absent or distorted memories, patients were interviewed after leaving the intensive care unit. We analysed key factors through content analysis of the interviews and field notes. SETTING The intensive care unit of a university hospital. MAIN OUTCOME MEASURE Patients' absent or distorted memories after leaving the intensive care unit. RESULTS Half the patients reported an absence of memories. This was associated with old age and with longer duration of mechanical ventilation. Absent or fragmentary memories were not distressing. Fragmentary and fearful intensive care unit memories were associated with being older. Delusional memories, some of which reflected actual events, were present in 3% of patients. CONCLUSION Absence of memories were not distressing, delusional memories occurred less and these memories could comprise of an event in ICU that is difficult for patients to understand.
Collapse
Affiliation(s)
- Ayako Noguchi
- Department of Nursing, University Hospital, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokouji-agaru Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Koji Hosokawa
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Fumimasa Amaya
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokouji-agaru Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Kita 8, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
| |
Collapse
|
20
|
Andersson M, Wilde-Larsson B, Persenius M. Oral care quality-Do humanity aspects matter? Nursing staff's and older people's perceptions. Nurs Open 2020; 7:857-868. [PMID: 33331694 PMCID: PMC7938398 DOI: 10.1002/nop2.461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/30/2019] [Accepted: 02/03/2020] [Indexed: 12/11/2022] Open
Abstract
Aim (a) To describe and compare perceptions of humanity aspects of oral care quality in relation to nursing staff in short‐term care units and intensive care units and older people in short‐term care units and their person‐related conditions; and (b) to compare humanity aspects of oral care quality perceptions between nursing staff and older people in short‐term care units. Design Cross‐sectional study. Self‐reported questionnaire and clinical assessments. Methods Nursing staff (N = 417) and older people (N = 74) completed the modified Quality of Care from a Patient Perspective instrument and person‐related items. Older people's oral health status was clinically assessed using the Revised Oral Assessment Guide. Data were analysed using descriptive and analytic statistics. The data were collected from 2013–2016. Results Nursing staff's perceptions of humanity aspects of oral care quality were related to gender, work role and care environment. Older people's perceptions of humanity aspects of oral care quality were related to self‐reported physical health. Nursing staff in short‐term care units perceived the subjective importance of humanity aspects of oral care quality higher compared with older people in short‐term care units.
Collapse
Affiliation(s)
- Maria Andersson
- Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Bodil Wilde-Larsson
- Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Public Health Studies, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Mona Persenius
- Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| |
Collapse
|
21
|
Wøien H. Movements and trends in intensive care pain treatment and sedation: What matters to the patient? J Clin Nurs 2020; 29:1129-1140. [PMID: 31904888 DOI: 10.1111/jocn.15179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/29/2019] [Accepted: 12/20/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Oversedation, delirium and immobilisation in the intensive care unit are associated with increased length of stay in the unit. Routines of systematic pain and sedation assessment and the use of valid tools are highly stressed in international guidelines. For improving the quality of pain treatment and sedation in a Norwegian intensive care unit, in 2009-2015, we compared supplementation with an analgosedation approach and the existing systematic approach, measured by the adherence to current international pain, sedation and delirium guidelines. METHODS In a longitudinal study following the Standards for Reporting Implementation Studies, pain, sedation, delirium and mobilisation data from patients' complete intensive care unit stays, encompassing three separate periods of 4-6 months, were compared. The primary outcome was adherence to current protocol including assessment and documentation of patients' level of pain, sedation and prevalence of delirium at least every 8 hr, early mobilisation and titration towards a light level of sedation. RESULTS We included 205 patients, corresponding to 1,607 patient intensive care unit days. The patient sedation levels, measured by the Richmond Agitation and Sedation Scale, decreased significantly, from -2.2 in 2009--1.7 in 2015, so did the amount of administrated propofol. Mean pain scores measured by the numeric rating scale during activity were maximum 3.1 in 2014, decreasing to 2.2 in 2015. In patients not able to self-report, pain mean scores were 1.7 in 2014 and 1.6 in 2015, measured by the Critical Care Pain Observational Tool. The number of patients unable to assess for delirium decreased significantly. By discounting the group of patients unable to assess, the prevalence of delirium varied from 32%, 25% and 33%. CONCLUSION The goal of having an awake patient able to cooperate, with acceptable levels of pain, was gradually achieved during a 6-year period. The results showed that pain treatment and sedation in the intensive care unit primarily succeeded in the setting of an established routine of systematic assessment and documentation. RELEVANCE TO CLINICAL PRACTICE The results of the study draw attention to pain treatment, sedation and delirium in intensive care patients, as well as implementation strategies aimed at achieving healthcare personnel's adherence to international guidelines in clinical practice.
Collapse
Affiliation(s)
- Hilde Wøien
- Department of Postoperative and Intensive Care, Division of Emergencies and Intensive Care, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
22
|
Iosifyan M, Schmidt M, Hurbault A, Mayaux J, Delafosse C, Mishenko M, Nion N, Demoule A, Similowski T. "I had the feeling that I was trapped": a bedside qualitative study of cognitive and affective attitudes toward noninvasive ventilation in patients with acute respiratory failure. Ann Intensive Care 2019; 9:134. [PMID: 31792644 PMCID: PMC6888797 DOI: 10.1186/s13613-019-0608-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background Noninvasive ventilation (NIV) is the application of mechanical ventilation through a mask. It is used to treat certain forms of acute respiratory failure in intensive care units (ICU). NIV has clinical benefits but can be anxiogenic for the patients. This study aimed at describing cognitive and affective attitudes toward NIV among patients experiencing NIV for the first time in the context of an ICU stay. Methods Semi-structured interviews were conducted in 10 patients during their ICU stay and soon after their first NIV experience. None of the patients had ever received NIV previously. Evaluative assertion analysis and thematic analysis were used to investigate cognitive and affective attitudes toward NIV before, during, and after the first NIV experience, as well as patient attitudes toward caregivers and relatives. Results Before their first NIV session, the cognitive attitudes of the patients were generally positive. They became less so and more ambiguous during and after NIV, as the patients discovered the actual barriers associated with NIV. Affective attitudes during NIV were more negative than affective attitudes before and after NIV, with reports of dyspnea, anxiety, fear, claustrophobic feelings, and reactivation of past traumatic experiences. The patients had more positive attitudes toward the presence of a caregiver during NIV, compared to the presence of a family member. Conclusion This study corroborates the possibly negative—or even traumatic—nature of the NIV experience, with emphasis on the role of affective attitudes. This is a rationale for evaluating the impact of NIV-targeted psychological interventions in ICU patients with acute respiratory failure.
Collapse
Affiliation(s)
- Marina Iosifyan
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, 75005, Paris, France.,Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France.,Department of Psychology, National Research University Higher School of Economics, Moscow, Russia
| | - Matthieu Schmidt
- Service de Réanimation Médicale de l'Institut de Cardiologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 75013, Paris, France
| | - Amélie Hurbault
- Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Julien Mayaux
- Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Christian Delafosse
- Service de Pneumologie-Explorations du Sommeil, Hôpital Simone Veil, 95600, Eaubonne, France
| | - Marina Mishenko
- Laboratoire Psychopathologie et Processus de Santé, EA 4057, Université Paris Descartes, 75005, Paris, France.,Laboratoire de psychologie du développement et de l'éducation de l'enfant, UMR 8240, CNRS, Université Paris Descartes & Université Caen Basse-Normandie, 75005, Paris, France
| | - Nathalie Nion
- Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Alexandre Demoule
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, 75005, Paris, France.,Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Thomas Similowski
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, 75005, Paris, France. .,Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France.
| |
Collapse
|
23
|
Koszalinski RS, Heidel RE, McCarthy J. Difficulty envisioning a positive future: Secondary analyses in patients in intensive care who are communication vulnerable. Nurs Health Sci 2019; 22:374-380. [PMID: 31736225 DOI: 10.1111/nhs.12664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/11/2019] [Accepted: 10/21/2019] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to report a secondary analysis of data collected through a primary study. The primary study was a, randomized, control trial that used a team-designed (nursing, speech language hearing, engineering, communication sciences, and biostatistics), nurse-led, electronic communication intervention (Speak for Myself Voice) and measured patient outcomes of symptoms of anxiety and depression in five intensive care units at a regional, magnet-status, academic medical center. A secondary analysis of data using the Hospital Anxiety and Depression scale is reported here. The extant literature supports patient expressions of frustration, anger, anxiety, and depression when unable to communicate. This secondary analysis study report adds information about Hospital Anxiety and Depression subscales in the communication-vulnerable population. Implications include emerging awareness of potential feelings of depression and anxiety in patients who are receiving mechanical ventilation or who are unable to verbally communicate for any reason (e.g. obstruction, trauma, head and neck cancer) in the intensive care unit.
Collapse
Affiliation(s)
| | - R Eric Heidel
- Department of Surgery, The University of Tennessee School of Graduate Medicine, Knoxville, Tennessee, USA
| | - Jillian McCarthy
- Department of Audiology and Speech Pathology, The University of Tennessee Health Science Center, Knoxville, Tennessee, USA
| |
Collapse
|
24
|
Egerod I, Kaldan G, Lindahl B, Hansen BS, Jensen JF, Collet MO, Halvorsen K, Eriksson T, Olausson S, Jensen HI. Trends and recommendations for critical care nursing research in the Nordic countries: Triangulation of review and survey data. Intensive Crit Care Nurs 2019; 56:102765. [PMID: 31685257 DOI: 10.1016/j.iccn.2019.102765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/04/2019] [Accepted: 08/31/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Priorities for critical care nursing research have evolved with societal trends and values. In the 1980s priorities were the nursing workforce, in 1990s technical nursing, in 2000s evidence-based nursing and in 2010s symptom management and family-centred care. OBJECTIVES To identify current trends and future recommendations for critical care nursing research in the Nordic countries. METHODS We triangulated the results of a literature review and a survey. A review of two selected critical care nursing journals (2016-2017) was conducted using content analysis to identify contemporary published research. A self-administered computerised cross-sectional survey of Nordic critical care nursing researchers (2017) reported current and future areas of research. RESULTS A review of 156 papers identified research related to the patient (13%), family (12%), nurse (31%), and therapies (44%). Current trends in the survey (n = 76, response rate 65%) included patient and family involvement, nurse performance and education, and evidence-based protocols. The datasets showed similar trends, but aftercare was only present in the survey. Future trends included symptom management, transitions, rehabilitation, and new nursing roles. CONCLUSION Critical care nursing research is trending toward increased collaboration with patient and family, delineating a shift toward user values. Recommendations include long-term outcomes and impact of nursing.
Collapse
Affiliation(s)
- Ingrid Egerod
- University of Copenhagen, Rigshospitalet, Intensive Care Unit 4131, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - Gudrun Kaldan
- Copenhagen University Hospital, Rigshospitalet, 7831, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - Berit Lindahl
- Faculty of Caring Sciences, Work Life & Social Welfare, University of Borås, Borås, Sweden.
| | - Britt Sætre Hansen
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, P.O. Box 8100, N-4068 Stavanger, Norway; Faculty of Health Sciences, Quality and Safety in Health Care Systems, University of Stavanger, N-4036 Stavanger, Norway.
| | - Janet Froulund Jensen
- Department of Anesthesiology, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark.
| | - Marie Oxenbøll Collet
- Department of Intensive Care 4131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - Kristin Halvorsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Norway.
| | - Thomas Eriksson
- Faculty of Caring Sciences, Work Life & Social Welfare, University of Borås, SE-501 90 Borås, Sweden.
| | - Sepideh Olausson
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Hanne Irene Jensen
- Department of Anaesthesiology and Intensive Care, Vejle and Middelfart Hospitals, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløwsvej 19, 5000 Odense, Denmark.
| |
Collapse
|
25
|
Promoting a nursing team’s ability to notice intent to communicate in lightly sedated mechanically ventilated patients in an intensive care unit: An action research study. Intensive Crit Care Nurs 2019; 51:64-72. [DOI: 10.1016/j.iccn.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/16/2018] [Accepted: 10/29/2018] [Indexed: 11/21/2022]
|
26
|
Berntzen H, Bjørk IT, Wøien H. "Having the compass-drawing the map": Exploring nurses' management of pain and other discomforts during use of analgosedation in intensive care. Nurs Open 2019; 6:453-462. [PMID: 30918696 PMCID: PMC6419128 DOI: 10.1002/nop2.227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/10/2018] [Accepted: 11/12/2018] [Indexed: 11/29/2022] Open
Abstract
AIM To explore the deliberation and enactment processes of nurses in relation to pain and other discomforts in the critically ill patients after the implementation of an analgosedation protocol. BACKGROUND Nurses in intensive care units (ICU) face great challenges when managing pain and other discomforts and distinguishing between patients' needs for analgesics and sedatives. An analgosedation protocol favouring pain management, light sedation and early mobilization was implemented in a university hospital ICU in Norway in 2014. Changing sedation paradigms resulting in an increasing number of awake patients during critical illness is expected to affect nursing practice. DESIGN Exploratory, single-unit study in a mixed adult ICU. METHODS Data collection with participant observation and semi-structured interviews in sixteen clinical situations in 2014 and 2015. Thirteen experienced certified critical care nurses were included. Thematic content analysis was conducted. RESULTS An overall theme "Having the compass-drawing the map" emerged from the analysis. The protocol or strategy of analgosedation appeared to provide a direction for treatment and care, although requiring extensive interpretation of needs and individualization of care, often in challenging situations. The overall theme was abstracted from three themes: "Interpreting a complex whole," "Balancing conflicting goals" and "Experiencing strain from acting across ideals." CONCLUSION Nurses seem to attend adequately to patient pain, but the approach to discomforts other than pain appears unsystematic and haphazard. More explicit goals of care and strategies to handle discomfort as distinct from pain are needed. More research is needed to identify effective comfort measures for ICU patients.
Collapse
Affiliation(s)
- Helene Berntzen
- Department of Postoperative and Intensive Care, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
- Department of Nursing ScienceUniversity of OsloOsloNorway
| | | | - Hilde Wøien
- Department of Postoperative and Intensive Care, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
- Department of Nursing ScienceUniversity of OsloOsloNorway
| |
Collapse
|
27
|
Laerkner E, Egerod I, Olesen F, Toft P, Hansen HP. Negotiated mobilisation: An ethnographic exploration of nurse-patient interactions in an intensive care unit. J Clin Nurs 2019; 28:2329-2339. [PMID: 30791156 DOI: 10.1111/jocn.14828] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 01/09/2019] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore nurse-patient interactions in relation to the mobilisation of nonsedated and awake, mechanically ventilated patients in the intensive care unit. BACKGROUND Lighter sedation has enabled the early mobilisation of mechanically ventilated patients, but little is known about the nurses' role and interaction with critically ill patients in relation to mobilisation. DESIGN AND METHODS The study had a qualitative design using an ethnographic approach within the methodology of interpretive description. Data were generated in two intensive care units in Denmark, where a strategy of no sedation was applied. Participant observation was conducted during 58 nurse-patient interactions in relation to mobilisation between nurses (n = 44) and mechanically ventilated patients (n = 25). We conducted interviews with nurses (n = 16) and patients (n = 13) who had been mechanically ventilated for at least 3 days. The data were analysed using inductive, thematic analysis. The report of the study adhered to the COREQ checklist. FINDING We identified three themes: "Diverging perspectives on mobilisation" showed that nurses had a long-term and treatment-oriented perspective on mobilisation, while patients had a short-term perspective and regarded mobilisation as overwhelming in their present situation. "Negotiation about mobilisation" demonstrated how patients actively negotiated the terms of mobilisation with the nurse. "Inducing hope through mobilisation" captured how nurses encouraged mobilisation by integrating aspects of the patient's daily life as a way to instil hope for the future. CONCLUSIONS Exploring the nurse-patient interactions illustrated that mobilisation is more than physical activity. Mobilisation is accomplished through nurse-patient collaborations as a negotiated, complex and meaningful achievement, which is driven by the logic of care, leading to hope for the future. RELEVANCE TO CLINICAL PRACTICE The study demonstrated the important role of nurses in achieving mobilisation in collaboration and through negotiation with mechanically ventilated patients in the intensive care unit.
Collapse
Affiliation(s)
- Eva Laerkner
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.,Department of Public Health, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Ingrid Egerod
- Intensive Care Unit 4131, Health & Medical Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Finn Olesen
- School of Communication and Culture-Information Studies, University of Aarhus, Aarhus, Denmark
| | - Palle Toft
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Helle Ploug Hansen
- Department of Public Health, Faculty of Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
28
|
Mortensen CB, Kjær MBN, Egerod I. Caring for non-sedated mechanically ventilated patients in ICU: A qualitative study comparing perspectives of expert and competent nurses. Intensive Crit Care Nurs 2019; 52:35-41. [PMID: 30737100 DOI: 10.1016/j.iccn.2019.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 12/20/2018] [Accepted: 01/21/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sedation practice has evolved from deep to lighter or no sedation in mechanically ventilated patients in the intensive care unit (ICU). The care of conscious intubated patients constitutes a change in the nurse-patient interaction. OBJECTIVE We aimed to compare the perspectives of expert and competent nurses regarding their interaction with non-sedated mechanically ventilated ICU patients. METHOD The study had a qualitative comparative design applying semi-structured dyadic interviews. We interviewed five pairs of expert and competent ICU nurses with respectively >8 and 2-3 years of ICU experience and performed qualitative content analysis to explore the two perspectives. FINDINGS We identified four main categories illustrating complexities of nurse-patient interaction: Managing frustration, Attempting dialogue, Negotiating reality and Alleviating discomfort. Expert nurses expressed more frustration and ambivalence towards light sedation than competent nurses, who took awake patients for granted. All nurses experienced communication issues, demanding patients, and inability to provide adequate patient comfort. CONCLUSION Our study added to the knowledge of nurse-patient interaction by describing issues of frustration, ambivalence and insecurity in a contemporary context of minimal sedation. Expert nurses were mere concerned by awake patients than competent nurses. Lighter sedation in ICU requires better staffing and improved communication tools.
Collapse
Affiliation(s)
- Camilla Bekker Mortensen
- Intensive Care Unit, Department of Anesthesiology, Zealand University Hospital, Koege, Lykkebaekvej 1, 4600 Koege, Denmark.
| | - Maj-Brit Nørregaard Kjær
- Intensive Care Unit 4131, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Ingrid Egerod
- Intensive Care Unit 4131, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| |
Collapse
|
29
|
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]
|
30
|
Wallander Karlsen M, Heggdal K, Finset A, Heyn LG. Attention‐seeking actions by patients on mechanical ventilation in intensive care units: A phenomenological‐hermeneutical study. J Clin Nurs 2018; 28:66-79. [DOI: 10.1111/jocn.14633] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/06/2018] [Accepted: 07/15/2018] [Indexed: 12/13/2022]
Affiliation(s)
| | | | - Arnstein Finset
- Faculty of Medicine Institute of Basic Medical Sciences University of Oslo Oslo Norway
| | | |
Collapse
|
31
|
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]
|
32
|
Karlsen MMW, Ølnes MA, Heyn LG. Communication with patients in intensive care units: a scoping review. Nurs Crit Care 2018; 24:115-131. [PMID: 30069988 DOI: 10.1111/nicc.12377] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 05/02/2018] [Accepted: 06/13/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients in intensive care units are generally more conscious and alert when they are on mechanical ventilation than in previous years because of the many potential benefits of being under less sedation. The endotracheal tube blocks the vocal cords when patients are on ventilation, thus making it impossible to speak. Many patients report that they struggle to make themselves understood. AIM The aim of this study was to assess previous knowledge about interaction and communication between health care personnel and conscious and alert patients under mechanical ventilation in intensive care units. DESIGN AND METHODS A literature review was performed following the steps of a scoping review. Studies published between 1998 and 2017 were identified in several databases: Cinahl, Embase, Medline, PsycINFO and Scopus. The first search returned 7386 unique references. The inclusion criteria consisted of empirical studies or studies related to interactions between health care personnel and patients over 18 years of age on mechanical ventilation. The relevant studies were summarized in a standardized data-charting sheet. RESULTS The inclusion criteria were met by 46 articles; 16 were qualitative studies, 17 were quantitative, 6 were mixed-methods studies, and 7 were pilot or feasibility studies. Of the studies, 37 were from nurses, 4 from physicians, 4 from speech language pathologists and 1 from psychologists. The most common topics investigated in the studies were 'experiences with communication on mechanical ventilation' and 'communication exchanges'. CONCLUSIONS A variety of communication aids that appear to have some effect on patients should be made available in intensive care units. More multidisciplinary approaches in future studies could enhance the knowledge in the field. RELEVANCE TO CLINICAL PRACTICE The education of intensive care unit personnel in the use of such aids should be a prioritized field, as should be the implementation of a variety of communication aids.
Collapse
Affiliation(s)
| | - Mia Alexandra Ølnes
- Lovisenberg Diaconal University College, Lovisenberggt 15b, 0456 Oslo, Norway
| | | |
Collapse
|
33
|
Lind R, Liland HI, Brinchmann BS, Akeren I. He survived thanks to a non-sedation protocol: Nurses' reflections about caring for critically ill, non-sedated and mechanically ventilated patients. Intensive Crit Care Nurs 2018; 47:54-61. [PMID: 29739651 DOI: 10.1016/j.iccn.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/12/2018] [Accepted: 04/15/2018] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- Ranveig Lind
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Campus Harstad, Pb. 1063, 9480 Harstad, Norway; Intensive Care Unit, University Hospital of North Norway, 9038 Tromsø, Norway.
| | - Hilde-Irén Liland
- Intensive Care Unit, University Hospital of North Norway, 9038 Tromsø, Norway.
| | - Berit S Brinchmann
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Campus Harstad, Pb. 1063, 9480 Harstad, Norway; Faculty of Nursing and Health Science, Nord University, Bodø, Norway.
| | - Inga Akeren
- Intensive Care Unit, University Hospital of North Norway, 9038 Tromsø, Norway.
| |
Collapse
|