Smith TA, Agar M, Jenkins CR, Ingham JM, Davidson PM. Experience of acute noninvasive ventilation-insights from 'Behind the Mask': a qualitative study.
BMJ Support Palliat Care 2016;
9:e11. [PMID:
27566721 DOI:
10.1136/bmjspcare-2015-000908]
[Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/28/2016] [Accepted: 08/08/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE
Non-invasive ventilation (NIV) is widely used in the management of acute and acute-on-chronic respiratory failure. Understanding the experiences of patients treated with NIV is critical to person-centred care. We describe the subjective experiences of individuals treated with NIV for acute hypercapnic respiratory failure.
DESIGN
Qualitative face-to-face interviews analysed using thematic analysis.
SETTING
Australian tertiary teaching hospital.
PARTICIPANTS
Individuals with acute hypercapnic respiratory failure treated with NIV outside the intensive care unit. Individuals who did not speak English or were unable or unwilling to consent were excluded.
RESULTS
13 participants were interviewed. Thematic saturation was achieved. Participants described NIV providing substantial relief from symptoms and causing discomfort. They described enduring NIV to facilitate another chance at life. Although participants sometimes appeared passive, others expressed a strong conviction that they knew which behaviours and treatments relieved their distress. Most participants described gaps in their recollection of acute hospitalisation and placed a great amount of trust in healthcare providers. All participants indicated that they would accept NIV in the future, if clinically indicated, and often expressed a sense of compulsion to accept NIV. Participants' description of their experience of NIV was intertwined with their experience of chronic disease.
CONCLUSIONS
Participants described balancing the benefits and burdens of NIV, with the goal of achieving another chance at life. Gaps in recall of their treatment with NIV were frequent, potentially suggesting underlying delirium. The findings of this study inform patient-centred care, have implications for the care of patients requiring NIV and for advance care planning discussions.
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