The work undertaken by mechanically ventilated patients in Intensive Care: A qualitative meta-ethnography of survivors’ experiences

BackgroundMechanical ventilation is a routine intervention for the critically ill but patients’ experiences of this intervention are largely hidden from clinicians. A comprehensive understanding of Intensive Care Units survivors’ accounts is required to provide health professionals with evidence about the patients’ experience to deliver patient-centred care.ObjectivesTo synthesise qualitative findings from international studies to understand Intensive Care Unit survivors’ experiences of mechanical ventilation, clarify the components of patient-centred care from the patient perspective and understand what can be done by health professionals to improve care processes.DesignA meta-ethnography of qualitative evidence following ENTREQ recommendations for reporting systematic reviews.Data sourcesEight databases (MEDLINE, AMED, CINAHL, PsychINFO, Scopus, WileyOnline, PubMed Central, TRIP) were systematically searched using a piloted strategy described in a published protocol. Searches were completed on 31.8.16 and no date restrictions were placed. Searches were updated on 25.4.17.Review methodsTwo researchers independently reviewed studies against pre-determined inclusion criteria to assess their eligibility. Studies were included if they reported on the adult patient experience of mechanical ventilation and used qualitative data collection and analysis methods. All included studies were quality appraised. Participant quotes and concepts, described within the categories and themes of published studies, were extracted by one reviewer and coded by two reviewers. A process of constant comparison, which is central to meta-ethnography, facilitated the re-interpretation of data by a team of researchers to generate the final qualitative synthesis. The Enhancing Transparency in Reporting the Synthesis of Qualitative (ENTREQ) statement was used to ensure that all synthesis stages were comprehensively reported.ResultsFindings from 38 studies, with 608 participants, informed a patient-centred trajectory model; three overlapping stages; alienation, hidden work and recovery characterised the experiences of mechanical ventilation survivors. Health professionals could positively influence the patient experience by promoting ‘trust’ and being vigilant so that patients felt ‘safe’. Care provision that promoted ‘personalisation’ helped participants to retain their identity as unique human beings.ConclusionsFor the first time the pooling of qualitative findings from international studies, using meta-ethnography, has provided a patient-centred model of mechanical ventilation survivors’ experiences of their care processes. Patients may actively engage or passively endure the treatment burden associated with mechanical ventilation.     

Dealing with care disruption in High and Intensive Care wards: From difficult patients to difficult situations

High and Intensive Care is a relatively new care model in Dutch mental health care for clinical admissions. One of the goals is to keep the admission short. For some patients, this goal is not realized, which results in a long‐term admission. Often, this is experienced as a disruption. Disruptions in care processes are frequently defined in terms of patient characteristics. Yet, it may be that other factors play a role. The aim of this study is to gain better insight into the perceptions of care professionals of what is characteristic for disruptions at High and Intensive Care wards and how professionals can deal with these. Qualitative research was performed by means of semi‐structured interviews and a focus group with professionals. Results show that a focus on patient characteristics is too narrow and that other factors also play an important role. These factors include challenges in the relation between professionals and the patient, a divided team, and a lack of collaboration with ambulatory care. In order to deal with these factors, professionals should invest in the relationship with the patient, identify destructive team processes early, and improve communication with ambulatory care. It is recommended to develop a monitoring tool that includes all these factors. Another recommendation is to organize structured reflection on dilemmas experienced in care. In conclusion, this study shows the importance of going beyond patient characteristics in order to better understand, identify, and deal with disruption at High and Intensive Care wards.     

The challenges in caring for morbidly obese patients in Intensive Care: A focused ethnographic study

Background

Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges. However little is known about the care of these patients in intensive care.

How to achieve self-growth as an intern nursing student in Intensive Care Unit: A qualitative study

AimsTo explore the clinical experiences of the intern nursing students who did their internship in the Intensive Care Unit (ICU) at least two months. The key point is to investigate how nursing students achieved self-development in ICUs.MethodsUsing qualitative study based on the grounded theory, we enrolled 15 intern nursing students from November 2021 to April 2022 in a Grade A hospital in Hunan Province, China.ResultsThis study developed an explanatory theoretical framework of the interns’ experience in ICUs, which was described as a comprehensive growth process for ICU interns. In this process, the intern nursing students often go through three stages: pressure period, adjustment period and growth period. Self-regulation and social interaction play a key role to help them get over the negative experiences they experienced in the stress period and achieve personal development.ConclusionClinical nursing educators could make appropriate interventions based on the characteristics of students at different intership stages in ICUs. The target training of intern nursing students should focus on their theoretical knowledge, emotion regulation, communication skills and personality optimization. In addition, clinical tutors should be trained regularly to prepare well for their important roles.     

Barriers to,and facilitators of post‐operative pain management in Iranian nursing: a qualitative research study

Background: Unrelieved post‐operative pain continues to be a major clinical challenge, despite advances in management. Although nurses have embraced a crucial role in pain management, its extent is often limited in Iranian nursing practice. Aim: To determine Iranian nurses' perceptions of the barriers and facilitators influencing their management of post‐operative pain. Methods: This study was qualitative with 26 participant nurses. Data were obtained through semi‐structured serial interviews and analysed using the content analysis method. Findings: Several themes emerged to describe the factors that hindered or facilitated post‐operative pain management. These were grouped into two main themes: (1) barriers to pain management after surgery with subgroups such as powerlessness, policies and rules of organization, physicians leading practice, time constraints, limited communication, interruption of activities relating to pain, and (2) factors that facilitated post‐operative pain management that included the nurse–patient relationship, nurses' responsibility, the physician as a colleague, and nurses' knowledge and skills. Conclusion: Postoperative pain management in Iran is contextually complex, and may be controversial. Participants believed that in this context accurate pain management is difficult for nurses due to the barriers mentioned. Therefore, nurses make decisions and act as a patient comforter for pain after surgery because of the barriers to effective pain management.     

ICU患者早期康复方案的构建及应用研究

目的 构建并应用ICU患者早期康复方案,以降低ICU获得性衰弱（intensive care unit acquired weakness,ICU-AW）的发生率,改善ICU患者的临床结局。方法 运用文献分析法和Delphi法构建ICU患者早期康复方案,将70例于2018年10月—2019年4月入住安徽省某三级甲等医院综合ICU的患者随机分为试验组和对照组,每组各35例,试验组按本研究制订的方案进行康复,对照组按ICU护理常规进行康复,干预后采用英国医学研究委员会（Medical Research Council,MRC）肌力评定法、Barthel指数评定表、ICU-AW的发生率、ICU住院时间评估两组的干预效果。结果 本研究构建的ICU患者早期康复方案包括早期运动、心理护理、营养支持、效果评价4个部分,32项具体康复内容。试验组转出ICU当天的肌力、Barthel指数评分均显著高于对照组（P<0.001）,ICU住院时间短于对照组（P<0.05）,ICU-AW的发生率显著低于对照组（P<0.05）。结论 本研究构建的ICU患者早期康复方案具有较强的科学性和可靠性,应用该方案能降低ICU-AW的发生率,改善患者的临床护理结局。     

Critical incidents rates and types in Italian Intensive Care Units: A five-year analysis

ObjectiveTo describe rates and types of critical incidents in Intensive Care Units.Research methodologyA retrospective study in four intensive care units of an Academic Hospital located in the North-East of Italy. All critical incidents recorded in an incident reporting system database from 2013 to 2017 were collected.Results160 critical incidents emerged. The rate was 1.7/100 intensive care-patient admissions, and 2.86/1000 in intensive care-patient days. Nurses reported most of the critical incidents (n = 113, 70.6%). In 2013 there were 19 (11.9%) critical incidents which significantly increased by 2017 (n = 38, 23.7%; p = 0.034). The most frequent critical incidents were medication/intravenous fluids issues (n = 35, 21.9%) and resources and organisational management (n = 35, 21.9%). Less frequently occurring incidents concerned medical devices/equipment (n = 29, 18.1%), clinical processes/procedures (n = 18, 11.3%), documentation (n = 14, 8.8%) and patient accidents (n = 13, 8.1%). Rare incidents included behaviour, clinical administration, nutrition, blood products and healthcare associated infection.ConclusionOver a five-year period, documented incidents were steadily increasing in four Italian intensive care units. A voluntary incident reporting system might provide precious information on safety issues occurring in units. at both policy and professional levels.     

Perceptions of nurses in Japan toward their patients' expectations of care: A qualitative study

ObjectivesThis study aimed to investigate ideal nurse involvement based on the expectations of patients. Data on conflicts between nurses and patients were obtained. The patient situation involved standard nursing treatment, rather than acute phase or palliative care.MethodsQuestionnaires were distributed among senior nurses attending a series of trainings in 2012 and 2013. The nurses were requested to return their completed questionnaires within two weeks. We ensured the effectiveness of the interview process to obtain accurate answers.The sample comprised 240 head nurses and assistant head nurses who were asked to respond anonymously to 57 questions about non-acute (stable) psychiatric or physical nurse–patient scenarios. Qualitative data analysis was conducted using these responses.ResultsWe received 41 completed responses (response rate = 17.1%). The expectations of patients and their families were reflected in five categories, namely, inference, empathic understanding, listening attitude, individual treatment, and reliable skills and explanations. Inference was independently categorized as a particularly strong characteristic of Japanese patients' expectations.ConclusionsNursing care in situations where conflicts or misunderstandings may arise can be improved by encouraging nurses to be attentive to the moods, feelings, and expectations of patients and their families. The findings from this study can improve the quality of Japanese nursing care with regard to sensing (inferring) and reacting to the expectations of patients.     

青少年服毒自杀患者心理体验的质性研究

目的 深入了解青少年服毒自杀患者的心理体验与感受,为临床护理人员开展心理干预提供参考依据.方法 采用现象学研究方法对温州市某三级甲等综合医院2019年6月—12月收治的11例青少年服毒自杀患者进行深入访谈,运用Colaizzi 7步分析法进行资料分析.结果 青少年服毒自杀患者的心理体验可归纳为4个主题:有效沟通的缺失、...     

Practice of sedation and the perception of discomfort during mechanical ventilation in Chinese intensive care units

Purpose

The purpose of this study was to investigate sedation practices and the perception of discomfort during mechanical ventilation in Chinese intensive care units (ICUs).

Material and Method

A prospective, observational, cohort study was conducted in 31 Chinese ICUs in academic hospitals from June 15 to August 15, 2006. Conscious patients who were discharged from the ICU after mechanical ventilation were consecutively included. Using a standardized questionnaire, a personal interview was conducted with each patient within 2 days after discharge from the ICU. Patients were asked about recollections of emotional and physical discomfort. Sedation and analgesia administration data were collected from patient records.

Results

As prospectively defined, 83 (50.9%) of 163 patients met criteria for complex-mixed discomfort (ie, at least 1 emotional and 2 physical disturbances). Similarly, 79.1% of patients remembered seriously uncomfortable experiences associated with 1 of the 3 predefined sources. Both protocolized sedation and continuous sedation without a defined protocol, but not intermittent sedation, significantly reduced the relative risk of complex-mixed discomfort occurrences (P < .001). Notably, only 14.7% of patients received protocolized sedation, and 61 (37.4%) of 163 were not given any sedatives.

Conclusion

Mechanically ventilated ICU patients in Chinese academic hospitals were inadequately treated for discomfort. Protocolized sedation can effectively improve patient comfort.     

Postoperative patients’ perspectives on rating pain: A qualitative study

BackgroundIn postoperative pain treatment patients are asked to rate their pain experience on a single uni-dimensional pain scale. Such pain scores are also used as indicator to assess the quality of pain treatment. However, patients may differ in how they interpret the Numeric Rating Scale (NRS) score.ObjectivesThis study examines how patients assign a number to their currently experienced postoperative pain and which considerations influence this process.MethodsA qualitative approach according to grounded theory was used. Twenty-seven patients were interviewed one day after surgery.ResultsThree main themes emerged that influenced the Numeric Rating Scale scores (0–10) that patients actually reported to professionals: score-related factors, intrapersonal factors, and the anticipated consequences of a given pain score. Anticipated consequences were analgesic administration—which could be desired or undesired—and possible judgements by professionals. We also propose a conceptual model for the relationship between factors that influence the pain rating process. Based on patients’ score-related and intrapersonal factors, a preliminary pain score was “internally” set. Before reporting the pain score to the healthcare professional, patients considered the anticipated consequences (i.e., expected judgements by professionals and anticipation of analgesic administration) of current Numeric Rating Scale scores.ConclusionsThis study provides insight into the process of how patients translate their current postoperative pain into a numeric rating score. The proposed model may help professionals to understand the factors that influence a given Numeric Rating Scale score and suggest the most appropriate questions for clarification. In this way, patients and professionals may arrive at a shared understanding of the pain score, resulting in a tailored decision regarding the most appropriate treatment of current postoperative pain, particularly the dosing and timing of opioid administration.     

轻度认知障碍患者记忆力下降体验的质性研究

目的 探讨轻度认知障碍患者记忆力下降的体验,为临床护理人员开展护理干预提供参考。 方法 采用目的抽样法,选取2021年5月—6月北京市某三级甲等医院神经内科门诊的9例轻度认知障碍患者作为研究对象进行半结构访谈,采用现象学研究中Colaizzi 7步分析法进行资料分析。 结果 轻度认知障碍患者记忆力下降的体验可归纳为3个主题：记忆力下降的疾病感知（轻视与否认的态度、反思与溯源的自省、互动关系的改变）;记忆力下降的情感体验（焦虑与恐惧情绪的产生、自我效能感的降低、自我开解态度的形成、对未来的期待）;记忆力下降的应对策略（生活方式的应对、体力与脑力活动的应对、未来规划的应对）。 结论 应加强对轻度认知障碍患者记忆力下降医疗知识的普及,关注其情感需求,给予心理疏导、家庭支持和社会支持,并进行个性化的认知干预,促进其认知改善,提高生活质量。