A sense of agency: An ethnographic exploration of being awake during mechanical ventilation in the intensive care unit

Lærkner, Eva; Egerod, Ingrid; Olesen, Finn; Hansen, Helle Ploug

doi:10.1016/j.ijnurstu.2017.06.016

Cited by 45 publications

(59 citation statements)

References 49 publications

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“…They found that the patients’ pain was largely relieved, but that they struggled with other discomforts, mainly due to MV, incomprehension and experiencing delusions. Lærkner, Egerod, Olesen, and Hansen () found that being awake during critical illness increased the ICU patient's awareness of the severity of their illness and increased their discomfort and sense of incapacity.…”

Section: Discussionmentioning

confidence: 99%

“Having the compass–drawing the map”: Exploring nurses’ management of pain and other discomforts during use of analgosedation in intensive care

2018

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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.

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Section: Discussionmentioning

confidence: 99%

“Having the compass–drawing the map”: Exploring nurses’ management of pain and other discomforts during use of analgosedation in intensive care

2018

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“…One Australian study showed that more than 50% of patients discharged from the ICU had developed ICU-acquired weakness, which was associated with death between ICU discharge and day 90 (TEAM Study Investigators, 2015). Early mobilisation is associated with more delirium-free days and improved cognitive outcome after ICU discharge (Devlin et al, 2018 (Berntzen et al, 2018;Cutler, Hayter, & Ryan, 2013;Laerkner et al, 2017;Marra et al, 2018). We still lack a systematic approach to help manage the discomfort described by the patients.…”

Section: Discussionmentioning

confidence: 99%

“…Early mobilisation of patients receiving mechanical ventilation (MV) and the maintenance of cognitive function may explain the lower rates of delirium in the ICU (Denehy, Lanphere, & Needham, 2017). However, knowledge is limited about how critically ill patients tolerate staying awake while treated in the ICU and how these patients manage to rehabilitate after hospital discharge (Berntzen, Bjørk, & Wøien, 2018;Holm & Dreyer, 2017;Laerkner, Egerod, Olesen, & Hansen, 2017).…”

Section: Introductionmentioning

confidence: 99%

Movements and trends in intensive care pain treatment and sedation: What matters to the patient?

Wøien

2020

Journal of Clinical Nursing

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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.

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“…Many patients in ICUs are comatose, sedated or in other ways affected by life‐threatening illnesses, and active patient participation in nursing care and treatment might be difficult to achieve (Schandl, Falk, & Frank, ). However, patients who are awake during critical illness and mechanical ventilation have reported experiencing a sense of vulnerability (Engström, Nyström, Sundelin, & Rattray, ; Karlsson, Bergbom, & Forsberg, ; Laerkner, Egerod, Olesen, & Ploug Hansen, ) and a desire to participate in communication and in their own care as soon as they perceived they could (Karlsson et al, ; Laerkner et al, ; Lindberg, Sivberg, Willman, & Fagerström, ).…”

Section: Discussionmentioning

confidence: 99%

Oral care quality—Do humanity aspects matter? Nursing staff's and older people's perceptions

2020

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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.

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A sense of agency: An ethnographic exploration of being awake during mechanical ventilation in the intensive care unit

Cited by 45 publications

References 49 publications

“Having the compass–drawing the map”: Exploring nurses’ management of pain and other discomforts during use of analgosedation in intensive care

“Having the compass–drawing the map”: Exploring nurses’ management of pain and other discomforts during use of analgosedation in intensive care

Movements and trends in intensive care pain treatment and sedation: What matters to the patient?

Oral care quality—Do humanity aspects matter? Nursing staff's and older people's perceptions

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