Understanding patients’ experiences of being mechanically ventilated in the Intensive Care Unit: Findings from a meta‐synthesis and meta‐summary

Abstract

Aims and objectives To synthesise the evidence reported in qualitative studies concerning the lived experiences of adult patients receiving mechanical ventilation in Intensive Care Unit (ICU). Background Critically ill patients receiving mechanical ventilation in the ICU have been reported to suffer from severe physical and emotional responses such as hopelessness, anxiety, high levels of frustration and stress. Recent improvements in the field of mechanical ventilation and sedative medications as experienced by patients that can inform nursing care have not been summarised to date. Design A systematic review of qualitative studies followed by a meta‐synthesis and a meta‐summary was performed. Methods Four electronic databases were searched by two authors in June 2019. A total of nine studies were included and evaluated based on their methodological quality using the Critical Appraisal Skills Programme checklist. Results A total of 24 codes emerged from the abstraction process, which were categorised into 11 categories and four themes: (a) “The effect of the intense stress on the body's systems,” (b) “The induced negative emotional situations,” (c) “The feeling of being cared for in a hospital setting” and (d) “The perceived support from the family and loved ones.” Furthermore, the most frequent codes across studies were “Being afraid,” “Feeling supervised,” “Feeling comforted,” “Failing to communicate,” and “Experiencing difficulties in breathing,” with an intensity of 66.6%. Conclusion Patients receiving mechanical ventilation have expressed a general sense of vulnerability, of which critical care nurses need to be aware. Relevance to clinical practice Findings suggest the need for improvements at the nursing, unit, educational and policy levels; furthermore, more research is also required at the international levels given the current trends towards no sedation protocols for the management of ICU patients: listening to their experiences becomes imperative, in order to ensure an awake, comfortable and ventilator‐tolerant patient.

Donning and doffing of personal protective equipment protocol and key points of nursing care for patients with COVID-19 in ICU

“…The endotracheal tube was carefully secured, and the length was checked in each shift to prevent displacement. 16 In order to decrease patient’s oxygen consumption, analgesia and sedation are often used to alleviate patients’ discomfort 17 and reduce patient’s irrigation; this is the routine treatment after intubation in patients with COVID-19. 18 Remifentanil, midazolam and propofol could be used as the analgesic and sedative drugs.…”

Nurses’ experiences of serving as a communication guide and supporting the implementation of a communication intervention in the intensive care unit

“…However, mechanically ventilated patients are deprived of the possibility to express themselves verbally and, for a period, only the nurse can communicate verbally during their encounter. The patient is trapped in a voiceless world where the expression of thoughts, wishes, needs and concerns depends on the nurse’s ability to interpret his or her nonverbal communication (Carroll, 2007 ; Danielis et al, 2020 ; Karlsson et al, 2012 ). Nurse-patient communication in the ICU is affected by multiple factors; 1) the patients’ communicative characteristics and general condition, which may vary from day to day; 2) the nurses’ communication approach and care focus; 3) the relation between the nurse and patient; and 4) external factors, e.g., pressure from busyness, the ICU environment and strategies implemented to promote communication (Dithole et al, 2016 ; Finke et al, 2008 ; Anna Holm et al, 2020 ).…”

What does coercion in intensive care mean for patients and their relatives? A thematic qualitative study

“…Whether restraining measures can prevent the removal of tubes or other devices is questionable [ 6 , 42 ]. There are additional risks particularly for physical restraints in the ICU, like an increased need for opioids or benzodiazepines to sedate the patient, which entails a higher risk of delirium and increased mortality [ 7 , 28 ]. The impact of restraining measures on the development of post-traumatic stress disorder is still under discussion [ 43 , 44 ].…”

“…The use of coercion in a clinical setting requires not only legal compliance, but also medical and moral justification, including a weighing up of benefits and risk reduction against induced harm [ 23 , 26 ]. Patients describe the situation of dependency in the ICU with feelings such as powerlessness, frailty, and vulnerability [ 27 , 28 ]. These rather negative associations might be explained, at least in part, by the high social value of autonomy in our Western societies [ 29 ].…”