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Relatives' experiences of visiting a conscious, mechanically ventilated patient: A hermeneutic study
Högskolan i Skövde, Institutionen för hälsa och lärande. Högskolan i Skövde, Forskningsspecialiseringen Hälsa och Lärande. Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden. (Äldre och långvariga hälsoproblem, Older Adults and Long-Term Health Problems).ORCID iD: 0000-0001-9423-9378
Lund University, Lund, Sweden / Skåne University Hospital, Lund, Sweden.
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden..
2010 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 26, no 2, 91-100 p.Article in journal (Refereed) Published
Abstract [en]

Background

In recent years, light or no sedation has become a common approach to invasive mechanical ventilation in patients with respiratory distress. The experience of visiting a conscious patient receiving mechanical ventilation in the ICU has to our knowledge not yet been investigated.

Aim

The aim of the study was to describe the meaning attributed by relatives to their experiences of meeting, seeing and communicating with a patient cared for on a mechanical ventilator while conscious.

Method

This study used a prospective, exploratory design comprising interviews with ten relatives conducted on two occasions; in connection with their visits to a patient cared for on a ventilator while conscious and approximately a week after the end of intensive care. The data were analysed by means of hermeneutic interpretation to obtain a deeper understanding of relatives' experiences.

Results

Striving to achieve contact with the patient was the most important aspect of being a close relative of a patient receiving ventilator treatment while conscious and was described by four main themes: feeling ambivalent towards consciousness; feeling ambivalent towards sedation; feeling dependent on the carer and being disappointed; and suppressing own suffering and sadness.

Conclusion

The patients' consciousness enabled the relatives to judge their condition for themselves and enter into contact. This resulted in a sense of being in control but also efforts to suppress own suffering.

Place, publisher, year, edition, pages
Elsevier, 2010. Vol. 26, no 2, 91-100 p.
Keyword [en]
Relatives’ experiences, Mechanical ventilation treatment, Conscious patient, Hermeneutics
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
URN: urn:nbn:se:hv:diva-10066DOI: 10.1016/j.iccn.2009.12.001OAI: oai:DiVA.org:hv-10066DiVA: diva2:1040186
Available from: 2016-10-26 Created: 2016-10-26 Last updated: 2016-10-31Bibliographically approved
In thesis
1. Att vårdas vaken med respirator: patienters och närståendes upplevelser från en intensivvårdsavdelning
Open this publication in new window or tab >>Att vårdas vaken med respirator: patienters och närståendes upplevelser från en intensivvårdsavdelning
2012 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
Being conscious during mechanical ventilator treatment : Patients' and relatives' experiences
Abstract [en]

In recent years, light or no sedation has become a common approach in patients who require mechanical ventilation (MV) when cared for in an intensive care unit (ICU). This new approach has resulted in medical advantages as well as a shorter time on MV and in the ICU. Aim: The overall objective of the thesis was to describe, illuminate and interpret patients' and relatives' experiences of caring and communication in connection with MV while the patient is conscious. Methods: The data collection methods were inductive and included interviews and observations, both audiotaped and video-recorded. The study group consisted of patients and relatives; fourteen patients in paper I, twelve in paper II and nineteen in paper III as well as ten relatives in paper IV. In paper I, the video-recorded interviews were analysed using content analysis and hermeneutics. The text in paper II was analysed using the phenomenological-hermeneutic method inspired by Ricoeur. The observations in paper III were analysed by means of a hermeneutic approach based on Gadamer's philosophy. In paper IV, relatives were interviewed on two occasions. The text from these interviews was also analysed using a hermeneutic method inspired by Gadamer. Results: The patients experienced an overall sense of being breathless. While conscious, they were aware of the mechanical ventilator as a life saver. Besides being breathless, being voiceless was considered the worst aspect. Communication was difficult and awkward as it demanded all their will power. Patients' communication patterns varied but there were commonalities; they also developed an individual style of communication. Being subjected to someone else's will and direction meant being painfully aware of one's dependency. Despite this, the patients struggled for independence in various ways as part of the recovery process. Being conscious while receiving MV demands caring communication, which in turn requires proximity, presence and constant attention by a nurse who is "standing by" and prepared to take care of the patient whatever happens. The patients' non-verbal communication through their gaze and facial expression was interpreted as sadness and sorrow, understood as expressions of unuttered suffering. The overall struggle and primary existential aim of relatives in the ICU is to be in contact with the patient, a need which overshadows everything else. Conclusion: Being conscious during MV means being painfully aware of one's dependency while voiceless and helpless. It is possible to endure this situation when the caregivers are "standing by", attentive to the patients' expressions, prepared to act to make sure that the patients are feeling better and do not leave them unattended. Caring for a conscious patient on MV presupposes nurses' ability to understand and be able to "standing by". If this approach is not possible, consciousness might be too painful and sedation should be considered.

Place, publisher, year, edition, pages
Göteborg: Institutionen för vårdvetenskap och hälsa vid Sahlgrenska akademin, Göteborgs universitet, 2012. 82 p.
Keyword
intensive care, mechanical ventilation, conscious, patient communication, relatives, experiences, standing by, hermeneutics, phenomenological-hermeneutics, content analysis
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-10097 (URN)978-91-628-8358-4 (ISBN)
Available from: 2016-10-31 Created: 2016-10-31 Last updated: 2016-10-31Bibliographically approved

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