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Att vårdas vaken med respirator: patienters och närståendes upplevelser från en intensivvårdsavdelning
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
2012 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Being conscious during mechanical ventilator treatment : Patients' and relatives' experiences (English)
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 [en]
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: urn:nbn:se:hv:diva-10097ISBN: 978-91-628-8358-4OAI: oai:DiVA.org:hv-10097DiVA: diva2:1042009
Available from: 2016-10-31 Created: 2016-10-31 Last updated: 2016-10-31Bibliographically approved
List of papers
1. Patients' statements and experiences concerning receiving mechanical ventilation: a prospective video-recorded study
Open this publication in new window or tab >>Patients' statements and experiences concerning receiving mechanical ventilation: a prospective video-recorded study
2012 (English)In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 19, no 3, 247-258 p.Article in journal (Refereed) Published
Abstract [en]

Patients' statements and experiences concerning receiving mechanical ventilation: a prospective video-recorded study Prospective studies using video-recordings of patients during mechanical ventilator treatment (MVT) while conscious have not previously been published. The aim was to describe patients' statements, communication and facial expressions during a video-recorded interview while undergoing MVT. Content analysis and hermeneutics inspired by the philosophy of Gadamer were used. The patients experienced almost constant difficulties in breathing and lost their voice. The most common types of communication techniques patients used were nodding or shaking the head. Their expressions were interpreted as stiffened facial expression, tense body position and feelings of sadness and sorrow. Nursing care for patients' conscious during MVT is challenging as it creates new demands regarding the content of the care provided. In caring for patients undergoing MVT while conscious, establishing a caring relationship, making patients feel safe and helping them to communicate seem to be most important for alleviating discomfort and instilling hope.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2012
Keyword
Hermeneutics, mechanical ventilation, video-recording., Vårdmiljö, intensivvård
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-10059 (URN)10.1111/j.1440-1800.2011.00576.x (DOI)
Available from: 2016-10-25 Created: 2016-10-25 Last updated: 2016-10-31Bibliographically approved
2. The lived experiences of adult intensive care patients who were conscious during mechanical ventilation: A phenomenological-hermeneutic study
Open this publication in new window or tab >>The lived experiences of adult intensive care patients who were conscious during mechanical ventilation: A phenomenological-hermeneutic study
2012 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 28, no 1, 6-15 p.Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to illuminate the lived experience of patients who were conscious during mechanical ventilation in an intensive care unit (ICU).Method: Interviews with 12 patients assessed as being conscious during mechanical ventilation were conducted approximately one week after discharge from an ICU. The text was analyse dusing a phenomenological-hermeneutic method inspired by Ricoeur. Results: Apart from breathlessness, voicelessness was considered the worst experience. The discomfort and pain caused by the tracheal tube was considerable. A feeling of being helpless,deserted and powerless because of their serious physical condition and inability to talk prompted the patients to strive for independence and recovery and made them willing to 'flowwith' the treatment and care. Comments from the patients suggest that their suffering can be alleviated by communication, participation in care activities and companionship. Conclusion: A patient's endurance whilst conscious during mechanical ventilation seems to be facilitated by the presence of nurses, who mediate hope and belief in recovery, strengthening the patient's will to fight for recovery and survival.

Place, publisher, year, edition, pages
Elsevier, 2012
Keyword
Phenomenological hermeneutic, Mechanical ventilation, Lived experience, Conscious adult patient
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-10060 (URN)10.1016/j.iccn.2011.11.002 (DOI)
Available from: 2016-10-25 Created: 2016-10-25 Last updated: 2016-10-31Bibliographically approved
3. Communication when patients are conscious during respirator treatment: A hermeneutic observation study
Open this publication in new window or tab >>Communication when patients are conscious during respirator treatment: A hermeneutic observation study
2012 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 28, no 4, 197-207 p.Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to observe, interpret and describe nurses' communication with conscious patients receiving mechanical ventilation treatment (MVT) in an intensive care unit(ICU), and to examine if such communication could be interpreted as caring. Design: Hermeneutic observational study inspired by the philosophy of Gadamer. Method: Nineteen patients were observed on several occasions for a total of 66 hours, when conscious during MVT. Findings: A form of caring communication was identified and interpreted as comprising seven themes: being attentive and watchful, being inclusive and involving, being connected, remaining close, being reassuring and providing security, keeping company and using humour and using a friendly approach. Communication that mediated a non-caring approach was also identified and described under two thematic headings, i.e. being neglectful and being absent. Conclusions: Caring is communicated by the caring act of ''standing-by'' the patient. Caring or non-caring is communicated in non-verbal and verbal communication, in the words used, the tone of voice and behaviour, as well as in the performance of nursing care activities.

Place, publisher, year, edition, pages
Elsevier, 2012
Keyword
Hermeneutic, Observations, Mechanical ventilation treatment, ICU, Caring, Communication
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-10067 (URN)10.1016/j.iccn.2011.12.007 (DOI)
Available from: 2016-10-26 Created: 2016-10-26 Last updated: 2016-10-31Bibliographically approved
4. Relatives' experiences of visiting a conscious, mechanically ventilated patient: A hermeneutic study
Open this publication in new window or tab >>Relatives' experiences of visiting a conscious, mechanically ventilated patient: A hermeneutic study
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
Keyword
Relatives’ experiences, Mechanical ventilation treatment, Conscious patient, Hermeneutics
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-10066 (URN)10.1016/j.iccn.2009.12.001 (DOI)
Available from: 2016-10-26 Created: 2016-10-26 Last updated: 2016-10-31Bibliographically approved

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