Patients' experience of being critically ill or severely injured and cared for in an intensive care unit in relation to the ICU syndrome. Part I

doi:10.1016/S0964-3397(98)80691-5

Intensive and Critical Care Nursing

Volume 14, Issue 6, December 1998, Pages 294-307

https://doi.org/10.1016/S0964-3397(98)80691-5 Get rights and content

The intensive care unit (ICU) syndrome is regarded principally as a complex interaction of several contributory factors, all of which can be seen as partly responsible for the development of the syndrome. The purpose of this study was to describe and give a deeper insight into patients' experiences and memory recall, both during and after their stay in the ICU. Nineteen patients who had been respirator treated (ventilated), and had stayed at least 36 hours in the ICU, were interviewed about one week after discharge, and again 4–8 weeks after their discharge from the ICU. Patients' experiences are interpreted and related to previous views held concerning the syndrome, together with an awareness of other important and significant phenomena, i.e. a hermeneutic approach. This study partly confirms the findings of earlier studies concerning the ICU syndrome, but also reveals some new aspects, which have not previously been considered. The patients described themselves as experiencing some sort of state of chaos following the onset of their sickness, injury or accident, which resulted in feelings of extreme instability, vulnerability and fear, often experienced as prolonged inner tension. It was reported that even the most trivial events in circumstances or routines could trigger changes — either an increase or decrease — in patients' feelings of fear or inner tension. The caring relationship was perceived as providing an important degree of security and comfort. Nursing care actions can therefore be seen as vital factors in patients overcoming the accompanying horrific experiences to which they can be subjected. This state of chaotic feeling, and how it is combated and treated, appear to be one critical factor in the development and progression of the ICU syndrome.

References (42)

Bergbom-EngbergI et al.
A retrospective study of patients' recall of respirator treatment: nursing care factors and feelings of security/insecurity
Intensive Care Nursing
(1988)
CliffordC
Patients, relatives and nurses in a technological environment
Intensive Care Nursing
(1986)
GranbergA et al.
Intensive care syndrome: a literature review
Intensive and Critical Care Nursing
(1996)
HafsteindóttirTB
Patients' experiences of communication during the respirator treatment period
Intensive and Critical Care Nursing
(1996)
LaitinenH
Patients' experience of confusion in the intensive care unit following cardiac surgery
Intensive and Critical Care Nursing
(1996)
MacKellaigJM
A study of the psychological effects of intensive care with particular emphasis on patients in isolation
Intensive Care Nursing
(1987)
McGonigalKS
The importance of sleep and sensory environment to critically ill patients
Intensive Care Nursing
(1986)
PlatzerH
Body image — a problem for intensive care patients (Part 1)
Intensive Care Nursing
(1987)
SmithS
Extended body image in the ventilated patient
Intensive Care Nursing
(1989)
ÅkerbergH
Hermeneutik och pedagogisk psykologi
(1986)

AurellJ et al.

Sleep in the surgical intensive care unit: continuous polygraphic recording of sleep in nine patients receiving postoperative care

British Medical Journal

(1985)

BallardKS

Identification of environmental stressors for patients in a surgical intensive care unit

Issues In Mental Health Nursing

(1981)

BelitzJ

Minimizing the psychological complications of patients who require mechanical ventilation

Critical Care Nurse

(1983)

Bergbom-EngbergI

Patients' experience of respirator treatment. A retrospective study of the influence of medical and nursing care factors on recall, experience of discomforts, and feelings of security or insecurity

Dissertation from the Department of Anaesthesiology, University of Göteborg, Vasastadens Bokbinderi, Göteborg

(1989)

DahlbergK

Qualitative methodology as caring science methodology

Scandinavian Journal of Caring Sciences

(1995)

Edéll-GustavssonUM et al.

Measurement of sleep and quality of life before and after coronary artery bypass grafting: a pilot study

International Journal of Nursing Practice

(1997)

EisendrathSJ

ICU syndromes revisited

Critical Care Update

(1982)

ErikssonK

Pausen En beskrivning av vård vetenskapens kunskapsobjekt

(1987)

FisherME et al.

ICU Syndrome

Critical Care Nurse

(1984)

FoxHM

Psychological observations of patients undergoing mitral surgery

Psychosomatic Medicine

(1954)

FöllesdalD et al.

Argumentationsteori, språk och vetenskapsfilosofi

(1993)

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Delirium-related distress in the ICU: A qualitative meta-synthesis of patient and family perspectives and experiences
2021, International Journal of Nursing Studies
Better understanding of patient and family member experiences of delirium and related distress during critical care is required to inform the development of targeted nonpharmacologic interventions.
To examine and synthesize qualitative data on patient and family member delirium experiences and relieving factors in the Intensive Care Unit (ICU).
We conducted a systematic review and qualitative meta-synthesis. Eligible studies contained adult patient or family quotes about delirium during critical care, published in English in a peer-reviewed journal since 1980. Data sources included PubMed, Embase, CINAHL, PsycINFO, Web of Science, Cochrane and Clinicaltrials.gov.
Systematic searches yielded 3238 identified articles, of which 14 reporting 13 studies were included. Two reviewers independently extracted data into a Microsoft Excel spreadsheet. Qualitative meta-synthesis was performed through line-by-line coding of relevant quotes, organization of codes into descriptive themes, and development of analytical themes. Five patients/family members with experience of ICU delirium contributed to the thematic analysis.
Qualitative meta-synthesis resulted in four major themes and two sub-themes. Key new patient and family-centric insights regarding delirium-related distress in the ICU included articulation of the distinct emotions experienced during and after delirium (for patients, predominantly fear, anger and shame); its ‘whole-person’ nature; and the value that patients and family members placed on clinicians’ compassion, communication, and connectedness.
Distinct difficult emotions and other forms of distress are experienced by patients and families during ICU delirium, during which patients and families highly value human kindness and empathy. Future studies should further explore and address the many facets of delirium-related distress during critical care using these insights and include patient-reported measures of the predominant difficult emotions.
The lived experience of delirium in intensive care unit patients: A meta-ethnography
2020, Australian Critical Care
The objectives were to interpretatively synthesise qualitative findings on patients' lived experience of delirium in the intensive care unit (ICU) and to identify meanings and potential existential issues that affect them during and after their experience. Patients may face existential challenges when they are vulnerable in their confusion, all while confronting the reality of their mortality in the critically ill state.
The study involved meta-ethnographic synthesis of published qualitative studies addressing the lived experience of delirium for patients in ICU based on a systematic literature search.
MEDLINE, PsycINFO, Embase, Scopus, CINAHL, ProQuest, and Cochrane were the sources. Studies were selected based on the predefined inclusion/exclusion criteria. The identified studies were subjected to a quality appraisal based on a Critical Appraisal Skills Programme tool.
Based on the eligibility criteria, nine qualitative studies were included, of overall medium to high quality. One core theme, “a perturbing altered reality” and four main themes were identified: “disturbed sense of time”, “omnipresent feeling of fear”, “impact of human connection”, and “perceiving surreal events”. These four themes illustrate how the three salient existential issues of uncertainty, self-perceived helplessness, and death that are present in delirium make it a highly distressing experience for patients in ICU.
Critically ill patients who experience delirium appear to face intense existential issues, which may not be identified by care providers and may remain unaddressed during their ICU stay and after discharge. Patients report that addressing the memories of these issues would be therapeutic. Future research needs to explore care approaches to meet the unique psychosocial needs of critically ill patients with delirium.
Quality of life improves for tracheostomy patients with return of voice: A mixed methods evaluation of the patient experience across the care continuum
2018, Intensive and Critical Care Nursing
A tracheostomy tube can profoundly impact ability to communicate. The impact of this on patients’ self-esteem and quality of life in the care continuum from the intensive care unit to after decannulation has not been reported. Therefore, the aim was to investigate the patient-reported experience regarding change in communication function, communication-related self-esteem and quality of life.
A mixed methods approach was utilised. Quantitative data were obtained using validated measures of self-esteem related to communication-related quality of life and general health. Data were measured before return of voice, within 48 hours of voice return and six months after tracheostomy decannulation. Qualitative data were collected through structured interviews six months after tracheostomy.
Seventeen participants completed the study. Four themes emerged from the interviews: It’s hard communicating without a voice; What is happening to me?; A storm of dark emotions and More than a response…it’s participating and recovering. Significant positive change occurred in six items of self-esteem related to communication from baseline to return of voice. Overall, positive changes in quality of life scores were observed.
Voice loss with tracheostomy significantly affected participants’ abilities to effectively communicate their care and comfort needs. Restoration of voice occurred in conjunction with patient-reported improved mood, outlook and sense of recovery.
The effect of guided imagery on physiological and psychological outcomes of adult ICU patients: A systematic literature review and methodological implications
2018, Australian Critical Care
Guided imagery (GI) is a relaxation technique that is being increasingly explored in various patients’ populations. We systematically reviewed evidence on the effects of GI on physiological and psychological outcomes of adult critically ill patients and extracted implications for future research.
Systematic literature review of published studies based on the Cochrane Guidelines.
Studies were located through literature searches of CINAHL, PubMed, Embase, Cochrane Database of Systematic Reviews and Psych-Info.
We explored effects of GI in critically illness. The outcome measures included pain, anxiety, hemodynamic measurements, stress neuropeptides, length of stay, sleep quality, inflammatory markers, patient satisfaction and cost of care. The Cochrane Collaboration’s tool for assessing risk of bias was employed. Extracted data included pathophysiological framework, sample, diagnoses of participants, specifics of intervention, design, experimental groups, analyses and main outcomes.
Based on the selection criteria, 10 studies were identified, involving N = 1391 critically ill patients. The main limitations include incomplete outcome data and selective reporting, incomplete blinding and lack of experimental group allocation concealment. Due to heterogeneity and incomplete reporting, a meta-analysis was not feasible. Our findings included: (a) favourable effects of the intervention with regard to decrease of pain, anxiety and LOS; (b) many studies employing randomised controlled trial designs; (c) a predominant focus on patients with cardiac surgery; (d) large heterogeneity in measurement of outcomes. Moreover, the evidence suggests that improvements in sleep quality, patient satisfaction and cost of care merit further investigation. Methodological implications include the need to clarify the underlying physiological framework, the use of repeated measure designs and the adjustment for confounders.
On the basis of these results, and of the absence of reported side-effects, we conclude that GI is a promising patient-centered approach for the improvement of a number of patients’ outcomes that merits further investigation in critical care.
An investigation of light and sound levels on intensive care units in China
2016, Australian Critical Care
The intensive care units’ (ICU) environment is considered clinically relevant sources of stress for patients.
To measure 24-h sound and light levels in 7 ICUs in China [four medical (MICU), two surgical (SICU) and one coronary (CCU) ICUs] and to identify the main sources related to increased sound levels.
Sound pressure and light levels were monitored for specific times over a 24-h period using a digital sound level meter and a light detector in 7 ICUs. Sound pressure levels were measured for 20 min every hour. The main events at the time of peak noise levels were recorded. Light levels were measured every 2 h at three locations for each ICU: near a window, in the centre of the room, at eye level of a patient receiving assisted ventilation.
The mean value of 24-h sound pressure levels exceeded 50 dB(A) in all ICUs, ranging from 56.5 to 70.1 dB(A). The SICUs and CCU had higher sound pressure readings from 0700 h to 1600 h, compared to the MICUs where the sound pressure readings reflected less variability across the 24-h period. Marked differences were observed in luminance levels among various ICUs and also across the 24-h period for all three locations. The mean highest level of nocturnal luminance at eye level of patients receiving assisted ventilation ranged from 15 to 489 lx before midnight (1800–2400 h) and 10 to 239 lx after midnight (2401–0759 h).
High sound pressure levels are prevalent throughout 24 h in the ICUs, especially in the SICU. Many of the readings exceeded international standards. Peak sound pressure levels were related primarily to staff activities and the alarm sounds of machines. ICU patients are exposed to high levels of artificial light continuously throughout the day and night.
To feel strong in an unfamiliar situation; Patients' lived experiences of neurosurgical intensive care. A qualitative study
2016, Intensive and Critical Care Nursing
Citation Excerpt :
Disorientation, nightmares and hallucinations were mentioned by the patients. These kinds of unreal experiences are well described in several studies, which included both mechanically ventilated and not mechanically ventilated patients (Granberg et al., 1998; Löf et al., 2006; Rundshagen et al., 2002). In our study we found the strict immobilisation and the repeated estimations of level of consciousness night and day were strains that increased the risk of disorientation, nightmares and hallucinations.
The aim of this study was to explore the lived experiences of conscious patients in neurosurgical intensive care.
Data collection was performed by qualitative interviews using an interview guide. Eleven former patients, seven women and four men, were interviewed two to 14 months after discharge. The interviews were recorded and transcribed verbatim and analysed using an interpretive phenomenological approach.
The analysis revealed three themes: To feel safe in an unfamiliar situation, to experience strains and limitations, and to be confirmed as a human being. These three themes culminated in the essence: To feel strong in an unfamiliar situation. Patients experienced a soothing environment where, despite strains, they felt safe being cared for in a ward with specialised medical treatment. When mental and physical strains decreased during the period of care, they experienced the ability to cope with the simplest tasks as a sign of regained identity.
Patients’ main experience during intensive care was security. Security along with human contact and interaction with staff and next of kin made the patients feel strengthened as human beings in an unfamiliar situation. The fact that the patients were conscious enabled them to understand their situation and to experience security.

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Patients' experience of being critically ill or severely injured and cared for in an intensive care unit in relation to the ICU syndrome. Part I

Intensive Care Nursing

Intensive Care Nursing

Intensive and Critical Care Nursing

Intensive and Critical Care Nursing

Intensive and Critical Care Nursing

Intensive Care Nursing

Intensive Care Nursing

Intensive Care Nursing

Intensive Care Nursing

Hermeneutik och pedagogisk psykologi

Sleep in the surgical intensive care unit: continuous polygraphic recording of sleep in nine patients receiving postoperative care

British Medical Journal

Identification of environmental stressors for patients in a surgical intensive care unit

Issues In Mental Health Nursing

Minimizing the psychological complications of patients who require mechanical ventilation

Critical Care Nurse

Patients' experience of respirator treatment. A retrospective study of the influence of medical and nursing care factors on recall, experience of discomforts, and feelings of security or insecurity

Dissertation from the Department of Anaesthesiology, University of Göteborg, Vasastadens Bokbinderi, Göteborg

Qualitative methodology as caring science methodology

Scandinavian Journal of Caring Sciences

Measurement of sleep and quality of life before and after coronary artery bypass grafting: a pilot study

International Journal of Nursing Practice

ICU syndromes revisited

Critical Care Update

Pausen En beskrivning av vård vetenskapens kunskapsobjekt

ICU Syndrome

Critical Care Nurse

Psychological observations of patients undergoing mitral surgery

Psychosomatic Medicine

Argumentationsteori, språk och vetenskapsfilosofi