ReviewLiving the situation stress-experiences among intensive care patients
Introduction
Serious disease or severe trauma often lead to life-threatening conditions. These are far beyond everyday experience. They can be experienced as stressful, particularly when a person is removed from the safety of his/her home and sent to an intensive care unit, an environment which can be experienced as unfamiliar, strange and frightening. In a scientific context, stress is referred to and is applicable in the natural sciences, as well as in the hermeneutic scientific tradition (Lazarus, 1993). Research on stress within health science has focused on physiological and psychological factors. Instead of seeing stress as the sum of variables describing conditions in the person or environment, this study explores how intensive care is experienced and interpreted by the patients and what the meaning of the situation might be for them. Stress appears when the patient loses the meaning of the situation (Lazarus and Folkman, 1984, Lazarus and Launier, 1978).
Being a victim of trauma or having severe disease is a condition, but it can also be described as an existence, a way to relate to the world (Eriksson, 2002). According to Ricoeur (1988), man is related to an exterior world and an inner world at the same time, which constitutes the lifeworld. Relating to something means being extrovert and introvert at the same time. Living a situation, especially one that threatens one's life and health, often activates former stressful experiences. Seen from a phenomenological perspective, these experiences remain and are always present in the body giving the body both reflective and physical dimensions (Merleau-Ponty, 1994). The physically reflective body, as it is referred to in this article, will react, experience and embody different elements of the situation in many different ways. People are always in a situation, and each situation provides different sets of experiences (Benner and Wrubel, 2001). Person and situation become one through the experiences the person defines as significant or non-significant. The body assimilates experience through sensations present in the situation as the focus of attention. The body is positioned in the situation. Man exists, acts and reflects as a living body (Heidegger, 1992, Engelsrud, 1990). In a sensuous presence with others, relations with others appear. Relating to others includes reciprocity by being in the world together. In this kind of relationship, the body performs a double function in its relationship to others; being touched and touching, it observes and it is observed (Martinsen, 1993).
The physical body links the intensive care patient to the intensive care room and by its experiences it becomes omnipresent in the room (Benner and Wrubel, 2001). For the intensive care patient, this involves being in a room which captures the attention of the physically reflective body. The extent of sensation will determine whether the body can push the experience of diseases aside and thus focus on the world beyond. The body's alternative is to focus inwards, towards a “bodily space” in which it becomes more aware of itself. The body exists at the same time in two aspects of the lifeworld (Leder, 1990). These two lifeworlds represent two separate sets of levels; one objective level and one phenomenological level. They share the fact that they are both caught up in the attention of the person's mind.
Much research has been associated with intensive care patients’ physiological reactions to stress and from a quantitative approach (Tracy and Ceronsky, 2001, Honkus, 2003, Baxter, 2004). However, it is also important to listen to those who have the lived experience of being a patient in an intensive care ward. The purpose of the present study was to describe the kind of stress patients in intensive care experience in relation to the body, room and relationships.
Section snippets
Method
This article is a literature review. The Pubmed and Cinahl databases were used and the search covers the period 1994–2003. The search words were “intensive care patients” and “stress”. The selection of articles was made in two steps.
Findings
The organization of the findings are based at the key question in the article, i.e. stress related to the body, room and relationships. The section also contains reflections, but these are of a more overall level.
Discussion
Benner and Wrubel (2001) claim that knowledge is embodied. This implies that the body affects the mind, as the mind affects the body. Stress comes from the person's relationship to the situation and his/her abilities to adapt to it. Ten review articles (see Table 1) were analysed from a phenomenological–hermeneutical angle to determine how stress is experienced by intensive care patients from three different approaches, related to: (1) the body, (2) the room and (3) relationships. The quality
Conclusion and clinical implications
This article shows that intensive care patients experience several types of stress related to the body, the room and their relationships with others, experiences that are integrated in the patient as the reflected body. This stress is vitally important to the patient's experience of body and situation and is often threatening to his/her existence. Being trapped in a condition of stress can affect the ICU patient's situation dramatically, because of small margins.
In a clinical context, this
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2019, International Emergency NursingCitation Excerpt :The final themes selected satisfied criteria; they appeared in approximately one third of participants or more and were of interest to the researcher. Participants were given identification codes consisting of their sequence number [1–42], gender (M,F), age, and type of trauma, i.e. (1-M-28 yr-Accident). Accounts were supplemented with case notes and information discussed in multi-disciplinary team meetings; credibility and authenticity were regarded throughout analysis [30].
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2015, Intensive and Critical Care NursingCitation Excerpt :Such experiences are also described in other studies. The sense of being dependent on others was described as stressful, burdensome and existential (Fredriksen and Ringsberg, 2006; Gjengedal, 1994; Hofhuis et al., 2008; Holland et al., 1997; Karlsson, 2012; Karlsson and Forsberg, 2008; McKinley et al., 2002; Samuelson, 2011; Wang et al., 2008). For an intensive care patient who is dependent on others the feeling of dependence and helplessness will be influenced by the patient-nurse relation.
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2013, Intensive and Critical Care NursingCitation Excerpt :Light sedation regimes are now, however, widely practised (Mehta et al., 2009). The literature emphasises that patients experience the ICU as a traumatic life event due to the loss of bodily functions and control (Gjengedal, 1994; Johansson and Fjellman-Wiklund, 2005), a restricted ability to communicate (Karlsson et al., 2012), experiences of stressful memories, nightmares (Samuelson et al., 2007b), unreal events (Ringdal et al., 2008), discomfort (Fredriksen and Ringsberg, 2007), environmental stress (Samuelson, 2011) and existential loneliness (Almerud et al., 2007). Moreover, Meriläinen et al. (2010) describe how nursing activities in the ICU patient room frequently violate patients’ personal territory.
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2012, Intensive and Critical Care NursingEffect of attachment styles of individuals discharged from an intensive care unit on intensive care experience
2012, Journal of Critical CareCitation Excerpt :Experiences of critically ill patients are an important aspect of the quality of care in an ICU [9]. They can be perceived as stressful, particularly when a person is removed from the safety of his/her home and sent to an ICU, an environment that can be experienced as unfamiliar, strange, and frightening [10,11]. Strahan and Brown [12] described the stressors that threaten the patient in the ICU.