‘I’ve never been surrounded by so many people and felt so alone’ : A Heideggerian phenomenological study investigating patients’ experiences of technology in adult intensive care

Research Question: What are patients’ experiences of technology in adult intensive care? Research Objectives: -To explore patients’ perceptions of receiving care in a technological environment -To explore patients’ perceptions of how technology has influenced their experience of care Background: Technology is fundamental to the physical recovery of critically ill patients in intensive care (ICU), however, there is a suggestion in the literature that its presence may dehumanise patient care and distract the nurse from attending to patients’ psychosocial needs. Little attention has been paid to patients’ perceptions of receiving care in a technological environment. The purpose of this research, therefore, was to explore patients’ experiences of technology and care within ICU. Methods: This study was informed by Heideggerian phenomenology. The research took place in a university hospital in England. Nineteen participants who had been a patient in ICU were interviewed using a semi-structured approach. Interviews were transcribed verbatim and analysed utilising Van Manen’s framework. Findings: Resulting themes were ‘My Useless Body’ which describes how participants experienced their body as dysfunctional, disconnected and invaded by technology, ‘Making Sense of It’, which describes how participants rationalised their experiences by constructing a story, and ‘Technology and Care’, which describes how and why participants endured technologies in ICU. Conclusions: The disintegrated body is central to the critically ill’s experiences in ICU. Families play an important role in helping patients make sense of their experiences by filling in gaps in memory and helping them to sort the real from unreal memories. Families therefore require support and information resources in fulfilling this role. Patients experience technology and care as a series of paradoxical relationships: alienating yet reassuring, uncomfortable yet comforting, impersonal yet personal. Nurses maintaining a close and supportive presence and providing personal comfort and care may minimise the invasive and isolating potential of technolog

Factors influencing nurses' intentions to leave adult critical care settings

© 2018 British Association of Critical Care Nurses Background: The shortage of critical care and specialist nurses has been an ongoing issue for many decades. Although all areas of nursing are affected, critical care areas are especially vulnerable to recruitment and retention problems. High nursing turnover in critical care areas is evident; however, research into the factors that influence nurses' intentions to leave adult critical care areas is limited. Aim: To explore factors that may influence nurses' intentions to leave adult critical care areas. Objectives: To appraise existing evidence and highlight gaps in knowledge regarding factors that may influence nurses' intentions to leave adult critical care areas. Methods: A systematic mixed-method literature review was conducted. The search strategy was developed using the List, Keep and Delete approach, a framework used to identify search terms for systematic health care reviews. The following key words were used: intentions to leave, nurses, adult and critical care. The databases searched were BNI, CINAHL, PubMed, PsycINFO, Embase and Health B Elite from 2005 to 2016. Primary data from non-critical care areas and neonatal and paediatric critical care areas were excluded. Comprehensive supplementary searching was performed. Papers were critically appraised using the NICE (2012) checklists. Data were analysed using the Braun and Clarke (2006) thematic framework. Results: A total of 15 studies, including 13 cross-sectional studies and 2 qualitative studies, were reviewed. Three main themes emerged following data analysis. These themes were quality of the work environment, nature of working relationships and traumatic/stressful workplace experiences. Conclusions: The literature review highlighted the need for further research and greater understanding of how these themes may impact critical care nurses. Nurse managers and leaders should consider these findings when developing strategies to improve nurse retention. Relevance to practice: The shortage of critical care nurses is currently a global issue impacting costs and quality of patient care

Fatigue After CriTical illness (FACT): Co-production of a self-management intervention to support people with fatigue after critical illness

Purpose: Fatigue is a common and debilitating problem in patients recovering from critical illness. To address a lack of evidence-based interventions for people with fatigue after critical illness, we co-produced a self-management intervention based on self-regulation theory. This article reports the development and initial user testing of the co-produced intervention. Methods: We conducted three workshops with people experiencing fatigue after critical illness, family members, and healthcare professionals to develop a first draft of the FACT intervention, designed in web and electronic document formats. User testing and interviews were conducted with four people with fatigue after critical illness. Modifications were made based on the findings. Results: Participants found FACT acceptable and easy to use, and the content provided useful strategies to manage fatigue. The final draft intervention includes four key topics: (1) about fatigue which discusses the common characteristics of fatigue after critical illness; (2) managing your energy with the 5 Ps (priorities, pacing, planning, permission, position); (3) strategies for everyday life (covering physical activity; home life; leisure and relationships; work, study, and finances; thoughts and feelings; sleep and eating); and (4) goal setting and making plans. All material is presented as written text, videos, and supplementary infographics. FACT includes calls with a facilitator but can also be used independently. Conclusions: FACT is a theory driven intervention co-produced by patient, carer and clinical stakeholders and is based on contemporary available evidence. Its development illustrates the benefits of stakeholder involvement to ensure interventions are informed by user needs. Further testing is needed to establish the feasibility and acceptability of FACT. Implications for clinical practice: The FACT intervention shows promise as a self-management tool for people with fatigue after critical illness. It has the potential to provide education and strategies to patients at the point of discharge and follow-up

Outcomes and experiences of relatives of patients discharged home after critical illness: A systematic integrative review

Background. Patients discharged from intensive care may experience psychological and physical deficits resulting in a long and complex rehabilitation upon discharge. Relatives are also vulnerable to psychological pathologies and diminished health‐related quality of life following the patients' critical illness. Relatives often provide care during the patients' rehabilitation, which may influence their health. Aim. To report the outcomes and experiences of relatives of patients discharged home after critical illness. Design. Systematic integrative review. Methods. Electronic databases Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase®, and PsychINFO® were searched using keywords, synonyms, and medical subject headings. Reference lists of articles and critical care journals were manually searched. Studies eligible for inclusion reported primary research and were published in English between 2007 and 2017. Studies were appraised using the Critical Appraisal Skills Programme checklists. Data were extracted and then analysed according to framework. Findings. Twenty‐five studies were included: 19 quantitative, 4 qualitative, and 1 mixed method study. Three themes were identified: health and well‐being, employment and lifestyle, and caregiving role. Health and well‐being reports the incidence and significance of psychological morbidity such as post‐traumatic stress disorder, anxiety, and depression. Employment and lifestyle describes the impact of caregiving on the relative's ability to work and engage in usual social activities. The final theme describes and discusses the caregiving role in terms of activities of daily living, knowledge and skills, and adaption to the role. Conclusions. There is a significant and meaningful impact on outcomes and experiences of relatives of patients discharged home after critical illness. Relatives' caregiving is embedded within the context of their psychological morbidity and social adjustment. Relevance to practice. If informal care giving is to be sustainable, there is a need to design effective strategies of supporting families through all stages of the critical illness trajectory

Making sense of it: Intensive care patients' phenomenological accounts of story construction

Background Patients entering intensive care encounter physical and psychological stress which may lead to psychological morbidity such as depression, anxiety and post-traumatic stress. It has been suggested that constructing a story may assist psychological recovery however this has been minimally investigated in the intensive care patient. Aim The aim of this paper is to examine the process of story construction in patients’ phenomenological accounts of being a patient in the technological environment of intensive care. Study design The study design was informed by Heideggerian phenomenology. Methods Semi-structured interviews were conducted in nineteen patients who had been in intensive care for at least four days. Interviews were digitally recorded, transcribed and analysed utilising Van Manen’s framework for thematic analysis. Findings Making sense of their experiences in ICU appeared to be fundamental to story construction. Themes that arose were: “Why am I here?”, “Filling in the gaps”, “Sorting the real from the unreal” and “Searching for familiarity”. These themes describe how participants sought temporal and causal coherence in order to construct their integrated and understandable story. Families appeared to play a critical role in assisting participants in filling in the gaps, sorting the real from the unreal and their subsequent psychological recovery. Conclusions and relevance to clinical practice The importance of early support from health care professionals to facilitate patients’ story construction is highlighted. The study also emphasizes the role of families in supporting patients in making sense of their experiences and the associated psychological recovery process. Further research to evaluate methods of facilitating story construction such as nurse-led de-briefing, patient diaries, is recommended. In addition investigation of families’ perceptions of their role in assisting patients to construct their story may facilitate health care professionals in developing strategies to effectively support families in their role

Patients’ experiences of technology and care in adult intensive care

Aims To investigate patients’ experiences of technology in an adult intensive care unit Background Technology is fundamental to support physical recovery from critical illness in Intensive Care Units. As well as physical corollaries, psychological disturbances are reported in critically ill patients at all stages of their illness and recovery. Nurses play a key role in the physical and psychological care of patients, however there is a suggestion in the literature that the presence of technology may dehumanise patient care and distract the nurse from attending to patients psychosocial needs. Little attention has been paid to patients’ perceptions of receiving care in a technological environment. Design This study was informed by Heideggerian phenomenology. Methods The research took place in 2009-2011 in a university hospital in England. Nineteen participants who had been patients in ICU were interviewed guided by an interview topic prompt list. Interviews were transcribed verbatim and analysed using Van Manen’s framework. Findings Participants described technology and care as inseparable and presented their experiences as a unified encounter. The theme ‘Getting on with it’ described how participants endured technology by ‘Being Good’ and ‘Being Invisible’. ‘Getting over it’ described why participants endured technology by ‘Bowing to Authority’ and viewing invasive technologies as a ‘Necessary Evil’. Conclusion Patients experienced technology and care as a series of paradoxical relationships: alienating yet reassuring, uncomfortable yet comforting, impersonal yet personal. By maintaining a close and supportive presence and providing personal comfort and care nurses may minimise the invasive and isolating potential of technology

COVID-19 and patient safety in intensive care : what can we learn?

In March 2020, the World Health Organization (WHO) declared Severe Acute Respiratory Syndrome Coronavirus (COVID-19) a worldwide pandemic. An influx of patients with COVID-19-related critical illness necessitated rapid changes in care strategies to address overwhelming intensive care unit (ICU) service demands, the continued care of non-COVID-19 patients, and mitigate viral spread. These unparalleled challenges highlighted the safety critical nature of nursing, with patient safety being core. As the world recovers from the pandemic, it is vital we reflect on patient using a systems approach, to identify areas of learning (Komashie, et al., 2021). This article outlines key COVID-19 ICU safety impacts to highlight opportunities for learning and inform future ICU patient’s care

‘Doing the best we can’: Registered Nurses' experiences and perceptions of patient safety in intensive care during COVID-19

Aims: To explore registered nurses' experiences of patient safety in intensive care during COVID-19.Design: A qualitative interview study informed by constructivism. Method: Semi-structured interviews were conducted and audio- recorded with 19 registered nurses who worked in intensive care during COVID-19 between May and July 2021. Interviews were transcribed verbatim and thematically analysed utilizing framework. Results: Two key themes were identified. ‘On a war footing’—an unprecedented situation which describes the situation nurses faced, and the actions are taken to prepare for the safe delivery of care. ‘Doing the best we can’—Safe Delivery of Care which describes the ramifications of the actions taken on short- and long-term patient safety including organization of care, missed and suboptimal care and communication. Both themes were embedded in the landscape of Staff Well-being and Peer Support. Conclusion: Nurses reported an increase in patient safety risks which they attributed to the dilution of skill mix and fragmentation of care. Nurses demonstrated an under-standing of the holistic and long-term impacts on patient safety and recovery from critical illness. Impact: This study explored the perceived impact of COVID-19 on patient safety in intensive care from a nursing perspective. Dilution of skill mix, where specialist critical care registered nurses were diluted with registered nurses with no critical care experience, and the fragmentation of care was perceived to lead to reduced quality of care and increased adverse events and risk of harm which were not consistently formally reported. Furthermore, nurses demonstrated a holistic and long-term appreciation of patient safety. These findings should be considered as part of future nursing work-force modelling and patient safety strategies by intensive care leaders and managers. No public or patient contribution to this study. The study aims and objectives were developed in collaboration with health care professional

Intensive care nurses' experiences of providing end-of-life care after treatment withdrawal: a qualitative study.

Aim and objectives. To explore the experiences of intensive care nurses who provided end-of-life care to adult patients and their families after a decision had been taken to withdraw treatment. Background. End-of-life care following treatment withdrawal is a common phenomenon in intensive care. Less is known about nurses’ experiences of providing care for the dying patient and their family in this context, when compared to specialist palliative care. Design. Descriptive exploratory qualitative study. Methods. A purposive sample of 13 intensive care nurses participated in a semi-structured face-to-face interview. Transcribed data was analysed using the principles of interpretative phenomenological analysis. Results. The essence of nurses’ experiences of providing end-of-life care after the withdrawal of treatment was interpreted as doing the best to facilitate a comfortable and dignified death’. Four master themes included: caring for the dying patient and their family; providing and encouraging presence; reconnecting the patient and family; and dealing with emotions and ambiguity. Uncertainties were evident on processes and actions involved in treatment withdrawal, how to reconnect patients and their family effectively and how to reduce the technological environment. Conclusions. Providing end-of-life care after a decision has been taken to withdraw treatment was a common aspect of intensive care. It was evident that nurses were doing their utmost to support patients and families at the end of life, despite the multiple challenges they faced. Relevance to clinical practice. The interpretive findings from this study should assist intensive care unit nurses to better understand and develop their role in providing high-quality end-of-life care after treatment withdrawal. Practice guidelines should be developed to reduce ambiguity and support the delivery of high-quality care for adults as they approach the final stages of life in intensive care units

‘Doing the best we can’: Registered Nurses' experiences and perceptions of patient safety in intensive care during COVID-19

Aims: To explore registered nurses' experiences of patient safety in intensive care during COVID-19. Design: A qualitative interview study informed by constructivism. Method: Semi-structured interviews were conducted and audio-recorded with 19 registered nurses who worked in intensive care during COVID-19 between May and July 2021. Interviews were transcribed verbatim and thematically analysed utilizing framework. Results: Two key themes were identified. ‘On a war footing’—an unprecedented situation which describes the situation nurses faced, and the actions are taken to prepare for the safe delivery of care. ‘Doing the best we can’—Safe Delivery of Care which describes the ramifications of the actions taken on short- and long-term patient safety including organization of care, missed and suboptimal care and communication. Both themes were embedded in the landscape of Staff Well-being and Peer Support. Conclusion: Nurses reported an increase in patient safety risks which they attributed to the dilution of skill mix and fragmentation of care. Nurses demonstrated an understanding of the holistic and long-term impacts on patient safety and recovery from critical illness. Impact: This study explored the perceived impact of COVID-19 on patient safety in intensive care from a nursing perspective. Dilution of skill mix, where specialist critical care registered nurses were diluted with registered nurses with no critical care experience, and the fragmentation of care was perceived to lead to reduced quality of care and increased adverse events and risk of harm which were not consistently formally reported. Furthermore, nurses demonstrated a holistic and long-term appreciation of patient safety. These findings should be considered as part of future nursing workforce modelling and patient safety strategies by intensive care leaders and managers. No public or patient contribution to this study. The study aims and objectives were developed in collaboration with health care professionals