‘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

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

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

Prevalence and experience of fatigue in survivors of critical illness: a mixed-methods systematic review

We conducted a mixed methods systematic review to investigate the prevalence, experience and management of fatigue in survivors of critical illness. We identified 76 studies investigating fatigue or vitality in adults discharged from an intensive care unit and split the data we extracted into three datasets: vitality scores from the Short Form Health Survey-36 (n = 54); other quantitative data (n = 19); and qualitative data (n = 9). We assessed methodological quality using critical appraisal skills programme tools. We adopted a segregated approach to mixed-methods synthesis. In a final step, we attributed combined results to one of four qualitative themes: prevalence and severity; contributing factors; impacts on quality of life; and assessment and management. Prevalence of fatigue ranged from 13.8 to 80.9%. Short Form Health Survey-36 vitality scores were commonly used as a marker of fatigue. Vitality scores reached a nadir approximately 1 month following ICU discharge (mean (SD) 56.44 (32.30); 95%CI 52.92–59.97). They improved over time, but seldom reached reference population scores. Associated biological, disease-related and psychological factors included age, poor pre-morbid status, sleep and psychological disturbance. Qualitative data highlight the profound negative impact of fatigue on survivors’ quality of life. Survivors seldom had any information provided on the potential impact of fatigue. No fatigue assessment tools specific to critical illness or evidence-based interventions were reported. Fatigue is highly prevalent in survivors of critical illness, and negatively impacts recovery. Further research on developing fatigue assessment tools specifically for critically ill patients and evaluating the impact of pharmacological and non-pharmacology interventions is needed

‘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

'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 professionals

Learning from COVID-19: Cross sectional e-survey of critical care nurses’ satisfaction and experiences of their role in the pandemic response across the UK

Background: Since the start of the global COVID-19 pandemic in 2019, critical care nurses across the world have been working under extreme levels of pressure. Aim: To understand critical care nurses’ experiences of and satisfaction with their role in the pandemic response across the United Kingdom (UK). Study design: A cross sectional electronic survey of critical care nurses (n=339) registered as members of the British Association of Critical Care Nurses. Anonymous quantitative and open-ended question data were collected in March and April 2021 during the height of the second surge of COVID-19 in the UK via an online questionnaire. Quantitative data were analysed using descriptive statistics and free text responses were collated and analysed thematically. Results: There was a response rate of 17.5%. Critical care nurses derived great satisfaction from making a difference during this global crisis and greatly valued teamwork and support from senior nurses. However, nurses consistently expressed concern over the quality of safe patient care, which they perceived to be suboptimal due to staff shortages and a dilution of the specialist skill mix. Together with the high volume of patient deaths, critical care nurses reported that these stressors influenced their personal wellbeing. Conclusions: This study provides insights into the key lessons health care leaders must consider when managing the response to the demands and challenges of the ongoing COVID-19 pandemic. COVID-19 is unpredictable in its course, and what future variants might mean in terms of transmissibility, severity, and resultant pressures to critical care remains unknown. Relevance to clinical practice: Future responses to the challenges that critical care faces must consider nurses’ experiences and create an environment that engenders supportive teamwork, facilitates excellent nursing practice and effective safe patient care where critical care nursing may thrive

Exploring adult critical illness survivors’ experiences of fatigue: A qualitative study

Aims: To explore adult experiences of fatigue after discharge from an intensive care unit and to identify potential management strategies. Design: An exploratory qualitative study Methods: One to one audio-recorded semi-structured interviews with 17 adult survivors of critical illness in the United Kingdom, lasting up to one hour, between September 2019 and January 2020. Anonymised and verbatim-transcribed interview data underwent a standard process of inductive thematic analysis as described by Braun and Clarke. Findings: Three themes were identified: fatigue is different for everyone; complex interrelating interactions; and personalised fatigue strategies. Fatigue was described as a distressing symptom, unique to the individual that causes an array of complex, often long-term interrelating impacts on the survivor and their wider family, made worse by a lack of understanding, empathy, and support resources. Support from others, alongside interventions such as exercise, good nutrition, information, and alternative therapies are used by survivors with variable degrees of success. Conclusions: This qualitative study reports peoples’ experiences of fatigue after critical illness. Findings highlight the significant impact it has on people’s lives and those of their family and friends

Recognizing and managing a deteriorating patient: a randomized controlled trial investigating the effectiveness of clinical simulation in improving clinical performance in undergraduate nursing students

Aims. To report the results of a randomized controlled trial which explored the effectiveness of clinical simulation in improving the clinical performance of recognizing and managing an adult deteriorating patient in hospital. Background. There is evidence that final year undergraduate nurses may lack knowledge, clinical skills and situation awareness required to manage a deteriorating patient competently. The effectiveness of clinical simulation as a strategy to teach the skills required to recognize and manage the early signs of deterioration needs to be evaluated. Design. This study was a two centre phase II single, randomized, controlled trial with single blinded assessments. Method. Data were collected in July 2013. Ninety-eight first year nursing students were randomized either into a control group, where they received a traditional lecture, or an intervention group where they received simulation. Participants completed a pre- and postintervention objective structured clinical examination. General Perceived Self Efficacy and Self-Reported Competency scores were measured before and after the intervention. Student satisfaction with teaching was also surveyed. Results. The intervention group performed significantly better in the postobjective structured clinical examination. There was no significant difference in the postintervention General Perceived Self Efficacy and Self-Reported Competency scores between the control and intervention group. The intervention group was significantly more satisfied with their teaching method. Conclusion. Simulation-based education may be an effective educational strategy to teach nurses the skills to effectively recognize and manage a deteriorating patient. Keywords: clinical performance, critical illness, nursing education, patient deterioration, patient simulation, randomized controlled trial, self-efficac

Non-pharmacological interventions for self-management of fatigue in adults : an umbrella review of potential interventions to support patients recovering from critical illness

Purpose: Fatigue is a common symptom after critical illness. However, evidence-based interventions for fatigue after critical illness are lacking. We aimed to identify interventions to support self-management of fatigue caused by physical conditions and assess their effectiveness and suitability for adaptation for those with fatigue after critical illness. Materials and methods: We conducted an umbrella review of systematic reviews. Databases included CINAHL, PubMed, Medline, PsycINFO, British Nursing Index (BNI), Web of Science, Cochrane Database of Systematic Reviews (CDSR), JBI Evidence Synthesis Database, and PROSPERO register. Included reviews were appraised using the JBI Checklist for Systematic Reviews and Research Syntheses. Results were summarised narratively. Results: Of the 672 abstracts identified, 10 met the inclusion criteria. Reviews focused on cancer (n=8), post-viral fatigue (n=1), and Systemic Lupus Erythematosus (SLE) (n=1). Primary studies often did not address core elements of self-management. Positive outcomes were reported across all reviews, and interventions involving facilitator support appeared to be most effective. Conclusions: Self-management can be effective at reducing fatigue symptoms and improving quality of life for physical conditions and has clear potential for supporting people with fatigue after critical illness, but more conclusive data on effectiveness and clearer definitions of self-management are required