Transformations of self: a phenomenological investigation into the lived experience of survivors of critical illness

Based on the hermeneutical, phenomenological perspective, this study explored the lived experience of individuals with a past hospitalization in an intensive care unit, with focus on their dreams. The purpose was to explore how it is to have been critically ill. Dreams are the language of the unconscious and can symbolically convey meanings. Eight participants recounted their experiences with critical illness through semi-structured phenomenological interviews and dream-telling. An interplay between the 'factual-external' world and the 'internal' world appeared to be the basis of their perception of the situation. Participants' narratives were immensely rich in symbols of transformation, transcendence and rebirth. Transformations in perception, in lived-body, and in lived time and space were some of the themes emerging as part of both conscious and dreaming experiences. Attitudes towards death were altered, and elements of heightened spirituality were evident in the aftermath of critical illness. Critical illness was conceptualized as a 'cocooning phase' leading to transformation of self, spiritual arousal and personal growth. Nurses may be able to alleviate suffering by supporting this process while in the ICU, as well as after discharg

Exploration of the Association Between Professional Interactions and Emotional Distress of Intensive Care Unit Nursing Personnel

Several studies provide evidence for the association between the quality of collaboration among intensive care unit (ICU) professionals and patients' outcomes, as well as nurses' moral distress and professional satisfaction. However, potential associations between collaboration and nurses' mental health indices have not been explored. The aim of this descriptive correlational study was to investigate the degree of satisfaction from interaction among ICU nursing personnel, as well as between ICU nursing personnel and physicians, and potential associations with ICU nursing personnel's anxiety symptoms. The sample consisted of ICU nursing personnel from 11 adult general hospitals in Greece (n = 229). Hamilton's Anxiety scale was applied for the quantitative assessment of anxiety symptoms and Stamps' Index of Work Satisfaction for the appraisal of nursing personnel's satisfaction from professional interactions. Demographic, vocational, and educational data were also recorded. Descriptive statistics were explored, and group comparisons, correlation, and regression analysis were used. The average satisfaction score from interaction among nursing personnel was moderate to high (5.3 [SD, 1.0]) and from nurse-to-physician interaction was moderate (4.0 [SD, 1.4]) (scale range, 1-7). The score of satisfaction from nurse-to-physician interaction was negatively mildly correlated with participants' (a) total anxiety score ( = ?0.160, P = .001), (b) tension ( = ?0.125, P = .015), and (c) depressive symptoms ( = ?0.148, P = .005). Weak negative correlations were detected between satisfaction from interaction among nursing personnel and participants' (a) total anxiety state ( = ?0.139, P = .003), (b) tension ( = ?0.137, P = .008), and (c) sleep disturbances ( = ? 0.150, P = .003). Overall, female respondents had higher levels of anxiety symptoms than male respondents (Mann-Whitney U, P = .007). Satisfaction from professional interaction was not a strong predictor of anxiety symptoms among ICU nursing personnel (R2 = 0.046, ?0.15). Nursing personnel in Greek ICUs seem to be satisfied with the quality of relationships among them, as well as with physicians. Despite that anxiety symptoms associate with the degree of satisfaction from professional interaction, the latter may not be a significant indicator of ICU nurses' well-being. Further qualitative research is needed to identify mediating factor

Interpersonal touch interventions for patients in intensive care: A design-oriented realist review

Aim: To develop a theoretical framework to inform the design of interpersonal touch interventions intended to reduce stress in adult intensive care unit patients. Design: Realist review with an intervention design‐oriented approach. Methods: We searched CINAHL, MEDLINE, EMBASE, CENTRAL, Web of Science and grey literature sources without date restrictions. Subject experts suggested additional articles. Evidence synthesis drew on diverse sources of literature and was conducted iteratively with theory testing. We consulted stakeholders to focus the review. We performed systematic searches to corroborate our developing theoretical framework. Results: We present a theoretical framework based around six intervention construction principles. Theory testing provided some evidence in favour of treatment repetition, dynamic over static touch and lightening sedation. A lack of empirical evidence was identified for construction principles relating to intensity and positive/negative evaluation of emotional experience, moderate pressure touch for sedated patients and intervention delivery by relatives versus healthcare practitioners

Respuestas psicológicas disfuncionales en enfermeros de Unidades de Cuidados Intensivos: una revisión sistemática de la literatura

OBJETIVOBuscar evidencias de respuestas psicológicas disfuncionales en Enfermeros de Unidades de Terapia Intensiva, con enfoque en la ansiedad, síntomas depresivos y factores relacionados.MÉTODORevisión sistemática, con evaluación crítica y síntesis de datos de los estudios, llevada a cabo en las bases de datos CINAHL, PubMed y Scopus, en el período de 1999 hasta el presente, utilizándose los siguientes términos de investigación, individualmente o en combinación: "estado mental", "síntomas depresivos", "ansiedad", "enfermeros de UCI", "estrés post traumático", "burnout", "fatiga por compasión" y "estrés psicológico".RESULTADOFueron incluidos trece estudios cuantitativos en Inglés y Griego. Los resultados sugieren un incremento de la carga psicológica en los Enfermeros de UCI comparativamente con otras especialidades de enfermería, así como con la población en general.CONCLUSIÓNEstudios internacionales de investigación acerca de la respuesta psicológica son limitados. Estudios futuros, longitudinales y de intervención, contribuirán a una mejor comprensión del fenómeno.OBJECTIVETo systematically review evidence on dysfunctional psychological responses of Intensive Care Units nurses (ICUNs), with focus on anxiety and depressive symptoms and related factors.METHODA literature search was performed in CINAHL, PubMed and Scopus databases, from 1999 to present, along with a critical appraisal and synthesis of all relevant data. The following key words, separately and in combination, were used: "mental status" "depressive symptoms" "anxiety" "ICU nurses" "PTSD" "burnout" "compassion fatigue" "psychological distress".RESULTSThirteen quantitative studies in English and Greek were included. The results suggested increased psychological burden in ICUNs compared to other nursing specialties, as well as to the general population.CONCLUSIONSStudies investigating psychological responses of ICUNs are limited, internationally. Future longitudinal and intervention studies will contribute to a better understanding of the phenomenon.OBJETIVORever sistematicamente evidências de respostas psicológicas disfuncionais em Enfermeiros de Unidades de Cuidados Intensivos (EUCI), com foco na ansiedade, sintomas depressivos e fatores relacionados.MÉTODOFoi realizada uma pesquisa bibliográfica, com avaliação crítica e síntese de dados dos estudos, nas bases de dados da CINAHL, PubMed e Scopus, para o período de 1999 até ao presente. Foram utilizados os seguintes termos de pesquisa, individualmente ou em combinação: "estado mental" "sintomas depressivos" "ansiedade" "enfermeiros de UCI" "PTSD" "burnout" "fadiga da compaixão" "stress psicológico".RESULTADOForam incluídos treze estudos quantitativos em Inglês e Grego. Os resultados sugerem um aumento da carga psicológica nos EUCI comparativamente com outras especialidades de enfermagem, assim como com a população em geral.CONCLUSÕESEstudos internacionais de investigação sobre a resposta psicológica de EUCI são limitados. Estudos futuros, longitudinais e de intervenção, irão contribuir para uma melhor compreensão do fenômeno

Five tips for conducting remote qualitative data collection in COVID times: theoretical and pragmatic considerations

Objetivo: Proporcionar cinco consejos metodológicos y pragmáticos para el manejo de la recogida de datos cualitativos durante el contexto de la pandemia de COVID-19. Método: Los consejos presentados en este artículo son extraídos de insights de nuestras propias experiencias como investigadores que realizan investigaciones cualitativas remotas y de la evidencia de la literatura sobre métodos cualitativos. La literatura relevante fue identificada a través de búsquedas utilizando palabras clave relevantes en las siguientes bases de datos: CINAHL, PubMed, SCOPUS y Web of Science. Las búsquedas se limitaron a artículos en inglés y portugués publicados entre 2010 y 2021 para asegurar una comprensión actual del fenómeno. Resultados: Se ofrecen cinco consejos: 1) Preste atención a las cuestiones éticas; 2) Identifique y seleccione potenciales participantes; 3) Escoja el tipo de entrevista remota; 4) Esté preparado para coordinar la entrevista remota; y 5) Promueva el vínculo con su participante. Conclusiones: A pesar de los desafíos en el manejo de la recogida remota de datos, también se reconocen las fortalezas y nuestra experiencia ha demostrado que es viable reclutar y entrevistar participantes remotamente. Las discusiones presentadas en este artículo beneficiarán, ahora y en el futuro, a otros equipos de investigación que puedan considerar recopilar datos para sus estudios cualitativos de forma remota.Objective: To provide five methodological and pragmatic tips for conducting remote qualitative data collection during the context of the COVID-19 pandemic. Method: The tips presented in this article are drawn from insights of our own experiences as researchers conducting remote qualitative research and from the evidence from the literature on qualitative methods. The relevant literature was identified through searches using relevant keywords in the following databases: CINAHL, PubMed, SCOPUS, and Web of Science. Searches were limited to articles in English and Portuguese, published from 2010 to 2021, to ensure a current understanding of the phenomenon. Results: Five tips are provided: 1) Pay attention to ethical issues; 2) Identify and select potential participants; 3) Choose the type of remote interview; 4) Be prepared to conduct the remote interview; and 5) Build rapport with the participant. Conclusion: Despite the challenges in conducting remote data collection, strengths are also acknowledged and our experience has shown that it is feasible to recruit and interview participants remotely. The discussions presented in this article will benefit, now and in the future, oResearch reported in this publication was supported by the Coordination for the Improvement of Higher Education Personnel – Brazil (CAPES) – Finance Code 001; and the National Council for Scientific and Technological Development (CNPq), Brazil, Process numbers 309528/2021-6 and 200580/2022-1

Empowerment, Communication, and Navigating Care: The Experience of Persons With Spinal Cord Injury From Acute Hospitalization to Inpatient Rehabilitation

BackgroundSpinal cord injury (SCI) results in long-term functional impairments that significantly impact participation and role in the community. Newly injured persons are often reintroduced to the community with significant deficits in knowledge, including how to access and navigate community resources and supports. This warrants a better understanding of the patient experience of in-hospital care and discharge planning to ensure individuals with SCI are best supported during transitions in care and while living in the community.ObjectiveTo explore the lived experience of persons with acute SCI and their perceptions of care, focusing on the initial hospital experiences to inpatient rehabilitation.MethodsA phenomenological research study was conducted using semi-structured interviews. Eligible participants had differing etiologies of SCI (including non-traumatic and traumatic SCI), were over the age of 18 at the time of initial care, and experienced acute hospital and inpatient rehabilitation at an Alberta-based institution within the last 10 years. One-on-one interviews took place between March and June 2021 over telephone or virtual platforms (Zoom). Interview transcripts, and field notes developed the text, which underwent hermeneutic analysis to develop central themes.ResultsThe present study included 10 participants living with an SCI in Alberta, Canada. Most participants (80%) were male. Participants' age ranged from 24 to 69 years. The median years since initial SCI was 3 years. Interviews lasted 45–75 min. Seven participants identified as having a traumatic SCI injury and three identified as having a non-traumatic SCI. The interplay between empowerment and disempowerment emerged as the core theme, permeating participants' meanings and perceptions. Three main themes emerged from the interviews regarding the perceptions of the SCI patient experience. Each theme represents a perception central to their inpatient experience: desire to enhance functional independence to empower confidence and self-management; need for effective communication with healthcare providers to support recovery; and navigating appropriate care supports to enhance preparedness for discharge and returning home.ConclusionThis study demonstrates the significant need to enhance education of person/family-centered SCI care, foster positive communication between care recipients and care providers, and facilitate better in-hospital access to appropriate navigation and wayfinding supports

Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study.

BACKGROUND: Ethical challenges are common in end of life care; the uncertainty of prognosis and the ethically permissible boundaries of treatment create confusion and conflict about the balance between benefits and burdens experienced by patients. OBJECTIVE: We asked physician trainees in internal medicine how they reacted and responded to ethical challenges arising in the context of perceived futile treatments at the end of life and how these challenges contribute to moral distress. DESIGN: Semi-structured in-depth qualitative interviews. PARTICIPANTS: Twenty-two internal medicine residents and fellows across three American academic medical centers. APPROACH: This study uses systematic qualitative methods of data gathering, analysis and interpretation. KEY RESULTS: Physician trainees experienced significant moral distress when they felt obligated to provide treatments at or near the end of life that they believed to be futile. Some trainees developed detached and dehumanizing attitudes towards patients as a coping mechanism, which may contribute to a loss of empathy. Successful coping strategies included formal and informal conversations with colleagues and superiors about the emotional and ethical challenges of providing care at the end of life. CONCLUSIONS: Moral distress amongst physician trainees may occur when they feel obligated to provide treatments at the end of life that they believe to be futile or harmful.This study was funded by the Health Resources and Service Administration T32 HP10025-20 Training Grant, the Gates Cambridge Scholarship, Society of General Internal Medicine Founders Grant, and the Ho-Chiang Palliative Care Research Fellowship at the Johns Hopkins School of Medicine.This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s11606-015-3505-