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Commentary on: Danielis M, Povoli A, Mattiussi E,Palese A. Understanding patients’ experiences of being mechanically ventilated in the Intensive Care Unit: Findings from a meta-synthesis and meta-summary. J Clin Nurs. 2020; 00:1–18.
Implications for practice and research
· Family members and nurses play a key role in addressing critical care patients’ negative feeling.
· More empirical research studies are encouraged to evaluate the efficacy of family presence-based interventions on patient experience.
Intubated patients in intensive care units (ICU) often express psychological distress as a result of their experiences.1 Patients often report feeling frightened of the technology being used as part of their care, and that these feelings of anxiety can persist long after critical care and hospital discharge.1 2 Understanding patients’ experiences in more depth will help practitioners understand how to develop educational and policy strategies that enhance care. This, in turn, can support a multidisciplinary approach that yields a shortened length of stay in ICU, a reduced mechanical ventilation time, early physical recovery and better patient experience.2
This study was a systematic review of qualitative studies followed by a metasynthesis and a metasummary on the feelings of mechanically ventilated adult patients in ICU.2 Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement was used in this study. This research was carried out to address the question ‘What is the patients’ lived experience of their mechanical ventilation in ICU?’ Four electronic databases (CINHAL, Medline, Scopus and Web of Science) were searched by two authors to identify relevant studies from 2013 to 2019 that addressed the research question. Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline were followed for full review process. Critical Appraisal Skills Programme (CASP) checklist was applied for quality assessment. All major characteristics were extracted while maintaining original study wording. Metasynthesis was carried out following three phases: Coding, Organising the codes as categories and Generating themes.
Nine studies were included in the review. Out of nine studies, three were from Norway, two from Denmark and one each from Australia, Iran, Sweden and USA. Phenomenological–hermeneutical approaches were the most common method used in the studies. Most of the studies were found to be high quality using CASP assessment. A total of 175 intubated patients reported their experience while in ICU, majority were female (56%) with average age of 54.4 years. Most of the patients was ventilated for 6.3 days on average. Metasynthesis was reported in four main themes: the effect of the intense stress on the body’s systems; the induced negative emotional situations; the feeling of being cared for in a hospital setting and the perceived support from family and loved ones. “Being afraid,” “Feeling supervised,” “Feeling comforted,” “Failing to communicate,” and “Experiencing difficulties in breathing” were the most repeated codes with an intensity of 66.6%.
This study focused on current trends and evidence on patients’ experiences of being mechanically ventilated in ICU. Intubated patients need multilevel interventions to support their multidimensional experience. The experience of feeling distant from a loved one, uncomfortable with medical equipment, dysfunction of body movement is very common for intubated patients’ in ICU.3 Previous studies show that involving the family members in nursing care provides patient benefits from the perspective of mental health and clinical outcomes.4 Equally, implementing strategies to enhance communication between caregivers and patients can reduce some of the stressors experienced by those who are intubated.5
The finding of this study will help nursing and healthcare professionals to better understand and improve the patients’ lived experience in mechanical ventilation. Stakeholder and policymakers can develop a more appropriate strategy to give family members more suitable access to their loved ones in ICU, with this involvement actively encouraged by nursing staff.2 Further research is needed to better understand the impact of the family presence at the bedside and create a more positive environment and lived experience for intubated patients.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.