Anna Forsberg

The lived experiences of adult intensive care patients who were conscious during mechanical ventilation: A phenomenological-hermeneutic study

AIMnThe aim of this study was to illuminate the lived experience of patients who were conscious during mechanical ventilation in an intensive care unit (ICU).nnnMETHODnInterviews with 12 patients assessed as being conscious during mechanical ventilation were conducted approximately one week after discharge from an ICU. The text was analysed using a phenomenological-hermeneutic method inspired by Ricoeur.nnnRESULTSnApart from breathlessness, voicelessness was considered the worst experience. The discomfort and pain caused by the tracheal tube was considerable. A feeling of being helpless, deserted and powerless because of their serious physical condition and inability to talk prompted the patients to strive for independence and recovery and made them willing to flow with the treatment and care. Comments from the patients suggest that their suffering can be alleviated by communication, participation in care activities and companionship.nnnCONCLUSIONnA patients endurance whilst conscious during mechanical ventilation seems to be facilitated by the presence of nurses, who mediate hope and belief in recovery, strengthening the patients will to fight for recovery and survival.

Close relatives’ experiences of caring and of the physical environment when a loved one dies in an ICU

AIMnThe aim of this study was to explore close relatives experiences of caring and the physical environment when a loved one dies in an intensive care unit (ICU).nnnMETHODnInterviews were conducted with 17 close relatives of 15 patients who had died in three adult ICUs. The interviews were analysed using a phenomenological-hermeneutic method.nnnFINDINGSnThe analysis resulted in seven themes; Being confronted with the threat of loss, Maintaining a vigil, Trusting the care, Adapting and trying to understand, Facing death, The need for privacy and togetherness and Experiencing reconciliation. The experience of a caring relationship was central, which meant that the carers piloted the close relatives past the hidden reefs and through the dark waters of the strange environment, unfamiliar technology, distressing information and waiting characterised by uncertainty. Not being piloted meant not being invited to enter into a caring relationship, not being allowed access to the dying loved one and not being assisted in interpreting information.nnnCONCLUSIONnThe participants showed forbearance with the ICU-environment. Their dying loved ones serious condition and his or her dependence on the medical-technical equipment were experienced as more frightening than the equipment as such. Returning for a follow-up-visit provided an opportunity for reconciliation and relief from guilt.

Doing one's utmost: Nurses' descriptions of caring for dying patients in an intensive care environment

AIMnThe aim of this study was to explore nurses experiences and perceptions of caring for dying patients in an intensive care unit (ICU) with focus on unaccompanied patients, the proximity of family members and environmental aspects.nnnMETHODnInterviews were conducted with nine experienced ICU nurses. A qualitative descriptive approach was employed. The analysis was performed by means of conventional content analysis [Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277-88] following the steps described by e.g. Elo and Kyngas [Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs 2008;62:107-15].nnnFINDINGSnThe analysis resulted in a main category; Doing ones utmost, described by four generic categories and 15 sub-categories, comprising a common vision of the patients last hours and dying process. This description was dominated by the nurses endeavour to provide dignified end-of-life care (EOLC) and, when relatives were present, to give them an enduring memory of their loved ones death as a calm and dignified event despite his/her previous suffering and death in a high-technological environment.nnnCONCLUSIONnThis study contributes new knowledge about what ICU nurses focus on when providing EOLC to unaccompanied patients but also to those whose relatives were present. Nurses EOLC was mainly described as their relationship and interaction with the dying patients relatives, while patients who died alone were considered tragic but left a lesser impression in the nurses memory.

Family presence and environmental factors at the time of a patient’s death in an ICU

Background:u2002 In an intensive care unit (ICU), privacy and proximity are reported to be important needs of dying patients and their family members. It is assumed that good communication between the ICU team and families about end‐of‐life decisions improves the possibilities of meeting families’ needs, thus guaranteeing a dignified and peaceful death in accordance with end‐of‐life care guidelines. The aim of this study was to explore the circumstances under which patients die in Swedish ICUs by reporting on the presence of family and whether patients die in private or shared rooms. An additional aim was to investigate the frequency of end‐of‐life decisions and whether nurses and family members were informed about such decisions.

The essence of living parental liver donation – donors’ lived experiences of donation to their children

Abstract:u2002 The use of living parental liver donors will continue and probably increase because of lack of cadaveric livers for paediatric transplantation and the excellent graft survival of parental livers. Therefore, it is important for the health care professionals involved in living parental liver donation to understand the experience of being a liver donor. The aim of this study was to investigate the expressed deeper feelings of parents who donated a part of their liver to their own child. The study took the form of in‐depth interviews with 11 donors. All donors were biological parents of the recipient, nine fathers and two mothers. The interpretive phenomenology method was used, and interpretive analysis was carried out in three interrelated processes in line with Benner. Data collection was guided by the researchers preliminary understanding of the donor experience from being involved in the surgery and care of the donors as well as the paediatric recipients. However, the research question was approached from the perspective of holistic care for the donor. In this study, the essence of living parental liver donation was found to be the struggle for holistic confirmation. There were three categories leading to this central theme; the total lack of choice, facing the fear of death and the transition from health to illness. There was total agreement among the respondents that there is no choice when it comes to the question of donation. The findings in this study stress the importance of organizing the parental liver donation programme with as much focus on the donor as on the child. Based on the results of this study, several clinical implications are suggested for the formation of guidelines for living parental liver donation.

Wishing for deburdening through a sustainable control after bariatric surgery

The aim of this study was an in-depth investigation of the change process experienced by patients undergoing bariatric surgery. A prospective interview study was performed prior to as well as 1 and 2 years after surgery. Data analyses of the transcribed interviews were performed by means of the Grounded Theory method. A core category was identified: Wishing for deburdening through a sustainable control over eating and weight, comprising three related categories: hoping for deburdening and control through surgery, feeling deburdened and practising control through physical restriction, and feeling deburdened and trying to maintain control by own willpower. Before surgery, the participants experienced little or no control in relation to food and eating and hoped that the bariatric procedure would be the first brick in the building of a foundation that would lead to control in this area. The control thus achieved in turn affected the participants’ relationship to themselves, their roles in society, and the family as well as to health care. One year after surgery they reported established routines regarding eating as well as higher self-esteem due to weight loss. In family and society they set limits and in relation to health care staff they felt their concern and reported satisfaction with the surgery. After 2 years, fear of weight gain resurfaced and their self-image was modified to be more realistic. They were no longer totally self-confident about their condition, but realised that maintaining control was a matter of struggle to obtaining a foundation of sustainable control. Between 1 and 2 years after surgery, the physical control mechanism over eating habits started to more or less fade for all participants. An implication is that when this occurs, health care professionals need to provide interventions that help to maintain the weight loss in order to achieve a good long-term outcome.

A phenomenographic study of ICU-nurses' perceptions of and attitudes to organ donation and care of potential donors.

UNLABELLEDnThere is a lack of organs for transplantation and the number of potential organ donors is limited. Several studies indicate that the most crucial factor is the attitude to organ donation among intensive care staff. The aim of this study was to describe intensive and critical care nurses (ICU-nurses) perceptions of organ donation based on their experience of caring for potential organ donors. A phenomenographic method was chosen. Nine nurses from three different Swedish hospitals were interviewed. All were women; aged 36-53 years, with 3-27 years ICU experience. The analysis revealed the crucial perception nothing must go wrong. The findings can be described in three parts: organ donation as a situation, organ donation as a phenomenon and different attitudes to organ donation.nnnIN CONCLUSIONnvarious perceptions adopted by ICU nurses might influence the chances of a potential donor becoming an actual donor. This study demonstrates that nurses who promote organ donation strive to fulfil the will of the potential donor by taking responsibility for the perception that nothing must go wrong.

Communication when patients are conscious during respirator treatment—A hermeneutic observation study

AIMnThe aim of this study was to observe, interpret and describe nurses communication with conscious patients receiving mechanical ventilation treatment (MVT) in an intensive care unit (ICU), and to examine if such communication could be interpreted as caring.nnnDESIGNnHermeneutic observational study inspired by the philosophy of Gadamer.nnnMETHODnNineteen patients were observed on several occasions for a total of 66 hours, when conscious during MVT.nnnFINDINGSnA form of caring communication was identified and interpreted as comprising seven themes: being attentive and watchful, being inclusive and involving, being connected, remaining close, being reassuring and providing security, keeping company and using humour and using a friendly approach. Communication that mediated a non-caring approach was also identified and described under two thematic headings, i.e. being neglectful and being absent.nnnCONCLUSIONSnCaring is communicated by the caring act of standing-by the patient. Caring or non-caring is communicated in non-verbal and verbal communication, in the words used, the tone of voice and behaviour, as well as in the performance of nursing care activities.

Relatives' experiences of visiting a conscious, mechanically ventilated patient — A hermeneutic study

BACKGROUNDnIn recent years, light or no sedation has become a common approach to invasive mechanical ventilation in patients with respiratory distress. The experience of visiting a conscious patient receiving mechanical ventilation in the ICU has to our knowledge not yet been investigated.nnnAIMnThe aim of the study was to describe the meaning attributed by relatives to their experiences of meeting, seeing and communicating with a patient cared for on a mechanical ventilator while conscious.nnnMETHODnThis study used a prospective, exploratory design comprising interviews with ten relatives conducted on two occasions; in connection with their visits to a patient cared for on a ventilator while conscious and approximately a week after the end of intensive care. The data were analysed by means of hermeneutic interpretation to obtain a deeper understanding of relatives experiences.nnnRESULTSnStriving to achieve contact with the patient was the most important aspect of being a close relative of a patient receiving ventilator treatment while conscious and was described by four main themes: feeling ambivalent towards consciousness; feeling ambivalent towards sedation; feeling dependent on the carer and being disappointed; and suppressing own suffering and sadness.nnnCONCLUSIONnThe patients consciousness enabled the relatives to judge their condition for themselves and enter into contact. This resulted in a sense of being in control but also efforts to suppress own suffering.

ICU nurses' perceptions of responsibilities and organisation in relation to organ donation--a phenomenographic study.

OBJECTIVESnAccording to the Istanbul declaration, health services should create better routines for identifying potential donors. A previous study involving 702 intensive and critical care (ICU) nurses revealed that only 48% trusted clinical diagnosis of brain death without a confirmatory cerebral angiography. The aim was to study ICU nurses perceptions of their experiences of professional responsibilities and organisational aspects in relation to organ donation and how they understand and perceive brain death.nnnMETHODSnA phenomenographic method was chosen. Data collection (interviews) took place in Sweden and included fifteen nurses; one man and fourteen women, from six hospitals serving different geographic areas.nnnRESULTSnThe findings pertain to three domains: ICU nurses perceptions of (1) their professional responsibility, (2) the role of the organisation regarding organ donation and (3) death and the diagnosis of brain death.nnnCONCLUSIONnThe ambiguity and various perceptions of brain death diagnosis seem to be a crucial aspect when caring for a brain dead patient. The lack of structured and sufficient organisation also appears to be a limiting factor. Both these aspects are essential for the ICU nurses opportunities to fulfil their professional responsibility during the organ donation process.