Egerod Ingrid, Bergbom Ingegerd, Lindahl Berit, Henricson Maria, Granberg-Axell Anetth, Storli Sissel Lisa
University of Copenhagen, Rigshospitalet, Trauma Center, Blegdamsvej 9, DK-2100 Copenhagen O, Denmark.
Institute of Health and Caring Sciences, The Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden.
Int J Nurs Stud. 2015 Aug;52(8):1354-61. doi: 10.1016/j.ijnurstu.2015.04.017. Epub 2015 May 8.
Sedation practices in the intensive care unit have evolved from deep sedation and paralysis toward lighter sedation and better pain management. The new paradigm of sedation has enabled early mobilization and optimized mechanical ventilator weaning. Intensive care units in the Nordic countries have been particularly close to goals of lighter or no sedation and a more humane approach to intensive care.
The aim of our study was to systematically review and reinterpret newer Nordic studies of the patient experience of intensive care to obtain a contemporary description of human suffering during life-threatening illness.
We conducted a meta-synthesis in which we collected, assessed, and analyzed published qualitative studies with the goal of synthesizing these findings into a new whole. Analysis was based on the scientific approach of Gadamerian hermeneutics.
Nordic intensive care units.
Patients in Nordic intensive care units.
We performed a literature search of qualitative studies of the patient experience of intensive care based on Nordic publications in 2000-2013. We searched the following databases: PubMed, CINAHL, Scopus, and PsycINFO. Each original paper was assessed by all authors using the Critical Appraisal Skills Program instrument for qualitative research. We included 22 studies, all of which provided direct patient quotes.
The overarching theme was identified as: The patient experience when existence itself is at stake. We constructed an organizing framework for analysis using the main perspectives represented in the included studies: body, mind, relationships, and ICU-environment. Final analysis and interpretation resulted in the unfolding of four themes: existing in liminality, existing in unboundedness, existing in mystery, and existing on the threshold.
Our main finding was that human suffering during intensive care is still evident although sedation is lighter and the environment is more humane. Our interpretation suggested that patients with life-threatening illness descend into a liminal state, where they face the choice of life or death. Caring nurses and family members play an important role in assisting the patient to transition back to life.
重症监护病房的镇静措施已从深度镇静和麻痹发展为更浅的镇静和更好的疼痛管理。新的镇静模式实现了早期活动并优化了机械通气撤机。北欧国家的重症监护病房尤其接近更浅或无镇静以及更人道的重症监护方法的目标。
我们研究的目的是系统回顾并重新解读北欧关于重症监护患者体验的最新研究，以获得对危及生命疾病期间人类痛苦的当代描述。
我们进行了一项元综合研究，收集、评估和分析已发表的定性研究，目的是将这些发现综合成一个新的整体。分析基于伽达默尔诠释学的科学方法。
北欧重症监护病房。
北欧重症监护病房的患者。
我们基于2000 - 2013年北欧的出版物对重症监护患者体验的定性研究进行了文献检索。我们检索了以下数据库：PubMed、CINAHL、Scopus和PsycINFO。所有作者使用定性研究的批判性评估技能计划工具对每篇原始论文进行评估。我们纳入了22项研究，所有这些研究都提供了患者的直接引述。
总体主题被确定为：当生存本身受到威胁时的患者体验。我们使用纳入研究中代表的主要观点构建了一个分析组织框架：身体、心理、人际关系和重症监护病房环境。最终的分析和解读产生了四个主题：存在于阈限状态、存在于无边界状态、存在于神秘状态和存在于临界状态。
我们的主要发现是，尽管镇静更浅且环境更人道，但重症监护期间的人类痛苦仍然明显。我们的解读表明，患有危及生命疾病的患者陷入一种阈限状态，在那里他们面临生死抉择。富有爱心的护士和家庭成员在帮助患者过渡回生活方面发挥着重要作用。
