Division of Nursing, Midwifery and Social Work, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Nurs Crit Care. 2022 Jan;27(1):91-105. doi: 10.1111/nicc.12643. Epub 2021 May 4.
Acute episodes of agitation are frequently experienced by patients during critical illness, yet what is not understood is the experience of agitation from the patient and family perspectives.
To search existing literature, appraise it and then provide a synthesized interpretation to broaden the understanding of patients' and their families' experience of agitation during an adult critical care admission.
Qualitative meta-synthesis.
A qualitative meta-synthesis based on a systematic literature search registered with PROSPERO. The search conducted between July and September 2019 was applied to ProQuest, Cumulative Index to Nursing and Allied Health, British Nursing Index, Cochrane Library, Ovid Medline, Web of Science, and PsycINFO databases. We appraised the selected literature and presented a synthesized interpretation. Analysis was based on the approach of Gadamerian hermeneutics. Due to the lack of data identified; the family experiences of agitation could not be addressed within the review.
In total, 8 studies were included capturing the experiences of 494 patients, aged between 18 and 92 years, with 225 (45%) women. The analysis generated three core themes: (a) What is real, what is not, (b) loss of communication and dependency, and (c) what helps, what does not. Fear of death, the emotion of anxiety, and feelings of pain alongside transient periods of fluctuating conscious levels provoked a feeling of intense vulnerability. The loss of effective communication and the feeling of dependence incite agitation and distress.
The patient's recollection of their critical illness can be completely or partially absent and disjointed with uncertainty around what is real and what is not. Family members observe the full effect of the patient's critical care illness and could be a wealth of untapped information.
Increasing awareness of the critically ill patients' experience of agitation highlights possible contributing factors to agitation development, such as staff interaction and communication skills, and the critical care environment.
危重病患者经常经历急性激动发作，但人们并不了解从患者和家属的角度来看，激动的体验是什么。
搜索现有文献，对其进行评价，然后提供综合解释，以扩大对成年重症监护患者入住期间激动体验的理解。
定性元综合。
基于系统文献检索的定性元综合，该检索于 2019 年 7 月至 9 月在 PROSPERO 上注册。该检索应用于 ProQuest、Cumulative Index to Nursing and Allied Health、British Nursing Index、Cochrane Library、Ovid Medline、Web of Science 和 PsycINFO 数据库。我们评价了选定的文献，并提出了综合解释。分析基于伽达默尔解释学的方法。由于缺乏已确定的数据；因此，在本次综述中无法涉及家庭对激动的体验。
共纳入 8 项研究，共纳入 494 名年龄在 18 至 92 岁之间的患者，其中 225 名（45%）为女性。分析产生了三个核心主题：（a）真实与非真实，（b）沟通和依赖的丧失，以及（c）有帮助的与无帮助的。对死亡的恐惧、焦虑的情绪以及与意识水平波动的短暂时期相关的疼痛，引发了强烈的脆弱感。有效沟通的丧失和依赖感引发了激动和痛苦。
患者对其危重病的记忆可能完全或部分缺失，对真实与非真实的认识存在不确定性。家属观察到患者重症疾病的全部影响，他们可能是一笔未被挖掘的宝贵信息来源。
提高对重症患者激动体验的认识，突出了可能导致激动发生的因素，如工作人员的互动和沟通技巧以及重症监护环境。
