Oyama Yusuke, Yamase Hiroaki, Fujita Kyosuke, Tashita Hiroshi, Honda Tomoharu, Yoshida Koji, Nagata Akira
Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki 852-8520, Japan.
Yamaguchi University Department of Health Sciences, Graduate School of Medicine, 1-1-1 Minamikogushi, Ube-shi, Yamaguchi 755-8505, Japan.
Aust Crit Care. 2025 Mar;38(2):101115. doi: 10.1016/j.aucc.2024.08.011. Epub 2024 Sep 19.
The physiological state of critically ill patients is severely impaired by illness or trauma and is uncomfortable. Such experiences cause long-term anxiety and post-traumatic stress disorder.
This study aimed to understand discomfort and comfort based on the experiences of critically ill adult patients in the intensive care unit and to explore ways to improve their comfort.
This qualitative descriptive study was conducted with 15 critically ill patients (age range: 46-81 years; six females) in the intensive care unit using semistructured interviews and participant observation. The data collected were analysed using Braun and Clarke's thematic analysis. Data were collected from the intensive care unit and general ward of a university hospital in Japan.
Six themes related to discomfort and comfort were identified. The three themes related to discomfort were "overlapping uncertainties", "being unable to control physical discomfort", and "having to endure psychologically and situationally". The three themes related to comfort were "feeling connected brings calm", "routine care relieves pain and thirst", and "ease when one can decide for oneself". Participants' discomfort involved physical and psychological factors and was related to treatments, procedures, care, and the environment. Moreover, more than half of the patients endured unmet needs. Comfort was brought about by providing routine care for physical discomforts that critically ill patients often experience, feeling alive and connected to others and encouraging independence.
Recognising the potential for physical and psychological discomfort, as well as communication and other difficulties, in critically ill patients is crucial. Patients may also experience discomfort when healthcare providers take the lead, which underscores the importance of involving patients in their care. By showing respect for patients' intentions and involving them in decision-making, healthcare providers can improve patient comfort and promote a more collaborative approach to care.
危重症患者的生理状态因疾病或创伤而严重受损，且身体不适。这些经历会导致长期焦虑和创伤后应激障碍。
本研究旨在基于重症监护病房成年危重症患者的经历，了解其不适与舒适情况，并探索改善其舒适度的方法。
本定性描述性研究对重症监护病房的15名危重症患者（年龄范围：46 - 81岁；6名女性）进行了半结构化访谈和参与观察。收集的数据采用布劳恩和克拉克的主题分析法进行分析。数据收集于日本一家大学医院的重症监护病房和普通病房。
确定了与不适和舒适相关的六个主题。与不适相关的三个主题是“重叠的不确定性”、“无法控制身体不适”以及“在心理和情境上不得不忍受”。与舒适相关的三个主题是“感觉有联系会带来平静”、“常规护理缓解疼痛和口渴”以及“能自己做决定时感到轻松”。参与者的不适涉及生理和心理因素，与治疗、程序、护理及环境有关。此外，超过半数的患者有未满足的需求。通过为危重症患者常经历的身体不适提供常规护理、感觉充满活力并与他人有联系以及鼓励自主，带来了舒适感。
认识到危重症患者存在身体和心理不适的可能性以及沟通等其他困难至关重要。当医护人员主导时，患者也可能会感到不适，这凸显了让患者参与其护理的重要性。通过尊重患者的意愿并让他们参与决策，医护人员可以提高患者的舒适度，并促进更具协作性的护理方式。
