Understanding the Course of Critical Illness Through a Lifeworld Approach

An increasing number of individuals receive and survive intensive care treatment; however, several individuals experience problems afterward, which may threaten recovery. Grounded in a lifeworld approach, the aim of this study was to explore and describe what intensive care patients experience as limiting and strengthening throughout their illness trajectories. Ten former intensive care patients were interviewed three to eight months after hospital discharge. Using Giorgi’s phenomenological analysis, a general structure of gaining strength through a caring interaction with others was revealed. The structure consisted of three constituents: feeling safe through a caring presence, being seen and met as a unique person, and being supported to restore capacity. Being met with a humanistic approach and individualized care appeared to be important, and the findings are discussed within the framework of lifeworld-led care. To facilitate improved aftercare of the critically ill, more tailored support throughout the illness trajectory is needed.

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Harming patients by provision of intensive care treatment: is it right to provide time-limited trials of intensive care to patients with a low chance of survival?

Medicine Health Care and Philosophy ◽

10.1007/s11019-020-09994-9 ◽

2021 ◽

Author(s):

Thomas M. Donaldson

Keyword(s):

Intensive Care ◽

Patient Specific ◽

Intensive Care Treatment ◽

Human Flourishing ◽

Intensive Care Patients ◽

Care Treatment ◽

Resource Limited ◽

Increasing Demand ◽

Risk Benefit Analysis ◽

High Chance

AbstractTime-limited trials of intensive care have arisen in response to the increasing demand for intensive care treatment for patients with a low chance of surviving their critical illness, and the clinical uncertainty inherent in intensive care decision-making. Intensive care treatment is reported by most patients to be a significantly unpleasant experience. Therefore, patients who do not survive intensive care treatment are exposed to a negative dying experience. Time-limited trials of intensive care treatment in patients with a low chance of surviving have both a small chance of benefiting this patient group and a high chance of harming them by depriving them of a good death. A ‘rule of rescue’ for the critically unwell does not justify time-limiting a trial of intensive care treatment and overlooks the experiential costs that intensive care patients face. Offering time-limited trials of intensive care to all patients, regardless of their chance of survival, overlooks the responsibility of resource-limited intensive care clinicians for suffering caused by their actions. A patient-specific risk–benefit analysis is vital when deciding whether to offer intensive care treatment, to ensure that time-limited trials of intensive care are not undertaken for patients who have a much higher chance of being harmed, rather than benefited by the treatment. The virtue ethics concept of human flourishing has the potential to offer additional ethical guidance to resource-limited clinicians facing these complex decisions, involving the balancing of a quantifiable survival benefit against the qualitative suffering that intensive care treatment may cause.

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The assessment of pain level among an adult ventilated patients in the intensive care unit

Ból ◽

10.5604/01.3001.0013.7879 ◽

2020 ◽

Vol 20 (3) ◽

pp. 23-31

Author(s):

Magdalena Weisbrot ◽

Katarzyna Kwiecień-Jaguś ◽

Wioletta Mędrzycka-Dąbrowska

Keyword(s):

Intensive Care ◽

Subjective Impression ◽

Mechanically Ventilated ◽

Intensive Care Patients ◽

Polish Version ◽

The One ◽

Pain At Rest ◽

Patients Experience ◽

Ventilated Patients ◽

Experience Pain

Introduction: Pain is a subjective impression, which means that its intensity can only be determined by the person who experiences it. Intensive care patients, often intubated, mechanically ventilated, are unable to determine the intensity of pain in a verbal manner. The pain experienced in these patients may occur both at rest and during various diagnostic, treatment or care procedures. Diagnosis and accurate assessment of pain are the basis for effective pain management. In modern practice, the nursing usually deals with the assessment and it is she who chooses the tool for the patient’s needs. Aim of the study: Analysis of pain complaints of mechanical ventilation patients, using the Polish version of the CPOT scale. Material and methods: The study was conducted using a prospective method, using a standardized CPOT pain assessment scale. The technique of the study consisted in observing patients at rest and during performing nursing procedures, such as tracheal suction and replacement of dressings. 58 patients were qualified for the study at the one of hospital in the Pomeranian province. Results: 20.7% of examined patients experience pain at rest. During tracheal suction, this percentage increased to 60.3%. During the replacement of the dressing, pain was felt by 31%. Conclusion: Mechanically ventilated patients experience pain both at rest and during routine nursing procedures.

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Trust in Intensive Care Patients, Family, and Healthcare Professionals: The Development of a Conceptual Framework Followed by a Case Study

Healthcare ◽

10.3390/healthcare9020208 ◽

2021 ◽

Vol 9 (2) ◽

pp. 208

Author(s):

Anne Lotte Lemmers ◽

Peter H. J. van der Voort

Keyword(s):

Intensive Care ◽

Health Care Professionals ◽

Healthcare Professionals ◽

Informational Privacy ◽

Intensive Care Patients ◽

Health Delivery ◽

Time Sensitivity ◽

Feedback Culture ◽

Patients Experience

Intensive care patients experience anxiety, pain, uncertainty, and total dependency. In general, it is important to develop trust between the healthcare professionals (HCPs), patients, and their family. Trust building in the ICU setting is challenging because of the time sensitivity of decision making and the dependency of patients on health care professionals. The objectives of this study are the development of a trust framework and then to use this framework in a case study in the intensive care. In three steps we developed a comprehensive trust framework from the literature concerning trust. First, we identified the elements of trust. Second, we adapted and integrated the dimensions to six concepts to construct the trust framework. Third, these concepts are incorporated into a comprehensive trust framework. In a case study we explored the facilitators and barriers within this framework in eight semi-open interviews with healthcare professionals and eight patients or partners. Trust was first explored inductively and then deductively. We showed that HCPs, patients, and family have largely the same perspective regarding the facilitators of trust, in which communication emerged as the most important one. Other facilitators are maintaining an open feedback culture for HCPs and being aware of patients’ physical and informational privacy. Patients want to be approached as an individual with individual needs. Dishonesty and differences in values and norms were the most important barriers. To contribute to a positive perception of health delivery and to avoid conflicts between HCP and patients or their family we formulated five practical recommendations.

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