A phenomenological study of medically induced unconsciousness in intensive care

Abstract

Critically ill patients who require mechanical ventilation in intensive care units (ICUs) are usually sedated with drugs such as Morphine and Midazolam in order to facilitate ventilation, relieve pain and lower metabolic demands. Participants in this research were sedated to the point of 'medically induced unconsciousness' in that they were non eye opening nor responsive to verbal directives. A purposive sample of five individuals who had experienced the phenomenon of 'medically induced unconsciousness' were interviewed indepth. These interviews were transcribed verbatim and then analysed using a Husserlian phenomenological approach. Three essences were revealed within the data, each with associated themes. These essences were utter helplessness, cognition and succour. Utter helplessness was linked to: an inability to communicate either verbally or physically; pain during procedures; a sense of threat to personal safety; depersonalisation; loss of control and a sense of loneliness. Rather than an alteration of cognition, the themes that emerged within this second essence revealed attempts by participants to understand the experiences associated with 'medically induced unconsciousness'. These themes were: dreams; dissociation of self from the physical body; time-space relatedness and chaos. The final essence to emerge was that of succour. This essence portrays some of the more positive aspects of the experience. The themes revealed were: security in the ventilator; comfort in voices; human presence; painfree and purpose. Participants in this study were experiencing many things as they lay unresponsive on their beds in the ICU. The absence of physical responses should not be misinterpreted to mean that cognitive processes are not occurring. Participants appeared to be attempting to make sense of their immediate environment through their dreams.