Understanding patients' experiences of being mechanically ventilated in the Intensive Care Unit: Findings from a meta-synthesis and meta-summary.

Abstract

To synthesise the evidence reported in qualitative studies concerning the lived experiences of adult patients receiving mechanical ventilation in Intensive Care Unit (ICU). Critically ill patients receiving mechanical ventilation in the ICU have been reported to suffer from severe physical and emotional responses such as hopelessness, anxiety, high levels of frustration and stress. Recent improvements in the field of mechanical ventilation and sedative medications as experienced by patients that can inform nursing care have not been summarised to date. A systematic review of qualitative studies followed by a meta-synthesis and a meta-summary was performed. Four electronic databases were searched by two authors in June 2019. A total of nine studies were included and evaluated based on their methodological quality using the Critical Appraisal Skills Programme checklist. A total of 24 codes emerged from the abstraction process, which were categorised into 11 categories and four themes: (a) "The effect of the intense stress on the body's systems," (b) "The induced negative emotional situations," (c) "The feeling of being cared for in a hospital setting" and (d) "The perceived support from the family and loved ones." Furthermore, the most frequent codes across studies were "Being afraid," "Feeling supervised," "Feeling comforted," "Failing to communicate," and "Experiencing difficulties in breathing," with an intensity of 66.6%. Patients receiving mechanical ventilation have expressed a general sense of vulnerability, of which critical care nurses need to be aware. Findings suggest the need for improvements at the nursing, unit, educational and policy levels; furthermore, more research is also required at the international levels given the current trends towards no sedation protocols for the management of ICU patients: listening to their experiences becomes imperative, in order to ensure an awake, comfortable and ventilator-tolerant patient.