Abstract
Background
Mechanical ventilation is a routine intervention for the critically ill but patients' experiences of this intervention are largely hidden from clinicians. A comprehensive understanding of Intensive Care Units survivors' accounts is required to provide health professionals with evidence about the patients' experience to deliver patient-centred care.
Objectives
To synthesise qualitative findings from international studies to understand Intensive Care Unit survivors' experiences of mechanical ventilation, clarify the components of patient-centred care from the patient perspective and understand what can be done by health professionals to improve care processes.
Design
A meta-ethnography of qualitative evidence following ENTREQ recommendations for reporting systematic reviews.
Data Sources
Eight databases (MEDLINE, AMED, CINAHL, PsychINFO, Scopus, WileyOnline, PubMed Central, TRIP) were systematically searched using a piloted strategy described in a published protocol. Searches were completed on 31.8.16 and no date restrictions were placed. Searches were updated on 25.4.17.
Review Methods
Two researchers independently reviewed studies against pre-determined inclusion criteria to assess their eligibility. Studies were included if they reported on the adult patient experience of mechanical ventilation and used qualitative data collection and analysis methods. All included studies were quality appraised. Participant quotes and concepts, described within the categories and themes of published studies, were extracted by one reviewer and coded by two reviewers. A process of constant comparison, which is central to meta-ethnography, facilitated the re-interpretation of data by a team of researchers to generate the final qualitative synthesis. The Enhancing Transparency in Reporting the Synthesis of Qualitative (ENTREQ) statement was used to ensure that all synthesis stages were comprehensively reported.
Results
Findings from 38 studies, with 608 participants, informed a patient-centred trajectory model; three overlapping stages; alienation, hidden work and recovery characterised the experiences of mechanical ventilation survivors. Health professionals could positively influence the patient experience by promoting ‘trust’ and being vigilant so that patients felt ‘safe’. Care provision that promoted ‘personalisation’ helped participants to retain their identity as unique human beings.
Conclusions
For the first time the pooling of qualitative findings from international studies, using meta-ethnography, has provided a patient-centred model of mechanical ventilation survivors’ experiences of their care processes. Patients may actively engage or passively endure the treatment burden associated with mechanical ventilation.
Mechanical ventilation is a routine intervention for the critically ill but patients' experiences of this intervention are largely hidden from clinicians. A comprehensive understanding of Intensive Care Units survivors' accounts is required to provide health professionals with evidence about the patients' experience to deliver patient-centred care.
Objectives
To synthesise qualitative findings from international studies to understand Intensive Care Unit survivors' experiences of mechanical ventilation, clarify the components of patient-centred care from the patient perspective and understand what can be done by health professionals to improve care processes.
Design
A meta-ethnography of qualitative evidence following ENTREQ recommendations for reporting systematic reviews.
Data Sources
Eight databases (MEDLINE, AMED, CINAHL, PsychINFO, Scopus, WileyOnline, PubMed Central, TRIP) were systematically searched using a piloted strategy described in a published protocol. Searches were completed on 31.8.16 and no date restrictions were placed. Searches were updated on 25.4.17.
Review Methods
Two researchers independently reviewed studies against pre-determined inclusion criteria to assess their eligibility. Studies were included if they reported on the adult patient experience of mechanical ventilation and used qualitative data collection and analysis methods. All included studies were quality appraised. Participant quotes and concepts, described within the categories and themes of published studies, were extracted by one reviewer and coded by two reviewers. A process of constant comparison, which is central to meta-ethnography, facilitated the re-interpretation of data by a team of researchers to generate the final qualitative synthesis. The Enhancing Transparency in Reporting the Synthesis of Qualitative (ENTREQ) statement was used to ensure that all synthesis stages were comprehensively reported.
Results
Findings from 38 studies, with 608 participants, informed a patient-centred trajectory model; three overlapping stages; alienation, hidden work and recovery characterised the experiences of mechanical ventilation survivors. Health professionals could positively influence the patient experience by promoting ‘trust’ and being vigilant so that patients felt ‘safe’. Care provision that promoted ‘personalisation’ helped participants to retain their identity as unique human beings.
Conclusions
For the first time the pooling of qualitative findings from international studies, using meta-ethnography, has provided a patient-centred model of mechanical ventilation survivors’ experiences of their care processes. Patients may actively engage or passively endure the treatment burden associated with mechanical ventilation.
| Original language | English |
|---|---|
| Pages (from-to) | 60-73 |
| Number of pages | 14 |
| Journal | International Journal of Nursing Studies |
| Volume | 86 |
| Early online date | 23 May 2018 |
| DOIs | |
| Publication status | Published - 1 Oct 2018 |
