Humanizing and dehumanizing intensive care: Thematic synthesis (HumanIC)

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Abstract

Background

Critical illness and the intensive care unit can be a terrifying experience to patients and relatives and they may experience the extreme life‐saving measures as dehumanizing. Humanizing intensive care is often described as holism or dignity, but these abstract concepts provide little bodily resonance to what a humanized attitude is in concrete situations.

Objective

To explore what contributes to patients' and relatives' experience of intensive care as humanized or dehumanized.

Design

Thematic synthesis.

Materials

Findings from 15 qualitative papers describing patients' and/or relatives' perceptions of humanizing or dehumanizing care.

Methods

A systematic literature search of PubMed, CINAHL, Scopus and EMBASE from 1 January 1999 to 20 August 2022 identified 16 qualitative, empirical papers describing patients' and relatives' experiences of humanizing or dehumanizing intensive care, which were assessed using Critical Appraisal Skills Programme Qualitative Checklist, 15 papers were included and analysed using Thematic Synthesis and Ricoeur's model of the text.

Findings

Intensive care was humanized when patients felt connected with healthcare professionals, with themselves by experiencing safety and well‐being and with their loved ones. Intensive care was humanized to relatives when the patient was cared for as a unique person, when they were allowed to stay connected to the patient and when they felt cared for in the critical situation.

Conclusion

Patients and relatives experienced intensive care as humanized when healthcare professionals expressed genuine attention and supported them through their caring actions and when healthcare professionals supported patients' and relatives' opportunities to stay connected in the disrupted situation of critical illness. When healthcare professionals offered a connection to the patients and relatives, this helped them hold on and find meaning.

Patient or Public Contribution

No patient and public contribution.

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Most cited references 41

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Methods for the thematic synthesis of qualitative research in systematic reviews

James Thomas, Angela Harden (2008)

Background There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies. Methods We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved. Results We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses. Conclusion We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.

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The lived experiences of adult intensive care patients who were conscious during mechanical ventilation: a phenomenological-hermeneutic study.

Veronika Karlsson, Ingegerd Bergbom, Anna Forsberg (2012)

The aim of this study was to illuminate the lived experience of patients who were conscious during mechanical ventilation in an intensive care unit (ICU). Interviews with 12 patients assessed as being conscious during mechanical ventilation were conducted approximately one week after discharge from an ICU. The text was analysed using a phenomenological-hermeneutic method inspired by Ricoeur. Apart from breathlessness, voicelessness was considered the worst experience. The discomfort and pain caused by the tracheal tube was considerable. A feeling of being helpless, deserted and powerless because of their serious physical condition and inability to talk prompted the patients to strive for independence and recovery and made them willing to 'flow with' the treatment and care. Comments from the patients suggest that their suffering can be alleviated by communication, participation in care activities and companionship. A patient's endurance whilst conscious during mechanical ventilation seems to be facilitated by the presence of nurses, who mediate hope and belief in recovery, strengthening the patient's will to fight for recovery and survival. Copyright © 2011 Elsevier Ltd. All rights reserved.

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Writing In and Reading ICU Diaries: Qualitative Study of Families' Experience in the ICU

Maité Garrouste-Orgeas, Antoine Périer, Philippe Mouricou … (2014)

Purpose Keeping an ICU patient diary has been reported to benefit the patient's recovery. Here, we investigated the families' experience with reading and writing in patient ICU diaries kept by both the family and the staff. Methods We conducted a qualitative study involving 32 semi-structured in-depth interviews of relatives of 26 patients (34% of all family members who visited patients) who met our ICU-diary criterion, i.e., ventilation for longer than 48 hours. Grounded theory was used to conceptualise the interview data via a three-step coding process (open coding, axial coding, and selective coding). Results Communicative, emotional, and humanising experiences emerged from our data. First, family members used the diaries to access, understand, and assimilate the medical information written in the diaries by staff members, and then to share this information with other family members. Second, the diaries enabled family members to maintain a connection with the patient by documenting their presence and expressing their love and affection. Additionally, families confided in the diaries to maintain hope. Finally, family members felt the diaries humanized the medical staff and patient. Conclusions Our findings indicate positive effects of diaries on family members. The diaries served as a powerful tool to deliver holistic patient- and family-centered care despite the potentially dehumanising ICU environment. The diaries made the family members aware of their valuable role in caring for the patient and enhanced their access to and comprehension of medical information. Diaries may play a major role in improving the well-being of ICU-patient families.

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Author and article information

Contributors

Anne Højager Nielsen:

ORCID: https://orcid.org/0000-0002-8955-9374

ahn@clin.au.dk , @AnneHoejager

Monica Evelyn Kvande:

ORCID: https://orcid.org/0000-0003-4384-4695

@MonicaKvande

Sanne Angel:

ORCID: https://orcid.org/0000-0001-7669-6743

@Angel123_Sanne

Journal

Journal ID (nlm-ta): J Adv Nurs

Journal ID (iso-abbrev): J Adv Nurs

Journal ID (doi): 10.1111/(ISSN)1365-2648

Journal ID (publisher-id): JAN

Title: Journal of Advanced Nursing

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 0309-2402

ISSN (Electronic): 1365-2648

Publication date (Electronic): 24 October 2022

Publication date (Print): January 2023

Volume: 79

Issue: 1 ( doiID: 10.1111/jan.v79.1 )

Pages: 385-401

Affiliations

[ ¹ ] Department of Anesthesiology and Intensive care Gødstrup Hospital Herning Denmark

[ ² ] Department of Clinical Medicine Aarhus University Aarhus Denmark

[ ³ ] Lovisenberg Diaconal University College Oslo Norway

[ ⁴ ] Operation and Intensive Care Unit University Hospital of North Norway Tromsø Norway

[ ⁵ ] Department of Public Health, Nursing Aarhus University Aarhus Denmark

Author notes

[*] [* ] Correspondence

Anne Højager Nielsen, Department of Anesthesiology and Intensive care, Gødstrup Hospital, Hospitalsparken 15, 7400 Herning, Denmark.

Email: ahn@ 123456clin.au.dk

Author information

Anne Højager Nielsen https://orcid.org/0000-0002-8955-9374

Monica Evelyn Kvande https://orcid.org/0000-0003-4384-4695

Sanne Angel https://orcid.org/0000-0001-7669-6743

Article

Publisher ID: JAN15477 Other ID: JAN-2022-0876.R2

DOI: 10.1111/jan.15477

PMC ID: 10092106

PubMed ID: 36281216

SO-VID: be491f8e-bca9-4650-9f90-99e020ebaad6

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date revision received : 13 September 2022

Date received : 18 May 2022

Date accepted : 12 October 2022

Page count

Figures: 2, Tables: 3, Pages: 17, Words: 6830

Funding

Funded by: Novo Nordisk Fonden , doi 10.13039/501100009708;

Award ID: NNFOC0058277

Custom metadata

source-schema-version-number 2.0

cover-date January 2023

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.7 mode:remove_FC converted:12.04.2023

ScienceOpen disciplines: Nursing

Keywords: critical care,de,hermeneutics,humanizing,intensive care,thematic synthesis

Data availability:

ScienceOpen disciplines: Nursing

Keywords: critical care, de, hermeneutics, humanizing, intensive care, thematic synthesis

Humanizing and dehumanizing intensive care: Thematic synthesis (HumanIC)

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Abstract

Background

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Patient or Public Contribution

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Hogrefe: COVID-19 in Focus

Most cited references 41

Methods for the thematic synthesis of qualitative research in systematic reviews

The lived experiences of adult intensive care patients who were conscious during mechanical ventilation: a phenomenological-hermeneutic study.

Writing In and Reading ICU Diaries: Qualitative Study of Families' Experience in the ICU

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