Patient's Experiences While Receiving Mechanical Ventilation In ICU

Objective:Along with the improvement of technology and medical & nursing science, mechanical ventilation is used more frequently as a vital means of respiratory support. At the present time, mechanical ventilation is an essential supporting technique for many pathological processes such as general anaesthesia and respiratory dysfunction caused by diversified reasons. In general, patients who received mechanical ventilation in an intensive care unit are more serious than other patients; they not only suffer from discomfort and affliction of hospitalization and somatic illness, but must sustain the painful experience of intubation needed by mechanical ventilation. Those patients have to depend on the ventilators to maintain life and rely on nurses to content their essential requirements. Once the artificial airway is established, patient can not express his or her feeling and requirement because of communication holdback. Many bad psychological and physical experiences are present while the treatment of mechanical ventilation has saved many patients' life. Patient may experience many difficulties in physical, mental, and cognitive during the treatment process. What's more, some intensive care experiences would last a long period of time and have effects on patient's quality of life even after recovery and leave hospital.To better understand mechanical ventilated patients' intensive care experience is needed.The present research try to focus on Chinese patient's experiences while receiving mechanical ventilation in an intensive unit. The aims are as following:I. Extending nurse's knowledge in intensive care area and promoting medical staff to understand patient's experiences by the quantificational studies.II. Preliminary developing a questionnaire to access patient's experiences while receiving mechanical ventilation in an intensive unit, testing reliability and validity of the questionnaire, and establishing the foundation for further research.III. Quantitative analysis on the patient's intensive care experiences and relative factors.IV. Developing clinical strategy that might improve nursing outcomes to enhance the nursing quality in intensive care area.Methods:I . Research 1: In-depth were carried out with a sample of 11 patients(≥18 yrs old) who have experienced the treatment of mechanical ventilation in the affiliated hospital of medical universities in Beijing. The interviews were audiotaped and transcribed verbatim. The transcripts were analyzed using the phenomenological analysis method devised by Giorgi.II. Research 2: A preliminary questionnaire entitled Intensive Care Experience with MV (ICE-MV) was developed based on the qualitative study and a review of the literature on intensive care experiences. The initial scale contained 50 items, which was content valid by 3 physicans, 4 nurses who worked in ICU, and 1 psychologist. 297 subjects were investigated using the scale when discharged from ICU. An exploratory factor analysis (EFA) was used to examine the psychometric characteristics of the ICE-MV scale.III. Research 3: The demographic and illness condition information including age, sex, severity of illness, etc. were collected while objects were asked to fill the ICE-MV scale. Based on all valid questionnaires, we established the database and employed SPSS11.5 software package was used to analyze data. Descriptive analysis, one-way ANOVA, one sample t-test, Pearson correlation analysis, and multiple regression analysis were used in data statistical management.Results:I . Research 1: Qualitative analysis on the patient's experiences while receiving mechanical ventilation in an intensive unit. 5 themes related to patient's experience were extracted by in-depth data analysis including being in an unconventionality environment, suffering for distress and affliction, encountering psychological crisis, seeking for help and support, and self-reflection. Each theme covered many sub-themes.II. Research 2: The final, 23 item ICE-MV scale consisted of five main components including "awareness of surrounding", "experience technique", "altered cognition and feeling", "inter-personal support demands", and "treatment and illness information". The overall experience scale demonstrated good internal consistency and reliability (Cronbach'sα= 0.80). The five components accounted for 52.50% of the whole variance.III. Research 3:①By the descriptive statistic to patient's experiences, we found that patients who have received mechanical ventilation underwent the moderate degree experience with the highest scored in dimension 4(inter-personal support) and the lowest scored in dimension 3(cognition and feeling) respectively.②Main influence factors including period of mechanical ventilation, disease severity, marital status, and patient's age. Period of mechanical ventilation, disease severity, marital status were positive correlated to patient's experiences while patient's age was negative correlated to patient's experiences.Multiple correlation coefficient R was 0.552 and the coefficient of determination R~2 was 0.305. That is to say, those four variables could prognosticate 30.5% of the total score variance.Conclusion:I . By in-depth analysis, we have found that, although each case had different psychological & physical experiences and some commonness, generally speaking, patient's experiences while receiving mechanical ventilation in an intensive unit were poignant and afeard. We extracted 5 themes from patient's experiences including being in an unconventionality environment, suffering for distress and affliction, encountering psychological crisis, seeking for help and support, and self- reflection.II. The scale consisted of 5 dimensions including "awareness of surrounding", "experience technique", "altered cognition and feeling", "inter-personal support demands", and "treatment and illness information". The questionnaire demonstrates good reliability and validity. It should be useful in further studies in the area of patient's experiences in the ICU.III. We have found that patient's experiences while receiving mechanical ventilation underwent the intensive care experience above the moderate degree. Lacking of inter-personal support was the strongest reflected factor while the alteration of cognition and feeling was the weakest reflected factor.IV. The period of mechanical ventilation, disease severity, marital status, and patient's age were the main factors that influenced patient's experiences while receiving mechanical ventilation in ICU. Younger patients with prolonged MV, more severe disease, negative marital status had worse experiences than others.In conclusion, the results remind us that patients who receiving mechanical ventilation treatment have suffered many negative experiences related to intensive care and treatment. Those experiences not only affected by demographic factors but influenced by the healthy condition of patients. Therefore, besides taking life-saving measurement, we should also understand patient's experiences and take intervention correspondingly to those meliorate the unpleasant experiences, promote the prognosis and improve patient's life quality.