Exploring adult patients’ perceptions of what enables them to make sense of their intensive care experience

Harmuth, Keryn (2019-04)

Thesis (MNur)--Stellenbosch University, 2019.

Thesis

ENGLISH SUMMARY : Critical illness requiring admission into an intensive care environment is a significant stressful event in any person’s life. Good caregiving in an intensive care environment is supported by appropriate, correct assessment and monitoring, drug and organ support interventions, patient comfort measures, psychological support, and early detection of complications. All these interventions and activities create experiences the critically ill person must make sense of in order to manage long-term consequences of this traumatic encounter (Leach, 2004:13). Critically ill patients’ experiences are an important component of a person’s perceptions of the quality of care provided in the intensive care unit (Wahlin, Ek & Idvall, 2009:332). During my clinical experiences as a critical care nurse and through listening to patients’ and colleagues’ accounts of their experiences of intensive care, it appears that in many instances the person’s negative experiences outweigh the positive ones. I was keen to explore adult patient’s perceptions of what aspects of the intensive care experience had an enabling influence on them making sense of their intensive care encounter and how these aspects enabled the patient to make sense of their experience of intensive care in order to move through the experience and make the experience tolerable. A qualitative descriptive phenomenological research approach was used. This study aimed to explore a participant’s own lived intensive care experience through their personal recollections in the intensive care unit. The participant’s experience of their time in an intensive care unit was the key event. A purposive sampling strategy using a network sampling method was applied to identify and include participants who had experienced an ICU admission, had recovered and moved from ICU to the ward or home, was able to give informed consent and able to talk with me about their admission and journey through their ICU stay. It was found that participants were enabled to make sense of their ICU experience when they were part of a trusting relationship with their caregiver. A trusting relationship also encompassed the patient knowing that they mattered to their caregiver and allowed the patient to feel at ease and in turn feel safe. Distrust in the caregiver erodes this notion of feeling safe and hindered the patient being able to make sense of their experience of ICU. It is recommended that education and training programmes should include specific content and application of trying to live in a critically ill person’s shoes in order to enable a nurse or doctor to have some insight as to what this experience means to a critically ill person. The study will be beneficial to nurses and other healthcare personnel who can offer care that is influenced by insights from this work and optimize a patient’s sense of being able to make sense of, tolerate and move through an experience of intensive care.

AFRIKAANSE OPSOMMING : Kritieke siekte wat toelating tot 'n intensiewe sorgomgewing vereis, is 'n beduidende stresvolle gebeurtenis in enige persoon se lewe. Goeie versorging in 'n intensiewe sorgomgewing word ondersteun deur toepaslike, korrekte assessering en monitering, middels en orgaanondersteuningsintervensies, pasiënt gemaksmaatreëls, sielkundige ondersteuning en vroeë opsporing van komplikasies. Al hierdie intervensies en aktiwiteite skep ervarings wat die kritiek siek persoon sin van moet maak om langtermyn gevolge van hierdie traumatiese ontmoeting te kan hanteer (Leach, 2004: 13). Kritiek siek pasiënte se ervarings is 'n belangrike komponent van 'n persoon se persepsies van die gehalte van sorg wat in die intensiewe sorgeenheid verskaf word (Wahlin, Ek & Idvall, 2009: 332). Tydens die navorser se kliniese ervarings as 'n kritieke sorg verpleegkundige en deur na die pasiënt- en kollegas se weergawes van hul ervarings van intensiewe sorg te luister, blyk dit dat die negatiewe ervarings van die persoon in baie gevalle die positiewe ervarings oorskadu. Ek was daarop uit om die volwasse pasiënt se persepsies te verken oor watter aspekte van die intensiewe ervaarervaring 'n invloed gehad het op hulle insig in hul intensiewe versorgings ervaring. Ook hoe hierdie aspekte die pasiënt in staat gestel het om sin te maak van hul ervaring in die intensiewe sorg eenheid, om sodoende aan te beweeg deur die ervaring en die ervaring verdraagsaam te maak. 'n Kwalitatiewe, beskrywende fenomenologiese navorsings ontwerp is gebruik. Hierdie studie het ten doel om 'n deelnemer se eie lewende intensiewe ervaring te verken deur middel van hul persoonlike herinneringe in die intensiewe sorgeenheid. Die deelnemer se ervaring van hul tyd in 'n intensiewe sorgeenheid was die belangrikste gebeurtenis. 'n Doelgerigte steekproef strategie met behulp van 'n network steekproefmetode is toegepas om deelnemers te identifiseer en in te sluit wat 'n toelating in die waakeenheid beleef het, herstel het en verskuif was vanaf ISE na die saal of 'n huis. Die persoon moes ook in staat wees om ingeligte toestemming te gee en met my te praat oor hul toelating en reis gedurende hul ISE tydperk. Daar is bevind dat deelnemers in staat gestel word om sin van hul ISE-ervaring te maak wanneer hulle deel was van 'n vertrouens verhouding met hul versorger. 'n Vertrouens verhouding het ook ingesluit dat die pasiënt geweet het dat hul versorger vir hul omgee, want dit het dan tot gevolg gehad dat die pasiënt gemaklik en veilig voel. Wantroue in die versorger verhinder die idee om veilig te voel en die pasiënt word dan verhoed om sin te maak van hul ondervinding van die ISE. Daar is aanbeveel dat opvoedings en opleidingsprogramme spesifieke inhoud en toepassing moet insluit om in 'n kritiek siek persoon se skoene te staan om sodoende 'n verpleegkundige of dokter in staat te stel om insig te hê wat hierdie ervaring beteken vir 'n kritiek siek persoon. Die studie sal voordelig wees vir verpleegkundiges en ander gesondheidsorg-personeel wat sorg kan bied wat deur insigte vanuit hierdie werk beïnvloed word. Dit kan ook die pasiënt se gevoel om sin te kan maak van die intensiewe sorg ervaring, dit te verdra en dan aan te beweeg optimaliseer.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/105805
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