The experience and caring needs of critically ill, mechanically ventilated patients

Twelve critically ill adults who had been mechanically ventilated (seven days or more) retrospectively (six to nine months after weaning) described their experiences and caring needs through a formal, semi-structured interview format guided by the Cognitive Interview (Fisher & Geiselman, 1987). Eight partners (relatives and friends), who spent significant time at the patient\u27s bedside also were interviewed. This qualitative study used a combination of methods including phenomenology, ethnography, and grounded theory (Swanson-Kauffman, 1986). Three groups of themes emerged from data analysis. The first, the MEANING of the experience included fear/anxiety, relating to others (communication, connecting, and communication difficulties), dependency, dehumanization and violation (by professional caregivers), and pain. The second group of themes involved the MANAGEMENT of the experience, e.g., methods of control, creating a world of their own (labelled confusion or hallucinations), and the role of hope. The final group, the CONSEQUENCES of the experience contained reflections on why the illness had occurred (smoking, alcoholism), and living with symptoms of Posttraumatic Stress Disorder (PTSD). The critical illness experience was central to the context of being mechanically ventilated. Although the subjects initially were fearful and anxious about being mechanically ventilated, most later referred to the ventilator as supportive and essential to their recovery. Ten of the patients created an insular world of their own that required little energy expenditure when compared to that of the Intensive Care Unit (ICU). They sometimes found comfort through scenes and visitors not seen by others in the ICU. Difficulties in communication were a universal and unresolved problem. Reports of dehumanizing behavior by nurse and physician caregivers demonstrated a violation of the ethical principles of truth telling and do no harm . Four of the patients and one partner still had symptoms of PTSD months after the experience. While some were able to laugh and find humor in the telling of their stories, others spoke of the sustenance of hope and spirituality