Some researchers tried to identify the factors contributing to the patients’ perceived positive experience (Karlsson, Lindahl, & Bergbom, 2012; Samuelson, 2011). Increased physical activity made them believe of recovery, and involvement in planning made their time pass quicker. The patients felt being treated as a human with respect when they received an explanation of the procedure and own condition. Familiar faces and objects remind them of value and confident, and calm nursing cares that met the patients’ needs made them feel secured.
Patients appreciated the quiet time spent in the middle of the day undisturbed without restraints. The prospective, longitudinal study conducted by Rattray et al. (2010) reported that there were no significant reduction of the score in the patients’ anxiety, depression, avoidance, and intrusion level 6 months after discharge from the hospital. However, this researchers listed their limitation that the study might have failed to exclude the patients with previous medical history of depression and anxiety before ICU admission, and those who was depressed may not have chosen to participate in the study.
The Patients’ Experience with ICU Delirium Two nursing researchers examined the patients’ experience through ICU delirium: Van Rompaey, Van Hoof, Van Bogaert, Timmermans, and Dilles (2016) and Whitehorne, Gaudine, Meadus, and Solberg (2015). The former researchers used hermeneutic design, and the other used Heideggerian hermeneutic phenomenology. Inclusion criteria comprised with adult patients with a positive score in delirium assessment scale during the ICU stay over 24hrs. The final sample size was 30 and 10 respectively.
Data was collected through the tape-recorded interview at least 48hrs after their last positive delirium score. The common findings in these studies were patients’ recollection and fear of their vivid hallucinations, frightening feeling of not being able to control self back to normal, confusion of reality and non-reality, and disruption of day and night. Also, in both studies, patients felt shame and guilt reflecting own behavior. In one of the studies, the patients were afraid of a recurrence of delirium or having a mental illness after their physical recovery (Whitehorne et al. 2015).
The Patients’ Experience in General Population in ICU Nursing researchers explored the experience of patients in ICU without specification of the condition in two studies (Abuatiq, 2015; Hupcey, 2000). One of them used a mixed method and the other one used grounded theory. In the former study, researchers obtained data through questionnaire from 70 participants, and in the latter study, an open-ended unstructured tape-recorded interview was done on 45 participants.
The study done in medical-surgical ICU reported that the stress score was highest among the gastrointestinal cases, followed by sepsis and oncology (Abuatiq, 2015). However, the study identified its limitation as the possibility of more stressful experience were masked by the sedatives during the mechanical ventilation. The findings in the second study done by Hupcey (2000) were similar to the contents discussed in the patients’ experience with mechanical ventilation. Summary 250 All of the research had its own theme but identified patients’ experiences were overwrapped and intertwined.
The interesting themes emerged from this literature review was that the patients in the ICU across the board expressed their distress related interpersonal in nature rather than physical despite the fact that there were at least ethnographical, geographical, and practical difference of the research exist. The significant interpersonal disturbance included physical dependency, helplessness, not capable of express their choice, feeling defeat, voicelessness, and a lost sense of belongings and connection.
To regain control of self and situation, some patients prefer staying awake and aware to sedation even though that means to experience pain and discomfort. Some were able to identify the patients’ positive experience in the ICU stay, and that might give some insight to nursing perspective. However, these findings lack in an exploration of the patients’ idea of how nurses can help them. Also, the number of the researchers used qualitative data, and more specifically, hermeneutic phenomenology design to discover patients’ lived experience.
As implied by several investigators (Fink et al. , 2015; Karlsson et al. , 2012; Khalaila et al. , 2011; Van Rompaey et al. , 2016), there is a concern for its generalizability and credibility as in the most of the qualitative research (Anderson, 2010). That means a reader has to be cautious of utilization of findings as it may not be applicable to own practice setting. And from anecdotal evidence, it will be desirable if additional research is available in similar geographical, ethnographical, cultural, and practical variables.
Limitations 166 The researchers who used hermeneutic phenomenology design, descriptive design, and cross-sectional design listed generalizability and credibility as its inherited limitation (Fink et al. , 2015; Karlsson et al. , 2012; Khalaila et al. , 2011; Van Rompaey et al. , 2016). There was some concern in the process of sample selection. In the study that attempted to discover the recovery from depression and anxiety after the hospital discharge, there was a possibility that patients refused to participate in the study because they were, in fact, anxious or depressed, hence, the likelihood of down estimate (Rattray et al. 2010).
And in the study that explored the patients’ experience through ICU delirium, the reliability of ICU delirium scoring done by the bedside nursing staffs was questioned, and the possibility of undetected hypoactive delirium was noted (Whitehorne et al. , 2015). Another study stated the missing exclusion criteria that might have affected the patients’ perception such as the information of previous hospitalization (Abuatiq, 2015), a possibility of potentially traumatic event occur before and after the interview, or pre-existing mental health status (Samuelson, 2011). Others reflected on their interview process.
Lack of audio assistance might have been as the cause of the disintegration of the data that risked the loss of meaning in one study (Samuelson, 2011). On contrast, another study listed videotaping and the presence of a caregiver in the room might have inhibited the patients’ honest expression (Karlsson, Lindahl, & Bergbom, 2012). The possibility of environmental disturbances and poor memories was also mentioned by Samuelson (2011). And Karlsson, Lindahl, and Bergbom (2012) noted their small sample size might have down-powered the study although it was due to limited patient availability.
Unrestricted various time frame between the time the patients’ experience and the interview caused high variability (Fink et al. , 2015). And retrospect data collection may have influenced the patients’ memory (Magarey & McCutcheon, 2005; Rattray et al. , 2010). In the study that aimed to assess perception of stress in different demographic data, the researcher revealed that there was missing information from the patient who could not recall the period of intubation due to sedation (Abuatiq, 2015).
Five out of 15 nursing literature had no listing of its research limitation (Holm, & Dreyer, 2015; Hupcey, 2000; Samuelson et al. , 2007; Soh et al. , 2014; Tembo et al. 2012) Reflection 666 Through the development of this essay, I encountered many challenges. It was a tedious and time-consuming process. It required patience and skills to organize the data in-depth. But what I found the most difficult was to stick with the data without changing the meaning of it. In fact, I caught myself trying to theorize my understanding of the articles instead of simply grouping them many times.
The reason was that I enjoyed reading these research articles because I picked the theme that Thave always been curious. Also because it was very much relevant to my practice, it was even harder to dissociate my experience from these research findings. At that point, my perspective unconsciously became that of a “research consumer” (LoBiondo-Wood & Haber, 2013, p. 95) rather than that of a researcher. To keep objective mindset, I repeatedly questioned myself whether the sentence I just wrote was my interpretation or accurate to the fact listed in the original article.
Although it is still essential to maintain conscious objectiveness throughout the research process, there are many strategies discussed by LoBiondo-Wood and Haber (2013), and I encountered more while developing the essay. Certainly, learning such system or methodology will encourage researchers to follow the guideline, and I realized it would be my objective in future learning. In contrary, the qualitative research itself is developed with acceptance of bias throughout the research process (LoBiondo-Wood & Haber, 2013; The Association of Faculties of Medicine of Canada, n. . ).
Particularly in the study tries to unfold the world of lived experience of others such as phenomenological research, the consensus is the agreement of unique perspective of an individual that is undeniably subjective even in attempted maintenance of objectiveness (Laverty, 2003; LoBiondo-Wood & Haber, 2013). In this theory, based on the constructivist view, even the same person’s perceived experience changes with the alteration of variables such as time of the day or food consumed (Laverty, 2003; LoBiondo-Wood & Haber, 2013).
Then the question was if | cannot rely on the reliability of the study due to the existence of different variables such as the difference in the country of origin of the research, what good it is to learn such research? Furthermore, what is the meaning of doing such research if every consumer and a unique individual perceived the context of the research different than the rest of the world? Consequently and undoubtedly, the applicability, reliability, and validity of findings from qualitative research attracted much debate among researchers (Laverty, 2003; The Association of Faculties of Medicine of Canada, n. . ).
And in my confused mind, the only thing I was sure of was, in the constructivist view, the definition of and relationships of the terms phenomenology and ontology would be different than that of post-positivist. And as a constructivist, I value my perception of my world. Hence, what | learned at the end of this struggle was the recognition of what | realized. And that is, even if the findings in research mentioned above may not be directly applicable to my patient population, the reading of these articles gave me an insight of what might be happening in the patients’ mind while they are in ICU.
Qualitative research, especially those belong to the phenomenological design may not be so generalizable but definitely transferable (Laverty, 2003; LoBiondo-Wood & Haber, 2013; The Association of Faculties of Medicine of Canada, n. d. ). Because the evidence obtained through these research will lead me to a better understanding of patients, it will support my evidence-based practice as well as patient-centered care. I would like to continue my journey of increased and improved insight through the practice of critical reading of research.
