Nurses' experiences of caring for critically ill, non-sedated, mechanically ventilated patients in the Intensive Care Unit: a qualitative study.
OBJECTIVE
The objective was to explore nurses' experiences of caring for non-sedated, critically ill patients requiring mechanical ventilation.


METHODS
The study had a qualitative explorative design and was based on 13 months of fieldwork in two intensive care units in Denmark where a protocol of no sedation is implemented. Data were generated during participant observation in practice and by interviews with 16 nurses. Data were analysed using thematic interpretive description.


RESULTS
An overall theme emerged: "Demanding, yet rewarding". The demanding aspects of caring for more awake intubated patients included unpredictability, ambiguous needs and complex actions, while the rewarding aspects included personal interaction. Three sub-themes were identified: (i) caring for and with the patient, (ii) negotiating relational and instrumental care and (iii) managing physical and emotional closeness.


CONCLUSIONS
Despite the complexity of care, nurses preferred to care for more awake rather than sedated patients and appreciated caring for just one patient at a time. The importance of close collaboration between nurses and doctors to ensure patient comfort during mechanical ventilation was valued. Caring for more awake non-sedated patients required the nurses to act at the interface between ambiguous possibilities and needs, which was perceived as both demanding and rewarding.
Faculty of Health, Department of Public Health, University of Southern Denmark, Denmark; Dept. of Anesthesiology and Intensive Care, Odense University Hospital, Denmark. Electronic address: elaerkner@health.sdu.dk.
Eva
E
Laerkner
University of Copenhagen, Copenhagen University Hospital Rigshospitalet, Trauma Centre, Denmark.
Ingrid
I
Egerod
Faculty of Health, Department of Public Health, University of Southern Denmark, Denmark.
Helle Ploug
HP
Hansen
D000328:Adult; D001291:Attitude of Health Personnel; D064648:Critical Care Nursing; D016638:Critical Illness / Q000451:nursing*; D003718:Denmark; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D009726:Nurses; D036301:Qualitative Research; D012121:Respiration, Artificial / Q000451:nursing*; D011795:Surveys and Questionnaires; D014851:Wakefulness
Critical illness; Fieldwork; Intensive care; Interpretive description; Interview; Mechanical ventilation; No sedation; Nursing