title: The patient experience of intensive care: a meta-synthesis of Nordic studies.
abstract: BACKGROUND
  Sedation practices in the intensive care unit have evolved from deep sedation and paralysis toward lighter sedation and better pain management. The new paradigm of sedation has enabled early mobilization and optimized mechanical ventilator weaning. Intensive care units in the Nordic countries have been particularly close to goals of lighter or no sedation and a more humane approach to intensive care.
  
  
  OBJECTIVE
  The aim of our study was to systematically review and reinterpret newer Nordic studies of the patient experience of intensive care to obtain a contemporary description of human suffering during life-threatening illness.
  
  
  METHODS
  We conducted a meta-synthesis in which we collected, assessed, and analyzed published qualitative studies with the goal of synthesizing these findings into a new whole. Analysis was based on the scientific approach of Gadamerian hermeneutics.
  
  
  METHODS
  Nordic intensive care units.
  
  
  METHODS
  Patients in Nordic intensive care units.
  
  
  METHODS
  We performed a literature search of qualitative studies of the patient experience of intensive care based on Nordic publications in 2000-2013. We searched the following databases: PubMed, CINAHL, Scopus, and PsycINFO. Each original paper was assessed by all authors using the Critical Appraisal Skills Program instrument for qualitative research. We included 22 studies, all of which provided direct patient quotes.
  
  
  RESULTS
  The overarching theme was identified as: The patient experience when existence itself is at stake. We constructed an organizing framework for analysis using the main perspectives represented in the included studies: body, mind, relationships, and ICU-environment. Final analysis and interpretation resulted in the unfolding of four themes: existing in liminality, existing in unboundedness, existing in mystery, and existing on the threshold.
  
  
  CONCLUSIONS
  Our main finding was that human suffering during intensive care is still evident although sedation is lighter and the environment is more humane. Our interpretation suggested that patients with life-threatening illness descend into a liminal state, where they face the choice of life or death. Caring nurses and family members play an important role in assisting the patient to transition back to life.
authors.affiliation: University of Copenhagen, Rigshospitalet, Trauma Center, Blegdamsvej 9, DK-2100 Copenhagen O, Denmark. Electronic address: Ingrid.Egerod@regionh.dk.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Egerod
authors.affiliation: Institute of Health and Caring Sciences, The Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden. Electronic address: Ingegerd.Bergbom@fhs.gu.se.
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Bergbom
authors.affiliation: School of Health Sciences, Borås University College, Sweden; Institute of Health and Caring Sciences, The Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden. Electronic address: Berit.Lindahl@hb.se.
authors.forename: Berit
authors.initials: B
authors.lastname: Lindahl
authors.affiliation: School of Health Sciences, University of Jönköping, Sweden. Electronic address: Maria.Henricson@hhj.hj.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Henricson
authors.affiliation: Clinical Lecturer, Lasarettsvägen, entré 13, 30185 Halmstad, Sweden. Electronic address: Anetth.Granberg-Axell@regionhalland.se.
authors.forename: Anetth
authors.initials: A
authors.lastname: Granberg-Axell
authors.affiliation: Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø - The Artic University of Norway, 9037 Tromsø, Norway. Electronic address: sissel.l.storli@uit.no.
authors.forename: Sissel Lisa
authors.initials: SL
authors.lastname: Storli
mesh_terms: D003422:Critical Care; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D012537:Scandinavian and Nordic Countries
keywords: Hermeneutics; Intensive care; Liminality; Meta-synthesis; Nursing; Patient experience