Critical care nurses' experiences of providing care for adults in a highly technological environment: A qualitative evidence synthesis

Abstract

Aims and objectives To synthesise the available body of qualitative evidence relating to nurses' perceptions and experiences of care provision in adult critical care environments. Methods The study adhered to ENTREQ (Confidence in Evidence of Reviews of Qualitative Research) guidelines. See Appendix S1. A systematic search of the literature in nine databases was undertaken: CINAHL, Web of Science, MEDLINE, EMBASE, PsycINFO, Campbell Collaboration, ProQuest A & I, DART and Lenus. Blind screening to select relevant studies was undertaken, and each selected study was assessed for quality using the Critical Appraisal Skills Programme framework. Guided by Thomas and Harden's three‐stage approach to thematic analysis, line‐by‐line coding of participants' verbatim accounts and the researchers' interpretations in the selected studies' findings was undertaken and then organised into higher order analytical themes. Confidence in the findings was reviewed using GRADE‐CERQual. Results Twelve studies reported in thirteen papers, including 122 nurses, were selected in the final sample for synthesis. Three analytical themes were identified: (a) sometimes machines get all the attention, (b) with experience the patient becomes the focus and (c) technology can't save everybody. Conclusions Providing care for adult patients in a highly technological environment is challenging particularly for novice nurses, who face the potential of technology drawing all their attention. Experienced critical care nurses learn to keep technology in abeyance and deliver person‐centred care within the bounds of a technological environment. Relevance to clinical practice The review supports Locsin's theory of technological competence and highlights that providing care in critical care requires nurses to actively balance attention for the person while managing machines. Experienced nurses achieve this balance and can offer support to novice nurses. Critical care nurse orientation programmes should be underpinned by a holistic approach which addresses the dualism of technology and care.

Critical care nurses’ experiences of working during the first phase of the COVID-19 pandemic – Applying the Person-centred Practice Framework

“…The notion of PCC might be especially challenging in an ICU’s technological environment ( Andersson, 2021 ) where nursing care is described as task-oriented and based mainly on the patient’s medical needs ( Falk et al, 2019 ). Even when CCNs want to attend to patients at a personal level, technology has sometimes appeared to be more important than the patients it is meant to serve ( Crilly et al, 2019 ). Cederwall et al (2018) conducted a deductive study using Ekman’s et al (2011) theoretical framework of person-centred nursing based on the routines to establish PCC in a secondary analysis of qualitative data collected to explore CCNs’ strategies in managing patients experiencing prolonged weaning ( Cederwall et al, 2014 ).…”

Institutional Constraints as an Obstacle for Prioritizing Nursing Interventions During the COVID-19 Pandemic—Critical Care Nurses’ Experiences

“…Person-centered care (PCC) has been described as bringing the person back into care ( Edvardsson, 2015 ; Ekman et al, 2011 ) and has become a key of quality care in many developed countries ( Hanefeld et al, 2017 ). The care environment has the potential to support or to restrict PCC ( Moore et al, 2017 ) and, according to Crilly et al (2019) , CCNs have sometimes experienced that the technology in ICUs appears to be more important than the patients. During the first phase of the COVID-19 pandemic, CCNs reported being ambitious and knowledgeable about PCC, but obstacles prevented them from providing it ( Andersson et al, 2022a ).…”

Philosophical knowledge is warranted for the successful implementation of person-centred care

“…14,15 Even if ICU nurses want to attend to patients at a personal level, the highly technological environment in ICUs might outmanoeuvre the patients. 16 In a recent systematic literature review, 17 including a synthesis of qualitative studies, the findings implied that ICU nurses experienced that technology sometimes appeared to be more important than the patient. In the highly technological environment of ICUs, the notion of PCC might be especially challenging.…”