Patients´ experiences of pain in the intensive care – The delicate balance of control

Abstract

Aim To explore the patients´ experiences of pain when being cared for in the intensive care. Design An exploratory, qualitative design was chosen. Method Interviews were performed with patients (October 2015–March 2017) within a week of post‐intensive care (N = 16). Thematic analysis was used as method for analysis. Results The findings generated two themes – a lack of control and to struggle for control. Pain was described as overwhelming, both in body and mind and generating the experience of a lack of control, with feelings of incapacitation, isolation, and having their needs unmet. Feeling in control of the pain and thus in control of the situation was experienced as a constant struggle. Well‐planned care, finding ways to handle the pain and good communication were all helpful in this struggle. Conclusion The participants recalled their experience of pain in the ICU and control seems to be crucial for how pain is experienced. They experienced a lack of control due to not only the pain but also the treatment, which can be avoided by the nurse continuously evaluating and individualising the care. Balanced care, meeting the patients’ needs and good communication helps the patient feel more in control when experiencing pain. Impact The experience of pain is dependent on control for the intensive care patient. The nurse may help them gain control and thereby handle the experience of pain through including the patient, striving for better communication and implementing individualised care that continuously assesses and treats pain.

Patient's experiences of endotracheal tubes and suction following cardiac surgery

“…Unlike others who have reported the presence of an ETT as a negative experience, 14 including that the ETT was moderately to extremely bothersome, [31][32][33] only one participant in our study described the ETT as causing feelings of panic, resulting in difficulty breathing. Our findings are similar to others who have reported that up to 80% of participants had no trouble breathing through the ETT, 15 and that the ETT was bothersome rather than painful.…”

“…Hallucinations have been well described by others, 13,32,37 and have been reported as the second most frequent source of ICU discomfort reported by patients, 13 and can be exacerbated by poor pain management, for example, when the dose of analgesia is too high, in turn affecting the sleep cycle. 32 Participants in our study had what was considered an uncomplicated postoperative recovery, and these findings confirm the complexity and challenges of post-operative management and recovery. Effective analgesia, mobilization, and maintaining a day night routine reduce the incidence of hallucinations and delirium.…”

“…37,38 However it should be acknowledged that nurses do not always deliver compassionate care, and that this can increase patients feelings of stress and anxiety. 15,32,33,38 Nursing interventions and management in ICU is complex and varied, 39 however, nurses are well placed to improve patient's experience while in ICU. Understanding and awareness of the patient experience can help inform and improve nursing practice.…”

“…Nurses being present and engaged increases patients feelings of being safe, respected, and treated as a person 37,38 . However it should be acknowledged that nurses do not always deliver compassionate care, and that this can increase patients feelings of stress and anxiety 15,32,33,38 . Nursing interventions and management in ICU is complex and varied, 39 however, nurses are well placed to improve patient's experience while in ICU.…”

Eratum

“…In article by Mia Hylén et al (2020), an error was published in Table 1 on page 2662. The value in the row “Length of stay in ICU: range in days (md)” was incorrectly published as 15–22 days.…”