“Please mind the gap”: A secondary analysis of discomfort and comfort in intensive care

Abstract

Aims and objectives To explore in depth discomfort in intensive care as experienced by patients and attended to by critical care nurses. Background Discomfort in illness is complex and persistent, and its alleviation is a challenge for nurses working in intensive care units (ICU). In previous studies, we showed that ICU patients described little actual pain but suffer from much discomfort. Critical care nurses had a systematic approach to the treatment of pain, but were more haphazard in dealing with other types of discomfort. Design Secondary qualitative analysis of data from two previous exploratory studies. Methods Content analysis was used on existing data from 28 interviews with ICU patients, and 16 field notes and interviews with critical care nurses. Kolcaba's Comfort Theory was applied for further analysis. The COREQ checklist was used. Results Three themes, “Being deprived of a functioning body”, “Being deprived of a functioning mind” and “Being deprived of integrity” characterised the discomfort experienced by ICU patients. The nurses appeared to attend to all areas of discomfort expressed by patients. In need of, and providing acknowledgment and alleviation became a common overarching theme. We identified a comfort gap caused by the discrepancy between the patients’ needs and the nurses’ achievements in fulfilling these needs. Conclusions A gap exists between ICU patients’ comfort needs and nurses’ achievements in fulfilling these, indicating that discomfort currently is an inevitable part of the critical illness trajectory. Increased knowledge about how the brain is affected in ICU patients and more systematic approaches to assessing comfort needs and enhancing comfort may support nurses in fulfilling patient needs and possibly diminish the existing comfort gap. Relevance for clinical practice An increased understanding of the complex experience of discomfort in ICU patients may bring about more systematic approaches to enhance comfort and direct for education and further research.

Above cuff vocalisation (ACV): A scoping review

“…The reported minor complications such as discomfort, excessive secretions, stomal air leak, burping, subglottic air trapping, retching, and nausea [6][7][8]15,19,24 will seldom override the benefits of the ability to speak in this population. Patient discomfort may be inevitable in intensive care 28 and should not necessarily be categorised as a complication or problem in relation to safety, but rather identified as an area in which comfort may be enhanced. The inability to communicate may in itself contribute to patient discomfort.…”

“…The inability to communicate may in itself contribute to patient discomfort. 28 Facilitating speech may enhance safety, comfort, and quality of care, by enabling both self-expression and communication of symptoms to HCP. 27,29 The most serious adverse events described were subcutaneous emphysema, 18 and cuff rupture following an incorrect procedure.…”

Understanding the Course of Critical Illness Through a Lifeworld Approach

“…Individuals who are affected by critical illness continue to live their lives in a multifaceted way and exploring their lifeworld can increase and give depth to their experiences. Patients’ stories from ICU have been widely studied in previous decades, describing memories of chaos, dreams and hallucinations, fear, pain, and other discomforts ( Berntzen et al, 2020 ; Cutler et al, 2013 ; Egerod et al, 2015 ; Sanson et al, 2021 ; Uotinen, 2011 ). In a synthesis of Nordic research, Egerod et al (2015) reported how the experience of suffering was evident in intensive care, even though measures had been implemented to improve and make intensive care treatment more humane.…”

Clinical Observation of Comfort Nursing Combined With Continuous Nursing Intervention After Discharge on Improving Pressure Ulcers, Falls, Quality of Life, and Prognosis in Patients With Intracerebral Hemorrhage

“…According to Kolcaba's comfort theory, when the disease deprives the integrity of the patient's body or deprives the normal functioning of the brain and body functions, the patient can have a strong demand for treatment and comfort due to all the current experience ( 10 ). But in the regular care mode, there is a gap between the patient's comfort needs and the caregivers meeting their needs, and there is a gap between the effect of hospital nursing and the effect of out-of-hospital nursing.…”