“Pain relieved, but still struggling”—Critically ill patients experiences of pain and other discomforts during analgosedation

Helene Berntzen, Ida Torunn Bjørk and Hilde Wøien

Journal of Clinical Nursing, 2018, vol. 27, issue 1-2, e223-e234

Abstract: Aims and objectives To explore how critically ill patients treated according to a strategy of analgosedation experience and handle pain, other discomforts and wakefulness. Background Patients experience both pain and discomfort while in the intensive care unit. International guidelines recommend focused pain treatment and light sedation. An analgosedation protocol favouring pain management, light sedation and early mobilisation was implemented in our university hospital medical and surgical intensive care unit in Norway in 2014. The analgosedation approach may affect patients’ experiences of the intensive care unit stay. Design Exploratory, descriptive design using semi‐structured interviews. Method Eighteen adult patients treated in intensive care unit >24 hr and receiving mechanical ventilation were interviewed 1–9 days after intensive care unit discharge. Ten patients were re‐interviewed after 3 months. Data were analysed using the “systematic text condensation” approach. Findings Four main categories emerged from the analysis: “In discomfort, but rarely in pain,” “Struggling to get a grip on reality,” “Holding on” and “Handling emotionally trapped experiences.” “Pain relieved, but still struggling” was the overarching theme. Analgosedation provided good pain relief, but patients still described frequent physical and psychological discomforts, in particular related to mechanical ventilation, not understanding what was going on, and experiences of delusions. To come to terms with their intensive care unit stay, patients needed to participate, trust in others and endure suffering. After hospital discharge, patients described both repression of experiences and searching for recognition of what they had gone through. Relevance to clinical practice Despite good pain relief during analgosedation, other discomforts were commonly described. Critically ill patients still experience an intensive care unit stay as a traumatic part of their illness trajectory. Nurses need to attend carefully also to discomforts other than pain.

Date: 2018
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