Patients' experiences of machanical ventilation in the intensive care unit of a public sector tertiary hospital in Johannesburg

Adeyemi, Ooreofe Bolanle
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Mechanical ventilation is a life-saving and frequently used treatment modality in a variety of medical diagnosis in the intensive care unit (ICU). Despite that fact, mechanical ventilation can be a distressing experience for the patient, and may result in anxiety and discomfort. In recent years, light or no sedation and the practice of wake-up calls have become common approaches allowing the patient to be more awake during mechanical ventilation. Little is known about how patients experience this particular aspect of ICU treatment in light of changes in sedation practices. This study explored and described the experiences of patients on mechanical ventilation in the intensive care unit of one public sector hospital in Johannesburg. A qualitative, descriptive and explorative design was used and ten mechanically ventilated patients were recruited from the intensive care units of one public sector hospital in Johannesburg. The data was collected using audio-taped in-depth interviews to keep a record of the actual information presented by the participants. The collected data was transcribed and the information was analysed using Clarke and Braun’s (2013) descriptive method. A general expression from the participants was the fact that being connected to a ventilator induces a physical and emotional discomfort. The data analysis identified three themes which were (i) physical experiences, (ii) emotional experiences and (iii) communication. The participants described their experiences of breathlessness, mouth dryness, pain and physical discomfort as a result of being placed on the ventilator which caused the physical experiences for the patients. The experiences of bothering, fear of unknown, anxiety, feeling shocked and frightened at the moment of waking up from anaesthesia culminated into an emotional experience for the patients. The participants described that the extubation process has hard and difficult to endure, also powerlessness, loss of body image and control and near death experiences were findings of the participants. The lack of information was viewed by the participants in terms of being connected to mechanical ventilation as an important component of the recovery period, the benefit of purpose of connection during this period and the weaning process although, some of the participants alluded to receiving a measure of information but described it as inadequate to prepare them emotionally for the procedure. The short time for visitation and family presence was also evident in this study as impacting on the emotional state of the participants. In the midst of these unpleasant experiences, most of the participants appreciated the caring attitude of the ICU nursing staff which gave them a sense of comfort and safety. The findings of this study further showed that administration of sedation to some of the participants affected their memory as they could not recollect things that happen while in the ICU. Communication was the third theme that emerged from this study as findings revealed that the participants were not happy with the inability to talk as a result of the endotracheal tube. Nevertheless, the use of alternative communication methods such as the use of sign language, writing, scribbling on paper and lip reading gave the participants a bit of a relief. The findings of this study support the previous findings of the experiences of patients on mechanical ventilation. The findings add to the body of knowledge from the South African context as little is known regarding the patients experiences of mechanical ventilation from the South African context and Africa at large. As the field of intensive care nursing is growing in the African continent, it becomes imperative for research to be conducted in order to determine the clinical, educational and managerial gaps in ICU focusing more on measures to reduce these unpleasant experiences, increase evidence based practise and nursing perspectives. It may be appropriate for this study to be replicated in other private and public institution on a larger scale to compliment these findings.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2016