Summary: The Study concentrates on the ICU and how patients are able to cope in this type of setting. The purpose of this qualitative study was to investigate the psychosocial needs of critically ill
patients, including these questions: (a) what are patients’ experiences when their needs are not met; and (b) what do families and ICU staff do that either help to meet or does not meet patients needs (p. 363) This is relevant to nursing knowledge because it explores different measures to increase a feeling of safeness to help with a inner state of wellness. These simple measures can ensure that ensure that nurses are providing traditional care as well as fulfilling the psychosocial needs of the patient.
The study uses four categories derived from a model of psychological needs for making the ICU pa-tient feel safe, which is not clearly stated in the title of the article. The categories or themes are hope, trust, control and knowing. The methods used in the study are taped interviews, theoretical sampling and constant comparative process. Although many of themes identified in this study have been found in earlier research, the importance of all four themes-knowing, regaining control, hoping and trusting-and their influence on feeling safe has not been previously identified. (Macnee, 2008) There have been other researches on feeling safe using only some of the components of this study. Feeling safe was related to the actions to foster these feelings (p. 369). The concept of knowing, or more specifically, not knowing has been examined in a few studies with the feelings of distress that were associated with the experience (p. 369). The concept of regaining control in prior research received little attention, except related to situations of complete loss of control, such as when a patient was either confused or dependent (p.369). There are no research articles that deal with the empirical data on hope and trust as related to the ICU patient.
The methods designed for the study were not reliable because the samples were chosen differently during the course of the study. The patients were only from the medical and surgical ICU units which does not represent all ICU patients. Interviews used open end questions and the sessions lasted from fifteen minutes to one hour depending on the patients’ tolerance. Threats to objectivity or confirmability, validity and reliability of qualitative studies can occur during the design of the study, data collection, and data analysis. According to Miles and Huberman (1994) objectivity is related to freedom from researcher bias (p. 365). There were measures in place to prevent bias; the interviews were screened for areas of bias the study also used three researchers instead of one to participate in reviewing the data and with the data analysis. Even though strict measures were followed there was still a small chance for the results to be manipulated in the data collection or interviewing phase.
The sample size was 45 ICU patients, which this is the appropriate size for a qualitative study to yield meaningful results. The only descriptive characteristics included were 20 men and 25 women, ages 25-80 years old. The setting for the study was a rural tertiary care medical center in the Eastern part of the United States. I think the results of the study would have been different if the setting was in an urban hospital. There is no information regarding race, education, physical or psychological condition. The study uses medical and surgical ICU patients with a minimum of three days in the unit. The researcher uses nonprobability sampling with a style of purposive due to the selection and the samples were chosen based on the needs of the study. It is unclear what type of informed consent was used but there is mention of personal identifying information being removed which would protect the rights of the human research subjects.
Implications The implications of the four categories are explained in detail telling what contributions were received from each of the themes. It also mentions the benefits that the patients received from family member and the presence to the ICU nurse. There are unbiased examples from actual statements of the patients that stress the importance of each of the themes mentioned earlier, which helps with the credibility of the finding of the study. The researcher categorized the data described by the participates of the study appropriately, and matched the information well to the table displayed (Figure A7-1, p.366). The findings collate with the information that the research set forth to study and are justified by the methods which are detailed. Future research should examine these under developed aspects of feeling safe. As these factors are delineated, and a full range of strategies is identified and tested the overarching need of ICU patients, that of feeling safe can be addressed. Within this process the influence of perceptions of feeling safe on both physiological and psychological outcomes can be evaluated (Morse, 2000).
The article was very interesting and easy to understand and follow. The only abbreviation observed in the article was QOA which stands for Qualitative Outcome Analysis.
Typically qualitative research doesn’t have a theoretical framework but if I had to include one my choice would be Maslow’s Hierarchy of Needs. The second level includes safety and security needs which involve physical and psychological security which is described in this study.
Application to nursing Practice
The significance of this study to nursing is implicated with the emphasis on the importance of having a pre-established plan to meet the challenges of providing complete nursing care for the ICU patient so that they can acquire a feeling of safeness while in the unit. With the knowledge from the research a nurse would be able to create a clinical pathway that includes traditional care as well as providing a state of inner wellness.
This study provides clear information in order to combine EBN and research to answer clinical questions regarding emotional needs of the ICU patient to provide better care.
Hupcey, J. E. (2000). Feeling Safe: The Psychosocial Needs of ICU Patients. In Macnee, C. L. & McCabe, S. (2008). Understanding Nursing Research: Reading and Using Research in Evidence-Based Practice. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins.