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A trajectory towards partnership in care - Patient experiences of autonomy in intensive care: A qualitative study
Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
Lunds universitet, SWE.
Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health. Malmö University, SWE.
Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
2015 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 31, no 5, p. 294-302Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to describe and elucidate patient experiences of autonomy in an intensive care context from a caring perspective. Background: Patients in intensive care units (ICUs) are critically ill and in a dependent and vulnerable position. There is thus a risk of staff taking command not only of the patients’ vital functions but also of their decision-making. Methods: A qualitative design was selected. Individual interviews were conducted with 11 adult patients with an intensive care episode of two days or more at six Swedish ICUs. The data were analysed using Inductive Content Analysis. Findings: Patient autonomy in intensive care was shown to be ’A trajectory towards partnership in care depending on state of health and mutual understanding’. It was experienced through acknowledged dependence, being recognised as a person, invited participation and becoming a co-partner in care. Conclusion: Patients in need of intensive care wanted to be involved in making decisions about their care as this creates a trusting and healthy care environment. Greater awareness is required about the ICU patient not only being a passive care recipient but also an active agent and where involvement in decision-making and participation in care are crucial. © 2015 Elsevier Ltd.

Place, publisher, year, edition, pages
2015. Vol. 31, no 5, p. 294-302
Keywords [en]
Caring; Content analysis; Intensive care; Interviews; Patient Autonomy; Qualitative research
National Category
Nursing
Identifiers
URN: urn:nbn:se:bth-10886DOI: 10.1016/j.iccn.2015.04.003ISI: 000362147700005Scopus ID: 2-s2.0-84941738418OAI: oai:DiVA.org:bth-10886DiVA, id: diva2:864262
Available from: 2015-10-26 Created: 2015-10-26 Last updated: 2018-08-27Bibliographically approved
In thesis
1. Patient autonomy in highly technological care environments from a caring perspective
Open this publication in new window or tab >>Patient autonomy in highly technological care environments from a caring perspective
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Patients in highly technological care environments are severely ill, and are often suffering from a reduced physical and/or cognitive capacity following their illness and treatment, making them exceedingly vulnerable. The most severely ill patients are cared for in the intensive care unit. These vulnerable persons are cared for in an environment traditionally associated with a paternalistic care culture, which implies that patients are at risk of being overridden in relation to ethical issues, and of having their autonomycompromised. The question is whether it is possible for the patient to be capable and autonomous in this context. Advanced home care involves an increasing amount of advanced medical technology, and is then to be characterized as a highly technological care context. The advancedhome care context is different from the intensive care context in that the patients are not sedated, they are cared for at home, and they are expected to be the masters of theirhome environment. They recognize their home as private territory which gives them the right to decide what to do and how and when to do it. Their need for technology and care from formal/informal carers points to a vulnerability on the part of the patient, risking a hidden paternalism in terms of overprotectiveness, including excesses of care.These aggravating circumstances may exert an influence on the patient’s everyday life, threatening the patient’s possibilities of remaining/becoming autonomous. This thesis is a response to the absence of consensual understanding in nursing of the concept of patient autonomy in a highly technological care context, as well as an answer to the lack of knowledge of the phenomenon of patient autonomy in highly technological care environments from the patient perspective and in a caring context.

Aim

The overall aim of this thesis was to describe and elucidate patient experiences of autonomy in highly technological care environments, and to create an extended understanding of the concept of patient autonomy in a highly technological care context, from a caring perspective.

Methods

In answering to the aim of this thesis, a diversity of qualitative methods for data collection and data analysis was used. Two empirical studies comprising individual patient interviews (n=23) within highly technological care environments were carried out, in intensive care (II) and in advanced home care (III). The patient experiences were analyzed through inductive content analysis (II) and descriptive phenomenology (III). Theoretical development was accomplished through a concept analysis (I) from scientific literature, and a concluding metasynthesis (IV) of the previous studies (I-III).

Findings

The concept analysis (I) revealed that increased vulnerability was the antecedent of patient autonomy in a caring context. It further showed that patient autonomy is not to be understood as absolute but as changing throughout the care episode. The interviews with patients being cared for in intensive care described patient autonomy in this highly technological care environment as a “trajectory towards partnership in care depending on state of health and mutual understanding”. Patient autonomy, in advanced home care including advanced medical technology, was differently described as “befriending everyday life when bringing technology into the private sphere”. The findings of the concept analysis (I) as well as the findings from the empirical studies of patient experiences of autonomy (II-III) resulted in the concluding theoretical framework (IV), adding new knowledge to ameliorate the clarity of the concept. A tentative framework, the Control-Partnership-Transition framework of patient autonomy, was delineated. This framework comprises four strategies, the strategy of control, of partnership, of trust, and of transition, used by patients to preserve or obtain autonomy in highly technological care environments. To experience autonomy, patients in highly technological care environments want to be considered as capable agents, and not only as a vulnerable person in need of care. Their thoughts and experiences reveal that patient autonomy should be understood as a process, something that changes over time, and is dependent on their health conditionas well as on others around them and the care environment. The knowledge obtained could be used to facilitate the adherence of health care professionals to ethical principles and codes related to patient autonomy, hence strengthening the patients’ position in regard to their autonomy.

Place, publisher, year, edition, pages
Lund: Lund University, Faculty of Medicine, 2016. p. 103
Series
Lund University, Faculty of Medicine Doctoral Dissertation Series 2016:73, ISSN 1652-8220 ; 2016:73
Keywords
autonomy caring context co-determination concept analysis concept development control descriptive phenomenology highly technological care inductive content analysis metasynthesis partnership patient experiences theoretical development transition trust vulnerability
National Category
Nursing
Identifiers
urn:nbn:se:bth-16941 (URN)978-91-7619-299-3 (ISBN)
Public defence
2016-06-10, Hörsal 1, HSC, Baravägen 3, Lund, 09:00
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Supervisors
Note

Doktor i medicinsk vetenskap, inriktning omvårdnad

Available from: 2018-09-11 Created: 2018-08-24 Last updated: 2018-09-11Bibliographically approved

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Lindberg, CatharinaWillman, AniaFagerström, Cecilia

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