| Objective:The purpose of this study was to investigate the discomfort and ICU memory status of patients on ICU mechanical ventilation under analgesia and light sedation or no sedation,to explore the discomfort and influencing factors of ICU memory of patients on ICU mechanical ventilation under analgesia and light sedation or no sedation,and to analyze the relationship between discomfort and ICU memory characteristics.In addition,the real experience of patients with mechanical ventilation in ICU under light sedation or no sedation for analgesia were deeply understood,in order to provide the basis for medical staff to formulate precise and individualized comfort nursing plan for ICU patients in the next step.Methods:1.Using convenience sampling method,136 mechanically ventilated patients under light sedation or no sedation were selected from intensive care units of two level-A hospitals in Nanchang City and Pingxiang City.The discomfort status of patients with mechanical ventilation in ICU and the characteristics of ICU memory were investigated using ICU discomfort scale and ICU memory scale respectively.SPSS20.0 software was used for descriptive analysis of the data,t-test,analysis of variance,nonparametric rank sum test,multiple linear regression analysis,to explore the influencing factors of discomfort and ICU memory of patients with mechanical ventilation in ICU under light sedation or no sedation,and to analyze the relationship between discomfort and ICU memory characteristics.2.The Husserl descriptive phenomenological research method was used to conduct semi-structured in-depth interviews with 8 ICU Patients on mechanical ventilation under light sedation or no sedation for analgesia.The data were managed by NVivo 12 Plus software and analyzed by colaizzi 7-step analysis method.Results:1.The overall score of discomfort of ICU mechanical ventilation patients under light sedation or no sedation was(42.97±23.75),and the standardized overall score of discomfort was(2.56±1.42),including 109 patients with mild discomfort(80.15%),25 patients with moderate discomfort(18.4%),and 2 patients with severe discomfort(1.5%).The scores of each dimension from high to low were psychological and physical discomfort(24.65±16.0),environmental discomfort(10.6±7.82),and physiological discomfort(7.71±5.08).The top four discomfort items in the patients were thirst(5.07±2.96),sleep disturbance(4.52±3.49),anxiety(4.01±3.04)and loneliness(3.75±3.34).In the related memory of ICU patients,44 patients(32.4%)forgot having received intensive care,and 92 patients(67.6%)remembered having received ICU treatment.132 Patients(97%)had factual memory,and the top four factual memory frequencies were: medical ward round(77.9%),voice(70.6%),Family(66.1%)and respiratory duct(63.2%).120 patients(88.2%)had emotional memory,among which the highest frequency were discomfort(61%),anxiety and Panic(60.2%),and pain(47%).One hundred patients(73.5%)had delusional memory,among which the top three were dreaming(62.5%),hallucination(41.2%)and nightmare(21.3%).2.Discomfort scores had statistical significance in marriage,ICU inpatient area,length of stay in ICU,duration of mechanical ventilation,whether to use analgesia treatment,time of physical constraint,and whether to indwelling gastrointestinal tube and other factors(P < 0.05);Regression analysis of discomfort showed that widowed status in marriage(β=0.352,P < 0.01)and mechanical ventilation time(β=0.256,P <0.01)were predictors of the severity of discomfort.Marital status was the influencing factor of ICU factual memory,whether to receive analgesia treatment was the influencing factor of ICU delusional memory,whether to receive sedation treatment was the influencing factor of ICU factual memory,affective memory and delusional memory.3,The memories associated with ICU characteristics and studies the correlation of discomfort,mild discomfort group,with her family about the fact that the memory was lower(P < 0.05),the relation between discomfort and anxiety/panic among groups on the incidence of emotional memory was higher(P < 0.05),and the delusion of memories related to the nightmare was higher(P < 0.01).4.Five themes were extracted from the real experience of ICU patients on mechanical ventilation under analgesia and light sedation: A variety of emotional experiences(happiness and hope,affirmation and understanding,the plight of not being understood,the feeling of mutual sympathy,the increased sense of autonomy);Fear,and anxiety(the gap between their own expectations and the status of the disease,the conflict between subjective activity and physical limitations,the proximity of perceived death,the strangeness of the environment);Coexistence of sensibility and reason(longing for the company of family,the company of yearning and understanding);A variety of physical discomforts(sleep disturbances,foreign body sensations,thirst,pain);Awareness and vagueness(false and true feelings,vagueness of time).Conclusion:1.The overall discomfort level of ICU mechanically ventilated patients with mild sedation or without sedation management was mild,and the major discomfort items were thirst,sleep disturbance,anxiety,and loneliness;At the same time,patients generally have ICU memory.2.Marital status,hospital area,length of stay,duration of mechanical ventilation,analgesia treatment,physical constraint time and gastrointestinal tube had certain influence on patients’ discomfort level;Among them,the widowed state in marriage and the duration of mechanical ventilation were the main influencing factors of patients’ discomfort level,which accounted for 15.8% of the total variation.3.Married patients had a higher incidence of factual memory;The incidence of delusional memory was lower in patients who had received analgesic therapy;The incidence of factual memory,affective memory and delusional memory is higher in patients who have received sedation treatment,suggesting that clinical staff should pay attention to the management of ICU analgesia and sedation,and give more humanistic care to married or widowed patients.4.Discomfort and patient and family about the fact that memory,and anxiety/panic about emotional memories related to the delusion of a nightmare and the correlation of memory,prompt medical staff in the comprehensive management of patients,need to be integrated into the family’s participation,pay attention to patients with anxiety/panic about psychological state,timely and targeted intervention,improve sleep quality.5.Under the management of analgesia and ligh sedation,patients on mechanical ventilation in ICU have a more conscious state,stronger autonomy,and the ability to interact with their surroundings.Patients have different dimensions of psychological and physiological feelings,clinical medical staff should strengthen the attention of such patients,dynamic assessment,early identification of patients’ psychological and physiological changes,develop targeted,personalized intervention plan,in order to comprehensively improve the sense of hospitalization of patients,improve the long-term prognosis of patients. |
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