Disempowered Warriors: Insights on Psychological Responses of ICU Patients Through a Meta-Ethnography

Objectives: to systematically examine and synthesize qualitative evidence on adult patients' psychological distress during an intensive care unit stay to inform development of interventions tailored to their needs. Method: We conducted systematic literature searches in CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Dissertations and Theses Global, and Google Scholar databases using predefined eligibility criteria. We synthesized primary qualitative research evidence using Noblit and Hare's meta-ethnographic approach. Reporting was based on the eMERGe framework. The quality of included articles was assessed by the Critical Appraisal Skills Program tool. Findings: We identified 31 primary studies from 19 countries. The studies were of moderate to high quality. Data analysis revealed five themes: "disempowerment", "altered self-identity" "fighting", "torment", and "hostile environment". One overarching theme, "the disempowered warrior", captured the perpetual tension between the need to fight for their lives and the need to succumb to the care process. Our synthesis discloses that critically ill patients perceive themselves to be in a battle for their lives; while at the same time they may feel helpless and disempowered. Conclusions: Our review revealed the tension between the need to fight for one's life and the sense of powerlessness in the intensive care unit environment. Although participants recognize the important role of healthcare workers, they desired more involvement, collaboration, control, empathy, and empowerment in the care process. These findings can inform approaches to empowering critically ill patients and managing their psychological responses. Care standards must include distress assessment and management that maximize patients' empowerment and emotional safety with the care process.