Patients’ lived body experiences in the intensive care unit and beyond - a meta-ethnographic synthesis

Figures & data

Figure 1. Flow diagram of study selection process.

Table 1. Study characteristics.

Authors, year, country, sample size	Setting	Study aim	Age (years)	Critical illness	Theoretical approach	Timing of data collection
Albanesi et al. (2022), Italy, n = 11	The Cardiac ICU of a cardiology research hospital	To describe Cardiac Surgery patients’ lived experiences.	Range: 42–75	Eight patients presented with a valve pathology; two of them had a vascular pathology. One patient was suffering from both diseases, and one was hospitalized as an emergency	A qualitative study, adopting an interpretative phenomenological analysis approach	At least 2 weeks after ICU discharge
Vester, Holm, and Dreyer (2021), Denmark, n = 12	Two multidisciplinary ICUs in a university hospital	To explore patients’ and relatives’ experiences of everyday life after critical illness.	18+	Not reported	A phenomenological-hermeneutic approach	After discharge from the hospital or rehabilitation ward.
Lee, Park, and Palese (2021), South Korea, n = 15	Two university hospitals	To derive an in-depth understanding of the transfer experience of ICU patients in South Korea through a phenomenological analysis.	Range: 29–64	Various	A phenomenological approach according to Colaizzi	3 to 5 days after ICU discharge
Ellingsen et al. (2021), Norway, n = 9	Two hospitals and one patient organization	To provide a deeper understanding of how former critically ill patients narrate their own experiences of the illness trajectory from the acute stage throughout rehabilitation and long term follow up.	Mean: 60	Various severe circulatory, respiratory or neurological diseases	A study grounded in phenomenological philosophy	All patients had been admitted to an intensive care unit over the last 5 years
Alexandersen et al. (2021), Norway, n = 17	A major hospital	To provide insights into what promotes and challenges inner strength and willpower in formerly critically ill patients back home after a long- term ICU stay.	Median: 55 Range: 27–76	Diagnoses included serious disease, severe trauma and complication	A qualitative hermeneutic- phenomenological approach according to Dahlberg	6 to 20 months after hospital discharge
Umberger and Thomas (2019), USA, n = 8	A medical ICU	To explore the experiences of sepsis survivors after 1 year of their index ICU stay.	Range: 37–74	Sepsis	A phenomenological study, guided by Merleau-Ponty’s philosophy	At least 1 year after ICU discharge
Alexandersen et al. (2019), Norway, n = 17	A university hospital	To explore aspects that promote and challenge long‐term ICU patients’ inner strength and willpower.	Mean: 55.2 Range: 27–76	Various	A qualitative, hermeneutic‐phenomenological approach	6 to 18 months after ICU discharge
Tingsvik, Hammarskjold, Martensson, and Henricson (2018), Sweden, n = 12	Three different hospitals	To explore the meaning of being a patient on mechanical ventilation during the weaning process in the ICU.	Mean: 66 Range: 43–82	All patients had previously been hospitalized for a variety of medical and surgical diagnoses	A hermeneutic- phenomenological approach according to Van Manen	2 to 4 months after ICU discharge
Felten-Barentsz et al. (2018) Netherlands, n = 12	A university hospital	To explore patient perspective regarding the impact of hydrotherapy on critically ill ventilated patients.	Range: 33–80	Cardiac surgery (n = 3); pulmonary disease (n = 3); high energetic trauma (n = 2); gastro-intestinal surgery (n = 2); out of hospital cardiac arrest (n = 1); complicated stem cell transplant (n = 1)	A phenomenological approach	6 to 12 weeks after hospital discharge
Holm and Dreyer (2017), Denmark, n = 4	Two multidisciplinary ICUs	To explore adult ICU patients’ experience of being conscious during endotracheal intubation and mechanical ventilation.	Range: 61–86	Pleural effusion, Multi-trauma, Pneumonia, Pleural effusion	A phenomenological-hermeneutic approach	1 to 2 days after extubation
Da Cruz de Castro and Rebelo Botelho (2017), Portugal, n = 12	A hospital	To assess the experience of persons with critical condition during hospitalization in an ICU.	Range: 27–77	Not reported	A phenomenological descriptive design	Not reported
Mylén, Nilsson, and Berterö (2016), Sweden, n = 11	A neurosurgical ICU	To explore the lived experiences of conscious patients in neurosurgical intensive care	Range: 37-81	Not reported	An interpretive phenomenological approach	2 to 14 months after discharge
Whitehorne, Gaudine, Meadus, and Solberg (2015), Canada, n = 10	Two acute care hospitals	To understand the lived experience of intensive care for critically ill patients who experienced delirium.	Range: 46–70	Critically ill patients who experienced delirium	Heideggerian hermeneutic phenomenology according to van Manen	After transfer from the ICU to a medical or surgical unit
Tembo, Higgins, and Parker (2015), Australia, n = 12	A 16 bed ICU in a large regional referral hospital	To describe the lived experience of people who experienced critical illness in ICU using a hermeneutic phenomenological approach in the DSI context.	Range: 20–76	Diverse	A hermeneutic- phenomenological approach	2 weeks after ICU discharge and 6 to 11 months later
Stayt, Seers, and Tutton (2015), UK, n = 19	A university teaching hospital	To explore patients’ experiences of technology in an adult ICU.	Range: 32–86	Elective post-operative admission, sepsis, pneumonia and trauma	Heideggerian phenomenology	12 weeks after discharge
Palesjö, Nordgren, and Asp (2015), Sweden, n = 7	An ICU with six beds	To describe and interpret the essential meaning of the lived experiences of being in a critical illness-recovery process after a life-threatening condition.	Range: 24–61	ARDS, cardiomyopathy, multi-trauma, cardiac arrest, septic shock, aspiration pneumonia after surgery to remove a malignant brain tumor, septic shock	A phenomenological hermeneutic approach	2 to 4 years after ICU discharge
Lykkegaard and Delmar (2015), Denmark, n = 3	An ICU at a larger university hospital	To explore the perceived meaning of being dependent on care as experienced by intensive care patients.	Range: 27–78	Surgical complication, medical problem	A phenomenological hermeneutic approach	6 to 12 months after ICU discharge
Moen and Nåden (2015), Norway, n = 7	An average-size ICU accommodating eight patients	What are the experiences of former intensive care patients of having their dignity upheld during their stay in the ICU?	Notreported	Not reported	A phenomenological approach according to Giorgi	5 to 12 months after ICU discharge
Torheim and Kvangarsnes (2014), Norway, n = 10	Two ICUs	To describe experiences of care of patients with advanced COPD when suffering acute exacerbation in ICUs.	Range 45–85	Patients diagnosed with COPD	A phenomenological descriptive design	After ICU discharge or within 2 weeks after hospital discharge
Alguindy, Mohamed, and Gado (2014), Egypt, n = 14	The ICU of cardiothoracic surgeries at a University Hospital	What are the personal lived experiences of patients connected to mechanical ventilator during recovery period after open-heart surgery at Al Maniel University Hospital?	Range: 21–53	Patients who underwent cardiothoracic surgery	A qualitative phenomenological design	Not reported
Olausson, Lindahl, and Ekebergh (2013), Sweden, n = 9	Three general ICUs, two in university hospitals and one in a regional hospital	To reveal the meanings of the ICU settings as a place of care.	Range: 38–80	Septic shock, Guillain-Barré syndrome, respiratory failure, pancreatitis, trauma, ruptured aorta aneurism, respiratory failure, trauma, endocarditis	A phenomenological approach	Not reported
Lykkegaard and Delmar (2013), Denmark, n = 3	An ICU of a larger university hospital.	To explore the perceived meaning of being dependent on care for intensive care patients.	Range: 22–76	Surgical complications, complicated postoperative course, medical problem	A phenomenological hermeneutic according to Ricoeur	3 to 12 months after discharge
Locsin and Kongsuwan (2013), Thailand, n = 10	Not reported	To describe the meaning of the experiences of patients who were dependent on technologies while being cared for in ICUs.	Mean: 44Range: 22–76	Various	A hermeneutic phenomenology design according to Van Manen	2 months to 5 years after hospital discharge
Tembo, Parker, and Higgins (2012), Sweden, n = 12	A tertiary referral hospital ICU	To enhance understanding experiences based on the descriptions of the participants	Not reported	Not reported	A hermeneutic phenomenological approach according to van Manen	2 weeks after ICU discharge and at 6 to 11 months later
Karlsson, Bergbom, and Forsberg (2012), Sweden, n = 12	An eight-bed ICU in a county hospital	To illuminate the lived experience of patients who were conscious during mechanical ventilation in an ICU.	Mean: 58 Range: 23–88	Epiglottitis throat abscess, stroke, myelitis, laryngeal cancer, multi-trauma, carotid surgery, airway obstruction, sepsis, pneumonia, pneumothorax	A phenomenological-hermeneutic approach according to Ricoeur	4 to 11 days after ICU discharge
Johansson, Bergbom, and Lindahl (2012), Sweden, n = 13	A general ICU with eight beds at a county/regional hospital	To illuminate the meanings of being critically ill in a sound-intense ICU patient room, as disclosed through patients’ narratives.	Range: 51–86	Pancreatitis, whipple-surgery, aortic aneurysm, guillain-barre´, pulmonary embolism, rectal cancer surgery, pain treatment, pneumonia, thrombosis, sepsis	A phenomenological hermeneutic approach	2 to 35 days after ICU discharge
Cypress (2011), USA, n = 5	An adult ICU in an urban, nonprofit, nonsectarian community hospital.	To describe and understand the lived ICU experience of nurses, patients and family members during critical illness.	Range: 23–70	Haemorrhagic stroke, diabetic ketoacidosis, asthma, emphysema, respiratory failure, multiple gunshot wounds, exacerbation of congestive heart failure	A phenomenological approach according to Merleau-Ponty	The first interview was conducted after ICU discharge. The second interview was conducted 4 days after the first interview
Fredriksen and Svensson (2010), Norway, n = 6	Not reported	To inquire and understand the patients’ experience of the body in relation to their significant others during critical illness.	Range: 20–75	Acute infection (n = 1); pulmonary disease (n = 2); infectious disease (n = 1); surgery for cancer (n = 1); intoxication due to substance abuse (n = 1)	A phenomenological hermeneutic approach according to Kvale	Within 6 months after hospital discharge
Foster (2010), UK, n = 3	An acute NHS Trust	Describing the experience of tracheostomy tube as lived by a group of people who had this tube inserted as a part of their critical illness or as a procedure related to an acute event	Not reported	Tracheostomy	Scientific phenomenology	Not reported
Wang, Zhang, Li, and Wang (2009), China, n = 11	A six-bed ICU of a university teaching hospital	To understand patients’ intensive care experience while receiving mechanical ventilation in ICUs.	Mean: 60 Range: 33–78	The mean score of acute physiology and chronic health evaluation (APACHE) was 21.4 (range: 14–30)	An ontological phenomenological approach according to Heidegger	3 to 14 days after the transfer from the ICU
Storli and Lind (2009), Norway, n = 10	A nine-bed general ICU in a university hospital,	To explore the meaning of patients’ lived experience of being followed-up in a program consisting of patient diaries, post-ICU conversations and visits back to the ICU.	Mean: 52 Range: 24–82	Admission diagnoses ranged from multi-trauma and extensive surgery to life-threatening infections	A phenomenological approach according to Kari Martinsen	about 6 months and again about 18 months after hospital discharge
Henricson, Segesten, Berglund, and Määttä (2009), Sweden, n = 6	Two general ICUs	To illuminate the meaning of receiving tactile touch when being cared for in an ICU.	Range: 54–78	The patients suffered from heart disease, heart surgery or intestinal surgery	A phenomenological – hermeneutic according to Ricoeur	3 to 4 months after hospital discharge
Storli, Lindseth, and Asplund (2008), Norway, n = 10	An ICU at a university hospital	To explore the meaning of living with memories from intensive care.	Range: 18–65	Admission diagnoses ranged from multi-trauma and extensive surgery to life-threatening infections	A phenomenological approach according to van Manen, Dahlberg and Merleau-Ponty	10 years after hospital discharge
Karlsson and Forsberg (2008), Sweden, n = 8	A rural hospital.	To investigate experiences of being conscious during ventilator treatment in the ICU from a patient perspective.	Mean: 46 Range: 21–81	Epiglottitis (n = 3); sepsis due to various causes (n = 3); Guillain-Barré syndrome and post-surgical complications involving perforation of the pericardium	Hermeneutic phenomenology	Not reported
Fredriksen, Talseth, and Svensson (2008), Norway, n = 7	Three hospitals	To inquire and understand the ways the body and its experience appear when the phenomena of strength and movement are altered.	Range: 34–82	Chronic lung disease with complication (n = 2)s; heart surgery with complications (n = 1); infectious disease with complications (n = 2); orthopedic surgery with postoperative complications (n = 1)	A phenomenological-hermeneutic approach according to Ricoeur	Within 6 months after hospital discharge
Storli, Lindseth, and Asplund (2007), Norway, n = 3	A nine-bed ICU in a university hospital.	To look more closely into this type of experience by turning to its meaning as reflected on by patients themselves.	Range: 30–60	Sepsis, multi-trauma, post-operative complications	A phenomenological approach	About 6 months after hospital discharge
Almerud, Alapack, Fridlund, and Ekebergh (2007), Sweden, n = 9	A moderately large hospital	To develop a knowledge base of what it means to be critically ill or injured and cared for in technologically intense environments.	Mean: 59 Range: 45–74	Not reported	A phenomenological approach according to Giorgi and Dahlberg	After ICU discharge or a few days after hospital discharge
Johnson, St John, and Moyle (2006), Australia, n = 9	CCUs	To describe and interpret the meaning for patients of being on long-term mechanical ventilation in a CCU.	Range: 21–69	Not reported	An ontological – phenomenological approach according to Heidegger	2 weeks to 2 months after hospital discharge
Ballard et al. (2006), USA, n = 11	Seven critical care areas within three suburban hospitals	To determine and describe the remembered experiences of critical care patients who were given neuromuscular blocking agents and sedatives and/or analgesics to facilitate mechanical ventilation, improve hemodynamic stability, and improve oxygenation.	Range: 19–69	Respiratory failure, shock, overdose, COPD, nausea and vomiting, dizziness and weakness, hyperosmolar state	A phenomenological approach	During admission to the critical care unit or another unit within the hospital
Strahan and Brown (2005), UK, n = 10	Not reported	To explore and describe the lived experiences of patients following transfer from the ICU.	Range: 18–77	Trauma (n = 4); vascular (n = 2); neurology (n = 2); thoracic (n = 1) and orthopedic (n = 1)	A Husserlian phenomenological approach	3 to 5 days after ICU discharge
Sheen and Oates (2005),Australia, n = 5	Not reported	It is easy for health professionals to assume that unresponsive patients are not feeling anything under their sedation. The aim of this research was to explore this phenomenon.	Not reported	Not reported	Phenomenology	6 to 12 months after hospital discharge
Del Barrio et al. (2004),Spain,n = 10	Not reported	To describe the liver transplant patient’s experience in the ICU.	Mean: 55	Liver transplant	A phenomenological descriptive study	1 to 12 months after transplant
Papathanassoglou and Patiraki (2003), Greece, n = 8	Not reported	To explore the lived experience of individuals with a past hospitalization in an ICU, with focus on their dreams.	Not reported	Not reported	An Interpretive hermeneutic phenomenological design	Four participants had been discharged between 12 and 24 months ago, and four between 4 and 6 years ago
Jordan, van Rooyen, and Strümpher (2002), South Africa, n = 5	Not reported	To identify, explore and describe the experiences of patients who were connected to a mechanical ventilator.	Range: 22–54	Not reported	A phenomenological approach	12 to 48 hours after discharge from the ICU
Granberg, Engberg, and Lundberg (1998), Sweden, n = 19	A general ICU	To describe and give a deeper insight into patients’ experiences and memory recall, both during and after their stay in the ICU.	Range: 25–82	Not reported	A qualitative hermeneutic approach according to Dahlberg and Gadamer	The first interview usually took place in the ward, between 6 and 10 days after ICU discharge. The second interview took place 4 to 8 weeks after the first interview

ICU= Intensive Care Unit; N = number; ARDS = Acute respiratory distress syndrome; COPD = chronic obstructive pulmonary disease.

Table 2. Results of line of argument synthesis with accompanying kinds of bodies.

Stages in recovery	Crisis	Normalization	Post-discharge
Kinds of bodies (Third-order constructs)	An intolerable body	A touched body	An unhomelike body
	An alienated body	A transforming body	A remembering body
	A powerless body	A rediscovering body
	A dependent body
	A restricted body
	A muted body
Lines of argument	Recovery from critical illness starts from a situation in which patients experience the lived body as unable	Patients experience progress in recovery from critical illness when the lived body is empowered	Recovery from critical illness results in a lived body changed for life

Table

	Criteria	Results
S	Sampling strategy	Comprehensive, Boolean search strategy
T	Types of studies	Qualitative research, fully reported
A	Approaches	Systematic electronic search, hand-searching, snowball-searching reference list
R	Range of years	No date limits (Search 1-11-2021 till 12-11-2021)
L	Limits	Language (English/Dutch), publication type (peer reviewed journal)
I	Inclusion and exclusions	Inclusion criteria: - Study includes patient experiences - Study includes bodily or embodied experiences - Study included experiences during ICU stay or in recovery from critical illness - Adult patients (aged 18 or over) - Study used a phenomenological approach Exclusion criteria: - Palliative care - Article type (e.g. abstract congress, thesis, and commentary) - Full text not available - Ineligible language
T	Terms used	Critical Care [MeSH], early goal-directed therapy [MeSH], Intensive Care Units [MeSH], Burn Units [MeSH], Coronary Care Units [MeSH], Recovery Room [MeSH], Respiratory Care Units [MeSH] Critical Illness [MeSH], respiratory distress syndrome, adult [MeSH] Airway Management [MeSH], Extracorporeal Membrane Oxygenation [MeSH], Critical Care Nursing [MeSH], acute ill*, acute respiratory failure, acutely ill, ARDS, artificial respiration, Critical Care, critical ill, critically ill, ECLS, ECMO, extracorporeal life support, Extracorporeal Membrane Oxygenation, ICU, ICUAW, intensive care, intubat*, mechanical respiration, mechanical ventilat*, mechanically ventilat*, medium care, PICS, respirator weaning, respiratory care unit*, respiratory distress syndrome*, ventilator weaning, critical care/psychology [MeSH], critical illness/psychology [MeSH] critical illness/rehabilitation [MeSH], survivors/psychology [MeSH], Life Change Events [MeSH], Self Concept [MeSH], Spirituality[MeSH], qualitative [All Fields], qualitatively [All Fields], qualitatives [All Fields], Grounded Theory [MeSH], Qualitative Research [MeSH]), Interviews as Topic [MeSH], Nursing Methodology Research [MeSH Terms], Focus Groups [MeSH], Narration”[MeSH Terms], Jungian Theory [MeSH] essential meaning, Experience, Experiences, lived experience, phenomenolog*, case stud*, ethnograph, focus group*, Grounded Theory, hermeneutic*, heuristic*, interview*, Jungian Theory, life-world, narrat*, Observation
E	Electronic resources	Pubmed/Medline, EMBASE, CINAHL, PsycINFO, Web of Science, Google Scholar

Table

	CASP items
	A) Are the results valid?						B) What are the results?
Study	1. Aim	2. Methodology	3. Design	4. Recruitment	5. Data Collection	6. Relationship	7. Ethics	8. Data Analysis	9. Clear findings	10. Local value
Albanesi et al. (2022)	N	Y	Y	Y	Y	N	Y	Y	Y	Y
Vester, Holm, and Dreyer (2021)	Y	Y	Y	N	Y	N	Y	N	Y	Y
Lee, Park, and Palese (2021)	Y	N	Y	N	Y	Y	Y	Y	Y	Y
Ellingsen et al. (2021)	Y	Y	Y	N	Y	Y	N	N	Y	Y
Alexandersen et al. (2021)	Y	Y	Y	N	Y	N	Y	Y	Y	Y
Umberger and Thomas (2019)	Y	Y	Y	N	Y	Y	Y	Y	Y	Y
Alexandersen et al. (2019)	Y	Y	Y	N	Y	Y	Y	Y	Y	Y
Tingsvik, Hammarskjold, Martensson, and Henricson (2018)	Y	Y	Y	N	Y	N	Y	Y	Y	Y
Felten-Barentsz et al. (2018)	Y	Y	Y	Y	Y	N	N	N	Y	Y
Holm and Dreyer (2017)	Y	Y	Y	Y	Y	N	Y	N	Y	Y
Da Cruz de Castro and Rebelo Botelho (2017)	Y	Y	Y	N	Y	N	N	Y	N	Y
Mylén, Nilsson, and Berterö (2016)	Y	Y	Y	N	Y	N	Y	Y	Y	Y
Whitehorne, Gaudine, Meadus, and Solberg (2015)	Y	Y	Y	N	Y	N	N	N	Y	Y
Tembo, Higgins, and Parker (2015)	Y	Y	Y	N	Y	Y	N	N	Y	Y
Stayt, Seers, and Tutton (2015)	Y	Y	Y	N	Y	N	N	Y	Y	Y
Palesjö, Nordgren, and Asp (2015)	Y	Y	Y	N	Y	N	Y	Y	Y	Y
Lykkegaard and Delmar (2015)	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
Moen and Nåden (2015)	Y	Y	Y	N	Y	N	Y	Y	Y	Y
Torheim and Kvangarsnes (2014)	Y	Y	Y	N	Y	N	Y	Y	Y	Y
Alguindy, Mohamed, and Gado (2014)	Y	Y	Y	N	Y	N	Y	Y	N	Y
Olausson, Lindahl, and Ekebergh (2013)	N	Y	Y	N	Y	N	N	Y	Y	Y
Lykkegaard and Delmar (2013)	Y	Y	Y	Y	Y	N	Y	Y	Y	Y
Locsin and Kongsuwan (2013)	Y	Y	Y	N	Y	N	Y	N	N	Y
Tembo, Parker, and Higgins (2012)	Y	Y	Y	N	Y	N	N	N	Y	Y
Karlsson, Bergbom, and Forsberg (2012)	Y	Y	Y	N	Y	N	Y	Y	Y	Y
Johansson, Bergbom, and Lindahl (2012)	Y	Y	Y	N	Y	N	N	Y	Y	Y
Cypress (2011)	Y	Y	Y	Y	Y	Y	N	Y	N	Y
Fredriksen and Svensson (2010)	Y	Y	Y	N	Y	N	N	Y	Y	Y
Foster (2010)	Y	Y	Y	Y	Y	N	Y	Y	N	Y
Wang, Zhang, Li, and Wang (2009)	Y	Y	Y	N	Y	N	N	N	Y	Y
Storli and Lind (2009)	Y	Y	Y	N	Y	Y	N	Y	Y	Y
Henricson, Segesten, Berglund, and Määttä (2009)	Y	Y	Y	N	Y	N	Y	Y	Y	Y
Storli, Lindseth, and Asplund (2008)	Y	Y	Y	N	Y	Y	N	Y	Y	Y
Karlsson and Forsberg (2008)	Y	Y	Y	Y	Y	N	Y	Y	Y	Y
Fredriksen, Talseth, and Svensson (2008)	Y	Y	Y	N	Y	N	N	Y	Y	Y
Storli, Lindseth, and Asplund (2007)	N	Y	Y	Y	Y	Y	Y	Y	Y	Y
Almerud, Alapack, Fridlund, and Ekebergh (2007)	N	Y	Y	N	Y	N	N	Y	Y	Y
Johnson, St John, and Moyle (2006)	Y	Y	Y	N	Y	N	N	N	Y	Y
Ballard et al. (2006)	Y	Y	Y	N	Y	N	Y	Y	Y	Y
Strahan and Brown (2005)	Y	Y	Y	N	Y	N	N	N	Y	Y
Sheen and Oates (2005)	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
Del Barrio et al. (2004)	Y	Y	Y	Y	Y	N	N	Y	N	Y
Papathanassoglou and Patiraki (2003)	Y	Y	Y	N	Y	N	N	Y	Y	Y
Jordan, van Rooyen, and Strümpher (2002)	Y	Y	Y	N	Y	Y	Y	N	Y	Y
Granberg, Engberg, and Lundberg (1998)	Y	Y	Y	N	Y	Y	N	Y	Y	Y
Y= Yes; N= No

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