NUR 315 Module 4 EBP Paper 3: Qualitative Critical Appraisal Example

Voiceless, Breathless, Powerless: A Critical Appraisal of a Phenomenological Study of Being Awake on a Ventilator

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

NUR 315: Nursing Research and Application to Practice

Instructor Name

Month Day, Year

Voiceless, Breathless, Powerless: A Critical Appraisal of a Phenomenological Study of Being Awake on a Ventilator

Introduction

The worksheet question behind this paper concerns music that ventilated ICU adults pick and control, and whether it leaves them calmer and less sedated. Paper 2 appraised a randomized trial that answered whether music works. This paper appraises a qualitative study that helps explain why ventilated patients are anxious and what they need: the phenomenological-hermeneutic study by Karlsson et al. (2012).

What the Researchers Asked

The study aimed to illuminate the lived experience of patients who were conscious during mechanical ventilation in an ICU. A question about lived experience is well suited to qualitative research, because it seeks meaning and description rather than measurement. The purpose is clearly stated and matches the method.

Method

The authors used a phenomenological-hermeneutic method inspired by the philosopher Paul Ricoeur (Karlsson et al., 2012). Phenomenology seeks to describe experience as people live it, and the hermeneutic element adds interpretation, moving between the parts of the text and the whole to reach deeper understanding. The choice fits the aim. A limitation for a beginning reader is that the method is philosophically complex, and the article gives only a brief account of how interpretation was carried out.

Sample and Setting

Twelve adults who had been assessed as conscious during mechanical ventilation were interviewed. Qualitative studies use small, purposeful samples chosen because participants have experienced the phenomenon, so twelve is reasonable. How the twelve were recruited, and how many said no, is left largely unreported, and the sample came from one country's ICUs, which may differ from American units in staffing and sedation practice.

Data Collection

Interviews took place about one week after discharge from the ICU. That timing is a strength, since memories were recent, but patients recovering from critical illness may have gaps or distortions in memory, especially after sedation. The authors relied on what patients could recall and tell, which is the nature of the method, but it means the experiences of patients who were too sedated to remember are missing.

Analysis and Trustworthiness

The text was analyzed using the Ricoeur-inspired approach, moving from a naive reading of the whole to a structural analysis of themes and then to a comprehensive understanding. Qualitative rigor is judged by trustworthiness, which includes credibility, dependability, confirmability and transferability. Credibility is supported by the use of participants' own words in the findings. The article reports little about steps such as having more than one researcher analyze the text or checking interpretations with participants, which makes dependability and confirmability harder to judge. Transferability depends on readers judging whether the context fits their setting.

Findings

Apart from breathlessness, participants described voicelessness as the worst experience. They reported considerable discomfort and pain from the tracheal tube. They felt helpless, deserted and powerless, which pushed them to strive for independence and recovery and to "flow with" their treatment and care. Participants suggested that suffering could be eased by communication, participation in care activities and companionship, and nurses who conveyed hope and belief in recovery seemed to help patients endure (Karlsson et al., 2012).

How the Findings Inform My Question

The findings deepen the music trial in three ways. First, they explain why anxiety is so common: patients who cannot speak and feel powerless have reason to be afraid. Second, they suggest why patient-directed music may work better than music chosen by staff. In the trial, patients started and stopped the music themselves (Chlan et al., 2013); for someone who feels powerless, controlling one part of the environment may matter as much as the music itself. Third, they warn against treating music as a replacement for nursing presence, which matches national ICU guidance to combine comfort measures with attentive care and light sedation (Devlin et al., 2018). Participants valued companionship and communication, so music should be offered alongside, not instead of, a nurse who explains, listens and stays.

Limitations

The study is small, from a single national context, and limited to patients who remember their ventilation. Its reporting of rigor is brief. As qualitative research, it does not test whether music or any intervention reduces anxiety; it describes experience and suggests what patients need.

Conclusion

The study is a credible, method-appropriate description of what being awake on a ventilator is like. Read together with the trial in Paper 2, it supports offering music in a way patients can control and pairing it with communication and nursing presence. The two papers together show how quantitative evidence answers whether an intervention works and qualitative evidence explains why it might.

References

Chlan, L. L., Weinert, C. R., Heiderscheit, A., Tracy, M. F., Skaar, D. J., Guttormson, J. L., & Savik, K. (2013). Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: A randomized clinical trial. JAMA, 309(22), 2335-2344. https://doi.org/10.1001/jama.2013.5670

Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande, P. P., Watson, P. L., Weinhouse, G. L., Nunnally, M. E., Rochwerg, B., Balas, M. C., van den Boogaard, M., Bosma, K. J., Brummel, N. E., Chanques, G., Denehy, L., Drouot, X., Fraser, G. L., Harris, J. E., ... Alhazzani, W. (2018). Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine, 46(9), e825-e873. https://doi.org/10.1097/CCM.0000000000003299

Karlsson, V., Bergbom, I., & Forsberg, A. (2012). The lived experiences of adult intensive care patients who were conscious during mechanical ventilation: A phenomenological-hermeneutic study. Intensive and Critical Care Nursing, 28(1), 6-15. https://doi.org/10.1016/j.iccn.2011.11.002