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This research study explored the meanings former patients attributed to being on long-term mechanical ventilation in a critical care unit (CCU). An interpretive phenomenological-ontological perspective informed by the philosophical tenets of Heidegger (1927/1962) was used to examine the lived experience of a group of people who had previously been hospitalised in one of three critical care units in southeast Queensland, Australia, during which time they were on a mechanical ventilator for a period of seven days or more. Data were collected using 14 unstructured audio-taped interviews from participants, who had indicated that they were willing and able to recall aspects of their critical care experience. The data were analysed using the method developed by van Manen (1990). A total of nine people participated in the study, of which six were male and three female. Their ages ranged from 21 to 69 years. Thematic analysis of the data revealed four themes: Being thrown into an uneveryday world; Existing in an uneveryday world; Reclaiming the everyday world; and Reframing the experience. Throughout the description of these themes, excerpts from the interviews with the participants are provided to demonstrate, and bring to light the meaning and interpretations constructed. From this thematic analysis, a phenomenological description drawing on Heidegger's tenets of Being was constructed. Titled Being at its most elusive, this description showed that participants experienced momentary lapses of: situation, engagement, concern and care, temporality, and the ability to self-interpret. These findings highlight and affirm the relevance of Heidegger's ontological tenets to reveal Being. The findings of this study served as a basis for a number of recommendations relating to nursing practice, education and research. Recommendations relating to practice include: constructing a more patient-friendly critical care environment, increased involvement of patients and their families in decision making and patient care activities; ensuring adequate critical care nursing staff levels; ensuring and maintaining appropriate skill level of critical care nurses; enhancing methods of communication with patients; planning for effective patient discharge and adoption of a designated nurse position for discharge planning; providing opportunities for follow up contact of patients once they are discharged from CCU; and promoting the establishment of follow up services for former CCU patients, and their families. Recommendations relating to critical care education include: incorporating more in-depth information of the psychological and social aspects of patient and family care into care planning; incorporating communication and counselling education and training to assist nurses caring for mechanically ventilated patients, and their families; further education regarding the role and responsibilities of patient discharge planning from CCU; incorporating more advanced research skills training and utilisation of research findings into practice; and the provision of appropriate and ongoing training and education in areas such as manual handling and communication skills for all health care staff involved in the direct care of CCU patients. This study also recommended that further research be undertaken to: examine and compare different sedative and analgesic protocols and their effects on the incidence of nightmares and hallucinations reported by CCU patients; replicate this study in a group of patients from different cultural or ethnic backgrounds; evaluate the efficacy of current methods for communicating with intubated and mechanically ventilated patients in the CCU; develop, test and evaluate the efficacy of new methods for communicating with intubated and mechanically ventilated patients in the CCU; examine CCU patients' perceived level of control and power; explore the extent and type of involvement patients would like to have in their care whilst in the CCU; investigate the extent and type of problems experienced by CCU patients after discharge; explore the usefulness and appropriateness of personal diaries for individual patients as an aid to assist in understanding and resolving their CCU experience; and examine the value of follow up contacts by CCU staff to former patients and their families. In summary, the findings from this study add substantial knowledge to critical care nurses' understanding and knowledge about what it means to be on long-term mechanical ventilation in a critical care unit. Findings will help inform future critical care nursing practice and education, and the provision of holistic and evidenced-based care.

The purpose of this study was. to compare critical care unit (CCU) nurses' and patients' perceptions of stress factors for patients in the CCU environment. The research questions were: 1. Which stressors do hospitalized CCU patients perceive to be the most significant? 2. What do nurses report as their perception of the most significant patient stressors in CCUs? 3. What is the relationship between the patients' reports of perceived stressors and CCU nurses reports of patients' perceived stressors. This comparative-descriptive study included a sample of 40 patients transferred from CCUs and 40 Registered Nurses employed in CCUs. A convenience sample was obtained from nine CCUs in three hospitals in a metropolitan area of the southeastern United States. Data were collected using a Personal Data Questionnaire and the Intensive Care Unit Environmental Stressor Scale (ICUESS). The ICUESS was designed to assess the level of perceived stressfulness of both patients and nurses in the critical care unit environment. Data were collected from the nurses by requesting them to complete the instruments following a shift worked in a CCU. Nurses were asked to complete the ICUESS by indicating the responses that they thought most CCU patients would indicate. Patient data were collected within 72 hours following transfer from a CCU. Comparison of group results from the ICUESS were analyzed using the Mann Whitney U Test and the independent T test. It was found that nurses reported higher levels of stress for patients than did the patients themselves on all of the items on the ICUESS. Comparison of all items was significant at the level 0.05 when analyzed by both parametric and nonparametric statistical methods. The results were consistent among the three hospitals and types of CCUs. Findings support those of previous studies in that nurses consistently perceive environmental stimuli as being more stressful than do patients. Findings of the study need to be made available to CCU nurses, to facilitate nursing focus on identified high patient stressors and minimize concern of the nurses about other environmental stimuli.