Factors promoting intensive care patients' perception of feeling safe: a systematic review

BACKGROUND: Feeling safe in the intensive care unit is of great importance while recovering from critical illness. Moreover, feeling unsafe can result in distress. In order to meet the safety needs of intensive care patients as well as to stimulate their recovery and prevent distress, nurses must be aware of factors promoting patients' perception of feeling safe during an intensive care admission. To our knowledge, there is no synthesis of these factors available as yet.OBJECTIVE: To systematically describe the factors that promote patients' perception of feeling safe in an intensive care unit.DESIGN: A systematic review of qualitative and quantitative studies.DATA SOURCES: PubMed, Embase, CINAHL, and PsycINFO were searched up to March 2012.REVIEW METHODS: Methodological quality was assessed by two authors using the QualSyst tool. Data from the included studies were extracted into a customised data extraction form.RESULTS: The initial search resulted in 1326 records. Ultimately, eleven studies were relevant to the research question and included in the review. No studies needed to be excluded because of low quality scores. Analysis of the factors in these studies resulted in four overarching themes that promote intensive care patients' perception of feeling safe. These themes were: nursing care, patients' issues, relatives, and technological support. Nursing care was described most frequently as an important factor promoting patients' feeling of safety in an intensive care unit. Relatives were the link between intensive care patients and staff.CONCLUSIONS: Nurses can increase the perception of feeling safe in critically ill patients by taking into account the promoting factors described in this review. By being aware of these factors nurses can improve quality of care in their intensive care unit.