Lived Experiences of Conscious Intubated Patients in the Intensive Care Units: A Qualitative Phenomenological Study in Iran

Abstract

Objective

Mechanically ventilated patients experience significant suffering in intensive care units (ICUs). Recognising and understanding these patients’ distressing experiences can greatly improve the quality of care provided. This study aims to explore the lived experiences of conscious intubated patients in ICUs in Iran.

Design

A qualitative study was conducted using an interpretative phenomenological approach. In-depth interviews served as the primary means of data collection. Subsequently, the collected data was analysed using the method of Diekelmann et al (1989).

Setting

The study was conducted in the ICU.

Participants

A purposive method was employed to select 13 patients who underwent conscious intubation for over 24 hours.

Results

Three main themes and seven subthemes emerged from the data analysis of the lived experience: (1) interpersonal discourse complexity (semantic misalignment and others’ impressionability), (2) sensory disquietude (pharyngeal discomfort, thirst beyond the quench and disgust with oral hygiene) and (3) resilient adaptation (emotional responses and coping strategies).

Conclusions

The findings of the lived experiences reveal a nuanced understanding of the intricate interplay between communication barriers, sensory discomfort and the adaptive capacities of conscious intubated patients in the ICU. This comprehensive analysis contributes to a deeper appreciation of their multifaceted experiences.

Strengths and limitations of this study.

• This study uses qualitative methodology to explore the experiences of a population that often hesitates to discuss their condition, providing valuable insights.

• The methodology is clearly outlined, enhancing the transparency of the research process.

• While focusing on the perspectives of intubated patients is valuable, incorporating the viewpoints of relatives and healthcare professionals could further enrich the insights gained.

• Similar to other qualitative studies, the findings may not directly apply to different communities or settings due to variations in healthcare practices and patient demographics.

• The subjective nature of patient experiences introduces variability in the collected data, potentially affecting the reliability of reported durations of being awake and the quality of interactions.

Introduction

Intubation and mechanical ventilation in intensive care units (ICUs) support the respiratory system and facilitate gas exchange in critically ill patients.¹ While these interventions are life-saving, they can lead to significant physical and psychological distress, including anxiety, confusion, agitation and delirium.^{2 3} Sedatives are commonly used to manage such reactions. However, evidence suggests that sedatives, particularly benzodiazepines, may not effectively reduce negative experiences or increase the risk of delirium.⁴ Prolonged sedation has been linked to adverse long-term outcomes such as post-intensive care syndrome and post-traumatic stress disorder (PTSD), particularly in patients who cannot recall their ICU experiences due to sedation.⁵

Studies suggest that lighter sedation strategies can enhance patient outcomes, including a reduced duration of mechanical ventilation and shorter ICU stays.⁶,⁸ Protocols emphasising daily sedation interruptions and careful monitoring can help mitigate the risks associated with deep sedation, thereby improving recovery and decreasing the incidence of complications, such as delirium and PTSD.⁹ In Iran, research has recommended implementing sedation-agitation protocols to optimise sedative administration in intubated patients.¹⁰ Although lighter sedation strategies have been shown to enhance patient outcomes, it is also essential to explore the experiences of conscious mechanically ventilated patients to understand their needs better and further improve sedation protocols.²

Conscious patients who have undergone intubation report experiencing unpleasant physical, psychological and communicative challenges.¹¹ The presence of a tracheal tube obstructs the vocal cords, making it difficult for them to speak. Many patients who were conscious during intubation expressed frustration in being understood by others,¹² which led to distress, lowered morale, separation from family and caregivers and negatively impacted their participation in treatment and recovery.² Poor interpersonal interactions in the ICU significantly contribute to the dissatisfaction of intubated patients and their family members.⁷

When a patient is confronted with a potentially life-threatening medical condition that necessitates ongoing treatments, such as mechanical ventilation and potent medications, they inevitably endure distinct physical pain and various psychological stresses. These experiences vary for each patient, resulting in significant psychological and physical reliance on caregivers. Therefore, it is essential to comprehend the individual experiences of ICU patients to create approaches that reduce their distress and suffering. Qualitative research can offer valuable insights into these unique experiences, enriching our understanding and enhancing patient care.¹³

Understanding the unpleasant experiences of intubated patients is essential for finding practical solutions to improve care. Effective communication between nurses and patients plays a significant role in helping patients adapt to their experiences. These considerations prompted researchers to conduct a qualitative study using the hermeneutic phenomenological method to explore the experiences of consciously intubated patients in Iranian ICUs. This study’s main goal was to explore these patients’ lived experiences and fill the gap in research concerning their unique perspectives. It is essential to recognise that experiences may vary across different cultures, and research in this field, particularly in Iran, is limited. The phenomenological approach used in this study allowed researchers to grasp the subjective meanings of the experiences of consciously intubated patients in the ICU. Therefore, the present study aimed to investigate the lived experiences of these patients, highlighting the significance of their voices in shaping care practices.

Methods

Design and setting

Qualitative research takes a naturalistic and interpretive approach to understanding and making sense of human experiences and phenomena. In the context of conscious intubated patients in the ICUs, a qualitative research methodology was chosen to delve deeper into their lived experiences, providing more comprehensive insights than previous literature.¹⁴ This qualitative approach allows for a better understanding of the unique experiences of conscious intubated patients in the ICUs, which quantitative studies have yet to capture fully. To thoroughly explore the lived experiences of these patients, an interpretive phenomenological approach was employed, as it enables profound and meticulous comprehension of participants’ emotions and perspectives.¹⁵ Phenomenology, derived from the Greek term ‘phainómenon’, meaning ‘to show itself’, is the study of phenomena, encompassing anything that presents itself.¹⁶ Within this framework, interpretive phenomenology is rooted in Heidegger’s work, which viewed phenomenological research as an interpretive process. Unlike descriptive phenomenology, interpretive phenomenology does not suspend biases but encourages the researcher to engage with participants actively. This approach was employed when the researcher aimed to explore the meaning of a phenomenon by focusing on participants’ life experiences and their interpretations of those experiences.^{15 17} Therefore, in this qualitative study, an interpretive phenomenological approach was employed, and the findings were reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist¹⁸ (see online supplemental file 1).

The research was conducted in the ICUs of a teaching hospital affiliated with the University of Medical Sciences in a city in northwestern Iran. The research setting includes several ICUs with varying patient populations and nurse-to-patient ratios. The cardiac ICU has a nurse-to-patient ratio 1:4, primarily caring for patients with severe cardiac conditions. The general ICU operates with a nurse-to-patient ratio 1:3, caring for surgical and medical patients requiring intensive monitoring and care. The surgical ICU also maintains a nurse-to-patient ratio 1:3, focusing on postoperative patients. Lastly, the cardiac surgery ICU has a more intensive nurse-to-patient ratio of 1:2, explicitly caring for patients recovering from cardiac surgery.

It is important to note that there were no established communication protocols for intubated patients in any department in this study. Communication with these patients was restricted to non-verbal methods, such as gestures, and for those who were able to read and write, using paper. Across all research departments, patients were sedated to ensure their calmness and care protocols were consistently followed. Intubation was only carried out with sedation, following best practice guidelines for awake tracheal intubation in adults. These guidelines recommended the use of light sedation to improve patient comfort while maintaining consciousness.¹⁹

Participants

Purposive sampling was used to select participants with different characteristics such as type of illness, duration of hospitalisation, duration of intubation, gender, education and occupation. The inclusion criteria required that participants had been hospitalised within the last month with an endotracheal tube in place for more than 24 hours, had an interest in communication and were not psychotic. The consciousness of participants during their intubation was determined using the FOUR (Full Outline of UnResponsiveness) score, which ranges from 0 to 16. This scale consists of four components: eye response, motor response, brainstem reflexes and respiration pattern. A score of 16/16 indicates complete consciousness, as noted in their medical records.²⁰

Additionally, patient reports were used to confirm their awareness during mechanical ventilation. The first author conducted face-to-face interviews until an adequate and rich data set was obtained.²¹ 13 individuals participated in the study, all of whom volunteered and gave informed consent without receiving any reimbursement for their participation. The researcher coordinated the timing and location of the interview with the participants, ensured effective communication and clarified the research objectives before starting the interview. It is important to note that the interviewer and participants were not friends before the interview.

Data collection

Data collection was conducted through interviews, which lasted an average of 56 min. The interviews were audio recorded with the participant’s consent. Each interview began with a general open-ended question, followed by specific questions aligned with the study’s purpose, as detailed in the guide (online supplemental file 2). The interview questions were formulated based on the researchers’ professional insights. Additional questions were asked based on the participants’ responses. After each interview, participants were allowed to provide final comments if they wished. A total of 13 participants were included in the study, and 15 interviews were conducted to ensure data adequacy and richness,²¹ as determined by the research team. Two additional interviews were conducted with two participants to delve deeper into specific themes that emerged during the initial interviews. This approach allowed us to capture a more comprehensive understanding of their experiences. All interviews were conducted in person in the patient’s room without the presence of others by the first author, a female lecturer with a faculty position who has experience teaching and conducting qualitative research.

Data analysis

Data were analysed using a hermeneutic approach based on the method described by Dickelman et al (1989). This method is an interpretive analysis based on Heideggerian phenomenology with teamwork character. It briefly involves reading the interviews and gaining a general understanding, writing an interpretive summary, coding the possible themes, analysing the selected versions in a group to identify themes, comparing and contrasting transcripts to identify and describe common functions and meanings, identifying structural patterns that connect themes and extracting responses and suggestions from the interpretive team and those familiar with the content or study method for the final version.²²

Following the method described above, each interview was transcribed and reviewed multiple times to gain a general understanding. An interpretive summary was created for each interview transcription, and efforts were made to uncover implicit meanings. Team members shared their opinions on the themes and extracted the content. As the interviews continued, previous themes were clarified or expanded on, and occasionally, new themes emerged and were discussed with the team. The interpretations and patterns were identified as themes, with explicit and implicit meanings derived from the interview transcriptions. This analysis encompassed the participants’ statements, the context of the conversations and their responses to the questions posed. We consistently referred to the transcripts and participants to clarify, categorise and resolve any discrepancies or contradictions in the interpretations. Integrated and cross-cutting analyses were carried out at each stage, and as the project progressed, interpretive summaries were combined to represent the emerging themes and subthemes best. Data management was conducted using MAXQDA20 software. The coding tree and data analysis process can be found in online supplemental file 3.

Trustworthiness and rigour

This study used several strategies to establish trustworthiness.¹⁵ Credibility was achieved by engaging with the participants and data over an extended period, allowing ample time for data collection. Dependability was ensured by cross-checking quotes and codes/subthemes by the research team and two experienced external observers. Confirmability was established by presenting quotes extracted from each interview. Transferability was enhanced by describing the research process, participant characteristics and the study context. The quotes were directly attributed to each participant (P).

Patient and public involvement

None.

Results

The study sample included 13 participants, comprising five men and eight women aged between 30 and 89. The participants came from various educational backgrounds, from illiterate to master’s degrees. Six participants were housemakers, whereas the others worked as drivers, teachers and farmers. A detailed summary of participants’ characteristics is provided in table 1. Three main themes emerged from the analysis: (1) interpersonal discourse complexity, (2) sensory disquietude and (3) resilient adaptation. Each finding is discussed, with relevant excerpts and quotes integrated into the text.

Table 1. Participants’ characteristics.

Participants	Gender	Age range	Hospitalisation duration (day)	Intubation duration (day)	Duration awake (day)
1	Male	60–69	20	15	5
2	Female	70–79	25	16	3
3	Female	40–49	10	2	1
4	Male	40–49	15	4	2
5	Female	70–79	10	2	1
6	Female	60–69	20	10	4
7	Female	80–89	7	2	1
8	Female	60–69	5	2	1
9	Male	60–69	120	90	14
10	Male	50–59	22	10	3
11	Female	30–39	15	7	2
12	Male	40–49	10	4	1
13	Female	50–59	7	3	2

Interpersonal discourse complexity

Patients who faced the challenge of communicating while using endotracheal tubes encountered significant complexities in interpersonal discourse due to their inability to use their voices. Two key subthemes emerged, highlighting the intricacies of their communication challenges: semantic misalignment and the impressionability of others.

Semantic misalignment

The patients reported facing significant challenges in expressing their needs and conveying the meaning of their words to those around them, resulting in a phenomenon known as semantic misalignment. This situation created an uncomfortable and distressing experience, as their inability to speak hindered effective communication with both medical staff and family members. Additionally, participants noted their lack of familiarity with communication tools, which worsened their difficulties, as highlighted in their accounts:

Disregarded requests: Participants highlighted that the medical staff, including nurses and doctors, often failed to take their requests seriously, such as asking for water.

The ward staff, including the nurses and doctors, did not take my requests seriously when I asked for water or removal of the tube, for example. (Participant 12)

Lack of understanding by others: Participants expressed frustration with not being understood, even by family members who claimed to comprehend. The inability to communicate with both the medical staff and family added to their emotional distress.

I was upset because no one understood me, not even my family, but they always said they understood me. I did not know how to communicate with them. (Participant 4)

Terrifying loss of voice: Participants stated that the experience of losing their voice due to the tracheal tube was terrifying, contributing to the fear of permanent voice loss.

When I had the tube in my trachea, my voice was cut off, and I could not speak anymore. The inability to speak and the loss of voice was terrifying to me; not being able to speak forever. (Participant 9)

Lack of information: Participants, including participant 13, expressed difficulties obtaining information about the tracheal tube, creating confusion and distress about the care, treatment process and tube duration.

They did not give me any explanation about the endotracheal tube. I did not know how long the tube would be in my mouth, and that lack of knowledge confused and upset me. (Participant 13)

Others impressionability

Participants emphasised the profound influence of healthcare professionals’ behaviour, particularly physicians and nurses, on their emotional well-being. Positive interactions, characterised by good behaviour and clear explanations during medical procedures, contribute to patient comfort and relaxation. Conversely, some nurses’ experiences of misbehaviour and aggressiveness resulted in patient discomfort, irritation and frustration.

Positive influence

The demeanor of the nurses and doctors significantly affected my mood. A compassionate nurse who explained everything made me feel at ease and positive. (Participant 9)

Negative impact

Conversely, encountering misbehavior and aggressiveness from certain healthcare professionals made me feel angry, upset, and disappointed. (Participant 9)

Sensory disquietude

The participants reported a range of sensory discomforts associated with tracheal tube placement that extended beyond mere communication challenges. These discomforts included feelings of pressure, a foreign body sensation in the mouth and throat, physical discomfort, pain, odynophagia, dissatisfaction with oral hygiene and persistent dry mouth, which resulted in an unquenchable thirst.

Pharyngeal discomfort

Participants vividly described sensations akin to a bent tongue or string-like object in their airways, particularly during coughing.

I felt like my tongue was bent in my mouth; something like a string was stuck in my throat; it went up and down when I coughed or tried to speak; like a razor, it went down my throat; it was annoying. (Participant 6)

Pressure from the tracheal tube was a significant issue for some individuals.

When I had a tube in my trachea, I could not eat. The tubes attached to the device were heavy and bothered me. (Participant 9)

When I had a tube in my trachea, I felt pressure on my throat, which bothered me. (Participant 11)

The discomfort persisted during and after the movement of the tube within the trachea, causing pain and nausea.

The tube was not very bothersome when it was tight, but when it came off and moved, I had pain and nausea; that was bothersome. (Participant 10)

I felt like something was sticking in my throat. Even after the tube was removed, I still had much pain in my throat. (Participant 8)

Many participants struggled with their inability to swallow saliva, leading to annoyance and discomfort.

I was drooling; I could not swallow my saliva, and that was very annoying. (Participant 7)

Thirst beyond the quench

Despite nurses’ attempts to provide fluids via the nasogastric tube, dry mouth and an unquenchable thirst remained prominent issues.

The feeling of dry mouth and thirst bothered me greatly, and I suffered. When I waved that I needed water, they gave me water from the tube on my nose, but it did not quench my thirst. It would have been good if they had moistened my mouth. (Participant 5)

Disgust with oral hygiene

Participants expressed discomfort due to the challenge of maintaining oral and dental hygiene, leading to feelings of dirty mouth and bad breath.

Having a dirty mouth and not brushing my teeth bothered me and made me feel bad. (Participant 3)

Resilient adaptation

The combination of emotional responses like fear, anxiety and helplessness, along with coping strategies such as acknowledging the crucial role of the tracheal tube, remaining silent and using difficult measures, together reflect a resilient adaptation to the challenges of intubation.

Emotional responses

The psychological reactions of most of the conscious intubated participants in the ICU to existing conditions included fear, anxiety, helplessness and despair. Participants reported that they were unable to speak because of the tube in their trachea and were, therefore, unable to call the nurses to express their needs. As a result, the nurses did not know the patients’ needs, and the failure to address their needs and loneliness led to uncomfortable feelings.

There was no one I could call. I only saw the nurses when they gave me medication or happened to pass by the bedside; their absence caused me a kind of vague anxiety. (Participant 2)

In addition, the feeling of needing an endotracheal tube for life and the feeling of dying triggered anxiety and fear.

I was afraid of dying or having to breathe through a tube for the rest of my life. (Participant 3)

Some participants expressed their fear in the absence of family and their comfort in the presence of family as follows:

The absence of my family by my side caused me to fear, loneliness, and anxiety. I feel that my family understood me better. I liked having a family member by my side. (Participant 9)

The participants’ inability to speak and communicate with others and their lack of understanding led to their anger and despair.

Because I could not speak, the people next to me did not understand what I meant; that made me angry and frustrated. (Participant 8)

The presence of a tracheal tube in the trachea and the inability to express needs were very challenging and frightening for most participants, and they considered this a threat to their independence. Feeling disabled and burdensome to others was frustrating for them.

I felt like I was going to be like this forever, a burden to others; that was upsetting to me. (Participant 12)

Some participants described their experiences of heavy and uncomfortable breathing, difficulty communicating, insomnia and confusion as helplessness. They likened their situation to that of headless chickens.

I felt like a headless chicken that cannot do anything, not even breathe; I felt helpless. (Participant 2)

Coping strategies

Given that participants were awake while the tube was in place in their trachea, they employed various adaptive or coping strategies to address the mentioned communication, psychological and physical challenges. These strategies included convincing themselves of the life-sustaining nature of the tracheal tube, choosing to remain silent and employing challenging methods.

Enduring the tube while I was awake was extremely painful, but I tried to adapt to it. I told myself that it was necessary for breathing and that it was saving me from death, so I had to endure it. (Participant 10)

Some participants coped by remaining silent due to their frustration over the inability to communicate. The inability to speak led to a conscious decision not to attempt any form of communication.

When I realized that I could not speak and that if I tried, no one would pay attention to me, I decided not to attempt to speak. (Participant 3)

Some participants resorted to extreme measures to express their needs, including attempts to remove the endotracheal tube. They employed actions such as banging their hands and feet on the bedposts and writing notes.

I was looking for a way to pull the tube out, but my hands were tied, and I could not do it. (Participant 13)

Another participant shared their experiences:

One night my tube was clogged, and I couldn’t call the nurses, so I kicked the front desk until they came and unclogged my tube. I felt relieved. Sometimes, I wrote down my needs, but they still did not understand. (Participant 4)

Whatever I did, no one understood me, so I would kick my feet on the table in front of my bed, and they would come to me. (Participant 2)

Discussion

This study provided valuable insights into the lived experiences of conscious intubated patients in Iranian ICUs. The findings were encapsulated in three main themes: the complexity of interpersonal discourse, sensory discomfort and resilient adaptation. This study aimed to address the gap in understanding how these patients navigated their unique challenges, which was crucial for improving their care.

Consistent with the present study, research indicated that mechanically ventilated patients exhibited variability and fluctuations in their physical and cognitive statuses, communication abilities and the capacity to use communication aids due to reduced sedative usage to maintain consciousness.²³,²⁵ The findings from studies in Iranian ICUs regarding communication tools for mechanically ventilated patients align with those from other countries. For instance, studies worldwide emphasised the importance of employing communication tools to enhance patient communication and alleviate frustration among mechanically ventilated patients.²⁶,²⁹ These challenges were not unique to Iranian ICUs but were prevalent in ICUs globally.

The study highlights the complexity of interpersonal discourse among conscious intubated patients, which impedes practical expression, understanding and access to vital information. Similar challenges have been reported in the literature, indicating that communication is a significant issue in ICU care that affects both patients and caregivers.²⁶,²⁹ The inability of patients to speak, compounded by the silence of the tracheostomy cuff, complicates their participation in care decisions.^{2 30} Conscious, mechanically ventilated patients often express frustration due to these communication limitations.³¹ Furthermore, the vigilance of intubated patients and the implementation of protocols without sedation underscore the necessity for adaptable communication strategies.³²

To address these issues, healthcare providers should allocate adequate time for communication, closely monitor patients’ non-verbal cues and undergo training in communication strategies and tools.^{12 33} It is important to note that patients may have difficulty using communication tools (eg, tablets, paper) due to fatigue, cognitive impairment or decreased muscle strength.³² Therefore, caregivers must recognise these communication barriers and, if necessary, involve families for effective resolution.³⁴

In addition to communication challenges, effective symptom management is crucial for decreasing patient anxiety, thirst, discomfort and fear. Our findings align with studies from various cultures, including those conducted in the USA and Germany, emphasising the importance of addressing these symptoms to enhance patient comfort. For instance, research has shown that effective management of anxiety and physical discomfort can significantly improve the overall experiences of intubated patients.³⁵,³⁷ The prevalence, intensity and distress of symptoms such as thirst, pain, anxiety, fatigue and shortness of breath are consistent across different studies, including those from other countries.^{38 39}

Sensory discomfort, including various physical and oral issues, significantly affects conscious intubated patients in the ICU. Studies corroborate these challenges, citing problems such as painful swallowing, muscle wasting and oral complications.^{25 35 36} These difficulties are exacerbated by care procedures like position changes and suctioning.^{25 36 37} However, some studies suggest that patients’ experiences during mechanical ventilation may not always align with severe distress.⁴⁰ Understanding these diverse perspectives enriches discussions on patient care and underscores the importance of individualised approaches. While comprehensive oral care is recommended,⁴¹ further research is needed to explore interventions that effectively address patients’ holistic needs.

Resilient adaptation among conscious intubated patients encompasses various emotional responses and coping mechanisms amid the challenging circumstances of having a tracheal tube. Studies underscore the diverse reactions, including fear, anxiety, depression and feelings of helplessness and sadness.²⁵⁴²,⁴⁵ Oral care procedures, including suctioning, contribute to pain and psychological distress, which are often misinterpreted by caregivers, resulting in physical limitations and unrelieved suffering.^{41 46} Despite the discomfort, supportive factors, such as family members and nurses, foster patient comfort.⁴⁶ Intubated patients employ adaptive strategies, such as silent communication and perceiving the tracheal tube’s importance, consistent with findings from other studies.^{12 33 46}

Communication between nurses and conscious intubated patients in Iranian ICUs typically occurs without structured communication tools, relying heavily on non-verbal methods initiated by the patients. Patients express their needs, including physical discomfort and pain, through gestures such as eye contact, hand movements and head-shaking,³⁶ which aligns with the present study’s findings. This reliance on non-verbal communication highlights the critical role of non-verbal cues in facilitating interactions in such challenging environments. However, interpreting these non-verbal signals can be more challenging and time-consuming. Given the shortage of healthcare personnel in Iran, many providers may need more time to dedicate to this aspect of communication, leading to misunderstandings and unmet patient needs.⁴⁷

Furthermore, the lack of structured communication tools underscores the need for healthcare providers to be attuned to patients’ non-verbal signals, ensuring that their needs are adequately recognised and addressed. While this non-verbal approach can enhance patient comfort and foster a supportive care environment, it is essential to acknowledge the importance of investing in communication tools to facilitate more accessible interactions between healthcare providers and patients. Implementing available communication aids can significantly improve the quality of care and patient satisfaction. There is a recognised need to develop and implement communication tools tailored for mechanically ventilated patients, which presents a global challenge.³⁸

Iranian ICUs can enhance the overall communication process by prioritising the development and integration of these tools, thereby improving patient outcomes and experiences. Additionally, there is a pressing need for investment in training programmes focused on understanding non-verbal communication. Research indicates that effective non-verbal communication requires training and awareness, often lacking in high-pressure environments like ICUs.³⁷ Therefore, addressing these challenges through targeted training and resource allocation is essential for improving communication practices in Iranian ICUs.

Acknowledging the professional barriers hindering communication with intubated patients is crucial. These barriers include communication skills, attitudes and beliefs among healthcare professionals. For instance, Nilsen et al (2014) identified an association between healthcare professionals’ pro-communicative behaviour and an increase in the communicative behaviour and strategies of intubated patients.⁴⁸ Additionally, a lack of prioritisation of communication has been identified as a negative attitude that hinders the communication process.^{49 50} Other attitudes, such as self-protection, predisposition to failure or communication restriction, have also been highlighted. For example, Tolotti et al (2018) pointed out that nurses often implement avoidance strategies when they cannot understand what their tracheostomised patients are trying to convey.⁴⁶ Recognising and addressing these barriers is essential for improving communication and overall patient care.

Methodological strengths and limitations

This study has several methodological strengths. First, using an interpretive phenomenological approach allowed for an in-depth exploration of the lived experiences of conscious intubated patients, providing rich qualitative data that captures the nuances of their challenges. Employing the FOUR score to assess consciousness adds rigour to the participant selection. However, there are limitations to consider. The study was conducted in a single cultural context, which may limit the generalisability of the findings to other settings. The reliance on self-reported data from patients with cognitive impairments could also introduce biases or inaccuracies in their accounts.

Given the current practices in Iranian ICUs, developing and implementing communication tools tailored for intubated patients is critical. Future research should explore interventions aimed at symptom management and assess the effectiveness of these tools in enhancing patient outcomes. We can foster a more holistic approach to patient care by addressing both communication and symptom management.

Conclusions

This study offers researchers and healthcare providers valuable insights regarding conscious, intubated patients. Understanding these patients’ experiences is crucial, as it enables healthcare providers to implement effective solutions to address challenges such as complex interpersonal communication, sensory discomfort and emotional distress. A lack of insight into the experiences of conscious, intubated patients can negatively impact patient care, highlighting the need for a nuanced understanding to prevent irreparable harm.

The study underscores the critical importance of strategic communication with conscious, intubated patients and addressing the aftermath of intubation. To enhance patient care, comprehensive training for ICU staff, equipping them with effective communication skills and using various communication aids, is essential. Furthermore, the findings support the need for further experimental research to evaluate the effectiveness of these communication strategies and training tools in understanding and meeting patients’ needs, ultimately improving their satisfaction.

Data availability statement

Data are available upon reasonable request.