Meaning of critical traumatic injury for a patient’s body and self

Abstract

Background:

Patients with a traumatic injury often require intensive care for life-saving treatments. Physical suffering and emotional stress during critical care can be alleviated by ethical caring provided by nurses. The relationship between body and self are fundamentally inseparable. Nurses need to understand the impacts of traumatic injury on a patient’s body and self.

Aim:

To understand the meaning of traumatic injury for body and self for patients receiving intensive care.

Research design:

A qualitative descriptive study using Giorgi’s phenomenological approach.

Participants and research context:

Patients receiving intensive care for physical trauma were selected by purposive sampling (N = 15) from a medical center in Taiwan. Individual in-depth, face-to-face audiotaped interviews, guided by semi-structured questions, were used to collect data. Each interview lasted 30–60 min. Audiotaped interviews were transcribed and analyzed.

Ethical considerations:

This study was approved by the Institutional Review Board of the medical center.

Findings:

The impact of the experience of traumatic injury on participants’ body and self was described by three main themes: (1) Searching for the meaning of the injured body, (2) Feeling trapped in the bed, and (3) The carer and the cared-for.

Discussion and conclusion:

The implications of the three themes described in the findings are as follows: Trauma as a source of meaning; Body and self are mutually limiting or mutually enabling; and Ethical relationships. The experience of needing intensive care following a traumatic injury on the body and self was dynamic and mutual. The experience of the injury changed the relationship between body and self, and gave new meaning to life. Nurses play a crucial role in continuity of care by understanding the meaning of a traumatic injury for patient’s body and self that facilitates ethical care and recovery from injury.

Keywords

Body and self ethical care intensive care meaning nursing phenomenology qualitative research traumatic injury

Introduction

Traumatic injury occurs suddenly and includes vehicle collisions, drowning, falls, burns, and acts of violence and war. It is a global health concern and accounts for 9% of global mortality.¹ Traumatic injury often requires transfer to the intensive care unit (ICU) for life-saving treatments, including resuscitation, intubation, and sedation.² In addition to the painful treatment procedures, the ICU environment is filled with loud, unfamiliar noises and bright lights, which can be stressful³ and can have a profound impact on the emotional and psychological status of patients.

Physical suffering and emotional stress during critical care in the ICU can be alleviated by interpersonal relationships with nurses that include psychosocial interventions.⁴ Most qualitative studies on the lived experiences of patients requiring critical care have focused on patients with chronic illness^4–6 or the psychological difficulties experienced by ICU patients.⁷ One component of suffering during a serious illness, which has not been addressed, is loss of the body and the self, described by Charmaz,⁸ who posited that patients are required to continually reassess the impact of the loss of body and self in order to adapt to an illness or injury.

The body describes a person’s relationship with their ability to perform physical tasks, whereas the self describes relationships with others that are social.⁸ Both the body and the self can affect a person’s self-image when comparing how they were prior to and after an illness or injury.⁹ The body can also be thought of as comprised of a person’s body, brain, and sensory system, such as touch, taste, smell, in contrast to the self, which can be viewed as a person’s individuality.¹⁰ Neo-Confucian philosophers define the self as psycho-physical, which includes both an image of one’s body as well as the spiritual self.¹¹ However, although it is difficult to separate the relationship between “body” and “self,” they are not the same phenomenon.¹² Therefore, providing ethical care to patients with a critical illness or injury in the context of the whole person requires nurses have an understanding of the body as well as the self.¹³

Background

Advanced technology has improved care for critically ill patients. However, the focus of treatment in the ICU is on saving lives, making it less likely needs of a patient’s mind and spirit will be considered. Even if a patient’s body is restored to health, there may be a perception the integrity of the body is lost, especially if the illness was serious.¹³ Understanding the meaning of a patient’s experience of an illness can provide clinicians with insight about the injured patient as a person, which can augment healing.¹⁴ Therefore, rather than focusing solely on an injured patient’s clinical status, ethical care and healing relationships should be fostered and attention focused on the meaning of the injury for the body and self.

A phenomenological study by Papathanassoglou and Patiraki⁴ explored the experience of a critical illness during recovery phase and how it affects a person’s perceptions and needs of their lives. Their study was guided by the theoretical framework of Heidegger’s existential philosophy of “Being-in-the-World.” However, there is a gap in the literature of the experience of patients cared for in the ICU due to a traumatic injury. Understanding the meaning of the traumatic injury for the patient’s body and self could help increase nurses’ ethical sensitivity and increase ethical care in the ICU.¹³ However, few studies have described the meaning of traumatic injury to the patient’s body and self. Therefore, this study aimed to understand the meaning of traumatic injury for a patient’s body and self while being cared for in the ICU. Understanding how the experience of traumatic injury impacts the body and self could help ICU nurses increase ethical care and could improve patients’ recovery.

Methods

Aim

This study aimed to understand the meaning of traumatic injury for the body and self of patients requiring critical care in the ICU.

Design

This study used a qualitative descriptive phenomenological design with face-to-face semi-structured interviews using the modified Husserlian approach of Giorgi.¹⁵ An understanding of the essence of the meaning of patients’ shared experiences of being in the ICU following a traumatic injury can be gained by applying phenomenological reduction, as suggested by Edward Husserl in order to get “back to the things themselves.”¹⁶ This approach requires the researcher to take themselves out of the picture by setting aside preconceived ideas in order to focus only on the participants’ experiences.^15,17

Participants

This study was conducted in the ICU of a medical center in Taiwan. Traumatically injured patients were selected to participate by purposive sampling. In this study, a patient was defined as “injured” if they had suffered an accident resulting in a major physical traumatic injury. Inclusion criteria for injured patients were (1) 20 years of age or older, (2) no cognitive impairment, (3) a score of 15 points on the Glasgow coma scale (GCS), (4) had been treated in the ICU for at least 48 h, and (5) able to understand and speak Mandarin. A total of 15 patients met the inclusion criteria and provided signed informed consent to participate in the interviews. Of the 15 participants, most were male (n = 11, 73 %). The mean age was 43 years (standard deviation (SD) = 15.6; range = 20–69 years); most were religious (60%). Participants’ traumatic injuries were the result of automobile, work-related, and sport/leisure accidents. Most injuries involved bone fractures (60%). Details of demographic and injury-related characteristics of the participants are shown in Table 1.

Table 1.

Demographic and injury-related characteristics of participants (N = 15).

Participant	Age, years	Gender	Religion	Accident type	Traumatic injury	Time in ICU, days
1	35	Male	No	Sport/leisure	Bone fractures	6
2	40	Male	No	Sport/leisure	Bone fractures	4
3	58	Female	Yes	Sport/leisure	Rib fractures	9
4	53	Male	Yes	Work-related	Burns	9
5	66	Female	Yes	Automobile	Bone fractures	5
6	25	Male	Yes	Sport/leisure	Bone fractures	9
7	38	Male	Yes	Work-related	Bone fractures	3
8	37	Male	Yes	Work-related	Burns	12
9	46	Female	No	Work-related	Severed fingers	6
10	28	Male	Yes	Work-related	Burns	10
11	39	Female	No	Work-related	Burns	42
12	63	Male	Yes	Automobile	Bone fractures	11
13	69	Male	Yes	Automobile	Bone fractures	8
14	20	Male	No	Sport/leisure	Bone fractures	5
15	28	Male	No	Sport/leisure	Bone fractures	4

ICU: intensive care unit.

Data collection

Data were collected from December 2018 to October 2019. Demographic and clinical characteristics of the participants were collected from patient charts. Interviews were conducted privately in the ICU at a time the participant was willing and available. Face-to-face semi-structured interviews were conducted by the first author, Y.L.T. After greeting the participant, the interviewer took a few moments to encourage the patient to focus on when they became aware of being injured and the impact of the traumatic injury on their life. Interviews were guided by the following five questions: (1) What is your experience of living in the ICU every day? (2) What do you think about? (3) What do you worry about? (4) What does the experience of being in the ICU mean to you? and (5) Is there anything else you would like to share with me? The researcher encouraged the participants to speak about their perceptions and experiences to facilitate deep reflection. When necessary, responses were followed with additional prompts to obtain more details, such as “Can you tell me more about that?” Interviews lasted between 30 and 60 min; participants were interviewed once. All the interviews were audiotaped and transcribed by Y.L.T. after completion of the interview. Data collection ceased when no new meanings emerged following analysis of the interview data; data saturation was reached after interviewing Participant 15.

Ethical considerations

This study was approved by the Institutional Review Board (IRB) of the medical center (IRB number: 1-106-05-019). Following approval of the study, Y.-L.T. approached patients who met the inclusion criteria and explained the purpose and design of the study. All participants provided signed informed consent prior to being interviewed. Patients were assured of privacy of their data and their right to withdraw from the study at any time and for any reason. We were aware that describing personal lived experiences might have emotional and psychological consequences for participants. Therefore, all patients were informed of the opportunity to receive psychological support.

Data analysis

Data analysis was conducted by the principal investigator (PI), Y.L.T., and the second author, H.H.C. Transcribed interview data were analyzed using the phenomenological approach developed by Giorgi,¹⁵ which was conducted in five steps: (1) Reading the transcript in its entirety in order to gain a sense of the whole, (2) Breaking the interview text into meaningful statements (primary meaning units), (3) Transforming meaning units into psychological statements describing how or what happened, (4) Identifying the essential features or essence of the phenomenon, and (5) Presenting a narration of the essence of the phenomenon by integrating essential features of the experience, which is the process of putting the “parts” back to constitute the “whole.” Data were synthesized by the PI, Y.L.T., and H.H.C. to express the essential structure of the lived experiences of the participants.

Rigor

Trustworthiness of the data was established by the criteria of Lincoln and Guba.¹⁸ Credibility was established by the experience of the researchers involved in data collection and analysis: Y.L.T. is an experienced registered nurse in the ICU and a PhD candidate with extensive training in conducting in-depth patient interviews and data analysis for qualitative studies; the PI and H.H.C. are accomplished nurse researchers and professors with more than 15 years’ experience in quantitative and qualitative studies. Transferability was enhanced by the thick descriptions provided by the participants and a reflective journal maintained by Y.L.T. The in-depth interviews conducted and transcribed by Y.L.T. resulted in abundant data that reflected the lived experiences of the injured patients. Member checking with participants, by providing summarized notes of each interview, enhanced credibility of the data. Peer debriefing from two PhD nurse researchers and a MD/PhD who are experts in critical care for patients in the ICU also enhanced dependability by providing feedback regarding interpretation of interview data, themes, and findings. Consensus between the PI, Y.L.T., and H.H.C. was obtained for descriptions of meaning units from significant statements, themes formed from meaning units, and the study findings, which enhanced confirmability. In addition, researchers maintained in-depth descriptions of the findings, which confirmed the research process was consistent with the results. Dependability and confirmability were further enhanced by preserving all data with an audit trail, including the interview guide, interview audiotapes, hardcopies of transcriptions, and records of data analysis.

Findings

In this study, our analysis of the data defined “body” as the impact on the lived experience of performing physical tasks; the “self” included social and spiritual experiences. Three main themes described the essence of the experience of injured patients cared for in the ICU and the impact on body and the self: (1) Searching for the meaning of the injured body, (2) Feeling trapped in the bed, and (3) The carer and the cared-for. Themes 2 and 3 were divided into subthemes as they related to either the body or the self. Themes and subthemes are summarized in Table 2.

Table 2.

Descriptions of identified themes and subthemes of injured patients’ experiences in the ICU.

Theme	Subtheme	Description
1. Searching for the meaning of the injured body		Participants examined how their injury might affect others, why they were injured, or their response to the accident, which was unrelated to their physical pain and discomfort.
2. Feeling trapped in the bed		Participants felt they no longer felt whole and experienced a loss of identity due to confinement to the ICU. They expressed worry about, “How can I return to my normal life in the past?”
	2.1. Feeling the body was trapped	The body was unable to meet the injured patients’ basic needs, due to lack of autonomy and loss of control of bodily functions.
	2.2. Feeling the self was trapped	The Self was consumed with never-ending thoughts and concerns about the past and future, how they would be as a person, and relationships with family members.
3. The carer and the cared-for		The experience of being a patient with a traumatic injury included their role as a caregiver and a care receiver.
	3.1. Being a caregiver	Participants needed care for their injury in order to fulfill caregiving roles for family members.
	3.2. Being a care receiver	Injured patients in the ICU also played the role who was being cared for.

ICU: intensive care unit.

Theme 1: Searching for the meaning of the injured body

The experience of searching for meaning of the injured body described participants trying to accept their new identity as an injured patient, which was unrelated to physical pain and discomfort. One female participant described the meaning of her injured body as causing her to feel sorry for her parents because the injury caused her body to feel broken and was not functioning properly. Her thoughts were focused on her parents’ response to her injury. She said, “My whole body was burned, damaged, and hurt after this accident. I feel I must apologize to my mother, because she gave me this body and now it is broken. I feel very, very sorry for my mother” (Participant 11).

Some participants were grateful they had survived, but their beliefs about why they survived differed. Participant 13 viewed his survival of the catastrophic event as a blessing from God. He said, “Although my body was damaged by the car accident, my life still was saved. I have had good luck, and have gained a big blessing from God.” In contrast, Participant 5 believed her accident as well as her survival was destiny, saying, “It is my fate. I am hurt; I had bad luck.”

One patient had a vivid recollection of the accident and described his self as embodied in the accident. He described his experience as follows: “The whole building caught fire. Although my body is hurting in the fire, I desperately strive to extinguish the primary fire in order to prevent injury of the other people” (Participant 4).

Some participants tried to make sense of the how-and-why of the injury and were unable to have a restful mind as they could not suppress their thoughts. Participant 8 described never-ending thoughts about these concerns, saying, “At first I was always thinking about how the event happened. Later I thought that it might be my mistake or negligence that caused the accident.”

Theme 2: Feeling trapped in the bed

Many participants felt being restricted to their beds made them feel trapped, which intensified feelings of, “How can I return to my normal life in the past?” They worried if the body or the self would ever be the same. As an injured patient in the ICU, they were unable to independently care for the body or resume their life as the self and no longer felt whole.

Subtheme 2.1. Feeling the body was trapped in the bed

Participants described the body waiting for a chance to escape from a state of uncertainty, a lack of autonomy, and a loss of control. Their body could do nothing, and its only function was to cause pain and suffering. Patients waited for the body to recover from the injuries and return to functioning in a manner that could meet their basic needs.

For some participants, the experience of the body trapped in the bed made them feel helpless and powerless. One participant, a 20-year-old college student, described the experience as causing prolonged psychological discomfort:

I only could close my eyes, hoping to fall asleep quickly. Because I only can lie down here. Apart from eating and taking medicine, I don’t know how to spend the remaining 20 hours. It makes me feel that the time is so long, and I feel very uncomfortable and uneasy. (Participant 14)

Feeling the body was trapped in the bed caused some participants to feel anxious and filled with worries. Participants were concerned their injured body would be able to function again. One patient described being afraid that the injuries from the traumatic event would cause permanent physical damage to the body and prevent a return to work:

I was anxious that both hands would not recover their normal functions, despite receiving rehabilitation. The most important thing is that the function of my hands can be restored, otherwise they can’t work. (Participant 11)

Another patient was angry about being unable to care for himself because his body was trapped in the bed, saying, “I feel that I am wasted lying in bed every day! I see that nurses are so busy caring for me, but I cannot do anything” (Participant 6).

Subtheme 2.2. Feeling the self was trapped in the bed

Although the bodies of the injured patients rested quietly in bed while trapped, the self was not at rest. The self was consumed with never-ending thoughts and concerns, and wandered from the past to the future. Participants’ thoughts sprang to mind about the role of the past self and what the self would be like in the future. This was described by a 28-year-old male, who said,

I know I can’t do anything, and escape from this hospital. It’s impossible for me to leave the ICU bed. If I had the ability to escape from the hospital, the consequences would be unimaginable. When I am not sleeping, I listen to some favorite songs, think about my past or what I expected, reflect on what I have experienced today, and ask myself what I want and what kind of person I want to be. (Participant 15)

One mother busied her mind with concerns about her children and wanted to be home to care for them. She would rather give up her body and delay the surgery to repair her severed fingers because the self was more worried about the family, her role as a mother, and her responsibilities. She said,

I never think about the length of time I need to remain in intensive care for replantation of my fingers, or the time and energy the physicians need to care for me. I miss my sons, I want to go home and not receive the replantation of my fingers now. (Participant 9)

Theme 3: The carer and the cared-for

Participants described their experience of receiving care from nurses for their injuries from two perspectives: (1) being willing to withstand treatment in order to recover and resume their role of caring for their family, and (2) being dependent on care from the nurses to help with their recovery. This overall experience was divided into two subthemes: being a caregiver and being a care receiver.

Subtheme 3.1. Being a caregiver

Participant 11 had suffered a work-related burn injury to her face and both hands. She described feeling hopeful her hands could recover first with help from an occupational therapist. Although her face had been disfigured from the injury, the patient only attended to the repair of her hands because of her responsibilities as a mother to her family. She said,

The burn injury on my face cannot be repaired. Fortunately, I still have my hands. Now the rehabilitation of the hands is the first priority, so that I can work and make money to support my family. After all, my kids are still very young, and my life still has to be sustained.

Another participant reported her stay in the ICU provided the self with insight into her relationship with her older father, who was in a nursing home. The care experienced by the patient in the ICU gave her a new perspective of how she could provide emotional support to her father and she looked forward to spending more time with him.

My father suffers from dementia. He tends to be aggressive and has attacked my mother. Therefore, he stays in the nursing home. Now I have a better understanding of my father’s feelings—the loneliness and expectations of him looking forward to our family’s visits. (Participant 9)

Subtheme 3.2. Being a care receiver

When patients were confined to their bed and immobile, their body could not function independently. They were dependent on care from nurses’ to help them perform daily bodily functions, such as eating, bathing, or eliminating. One participant described feeling frustrated while waiting for assistance from a nurse:

I wanted to get out of bed to defecate because I could not eliminate while lying on the bed. Give me some time, and just lend me a hand. I can get off (the bed) slowly. I needed to walk to the bathroom; however, I can only walk when I have a hand to help me. It depends on whether someone like you (a nurse) is willing to give me help, that’s all. (Participant 10)

Being a care receiver also had an impact on the self. Receiving care from nurses who were attentive and thoughtful about the needs of the patient inspired patients with hope for recovery.

One day when my mood was down and I was suffering and feeling distressed in the ICU, a nurse came to my bedside early in the morning to brush my teeth, wipe my face, and change my wound dressing. She was gentle and treated me well and was so kind that I felt as if we were family. Her caregiving behaviors were so gentle and careful that touched my mind. I felt I was given all the attention that was needed. (Participant 4)

Another participant described care received from a nurse allowed her to maintain her role as a mother, which brought her comfort and the resilience needed to undergo treatment:

After talking with a nurse, I felt that I was more relaxed. I think that the nurse did not only care for the physical problems, but also helped my mind feel more relaxed. I think that helped my injured body recover very soon. The nurse also helped me record a video of me and sent it to my kids so that I could have a more peaceful mind during treatment. (Participant 9)

Discussion

The findings of our study provide an understanding of the meaning of traumatic injury of the body and self for patients requiring critical care in the ICU. Our findings of the transformative experience of a traumatic injury are partly similar to the experience of a critical illness during recovery, which provided patients with a new awareness of body and self.⁴ The implications of the three themes described in the findings are compared with other related studies and literature below.

Trauma as a source of meaning

A sudden accident requiring critical care alters patients’ body functions. The experience of a traumatic injury, and how the injury disrupted a patient’s sense of the body and the self, had different meanings among the participants in our study. The patient who was more worried about the impact of her injury on her parents than her own self may be influenced by Chinese cultural beliefs. A proverb in Chinese culture states, “every hair and bit of skin” of our bodies is received from our parents.¹⁹ Damaging or injuring the body indicates a lack of respect for filial piety. The influence of traditional Chinese culture remains strong in Taiwan. Therefore, the concern Participant 11 described for her mother was because she had a filial responsibility to protect and cherish her own body.

Two other participants described the meaning of the injured body that also reflects the impact of Chinese culture on their perceptions. The traumatic injury was viewed from two different ends of the spectrum of fate: “good luck a big blessing from God” (Participant 13) and “It is my fate. I am hurt; I had bad luck” (Participant 5). Zhuangzi, an ancient Chinese philosopher, described the Taoist belief in “fate” as inevitability, which can have two situations: (1) fate as a natural inevitability and (2) fate as haplessness inevitability.²⁰ Taiwan is strongly influenced by Buddhism and Taoism. For both participants, the injured body and the disruptions of the body functions were considered as a destiny.

One other source of meaning was provided by a participant who described the self as being embodied in the experience when he reflected on the traumatic event. He wanted desperately to protect the lives of others by extinguishing the fire, regardless of the injuries sustained by his own body. This is similar to Lévinas’ embodied ethics, and the notion of “the other’s fragile face,” which is the ethical requirement to be responsible not only for protecting one’s own life, but also to risk one’s life in order to save the life of another.²¹

Accidents occur suddenly and without warning. Few studies have explored the meaning of an acute injury due to an accident from the perspective of the self. Whereas chronic long-term illness causes a continued loss of self,⁸ one might think the disruption of the self as temporary, similar to the experience of an acute illness. However, Frank²² reported his own personal experience with acute injury caused changes in the self in concert with alterations in the functions of the body; these changes also altered relationships with others, and his sense of self.²² Over the course of a chronic illness, the self needs to readjust in order to face the changes that occur,²³ and these adjustments allow one to maintain a balance between control and autonomy.²⁴ Therefore, further studies should be conducted to determine factors that influence the response of the self to a traumatic injury, and whether there are long-term effects and adjustments.

Body and self are mutually limiting or mutually enabling

The injured patients in this study coped with the difficulty of their body and self being trapped in the bed in multiple ways. Participants reported the inability to get out of bed unassisted made them feel trapped, which affected both their body and the self. Most of their time was spent waiting: waiting to fall asleep, waiting for their physiological functions to recover, and worrying if the self could return a normal life. Waiting for recovery of physiological functions is similar to patients in the ICU who waited for their voice to recover; they could not communicate due to damaged vocal cords following placement of an endotracheal tube, and these patients waited for their own familiar voice to return.²⁵ Understanding the meaning of “waiting” for patients with traumatic injuries in the ICU can increase meaningful nurse–patient communication, and can build caring relationships, which can improve healing for injured patients.²⁶ A healing relationship between nurses and patients not only provides patients with positive feelings about the body and self but is also an important component of ethical care.¹³

The experience of being trapped in the bed and waiting differed among participants. The participant who felt waiting was long and difficult experienced discomfort and uneasiness. In contrast, the participant who was able to accept the limitations of the injured body avoided feelings of discomfort. This finding echoes the findings of Charmaz⁸ who describes adapting to, rather than struggling against, an illness, or in this case an injury, can help one accept their limitations. This is also similar to the philosophy of Lévinas²¹ in which one who “waits with patience” has the ability to cope with difficulties. For the injured patients in our study, the self was trapped in continuous thoughts and worries about whether previous roles and functions could be regained. This finding is similar to the findings of Mylén et al.²⁷ for patients faced with the sudden onset of an illness. Patients believed they had lost their identity, their previous life, and worried about recovering their physical functions.

Understanding experiences of the others can help nurses provide ethical care from the perspective of the patient, which is more humanized and closer to their needs. Nurses should understand the experience of injured patients in the ICU who are restricted to their hospital bed is often one which provokes feelings that the body and the self are trapped. Nurses should use their auditory senses to pay particular attention to the true voice of the injured patient.

Ethical relationships

Relationships between nurses and patients that are “transpersonal” are a component of the caring theory described by Jean Watson,²⁸ which is characterized by a nurse’s commitment to a patient’s subjective feelings. The nurse, as the “one caring” and the patient as the “one cared-for” connect at a deep personal level that provides not only healing but also comfort. The nurse who cared for the participant who was a mother and prioritized recovery of her hands was sensitive to the mother’s desire to recover in order to return to work and sustain her family. She saw the participant as a mother first and a patient was second, which is not unusual for mothers who have a serious illness.²⁹

One participant’s relationship with her father was altered by the care she received for her traumatic injury. She gained a new perspective of her father’s loneliness and isolation living in a nursing home. Her new level of empathy helped her realize she could provide support for her father with dementia. This finding suggests that although we may not have the ability to “become others,”²¹ the experience of being well cared for might help one adopt an attitude that is “for others.”^21,30

The need for compassionate care from nurses was important for injured patients in the ICU. The nurses helped participants overcome feelings of powerlessness and helplessness. Attentive and caring nurses helped patients experience feelings of comfort and hope. These findings are similar to a report demonstrating the interactions between nurses and patients during procedures assessing their level of consciousness increased feelings of dignity and strengthened their feelings that they were respected as a person, not merely a patient.²⁷

Limitations

This qualitative study had some limitations. We only recruited patients who had not experienced a loss of consciousness and were able to communicate verbally with the interviewer. Therefore, we do not know the experience and perceptions of patients who lost consciousness following their traumatic injury or those who might have been able to communicate in a non-verbal manner. In addition, the severity of the injury of the participants varied widely, and the patients played different roles in their family. Therefore, the impacts of the traumatic injury on the patients, and their experiences and perceptions differed significantly. Finally, the researchers were unable to obtain feedback from participants on the final findings of the study because they had been discharged by the time the analysis of the interview data was completed.

Conclusion

Three main themes described the meaning of the traumatic injury for the body and the self of the patients cared for in the ICU: (1) Searching for the meaning of the injured body, (2) Feeling trapped in the bed, and (3) The carer and the cared-for. The traumatic injury was a source of meaning, which varied widely among participants. For some, the meaning of the injury was also influenced by Chinese culture. The traumatic event provided enlightenment about the self and the importance of relationships with others, as well the ability to accept the physical limitations to the body as a result of the injury. The injured patients coped with the disruption of the body and the self being trapped in the bed in multiple ways. The patient who accepted their injured body was more likely to experience hope for recovery. Nurses were important for facilitating patients’ recovery of the self and the body, which was accomplished through transpersonal relationships. Patients saw the help from nurses as a means to recover and resume their role as caregiver, which was disrupted by the injury. Other patients put themselves in the position of care receiver, to recover physical bodily functions and return to their previous self. Attentive nurses who could concern needs of the others could see the patient as a whole person, and help building healing relationship. Healing relationships between nurses and patients not only provide ethical care but can also alleviate tension between the body and self. The study findings could be used to help nurses cultivate ethical sensitivity to patients’ responses to a traumatic injury, which include injury to a patient’s sense of the body and the self. Nurses should provide respectful and ethical care not only for the body but also for the patient’s self.

Footnotes

Acknowledgements

The authors wish to express their deepest appreciation to all injured participants in this study. We extend our thanks to all nurses and doctors in the intensive care unit at Tri-Service General Hospital, Taipei, Taiwan.

Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by a grant from the Ministry of Science and Technology of Taiwan, R.O.C. (MOST 106-2629-B-016-0012).

ORCID iDs

Yu-Lun Tsai

Jen-Jiuan Liaw

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