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Rohr M, Weiß A, Bein T, Bernardi C, Brandstetter S, Drewitz KP, Fisser C, Loss J, Malfertheiner M, Apfelbacher C. Experiences, opinions and expectations of health care providers towards an intensive care unit follow-up clinic: Qualitative study and online survey. Intensive Crit Care Nurs 2021; 67:103084. [PMID: 34304978 DOI: 10.1016/j.iccn.2021.103084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/17/2021] [Accepted: 05/01/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Independent of the underlying disease, intensive care unit survivors often suffer from cognitive, physical and mental impairments, also known as post-intensive care syndrome (PICS). Specific follow-up services are recommended for these patients. This study aims to capture the perspectives of health care providers on the development of the first intensive care unit follow-up-clinic in Germany. RESEARCH METHODOLOGY A qualitative study with six focus groups (n = 41) and six expert interviews, followed by a quantitative survey was conducted, involving nine different professions. Qualitative and quantitative data were analysed using thematic analysis and descriptive statistics, respectively. FINDINGS Participants described aftercare of former intensive care unit patients as complex and appreciated the idea of an intensive care unit follow-up clinic to improve continuity of care and multidisciplinary collaboration. The favoured model combined diagnostics and targeted referral of patients to specialists and therapists with the provision of information. In the survey, participants disagreed on how to implement this referral system but agreed that assessments should be multidimensional. CONCLUSION The necessity of and important criteria for the design of an intensive care unit follow-up clinic were identified. We will integrate these data with further evidence to develop a concept for a complex intervention.
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Affiliation(s)
- Magdalena Rohr
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
| | - Annette Weiß
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany; Bavarian Care and Nursing Authority, Amberg, Germany.
| | - Thomas Bein
- Department of Anesthesia & Operative Intensive Care, University Hospital Regensburg, Regensburg, Germany.
| | - Christine Bernardi
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
| | - Susanne Brandstetter
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany; University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Regensburg, Germany.
| | - Karl Philipp Drewitz
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany; Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany.
| | - Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
| | - Julika Loss
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
| | | | - Christian Apfelbacher
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany; Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany; Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore.
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[Post-intensive care syndrome]. Rev Med Interne 2021; 42:855-861. [PMID: 34088516 DOI: 10.1016/j.revmed.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/29/2021] [Accepted: 05/09/2021] [Indexed: 11/23/2022]
Abstract
Post-intensive care syndrome is an entity defined in 2010 and covering any sequelae following an extended hospitalization in intensive care unit. It comprises psychological, cognitive and physical disorders (neuromyopathy, respiratory dysfunction, joint stiffness, among others). These sequelae have important consequences on autonomy and quality of life of these patients, as well as on their healthcare consumption and on mortality. Psychological sequelae can also be seen in hospitalized patients' relatives. Screening and management of these disorders is more and more frequent but no method has formally proven effective. The number of patients surviving an intensive care unit hospitalization is increasing, and management of post-intensive care syndrome is a major issue. It seems important that the internist be aware of this syndrome, given his pivotal role in global management of patients and frequent implication into care after the intensive care unit.
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Teixeira C, Rosa RG. Post-intensive care outpatient clinic: is it feasible and effective? A literature review. Rev Bras Ter Intensiva 2018; 30:98-111. [PMID: 29742221 PMCID: PMC5885237 DOI: 10.5935/0103-507x.20180016] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/05/2017] [Indexed: 11/20/2022] Open
Abstract
The follow-up of patients who are discharged from intensive care units follows
distinct flows in different parts of the world. Outpatient clinics or
post-intensive care clinics represent one of the forms of follow-up, with more
than 20 years of experience in some countries. Qualitative studies that followed
up patients in these outpatient clinics suggest more encouraging results than
quantitative studies, demonstrating improvements in intermediate outcomes, such
as patient and family satisfaction. More important results, such as mortality
and improvement in the quality of life of patients and their families, have not
yet been demonstrated. In addition, which patients should be indicated for these
outpatient clinics? How long should they be followed up? Can we expect an
improvement of clinical outcomes in these followed-up patients? Are outpatient
clinics cost-effective? These are only some of the questions that arise from
this form of follow-up of the survivors of intensive care units. This article
aims to review all aspects relating to the organization and performance of
post-intensive care outpatient clinics and to provide an overview of studies
that evaluated clinical outcomes related to this practice.
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Affiliation(s)
- Cassiano Teixeira
- Centro de Tratamento Intensivo de Adultos, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Regis Goulart Rosa
- Centro de Tratamento Intensivo de Adultos, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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Jónasdóttir RJ, Jones C, Sigurdsson GH, Jónsdóttir H. Structured nurse-led follow-up for patients after discharge from the intensive care unit: Prospective quasi-experimental study. J Adv Nurs 2017; 74:709-723. [DOI: 10.1111/jan.13485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Rannveig J. Jónasdóttir
- Faculty of Nursing; School of Health Sciences; University of Iceland; Reykjavik Iceland
- Intensive Care Units; Landspitali - The National University Hospital 101 Reykjavik; Iceland
| | - Christina Jones
- Institute of Ageing and Chronic Disease; Faculty of Health & Life Sciences; University of Liverpool; Liverpool UK
| | - Gisli H. Sigurdsson
- Faculty of Medicine; School of Health Sciences; University of Iceland; Vatnsmýrarvegur 16, 101 Reykjavík Iceland
- Intensive Care Units; Landspitali - The National University Hospital 101 Reykjavik; Iceland
| | - Helga Jónsdóttir
- Faculty of Nursing; School of Health Sciences; University of Iceland; Reykjavik Iceland
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Jónasdóttir RJ, Klinke ME, Jónsdóttir H. Integrative review of nurse-led follow-up after discharge from the ICU. J Clin Nurs 2015; 25:20-37. [DOI: 10.1111/jocn.12939] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Rannveig J. Jónasdóttir
- Faculty of Nursing; University of Iceland; Reykjavik Iceland
- Intensive Care Unit; Landspítali The National University Hospital of Iceland; Reykjavik Iceland
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Haraldsson L, Christensson L, Conlon L, Henricson M. The experiences of ICU patients during follow-up sessions--a qualitative study. Intensive Crit Care Nurs 2015; 31:223-31. [PMID: 25724102 DOI: 10.1016/j.iccn.2015.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Evidence supports the recommendation for follow-up session(s) for patients after discharge from an intensive care unit (ICU). The aim of these follow-up sessions is to allow patients to express and discuss their experiences and problems following their time in an ICU. To optimise the knowledge gained from the follow-up session experience, it is necessary to describe how patients experience these sessions. The aim of this study was to describe how ICU-patients, experience a follow-up session. DESIGN/SETTING This study adopted a qualitative design utilising semi-structured interviews, and which examined the experiences of seven men and five women. Qualitative content analysis was utilised. FINDINGS The participants stated that the information gained from these sessions, which had previously seemed unclear to some of them, was, on the whole, now clarified and confirmed. A discernible difference was found between participants who were cared for on a general ward and those who were cared for on a rehabilitation ward and also were offered a meeting with a counsellor, following discharge their from the ICU. The findings also indicated that participants who were not offered psychosocial support showed a greater need for a follow-up session. CONCLUSION This study has highlighted the need for increasing collaboration between intensive care staff and staff in other units to provide support to this patient group in order to reduce their suffering post intensive care experience.
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Affiliation(s)
- Lena Haraldsson
- School of Health Sciences, Jönköping University, Box 1026, SE-551 11 Jönköping, Sweden.
| | - Lennart Christensson
- School of Health Sciences, Jönköping University, Box 1026, SE-551 11 Jönköping, Sweden.
| | - Lisa Conlon
- School of Health Sciences, Jönköping University, Box 1026, SE-551 11 Jönköping, Sweden
| | - Maria Henricson
- School of Health Sciences, Jönköping University, Box 1026, SE-551 11 Jönköping, Sweden.
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Engström Å, Rogmalm K, Marklund L, Wälivaara BM. Follow-up visit in an ICU: receiving a sense of coherence. Nurs Crit Care 2015; 23:308-315. [PMID: 25690677 DOI: 10.1111/nicc.12168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 11/25/2014] [Accepted: 01/22/2015] [Indexed: 01/03/2023]
Abstract
AIM To describe patients' experiences of a follow-up visit to an intensive care unit (ICU) after being critically ill and nursed there. BACKGROUND Knowledge about the follow-up visit needs to be developed, with the previously critically ill patient in focus. DESIGN Qualitative descriptive. METHOD Semi-structured interviews were conducted with nine patients and analysed using qualitative content analysis. The data collection occurred during spring 2014. FINDINGS During the follow-up visits in ICU, the relatives, the patient diary, and those who took part in the care contribute to fill memory gaps to create a picture and an explanation of the care period. CONCLUSION The follow-up visit is an important tool in the patients' struggle to create a context and coherence from a missing or unreal time. The patient diary is essential to subsequently be able to relate to the period of care. RELEVANCE TO CLINICAL PRACTICE The follow-up visit, together with a personal diary, after an ICU stay could be seen as significant for strengthening the patients' feeling of coherence and better health.
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Affiliation(s)
- Åsa Engström
- Associate Professor, Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | | | | | - Britt-Marie Wälivaara
- Senior Lecturer, Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
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Glimelius Petersson C, Bergbom I, Brodersen K, Ringdal M. Patients' participation in and evaluation of a follow-up program following intensive care. Acta Anaesthesiol Scand 2011; 55:827-34. [PMID: 21658020 DOI: 10.1111/j.1399-6576.2011.02474.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients' difficulties following critical illness and the willingness of intensive care units (ICU) to take an expanded responsibility during the recovery period have led to the development of different follow-up programs. The aim of this study was to explore and describe patients' participation in and evaluation of a follow-up program at a nurse-led clinic (NLC). METHODS Patients with a length of stay ≥72 h, discharged from the ICU, participated in a follow-up program based on three contacts, as a visit to the NLC, telephone contact, ward visit or as an indirect contact, during a 6-month period. A specially developed database recorded information regarding patients' participation and questionnaires were used to obtain patients' views of the follow-up program. RESULTS Of 96 study patients, 51% visited the NLC once or twice. These patients were younger (P<0.001) and had lower Acute Physiology and Chronic Health Evaluation II (P=0.017) compared with those who did not visit the clinic. The most common reason for not visiting the clinic was not enough strength, chiefly physical. In the evaluation, patients answered that they received advice and information, an opportunity to talk, increased knowledge and re-evaluated memories and experiences from the ICU stay. Patients appreciated the follow-up and expressed gratitude to the competent and obliging staff. CONCLUSION The current follow-up program, adjusted to individual patients' conditions and needs in terms of different types of contacts and continuity, was found to be of great value. Effects of the program other than the patient perspective are also relevant to evaluate.
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Williams TA, Leslie GD. Challenges and possible solutions for long-term follow-up of patients surviving critical illness. Aust Crit Care 2011; 24:175-85. [PMID: 21514838 DOI: 10.1016/j.aucc.2011.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/17/2011] [Accepted: 03/23/2011] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Surviving critical illness can be life-changing and present new healthcare challenges for patients after discharge from hospital. Optimisation of recovery, rather than mere survival, is an important goal of intensive care. Observational studies have identified decreased quality of life and increased healthcare needs for survivors but loss to follow-up can be high with possible selection bias. Patients in need of support may therefore not be included in study results or allocated appropriate follow up support. AIM To examine the frequency and reasons patients admitted to general ICUs who survive critical illness are excluded from study participation or lost to follow-up and consider the possible implications and solutions. METHOD The literature review included searches of the MEDLINE, EMBASE, and CINAHL databases. Studies (2006-2010) were included if they described follow-up of survivors from general ICUs. RESULTS Ten studies were reviewed. Of the 3269 eligible patients, 14% died after hospital discharge, 27% declined, and 22% were lost to follow-up. Reasons for loss to follow-up included no response, inability to contact the patient, too ill or admitted to another facility. CONCLUSION The most appropriate method of care follow-up has yet to be established but is likely to involve an eclectic model that tailors service provision to support individual patient needs. Identifying methods to minimise loss to follow-up may enhance interpretation of patients' recovery, lead to improvements in clinical practice and inform healthcare service decisions and policy.
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Affiliation(s)
- Teresa A Williams
- School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, Western Australia, Australia.
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Salmond SW, Evans B, Hamdi HA, Saimbert MK. A systematic review of relocation stress following in-house transfer out of critical/intensive care units. ACTA ACUST UNITED AC 2011; 9:2684-2777. [PMID: 27820458 DOI: 10.11124/01938924-201109610-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
EXECUTIVE SUMMARY Objective The objective was to conduct a mixed methods systematic review to determine the occurrence and meaningfulness of relocation stress and the effectiveness of strategies for decreasing transfer anxiety in patients and their families upon transfer from an intensive care unit to a non-intensive care unit and to offer evidence-based recommendations for best practice.Inclusion criteria The review included quantitative and qualitative studies where the participants were adult intensive care patients, family members of adult intensive care patients, intensive care nurses caring for the adult critically ill patient, and ward/unit nurses receiving transfer patients from the ICU (intensive care unit). Studies examining the transfer experience for infants, children or psychiatric patients were excluded from this review.Search strategy The search strategy sought to find both published and unpublished studies and papers limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of text words contained in the title and abstract, and of index terms to describe the article. A second extensive search was then undertaken using identified key words and index terms.Methodological quality Each paper was assessed by two independent reviewers for quality prior to inclusion in the review using the Joanna Briggs Critical Appraisal Tools for experimental, cohort, descriptive, qualitative and expert text papers. Disagreements were discussed and resolved among the reviewers without needing to rely on a third reviewer.Data collection Information was extracted from each paper independently by two reviewers using the JBI extraction tools for quantitiative, qualitaitive and expert opinion papers and narrative table summaries were prepared.Data synthesis Data synthesis aimed to portray an accurate interpretation and synthesis of concepts arising from the experiences of patients and families transferring out of ICU and the nurses on the receiving and sending ends of the transfer.Results A total of 35 studies were identified and of those 25 were included in the review consisting of 15 qualitative studies, 9 quantitative studies and 1 clinical practice guideline. Qualitative papers were analyzed using JBI-QARI and involved categorizing findings and developing synthesized topics from the categories. Three syntheses were developed related to response to transfer, meaning of transfer, and strategies to facilitate successful transfer. Quantitative data could not be pooled and is presented in the narrative table.Conclusion For most, transfer to the general unit was not a traumatic or negative experience but viewed positively as a sign of recovery and sometimes the positive emotions coexisted with uncertainty or fear. The most negative experience was related to lack of observation and care on the general unit where nurses many times were unaware or unresponsive to functional deficits that the patients required assistance with. Patients were consequently challenged to do more for themselves and depending on their success or progress with independence resulted in growing confidence or frustration and embarrassment. The systems of care were not structured to effectively deal with the complex ICU transfer patient.Implications for practice Specific practice recommendations are made for pretransfer from ICU, system improvements to facilitate transfer and posttransfer care while on the general unit.Implications for research Additional research is needed to confirm the frequency of negative relocation stress, test efficacy of direct interventions and explore the meaning of transfer for family members.
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Affiliation(s)
- Susan Warner Salmond
- 1. University of Medicine and Dentistry of New Jersey, The New Jersey Center for Evidence-Based Nursing: a collaborating centre of the Joanna Briggs Institute 2. Bergen Pines Regional Medical Center
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Abstract
AIM The aim of this study was to describe critical care nurses' experiences of follow-up visits for formerly critically ill people discharged from an intensive care unit and their close relatives. BACKGROUND The critical illness experience affects the ill person and their close relatives not only during the stay in an intensive care unit, but also for a long time afterwards. Follow-up visits were introduced to offer people the opportunity to talk about their experiences. This activity has not been studied earlier from the perspective of critical care nurses. DESIGN The design of this study was qualitative. METHOD Eight critical care nurses narrated their experiences of follow-up visits by formerly critically ill people and their close relatives to an intensive care unit. Data were collected during 2007-2008. Qualitative thematic content analysis was applied to the interview texts. RESULTS The findings show that to feel they were doing a good job it was vital for the critical care nurses to be well prepared for the follow-up visits. It was difficult, in a positive way, to recognise formerly critically ill people when they returned looking healthy. The critical care nurses were disappointed that their former patients remembered so few real events. The follow-up visits gave the critical care nurses a new picture of how the critically illness experience influenced the former patient's everyday life during and after their stay in the intensive care unit and how it affected the lives of their close relatives. CONCLUSIONS Through sharing the experiences of formerly critically ill peoples' and their close relatives' critical care nurses receive valuable feedback about their work. RELEVANCE TO CLINICAL PRACTICE Receiving feedback about one's work from follow-up visits gives critical care nurses the possibility for to evaluate given care. Follow-up visits to intensive care units can provide them with valuable knowledge that might lead to improved nursing care.
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Affiliation(s)
- Asa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technolog, Luleå, Sweden.
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Gjengedal E, Storli SL, Holme AN, Eskerud RS. An act of caring - patient diaries in Norwegian intensive care units. Nurs Crit Care 2010; 15:176-84. [PMID: 20626794 DOI: 10.1111/j.1478-5153.2010.00402.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to obtain more knowledge about the background, extent and implementation of diaries in Norwegian intensive care units (ICUs) providing mechanical ventilation to adult patients. BACKGROUND The growing understanding of long-term consequences of intensive care therapy has compelled nurses to introduce patient diaries to prevent problems after discharge from ICU. Research on this practice is limited. DESIGN/METHOD The study had a qualitative descriptive design, and was conducted by means of semi-structured telephone interviews with 30 participants, all experienced intensive care nurses. The strategy of analysis was a template organizing style. FINDINGS The findings show that 31 out of 70 ICUs offer patient diaries, and many units have a long history of diary writing. Most of the units have some kind of guidelines, and the study has shown that diaries serve dual purposes; one of caring and another of therapy. Although these two dimensions seemingly present a paradox from a theoretical point of view, a combination appears to be at work in clinical practice. This may be explained by a tendency in nursing to regard caring as superior to therapy. The writing frequency varies, and the units that reported high activity provided follow-up programs in addition to diary writing. Diary writing as a nursing intervention is threatened by a lack of funding.
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Affiliation(s)
- Eva Gjengedal
- Section of Nursing Science, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
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Williams TA, Leslie GD, Brearley L, Dobb GJ. Healthcare Utilisation among Patients Discharged from Hospital after Intensive Care. Anaesth Intensive Care 2010; 38:732-9. [DOI: 10.1177/0310057x1003800417] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surviving critical illness can be life-changing and presents new healthcare challenges for patients after hospital discharge. This feasibility study aimed to examine healthcare service utilisation for patients discharged from hospital after intensive care unit stay. Following Ethics Committee approval, patients aged 18 years and older were recruited over three months. Those admitted after cardiac surgery, discharged to another facility or against medical advice were excluded. Patients were informed of the study by post and followed-up by telephone at two and six months after discharge. General practitioners were also contacted (44% responded). Among 187 patients discharged from hospital, 11 died, 25 declined to participate and 39 could not be contacted. For 112 patients (60%) who completed a survey, the majority (82%) went home from hospital and were cared for by their partner (53%). More than half of the patients (58%) reported taking the same number of medications after intensive care unit stay but 30% took more (P=0.023). While there was no change in the number of visits to the general practitioner for 64% of patients, 29% reported an increase after intensive care unit stay. At six months, 40% of responders who were not retired were unemployed. Discharge summary surveys revealed 39 general practitioners (71%) were satisfied with details of ongoing healthcare needs. Twenty-one general practitioners wrote comments: 10 reported insufficient information about ongoing needs/rehabilitation and two reported no mention of intensive care unit stay. Survivors of critical illness had increased healthcare needs and despite most returning home, had a low workforce participation rate. This requires further investigation to maximise the benefits of survival from critical illness.
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Affiliation(s)
- T. A. Williams
- Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia, Australia
- Adjunct Research Fellow, Curtin Health Innovation Research Institute, Curtin University and Nurse Researcher Critical Care Division, Royal Perth Hospital
| | - G. D. Leslie
- Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia, Australia
- Professor, Critical Care Nursing, Curtin Health Innovation Research Institute, Curtin University and Royal Perth Hospital
| | - L. Brearley
- Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia, Australia
- Nursing Director, Critical Care Division
| | - G. J. Dobb
- Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia, Australia
- Head of Department and Senior Intensivist, Critical Care Division, Royal Perth Hospital and School of Medicine and Pharmacology, The University of Western Australia
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Samuelson KAM, Corrigan I. A nurse-led intensive care after-care programme - development, experiences and preliminary evaluation. Nurs Crit Care 2009; 14:254-63. [DOI: 10.1111/j.1478-5153.2009.00336.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Prinjha S, Field K, Rowan K. What patients think about ICU follow-up services: a qualitative study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:R46. [PMID: 19338653 PMCID: PMC2689490 DOI: 10.1186/cc7769] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 01/15/2009] [Accepted: 04/01/2009] [Indexed: 11/24/2022]
Abstract
Introduction UK policy recommendations advocate the use of intensive care unit (ICU) follow-up services to help detect and treat patients' physical and emotional problems after hospital discharge and as a means of service evaluation. This study explores patients' perceptions and experiences of these services. Methods Thirty-four former ICU patients were recruited throughout the UK, using maximum variation sampling to achieve as broad a range of experiences of the ICU as possible. Participants were interviewed at home by a qualitative researcher unconnected to their hospital care. Interviews were recorded and transcribed for analysis. We report a qualitative thematic analysis of patients' experiences of ICU follow up. Results Former patients said they valued ICU follow-up services, which had made an important contribution to their physical, emotional and psychological recovery in terms of continuity of care, receiving information, gaining expert reassurance and giving feedback to ICU staff. Continuity of care included having tests and being monitored, referrals to other specialists and ICU follow-up appointments soon after hospital discharge. Information about physical, emotional and psychological recovery was particularly important to patients, as was information that helped them make sense of their ICU experience. Those without access to ICU follow-up care often felt abandoned or disappointed because they had no opportunity to be monitored, referred or get more information. Conclusions Former patients value having ICU follow-up services but many found that their healthcare needs were unmet because hospitals were unable to provide the aftercare they required. Most participants were aware of the financial constraints on the health system. Although they valued ICU follow-up care, they did not want it to continue indefinitely, with many of them declining appointment invitations when they themselves felt they no longer needed them.
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Affiliation(s)
- Suman Prinjha
- DIPEx Research Group, Department of Primary Health Care, University of Oxford, Rosemary Rue Building, Old Road Campus, Headington, Oxford OX3 7LF, UK.
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Storli SL, Lind R. The meaning of follow-up in intensive care: patients’ perspective. Scand J Caring Sci 2009; 23:45-56. [DOI: 10.1111/j.1471-6712.2007.00589.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Re-visiting the ICU Experiences of follow-up visits to an ICU after discharge: a qualitative study. Intensive Crit Care Nurs 2008; 24:233-41. [PMID: 18434156 DOI: 10.1016/j.iccn.2008.03.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Revised: 03/07/2008] [Accepted: 03/12/2008] [Indexed: 11/20/2022]
Abstract
The aim of this study is to describe how people who have been critically ill, and their close relatives experience a post-discharge, follow-up visit to the intensive care unit (ICU) that provided the care. There is a lack of studies from such a standpoint. The study design is qualitative. A total of 18 adults participated; nine had been critically ill and nine were close relatives, all made a post-discharge follow-up visit to an ICU in the northern part of Sweden. The study data was collected through personal interviews, conducted after the follow-up visit, using a narrative approach. The data were then subjected to qualitative thematic content analysis which resulted in four themes: receiving strength from returning together; making sense of the critical-illness experience; feeling grateful to have survived and the possibility of improving the care. People who had been critically ill and close relatives felt that returning together was valuable. Meeting the staff, with whom participants felt they had developed a relationship, made it possible for them to express their gratitude for the treatment and nursing care received, and to suggest improvements. The interviews revealed that the follow-up visit was seen as an important way of learning what had happened and why during the period of critical illness.
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Williams TA, Leslie GD. Beyond the walls: A review of ICU clinics and their impact on patient outcomes after leaving hospital. Aust Crit Care 2008; 21:6-17. [DOI: 10.1016/j.aucc.2007.11.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 10/30/2007] [Accepted: 11/21/2007] [Indexed: 01/21/2023] Open
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Patient empowerment: does it still occur in the ICU? Intensive Crit Care Nurs 2007; 23:156-61. [PMID: 17412592 DOI: 10.1016/j.iccn.2006.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Revised: 03/06/2006] [Accepted: 03/08/2006] [Indexed: 11/21/2022]
Abstract
The theoretical underpinnings of patient empowerment were developed through the work of educators and community psychologists, working primarily with the socially disadvantaged. Empowerment is seen as a philosophy based upon the belief of the inherent worth and creative potential of each individual. Therefore, the aim of this paper is to explore whether this creative potential associated with patient choice that encapsulates empowerment is applicable to the Intensive Care Unit.
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Chaboyer W, Gillespie B, Foster M, Kendall M. The impact of an ICU liaison nurse: a case study of ward nurses’ perceptions. J Clin Nurs 2005; 14:766-75. [PMID: 15946285 DOI: 10.1111/j.1365-2702.2005.01141.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To provide a description of ward nurses perceptions of the intensive care unit liaison nurse role. BACKGROUND Critical care outreach services have become commonplace over recent years. In Australia, the intensive care unit liaison nurse, developed at a local level by healthcare providers, has emerged as a way of improving the continuity of care offered to this patient group. As a relatively new development in critical care services, evaluation of this role has been limited, particularly in relation to the perceptions of ward nurses who receive patients on discharge from intensive care unit. DESIGN Case study of one Australian hospital that utilizes an intensive care unit liaison nurse. METHODS Ten ward nurses were purposefully selected for their representativeness of the population and for their experience with the intensive care unit liaison nurse role. Each of these nurses participated in semi-structured in-depth interviews. Thematic analysis was used to analyse the data. FINDINGS Three major themes emerged from the interviews, highlighting role behaviours, contextual demands and outcomes associated with the intensive care unit liaison nurse role. The role behaviours of the liaison nurse included the professional characteristics of the individual and the primacy of clinical liaison as a role descriptor. Contextual demands were environmental characteristics relevant to providing patient, family and staff support. Outcomes of the role were perceived to include environmental preparation and education. CONCLUSIONS This qualitative study has presented an overview of ward nurses perceptions of the intensive care unit liaison nurse role within one Australian hospital, illustrating the educative and empathic support that the liaison nurse role can provide to ward nurses. RELEVANCE TO CLINICAL PRACTICE Collaboration with ward nurses in developing specialist roles such as the intensive care unit liaison nurse is essential in ensuring improvements in patient and family care across the continuum.
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Affiliation(s)
- Wendy Chaboyer
- Research Centre for Clinical Practice Innovation, Griffith University, Bundall, Qld, Australia.
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