Being in a critical illness-recovery process: a phenomenological hermeneutical study

Role of Social Determinants of Health in COVID-19 Recovery: A Qualitative Study

Importance

Health systems are increasingly required to conduct health-related social needs screening. However, how social resources negatively and positively affect recovery from acute illnesses, such as COVID-19, is incompletely understood.

Objective

To examine how social determinants of health (SDOH) influence recovery from COVID-19.

Design, Setting, and Participants

In this qualitative study, patients were recruited for semistructured interviews from a post-COVID-19 pulmonary clinic at a southeastern US academic medical center between November 2022 and March 2023. Caregivers were included in dyadic interviews when available. Interviews queried participants about SDOH domains, as defined by the US Centers for Disease Control and Prevention, and their relationship with COVID-19 recovery.

Main Outcome and Measures

Phenomenologic analysis identified themes characterizing participant perspectives on the influence of SDOH on COVID-19 recovery.

Results

A total of 24 interviews were conducted: 10 (42%) with patient-caregiver dyads, 13 (54%) with patients alone, and 1 (4%) with 2 patients who also served as each other's caregiver. Most participants were female (18 patients [72%] and 6 caregivers [60%]). The median age of patients was 57 years (IQR, 44-61 years) and of caregivers was 47 years (IQR, 39-62 years). Three cross-cutting themes that overlapped SDOH domains were identified. Participants noted that innovative mobilization of social resources (eg, policies to secure income during time away from work) supported recovery from COVID-19 illness, but destabilization and change introduced by illness (eg, disrupted social support networks) and mistrust of previously established institutions (eg, public health misinformation) hindered recovery.

Conclusions and Relevance

Participants identified 3 distinct SDOH domains positively and negatively influencing recovery from COVID-19 illness. The findings suggest that longitudinal, multidomain data on SDOH are needed to best address barriers and identify resources for patients recovering from acute illness and may help determine opportunities for system- and policy-level interventions that can mitigate the influence of long-standing structural inequities on health.

The interactivity and independence of Recovery challenges and coping strategies for ICU survivors and their caregivers: a systematic review and Meta-synthesis

BACKGROUND

The post-ICU home recovery period requires patients and caregivers to confront recovery challenges and adopt coping strategies as a family dyad, necessitating effective dyadic interaction patterns. Existing qualitative research shows that the dyads face interactive or independent challenges and employs varying coping strategies, which may include strong communication or, conversely, avoidance. However, a single qualitative study alone might offer limited generalizability, and there is a lack of broader, more nuanced understanding about the recovery challenge and copings among ICU survivors and caregivers. This meta-synthesis aims to figure out the interactivity and independence of challenges and coping strategies during the recovery process for ICU survivors and caregivers.

METHODS

This is a meta-synthesis of qualitative studies, which was guided by the Stress and Coping Framework. We systematically reviewed six electronic databases, including PubMed, Medline, the Cochrane Library, CINAHL, PsycArticles, and PsycInfo, for relevant qualitative studies published from inception to January, 2024. We utilized a content analysis approach for data analysis. Presentation of this synthesis adhered to the PRISMA guideline and the ENTREQ guideline.

RESULTS

After full-text screening, 49 studies were included. Four themes with 16 sub-themes emerged from this synthesis including, interactivity of recovery challenges for ICU survivors and caregivers (subthemes: Life was turned upside down, Situational overstrain, Isolation without compassion, Empowerment conflicts, Marginalized support), independence of recovery challenges for ICU survivors and caregivers (subthemes: Recovery means silent suffering, Gap in memory, Sacrificing to caregiving), interactivity of recovery coping strategies for ICU survivors and caregivers (subthemes: Reorientation of mindset, Cultivating inner power, Sharing burden with an open-ear, Going through thick and thin together, Negotiating care level), and independence of recovery coping strategies for ICU survivors and caregivers (subthemes: Wearing a faked smile, Developing daily routine, Seeking respite).

CONCLUSIONS

The findings suggest that ICU survivors and caregivers experience overlapping yet distinct challenges during recovery, often involving shared coping strategies, alongside a need for individual space. These results support the presence of both interactivity and independence in recovery challenges and coping strategies for ICU survivors and their caregivers. Therefore, we call for future dyadic or family interventions to target both ICU survivors and caregivers, taking advantage of their interactivity and desire for gradual independence, so that fostered individualized coping strategies adapted to flexible contexts.

Patients' lived body experiences in the intensive care unit and beyond - a meta-ethnographic synthesis

INTRODUCTION

Physical therapists supporting patients in intensive care unit (ICU) rehabilitation can improve their clinical practice with insight in patients' lived body experiences.

OBJECTIVE

To gain insight in patients' lived body experiences during ICU stay and in recovery from critical illness.

METHODS

Through a comprehensive systematic literature search, 45 empirical phenomenological studies were identified. Patients' lived body experiences were extracted from these studies and synthesized following the seven-phase interpretative approach as described by Noblit and Hare.

RESULTS

Three lines of argument were illuminated: 1) "recovery from critical illness starts from a situation in which patients experience the lived body as unable;" 2) "patients experience progress in recovery from critical illness when the lived body is empowered;" and 3) "recovery from critical illness results in a lived body changed for life." Eleven third-order constructs were formulated as different kinds of bodies: 1) "an intolerable body;" 2) "an alienated body;" 3) "a powerless body;" 4) "a dependent body;" 5) "a restricted body;" 6) "a muted body;" 7) "a touched body;" 8) "a transforming body;" 9) "a re-discovering body;" 10) "an unhomelike body;" and 11) "a remembering body."

CONCLUSION

Patients' lived body experiences during ICU stay and in recovery from critical illness have richly been described in phenomenological studies and were synthesized in this meta-ethnography.

Aspiration pneumonia in nursing literature-a mapping review

Introduction

Aspiration pneumonia (AP) is an infection of the lungs caused by inhalation of material. The reported incidences vary across literature and clinical populations and is associated with high morbidity and mortality. Management of AP is best carried out by a multidisciplinary team.

Methods

This aim of this review was to collate and describe the available evidence on AP to develop a greater understanding of the concept of AP as it is represented in the nursing literature. As a collaborative team, we undertook the six stages of a systematic mapping review. We searched for the term aspiration pneumonia in 200 peer reviewed nursing journals across 10 databases, over a ten-year period (2013-2023).

Results

In this review, 293 papers were coded. Dysphagia, oral health and tube feeding emerged as the most frequent risk factors for AP, and the most reported factors for preventing this condition. Mortality was the most commonly described consequence of AP, followed by hospitalisations and morbidity. Multiple management approaches were reported including dysphagia assessment, risk evaluation, oral care and texture modification of food and fluids. The role of nurses and interprofessional collaborations were described.

Discussion

Despite limited evidence related to the topic of AP in the nursing literature, the complexity of the causes, prevention, management and consequences of AP emerged. Certain factors, such as dysphagia, oral health, and tube feeding, were described under prevention, cause and management of AP. The importance of multidisciplinary approach in the management and prevention of AP was presented.

Longing for homelikeness: A hermeneutic phenomenological analysis of patients' lived experiences in recovery from COVID-19-associated intensive care unit acquired weakness

Aims

To explore lived experiences of patients recovering from COVID‐19‐associated intensive care unit acquired weakness and to provide phenomenological descriptions of their recovery.

Design

A qualitative study following hermeneutic phenomenology.

Methods

Through purposeful sampling, 13 participants with COVID‐19‐associated intensive care unit acquired weakness were recruited with diversity in age, sex, duration of hospitalization and severity of muscle weakness. Semi‐structured in‐depth interviews were conducted from 4 to 8 months after hospital discharge, between July 2020 and January 2021. Interviews were transcribed verbatim and analysed using hermeneutic phenomenological analysis.

Results

The analysis yielded five themes: ‘waking up in alienation’, ‘valuing human contact in isolation’, ‘making progress by being challenged’, ‘coming home but still recovering’ and ‘finding a new balance’. The phenomenological descriptions reflect a recovery process that does not follow a linear build‐up, but comes with moments of success, setbacks, trying new steps and breakthrough moments of achieving mobilizing milestones.

Conclusion

Recovery from COVID‐19‐associated intensive care unit acquired weakness starts from a situation of alienation. Patients long for familiarity, for security and for recognition. Patients want to return to the familiar situation, back to the old, balanced, bodily self. It seems possible for patients to feel homelike again, not only by changing their outer circumstances but also by changing the understanding of themselves and finding a new balance in the altered situation.

Impact

Muscle weakness impacts many different aspects of ICU recovery in critically ill patients with COVID‐19‐associated intensive care unit acquired weakness. Their narratives can help nurses and other healthcare professionals, both inside and outside of the intensive care unit, to empathize with patient experiences. When healthcare professionals connect to the lifeworld of patients, they will start to act and communicate differently. These insights could lead to optimized care delivery and meeting patients' needs in this pandemic or a possible next.

The physical and mental impact of surviving sepsis - a qualitative study of experiences and perceptions among a Swedish sample

BACKGROUND

Sepsis is a critical illness with high morbidity and mortality rates. Each year, sepsis affects about 48.9 million people all over the world. This study aims to illuminate how sepsis survivors experience sepsis and the impact of sepsis, as well as the health-related quality of life thereafter.

METHODS

An interview study with eight sepsis survivors was carried out in Sweden with an inductive qualitative method. The data were analyzed with content analysis.

RESULTS

Four themes were identified during the analysis; The experience of health care and being a sepsis patient, New circumstances´ impact on life, Family and social interactions, and The psychological impact on life. The lack of information about how sepsis can impact the survivors' lives and what to expect can lead to prolonged agony. The long recovery time comes as an unexpected and unpleasant surprise to those affected. Initially, the sepsis survivors are almost euphoric that they have survived, which can later lead to chock and trauma when they realize that they could have died. This insight needs to be processed in order to reach reconciliation with life after sepsis.

CONCLUSION

Sepsis has a huge impact on both physical and mental aspects of life. Many survivors suffer from persistent residual symptoms of varying degrees, to which they have to adapt. The sepsis survivors need individually adjusted information about the sepsis recovery trajectory, and what to expect during and after the hospital stay.

Experiencias de pacientes con discapacidades funcionales posteriores al tratamiento en la Unidad de Cuidados Intensivos

Introducción: Comprender las experiencias de los pacientes con discapacidades funcionales después del tratamiento en la Unidad de Cuidados Intensivos a su regreso a casa. Materiales y métodos: Se trata de un estudio de enfoque cualitativo que utilizó el estudio de caso como método de investigación. La muestra de ocho participantes fue compuesta intencionalmente y cerrada por saturación teórica. La recolección de datos se realizó a través de entrevistas domiciliarias semiestructuradas complementadas con notas y diarios de campo. Los datos fueron analizados mediante el análisis de contenido temático propuesto por Minayo. Resultados: La atención primaria, a través de la atención domiciliaria, fue la principal responsable del seguimiento posterior al alta de los participantes. Del material empírico, surgieron las categorías "sufrimiento emocional y sus repercusiones en la recuperación funcional" y "la pérdida del rol familiar y los conflictos con los cuidadores". Discusión y conclusiones: La recuperación funcional de pacientes con discapacidades funcionales después de pasar por cuidados intensivos puede ser compleja y requiere, además de rehabilitación física, monitoreo psicoemocional adecuado, aclaración de los recuerdos de hospitalización y apoyo profesional a la familia. Se sugiere que la atención primaria reciba capacitación sobre la complejidad de estos pacientes y la creación de estrategias que lo acerquen a la atención hospitalaria, lo que permite una atención compartida y continua. Como citar este artículo: Silva, Camila Zucato; Campos, Claudinei José Gomes; Jamarim, Michelle Ferraz Martins; Lima, Gerusa Marcondes Pimentel de Abreu. Vivências de pacientes diante de incapacidades funcionais pós-tratamento em Unidade de Terapia Intensiva. Revista Cuidarte. 2020; 11(2): e1018. http://dx.doi.org/10.15649/cuidarte.1018

Insights Into the Experience of Liver Transplant Recipients With Alcoholic Liver Disease: A Descriptive Qualitative Study

Background.

Alcoholic liver disease (ALD) due to alcohol use disorder (AUD) is the primary cause of liver transplantation (LT) in the United States. Studies have found that LT recipients experience a range of physical and emotional difficulties posttransplantation including return to alcohol use, depression, and anxiety. The aim of this study is to better understand the experiences of LT recipients with ALD because they recovered posttransplant to inform the development of a patient-centered intervention to assist patients during recovery.

Methods.

Using qualitative methods, researchers conducted semi-structured interviews with 16 ALD LT recipients. The primary topics of the interview were physical recovery, mental health, substance use including alcohol and tobacco use, and financial experiences. Common patient themes were identified and coded.

Results.

Within the domain of physical health, patients stressed that undergoing LT was a near-death experience, they were helpless, changes in weight influenced their perception of their illness, and they have ongoing medical problems. In the domain of mental health, patients described cognitive impairments during their initial recovery, difficulty in processing the emotions of having a terminal condition, ongoing depression, anxiety, and irritability. The patients also described their perception of having AUD, the last time they used alcohol and their attitude to AUD treatment posttransplant. Patients also described their reliance on one member of their social support network for practical assistance during their recovery and identified one member of their medical team as being of particular importance in providing emotional as well as medical support during recovery.

Conclusions.

The patient’s description of their lived experience during the months following transplant informed the development of a patient-centered intervention that colocates behavioral health components with medical treatment that helps broaden their social network while addressing topics that emerged from this study.

The Patient's Situation During Interhospital Intensive Care Unit-to-Unit Transfers: A Hermeneutical Observational Study

Interhospital intensive care unit-to-unit transfers are an increasing phenomenon, earlier mainly studied from a patient safety perspective. Using data from video recordings and participant observations, the aim was to explore and interpret the observed nature of the patient's situation during interhospital intensive care unit-to-unit transfers. Data collection from eight transfers resulted in over 7 hours of video material and field notes. Using a hermeneutical approach, three themes emerged: being visible and invisible; being in a constantly changing space; and being a fettered body in constant motion. The patient's situation can be viewed as an involuntary journey, one where the patient exists in a constantly changing space drifting in and out of the health personnel's attention and where movements from the journey become part of the patient's body. Interhospital transfers of vulnerable patients emerge as a complex task, challenging the health personnel's ability to maintain a caring atmosphere around these patients.

Experiences of partners of intensive care survivors and their need for support after intensive care

BACKGROUND

When a relative with a critical illness is admitted to an intensive care unit (ICU), it can be a life-changing event for the partner. There is a lack of studies that focus on the partners' experiences of the time after intensive care.

AIMS AND OBJECTIVES

The aim of this study was to explore the experiences of partners of intensive care survivors and their need for support after intensive care.

DESIGN

A qualitative descriptive design was used.

METHODS

Six semi-structured interviews was conducted in Sweden and analysed using inductive content analysis with inspiration from Graneheim and Lundman.

RESULTS

Three categories emerged from the data: Being in chaos when a partner needs intensive care, Being the one who everyone depends on, and Life goes on after intensive care. The findings indicate that life goes on after intensive care even if recovery takes time, and during that time, the partners need comforting support from people around them.

CONCLUSION

Partners need extensive and continuous support from health care staff and others during and after intensive care. Intensive care leads, on the one hand, to a sense of chaos for the partner, but on the other hand, if the family relations are strengthened and the partner receives the right kind of comforting support, it can relieve the chaos and facilitate a smoother recovery path to help them view the future more positively.

RELEVANCE TO CLINICAL PRACTICE

This study can contribute knowledge that guides nurses in the ICU and at the ICU follow-up service and could also help nurses in other areas of care in communication with relatives.

Identifying patients' support needs following critical illness: a scoping review of the qualitative literature

BACKGROUND

Intensive care survivors suffer chronic and potentially life-changing physical, psychosocial and cognitive sequelae, and supporting recovery is an international priority. As survivors' transition from the intensive care unit to home, their support needs develop and change.

METHODS

In this scoping review, we categorised patients' support needs using House's Social Support Needs framework (informational, emotional, instrumental, appraisal) and mapped these against the Timing it Right framework reflecting the patient's transition from intensive care (event/diagnosis) to ward (stabilisation/preparation) and discharge home (implementation/adaptation). We searched electronic databases from 2000 to 2017 for qualitative research studies reporting adult critical care survivors' experiences of care. Two reviewers independently screened, extracted and coded data. Data were analysed using a thematic framework approach.

RESULTS

From 3035 references, we included 32 studies involving 702 patients. Studies were conducted in UK and Europe (n = 17, 53%), Canada and the USA (n = 6, 19%), Australasia (n = 6, 19%), Hong Kong (n = 1, 3%), Jordan (n = 1, 3%) and multi-country (n = 1, 3%). Across the recovery trajectory, informational, emotional, instrumental, appraisal and spiritual support needs were evident, and the nature and intensity of need differed when mapped against the Timing it Right framework. Informational needs changed from needing basic facts about admission, to detail about progress and treatments and coping with long-term sequelae. The nature of emotional needs changed from needing to cope with confusion, anxiety and comfort, to a need for security and family presence, coping with flashbacks, and needing counselling and community support. Early instrumental needs ranged from managing sleep, fatigue, pain and needing nursing care and transitioned to needing physical and cognitive ability support, strength training and personal hygiene; and at home, regaining independence, strength and return to work. Appraisal needs related to obtaining feedback on progress, and after discharge, needing reassurance from others who had been through the ICU experience.

CONCLUSIONS

This review is the first to identify the change in social support needs among intensive care survivors as they transition from intensive care to the home environment. An understanding of needs at different transition periods would help inform health service provision and support for survivors.