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Razban F, Arab M, Radfar A, Karzari Z, Hosseini SMA. Recall of Intensive Care Unit Stay in Critical Illness Survivors in Southeast Iran. AACN Adv Crit Care 2022; 33:23-30. [PMID: 35259222 DOI: 10.4037/aacnacc2022823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND In survivors of critical illness, recall of an intensive care unit stay plays an important role in the development of post-intensive care unit syndrome, which includes psychological impairment after intensive care unit discharge. OBJECTIVE To investigate memories of the intensive care unit among survivors in southeast Iran. METHODS In this descriptive study, the intensive care unit memory tool was used to assess patients' memories of intensive care units. RESULTS All participants (N = 100) had 1 or more factual memories (89%), memories of feelings (66%), or delusional memories (34%) from the intensive care unit. Patients who received mechanical ventilation were 4 times as likely to have delusional memories as those who did not receive mechanical ventilation. Unmarried patients were 4.8 times as likely as married patients to have memories of feelings from the intensive care unit. CONCLUSIONS Steps should be taken to minimize distressing memories of an intensive care unit admission. Follow-up programs should take into account the psychological problems faced by intensive care unit survivors.
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Affiliation(s)
- Farideh Razban
- Farideh Razban is Assistant Professor, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansoor Arab
- Mansoor Arab is Lecturer, Bam University of Medical Sciences, Bam, Iran
| | - Ali Radfar
- Ali Radfar is Assistant Professor, Faculty of Medicine, Bam University of Medical Sciences, Bam, Iran
| | - Zahra Karzari
- Zahra Karzari is Lecturer, Department of Nursing and Midwifery, Islamic Azad University, Kerman Branch, Kerman, Iran
| | - Seyed Mohsen Askari Hosseini
- Seyed Mohsen Askari Hosseini is Nurse, Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Medical University Campus, Haft-Bagh Highway, Kerman, Iran, 7616913555
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Engström Å, Juuso P, Andersson M, Nordin A, Strömbäck U. The Meaning of Critical Illness for People Suffering From COVID-19: When a Frightening Unreality Becomes Reality. QUALITATIVE HEALTH RESEARCH 2022; 32:135-144. [PMID: 34839759 PMCID: PMC8739569 DOI: 10.1177/10497323211050048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The aim of this study was to elucidate the meaning of critical illness for people with COVID-19. This study used a qualitative design. Thirteen people who were critically ill with COVID-19 during 2020 and admitted to a COVID-19 intensive care unit in northern Sweden participated in the study. Data collection was conducted as individual interviews with a narrative approach, and data were analyzed with phenomenological hermeneutic interpretation. The participants did not think they would get critically ill with this unexpected illness. They experienced terrible nightmares where their relatives had been killed, and they missed their relatives both in their dreams and in reality, as they had not been allowed to be with them due to the virus. Gratefulness was described for surviving. Participants described thoughts of not being able to imagine going through this again. They felt fear and loneliness, as a terrifying unreality had become a reality.
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Affiliation(s)
- Åsa Engström
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Lulea University of Technology, Luleå, Sweden
| | - Päivi Juuso
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Lulea University of Technology, Luleå, Sweden
| | - Maria Andersson
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Lulea University of Technology, Luleå, Sweden
- Faculty of Health, Science, and Technology, Department of Health Science, Karlstad University, Karlstad, Sweden
| | - Anna Nordin
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Lulea University of Technology, Luleå, Sweden
- Faculty of Health, Science, and Technology, Department of Health Science, Karlstad University, Karlstad, Sweden
| | - Ulrica Strömbäck
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Lulea University of Technology, Luleå, Sweden
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Fukuda T, Watanabe N, Sakaki K, Monna Y, Terachi S, Miyazaki S, Kinoshita Y. Identifying cues of distorted memories in intensive care by focus group interview of nurses. Nurs Open 2021; 9:666-675. [PMID: 34719130 PMCID: PMC8685829 DOI: 10.1002/nop2.1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/10/2021] [Accepted: 10/14/2021] [Indexed: 11/06/2022] Open
Abstract
AIM To determine cues to identify intensive care unit patients with distorted memories and related practices. DESIGN Qualitative descriptive study. METHODS Twenty nurses were included in semi-structured focus groups. Qualitative content analysis was conducted. RESULTS Cues and nursing practices related to distorted memories emerged under the following categories: "Get to know daily life before admission," "Facial expressions and behaviour are different from usual," "Pay close attention to the treatment outcome," "Notice it after the fact," "Sharing patients' intensive care unit experiences" and "Creates a new life." Nurses tried to detect distorted memories by observing the patients' facial expressions, medication effects and delirium presence during their normal lives and treatments, while trying to understand the patients' intensive care unit experiences and provide care that promotes autonomous living. This study emphasizes the importance of support for reconstructing ordinary life through communication and rehabilitation, in addition to support for medical care for distorted memories.
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Affiliation(s)
- Tomohide Fukuda
- Faculty of Nursing, Musashino University, Koto, Tokyo, Japan
| | - Naoki Watanabe
- Department of Nursing, Tokai University Hospital, Isehara,Kanagawa, Japan
| | - Kosuke Sakaki
- Department of Nursing, The Jikei University Hospital, Minato, Tokyo, Japan
| | - Yuriko Monna
- Department of Nursing, Hamamatsu University Hospital, Hamamatsu, Shizuoka, Japan
| | - Saori Terachi
- Department of Nursing, Tokai University Hospital, Isehara,Kanagawa, Japan
| | - Satoko Miyazaki
- Department of Nursing, Tokai University Hospital, Isehara,Kanagawa, Japan
| | - Yoshiko Kinoshita
- Department of Nursing, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan
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Halvorsen K, Jensen JF, Collet MO, Olausson S, Lindahl B, Saetre Hansen B, Lind R, Eriksson T. Patients' experiences of well-being when being cared for in the intensive care unit-An integrative review. J Clin Nurs 2021; 31:3-19. [PMID: 34159663 DOI: 10.1111/jocn.15910] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this integrative review was to identify facilitators and barriers to patients' well-being when being cared for in an ICU setting, from the perspective of the patients. BACKGROUND To become critically ill and hospitalised in an ICU is a stressful, chaotic event due to the life-threatening condition itself, as well as therapeutic treatments and the environment. A growing body of evidence has revealed that patients often suffer from physical, psychological and cognitive problems after an ICU stay. Several strategies, such as sedation and pain management, are used to reduce stress and increase well-being during ICU hospitalisation, but the ICU experience nevertheless affects the body and mind. DESIGN; METHODS: Since research exploring patients' sense of well-being in an ICU setting is limited, an integrative review approach was selected. Searches were performed in CINAHL, Medline, Psych Info, Eric and EMBASE. After reviewing 66 studies, 12 studies were included in the integrative review. Thematic analysis was used to analyse the studies. The PRISMA checklist for systematic reviews was used. RESULTS The results are presented under one main theme, 'Well-being as a multidimensional experience-interwoven in barriers and facilitators' and six sub-themes representing barriers to and facilitators of well-being in an ICU. Barriers identified were physical stressors, emotional stressors, environmental disturbances and insecurity relating to time and space. Facilitators were meeting physical needs and activities that included dimensions of a caring and relational environment. CONCLUSION Our main findings were that experiences of well-being were multidimensional and included physical, emotional, relational and environmental aspects, and they were more often described through barriers than facilitators of well-being. RELEVANCE FOR CLINICAL PRACTICE This integrative review has shown that it is necessary to adopt an individual focus on patient well-being in an ICU setting since physical, emotional, relational and environmental stressors might impact each patient differently.
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Affiliation(s)
| | - Janet F Jensen
- Department of Anesthesiology, Holbaek Hospital, Holbaek, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Marie O Collet
- Intensive Department, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sepideh Olausson
- Institute of Health and Care Sciences, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Berit Lindahl
- Department of Health Sciences and the Institute for Palliative Care, Medical Falucty Lund University, Lund, Sweden.,Faculty of Caring Sciences, Work Life and Social Welfare, Borås University, Borås, Sweden
| | - Britt Saetre Hansen
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Ranveig Lind
- Department of Health and Care Sciences, The Arctic University of Norway, Harstad, Norway.,Research Nurse at Intensive Care Unit, University Hospital of North Norway, Tromsø, Norway
| | - Thomas Eriksson
- Faculty of Caring Sciences, Work Life and Social Welfare, Borås University, Borås, Sweden
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Effect of Nurse-Led Consultations on Post-Traumatic Stress and Sense of Coherence in Discharged ICU Patients With Clinically Relevant Post-Traumatic Stress Symptoms-A Randomized Controlled Trial. Crit Care Med 2021; 48:e1218-e1225. [PMID: 33048906 DOI: 10.1097/ccm.0000000000004628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate the effect of nurse-led consultations on reducing post-traumatic stress symptoms and increasing sense of coherence in discharged ICU patients with clinically relevant post-traumatic stress symptoms and to identify variables associated with symptoms 12 months later. DESIGN A pragmatic nonblinded randomized controlled trial. SETTINGS Five surgical and medical ICUs at Oslo University Hospital. PATIENTS Adult patients treated in the ICU greater than or equal to 24 hours were screened with Post-Traumatic Stress Scale 10 intensive part B after ICU discharge. Those scoring greater than or equal to 25 were included in the study. INTERVENTION Patients randomized to intervention group were offered three nurse-led consultations within 2 months, and patients in the control group received standard care. MEASUREMENTS AND MAIN RESULTS Sense of Coherence Scale 13 and Post-Traumatic Stress Scale 10 intensive part B were completed after inclusion, and reevaluated after 3, 6, and 12 months. Linear mixed model for repeated measures and linear regression analyses were performed. Among 523 screened patients, 111 and 113 were randomized to intervention group and control group, respectively. Mean Post-Traumatic Stress Scale 10 intensive part B score was 37 (±10) before randomization. No differences in post-traumatic stress symptoms or sense of coherence were found between intervention group versus control group, with a mean Post-Traumatic Stress Scale 10 intensive part B score 39 (95% CI, 37-41) versus 37 (95% CI, 35-39), 32 (95% CI, 28-35) versus 32 (95% CI, 29-35), 31 (95% CI, 28-34) versus 30 (95% CI, 27-33), and 31 (95% CI, 28-34) versus 29 (95% CI, 26-33) at baseline, 3, 6, and 12 months, respectively. There was a significantly reduced Post-Traumatic Stress Scale 10 intensive part B score for both groups during the year (p = 0.001). Low sense of coherence, pain, and previous psychiatric problems were associated with increased level of post-traumatic stress symptoms at 12 months. CONCLUSIONS Nurse-led consultations did not reveal any significant effect on post-traumatic stress symptoms or sense of coherence after ICU discharge in patients with clinically relevant symptoms.
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Moi AL, Storli SL, Gjengedal E, Holme AN, Lind R, Eskerud R, Fenstad AM, Kvåle R, Halvorsen K. The provision of nurse-led follow-up at Norwegian intensive care units. J Clin Nurs 2018; 27:2877-2886. [PMID: 29633421 DOI: 10.1111/jocn.14379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe the prevalence, content and administration of intensive care unit diaries and follow-up practices offered to patients and their families in Norway. BACKGROUND Intensive care treatment has been associated with risks for new or increased health impairments affecting both patients and their families. These impairments have the potential of continuing beyond the acute phase of treatment. In parallel, preventive actions have gradually become an integrated part of critical care nursing, and in Norway, national recommendations for the use of intensive care unit diaries have been established. DESIGN AND METHODS A survey was conducted in Norwegian intensive care units offering care for adult patients, using a questionnaire asking about the frequency, administration and content of the follow-up offered to patients, their relatives, as well as bereaved family members. RESULTS Thirty-nine of 66 (59.1%) invited intensive care units answered the questionnaire. The majority (n = 33, 84.6%) of the responding units had follow-up routines. The provision of diaries was the most frequent follow-up activity (n = 24, 61.5%), and consultations postdischarge formed an integrated part of the diary practice. Consultations with bereaved were conducted in 21 (53.8%) of the intensive care units. About one quarter of the responding intensive care units had positions for follow-up nursing staff. CONCLUSION Nurse-led follow-up after critical care was a common activity in Norwegian intensive care units, comprising diaries and consultations offered to patients and family members. The follow-up was mainly driven by bottom-up processes conducted by dedicated nurses motivated by the patients' and their families' situation and feedback. RELEVANCE TO CLINICAL PRACTICE Adherence to recommendations, as well as the availability of defined positions for aftercare nurses or teams, may improve the implementation of follow-up practices and reduce suffering after discharge from Norwegian intensive care units.
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Affiliation(s)
- Asgjerd Litleré Moi
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Plastic Surgery and Burn Center, Haukeland University Hospital, Bergen, Norway
| | - Sissel Lisa Storli
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Eva Gjengedal
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Health and Social Care, Molde University College, Molde, Norway
| | - Anny Norlemann Holme
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ranveig Lind
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,University Hospital of North Norway, Tromsø, Norway
| | - Ragne Eskerud
- Intensive Care Unit, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Reidar Kvåle
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Kristin Halvorsen
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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Strandberg S, Vesterlund L, Engström Å. The contents of a patient diary and its significance for persons cared for in an ICU: A qualitative study. Intensive Crit Care Nurs 2017; 45:31-36. [PMID: 29295760 DOI: 10.1016/j.iccn.2017.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/15/2017] [Accepted: 12/11/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to describe the contents of a patient diary and its significance for persons cared for in an ICU. RESEARCH METHODOLOGY An empirical study with a qualitative design. Eight telephone interviews and one face-to-face interview were conducted with nine persons previously been treated in an ICU and been given a patient diary. In addition, the person would have read his/her diary. The data have been analysed with qualitative content analysis. FINDINGS The study identified one overarching theme; Gaining understanding, and four categories; The diary is written for me, Creating memories from the time of care, Who writes in the diary and, The ability to return to the diary. The diary meant that participants gained an understanding of their time in the ICU while they were critically ill and the diary was important to be able to return to. CONCLUSION What formerly critically ill patients appreciate most about the diary is that the diary is personally written, which makes them feel confirmed and valuable as a person. Guidelines for how and when a diary should be written and used would likely encourage critical care nurses and relatives to write in it.
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Affiliation(s)
| | | | - Åsa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technology, SE-971 87 Luleå, Sweden.
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Ednell AK, Siljegren S, Engström Å. The ICU patient diary-A nursing intervention that is complicated in its simplicity: A qualitative study. Intensive Crit Care Nurs 2017; 40:70-76. [PMID: 28233651 DOI: 10.1016/j.iccn.2016.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 11/19/2016] [Accepted: 12/03/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Writing a diary for intensive care patients has been shown to facilitate patientrecovery and prevent post-traumatic stress following hospitalisation. AIM This study aimed to describe the experiences of critical care nurses' (CCNs') in writing personal diaries for ICU patients. METHOD The study was conducted with a qualitative design. Ten CCNs from two hospitals participated. Data were collected with semi-structured interviews and analysed using a qualitative thematic content analysis. FINDINGS The result consists of a theme: Patient diary: a complex nursing intervention in all its simplicity, as well as four categories: Writing informatively and with awareness shows respect and consideration; The diary is important for both patient and CCN; To jointly create an organisation that facilitates and develops the writing; Relatives' involvement in the diary is a matter of course. CONCLUSION CCNs are aware of the diary's importance for the patient and relatives, but experience difficulties in deciding which patients should get this intervention and how to prioritize it. Writing a personal diary for an ICU patient is a nursing intervention that is complicated in its simplicity.
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Affiliation(s)
| | | | - Åsa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
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Jensen JF, Overgaard D, Bestle MH, Christensen DF, Egerod I. Towards a new orientation: a qualitative longitudinal study of an intensive care recovery programme. J Clin Nurs 2016; 26:77-90. [PMID: 27667681 DOI: 10.1111/jocn.13372] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 01/01/2023]
Abstract
AIMS AND OBJECTIVES To describe the patient experience of ICU recovery from a longitudinal perspective by analysing follow-up consultations at three time-points. BACKGROUND After a stay in the intensive care unit, patients risk physical and psychological problems during recovery. Follow-up after intensive care has emerged to aid psychological recovery, and improve health-related quality of life. More insight is needed into the mechanisms of intensive care recovery. DESIGN A descriptive multicenter longitudinal qualitative design. METHODS A subsample of 36 consultations with 12 patients strategically selected from a randomised controlled trial on intensive care recovery from 10 Danish intensive care units. Data were generated during an ICU recovery programme including three consultations (at 1-3, 4-5, 9-11 months). First consultation was face-to-face using patient photographs to aid memory. Second and third consultations were by telephone using reflection sheets to focus dialogue. Thematic analysis and narrative theory were used to explore mechanisms of recovery using audio-recordings of consultations, patient photographs and reflection sheets as the sources of data. RESULTS The basic narrative of recovery was 'toward a trajectory of new orientation'. This narrative contained the chronological narratives of being 'at death's door', 'still not out of the woods' and 'on the road to recovery'. The road to recovery was described as downhill, steady-state or progressive. New orientation was obtained in steady-state or progressive recovery. CONCLUSIONS This study provides a contemporary understanding of the process of intensive care recovery. Recovery evolves through narratives of mortal danger, risk of relapse and moving forward towards a new orientation in life. RELEVANCE TO CLINICAL PRACTICE These findings enable health care professionals to understand what patients experience during stages of recovery. This is important to improve health care professionals in the assessment of long-term outcome, and management of patients after intensive care.
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Affiliation(s)
- Janet F Jensen
- Department of Anesthesiology, Nordsjaellands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Dorthe Overgaard
- Research Unit, Nordsjaellands Hospital, Hillerød, Denmark.,Department of Nursing, Metropolitan University College, Copenhagen, Denmark
| | - Morten H Bestle
- Intensive Care Medicine, Department of Anesthesiology, Nordsjaellands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Doris F Christensen
- Intensive Care Medicine, Department of Anesthesiology, Nordsjaellands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Ingrid Egerod
- Rigshospitalet, Neurointensive Care Unit 2093, University of Copenhagen, Copenhagen, Denmark
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