Patients' experience while transitioning from the intensive care unit to a ward

Parents' experience of children's transitions from intensive care unit after liver transplantation: A qualitative study

OBJECTIVE

The aim of this study was to understand parents' perspectives on caring for children who underwent liver transplantation in the intensive care unit transition period and to provide a reference for the development of targeted intervention strategies.

METHODS

Thirteen parents of children who underwent liver transplantation at a tertiary hospital in Hangzhou, Zhejiang Province were chosen for in-depth semi-structured interviews via purposive sampling. The interview data were analyzed and summarized via content analysis.

FINDINGS

Three themes were extracted, including a period of separation and suffering (being apart from child is tough, chilling atmosphere, and limited family access); being an overwhelming caregiver (hope coupled with worry, conflict of roles, and existential care dilemmas); and facing a new normal: searching for information and support (information on medical conditions, post-discharge care assistance, educational support, and peer support).

CONCLUSION

For parents whose child underwent liver transplantation, the transition period from the intensive care unit to the general ward is challenging. Parents are burdened with several caregiving responsibilities and require a variety of information and support. It is advised that nurses should offer sufficient information and suitable educational approaches to enhance these parents' capacity to care for their children and assist children and their parents in making a smooth transition.

IMPLICATIONS FOR CLINICAL PRACTICE

This study highlights parents' perspectives on caring for children with liver transplants transferred from the intensive care unit to a general ward. Transitional care is strenuous, evoking different feelings before and after transfer. The health care professionals should focus on the needs and challenges faced by parents who are caring for children with liver transplants during the intensive care unit transition period. To achieve this, it is critical to establish a supportive environment and provide suitable information and education for parents to enhance their caregiving abilities.

Intensive Care Unit Without Walls

Critical illness is a continuum with different phases and trajectories. The "Intensive Care Unit (ICU) without walls" concept refers to a model whereby care is adjusted in response to the patient's needs, priorities, and preferences at each stage from detection, escalation, early decision making, treatment and organ support, followed by recovery and rehabilitation, within which all healthcare staff, and the patient are equal partners. The rapid response system incorporates monitoring and alerting tools, a multidisciplinary critical care outreach team and care bundles, supported with education and training, analytical and governance functions, which combine to optimise outcomes of critically ill patients, independent of location.

Qualitative Insights Into Patients' and Family Members' Experiences of In-Hospital Medication Management After a Critical Care Episode

Background

Patient recovery after a critical illness can be protracted, requiring a care continuum that extends along a patient pathway from the critical care unit, hospital ward, and into the community care setting. High-quality care on patient transfer from critical care, including medication safety, is facilitated by education for patients and families, family engagement, support systems, and health care professional (HCP)-patient communication. Currently, uncertainty exists regarding how HCPs can and should engage with critical care patients and family members about their medication.

Research Question

What are the views and experiences of critical care patients and family members about their involvement in, communication about, understanding of, and decision-making related to their medication after transfer from critical care to the hospital ward?

Study Design and Methods

This qualitative study used semistructured interviews, conducted with critical care patients and family members after transfer from critical care to a hospital ward in a large National Health Service hospital trust. Anonymized transcripts of interviews were analyzed thematically using a coding framework developed from understandings of patient and family engagement in medication administration.

Results

Twenty-seven participants (15 patients and 12 family members of patients) completed the interviews. We identified five themes and 15 subthemes, providing an overview of patients' and family members' views on medication management during acute illness and ongoing recovery. Themes identified were: impact of acute illness and treatment burden on preexisting illness, preexisting knowledge and capability, beliefs about persons roles and expectations, care continuity and individualized information exchange, and engagement in practice.

Interpretation

This study demonstrated that critical care patients and family members want to engage with HCPs about medication administration. HCPs must take an individualized approach to communication and timing, acknowledging the dynamic interplay between patients and family members, using multimodal forms of communication.

The chain of survival and rehabilitation for sepsis: concepts and proposals for healthcare trajectory optimization

This article describes the structures and processes involved in healthcare delivery for sepsis, from the prehospital setting until rehabilitation. Quality improvement initiatives in sepsis may reduce both morbidity and mortality. Positive outcomes are more likely when the following steps are optimized: early recognition, severity assessment, prehospital emergency medical system activation when available, early therapy (antimicrobials and hemodynamic optimization), early orientation to an adequate facility (emergency room, operating theater or intensive care unit), in-hospital organ failure resuscitation associated with source control, and finally a comprehensive rehabilitation program. Such a trajectory of care dedicated to sepsis amounts to a chain of survival and rehabilitation for sepsis. Implementation of this chain of survival and rehabilitation for sepsis requires full interconnection between each link. To date, despite regular international recommendations updates, the adherence to sepsis guidelines remains low leading to a considerable burden of the disease. Developing and optimizing such an integrated network could significantly reduce sepsis related mortality and morbidity.

Measuring the intensive care experience of intensive care unit patients: A cross-sectional study in western China

BACKGROUND

The negative experiences of intensive care unit (ICU) patients seriously affect their quality of life and survival outcomes. Thus, it is of great significance to evaluate the monitoring experience of ICU patients for the clinical improvement of their experiences and promote interventions.

OBJECTIVES

The objective of this study was to investigate patients' experiences of ICU and to understand the sources of patient experience and influencing factors.

METHODS

From November 2021 to September 2022, a cross-sectional survey was conducted with 600 inpatients from four grade A-III hospitals in western China. Data were collected using the Chinese version of the Intensive Care Experience Questionnaire.

RESULTS

585 valid questionnaires were collected, the response rate was 97.5%. ICU patients in western China scored below-the-average for their intensive care experience. Family monthly income, occupation types, medical payment method, type of ICU, ICU admission plan, ICU admission times, mechanical ventilation use, fertility status, analgesia, sedation, and Acute Physiology and Chronic Health Evaluation II scores are important factors influencing ICU patients' intensive care experience.

CONCLUSIONS

Medical staff need to pay attention to patient experience, improve the awareness of patient stressors and influencing factors, design nursing programs conducive to patient-positive experience, and promote interventions to further improve the long-term prognosis of patients. The results of this study can also be used as a set of nursing-sensitive indicators for evaluating nursing structure, process, and outcomes.

Experiences and care needs of post-discharge patients who underwent cardiac surgery: A qualitative study

AIM

This study clarifies the physical, psychological, and social forms of distress in, and care needs of, cardiac surgery patients, including optimal times for supporting them in their post-hospital discharge daily lives.

METHODS

Semi-structured qualitative interviews were conducted. Participants included 12 adults (11 male and one female, mean age = 66.5 years) who had undergone cardiac surgery, experienced intensive care, and received outpatient care at the first post-discharge visit (around 2 ~ 3 weeks after discharge), around 3 months after discharge, and between 3 months and 1 year after discharge. Verbatim transcripts were analyzed based on similarities and differences for codes based on assessment items, and subcategories and categories were generated.

RESULTS

After surgery, patients experienced physical, psychological, and social distress. First, they experienced physical pain shortly after discharge. Moreover, as they recovered at home, a gap between their sense of their recovery and the perceptions of those around them about their recovery often persisted, which led to psychological and social distress. Patients gained a sense of safety through "assurance of physical recovery" and security through "shared subjective distress."

CONCLUSIONS

Post-cardiac surgery patients seek reassurance and safety by sharing experiences owing to daily life distress. Our findings could help provide better support to meet the care needs of such patients.

Patient transfer from intensive care units to general wards: An exploratory qualitative study of ward nurses' experiences of patient safety

AIM

Patient transfer from intensive care units (ICUs) to general wards is a routine part of hospital care. However, if the transfer is not optimal, it can result in increased readmissions to the ICU, increased stress and discomfort for the patient and, thus, a threat to patient safety. The aim of this study was to explore how general ward nurses experience patient safety during patient transfers from ICUs to general wards.

DESIGN

A qualitative design based on a phenomenological approach was used.

METHODS

Two focus group interviews were conducted with a total of eight nurses from a medical ward and a surgical ward at one hospital in Norway. The data were analysed using systematic text condensation.

RESULTS

The nurses' experiences of patient safety during patient transfer had four themes: (1) the importance of preparedness; (2) the importance of the handover of information; (3) stress and a lack of resources and (4) a feeling of two different worlds.

CONCLUSION

In order to promote patient safety, the informants highlighted the importance of being well prepared for transfer, and to have optimal handover of information. Stress, lack of resources and a feeling of two different worlds may pose threats to patient safety.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

We suggest several intervention studies testing the effect of intervention improving patient safety during the transfer process are designed, and that increased knowledge in this area is used to develop local practice recommendations.

PATIENT OR PUBLIC CONTRIBUTION

The participants of this study were nurses and this contribution has been explained in the Data collection section. There was no patient contribution in this study.

ICU without borders

Critical illness is a continuum, but patient care is often fragmented. Value-based critical care focuses on the overall health of the patient, not on an episode of care. The "ICU without borders" model incorporates a concept where members of the critical care team are involved in the management of patients from the onset of critical illness until recovery and beyond. In this paper, we summarise the potential benefits and challenges to patients, families, staff and the wider healthcare system and list some essential requirements, including a tight governance framework, advanced technologies, investment and trust. We also argue that "ICU without borders" should be viewed as a bi-directional model, allowing extended visiting hours, giving patients and families direct access to experienced critical care staff and offering mutual aid when needed.

Impact of a Nurse-Driven Patient Empowerment Intervention on the Reduction in Patients' Anxiety and Depression During ICU Discharge: A Randomized Clinical Trial

OBJECTIVES

To assess the impact of a nurse-driven patient empowerment intervention on anxiety and depression of patients during ICU discharge.

DESIGN

A prospective, multicenter, randomized clinical trial.

SETTING

Three ICUs (1 medical, 1 medical and surgical, and 1 coronary) of three tertiary hospitals.

PATIENTS

Adults admitted to the ICU greater than 18 years old for greater than or equal to 48 hours with preserved consciousness, the ability to communicate and without delirium, who were randomized to receive the nurse-driven patient empowerment intervention (NEI) (intervention group [IG] or standard of care [control group (CG)]) before ICU discharge.

INTERVENTION

The NEI consisted of an individualized intervention with written information booklets, combined with verbal information, mainly about the ICU process and transition to the ward, aimed at empowering patients in the transition process from the ICU to the general ward.

MEASUREMENTS AND RESULTS

Patients completed the Hospital Anxiety and Depression Scale before and after (up to 1 wk) ICU discharge. IG ( n = 91) and CG ( n = 87) patients had similar baseline characteristics. The NEI was associated with a significant reduction in anxiety and depression ( p < 0.001) and the presence of depression ( p = 0.006). Patients with comorbidities and those without family or friends had greater reductions in anxiety and depression after the NEI. After the intervention, women and persons with higher education levels had lower negative outcomes.

CONCLUSIONS

We found that a NEI before ICU discharge can decrease anxiety and depression in critically ill survivors. The long-term effect of this intervention should be assessed in future trials.

TRIAL REGISTRATION

NCT04527627 ( https://clinicaltrials.gov/ct2/show/NCT04527627 ).