The patient experience of a nurse-written ICU-diary intervention: A cross sectional survey

BACKGROUND

A diary written for intensive care patients might help fill in memory gaps and promote psychological recovery. In Norway intensive care diaries are mainly authored by nurses and national recommendations ensure a systematic approach to the intervention. Studies describing the patient experience of nurse-written intensive care diaries are needed.

OBJECTIVES

The aim of this exploratory study is to investigate patientś experience of receiving and reading a nurse-written diary.

DESIGN AND SETTING

This is a cross-sectional multicentre survey among patients discharged from seven intensive care units in Norway.

RESULTS

Among the 88 patients included, 90 % were satisfied with the diary handover process. As many as 88 % of the respondents agreed that the diary demonstrated good care, helped them realize how critically ill they had been and understand why recovery takes time (76 %), and made them grateful for surviving (74 %). One third of the respondents (30 %) reported that the diary saddened them, 6 % reported that the diary reminded them of a time in their lives they would rather forget, while 17 % reported that critical events were missing in the diary. However, nearly all patients were in favour of continuing the diary intervention (98 %).

CONCLUSION

Overall, the respondents were satisfied with the nurse-written diary, the handover as well as the content, and they recommended that the intervention should be sustained.

IMPLICATIONS FOR CLINICAL PRACTICE

The handover of the diary should be tailored to meet the individual preferences of the patients in terms of timing and approach, since the diary intervention may not suit all patients. Improvements to the intervention could be a more complete narrative in the diary including both positive and critical events during the intensive care trajectory.

Recovery following discharge from intensive care: What do patients think is helpful and what services are missing?

BACKGROUND

Recovery following critical illness is complex due to the many challenges patients face which influence their long-term outcomes. We explored patients' views about facilitators of recovery after critical illness which could be used to inform the components and timing of specific rehabilitation interventions.

AIMS

To explore the views of patients after discharge from an intensive care unit (ICU) about their recovery and factors that facilitated recovery, and to determine additional services that patients felt were missing during their recovery.

METHODS

Qualitative study involving individual face-to-face semi-structured interviews at six months (n = 11) and twelve months (n = 10). Written, informed consent was obtained. [Ethics approval 17/NI/0115]. Interviews were audiotaped, transcribed and analysed using template analysis.

FINDINGS

Template analysis revealed four core themes: (1) Physical activity and function; (2) Recovery of cognitive and emotional function; (3) Facilitators to recovery; and (4) Gaps in healthcare services.

CONCLUSION

Patient reported facilitators to recovery include support and guidance from others and self-motivation and goal setting, equipment for mobility and use of technology. Barriers include a lack of follow up services, exercise rehabilitation, peer support and personal feedback. Patients perceived that access to specific healthcare services was fragmented and where services were unavailable this contributed to slower or poorer quality of recovery. ICU patient recover could be facilitated by a comprehensive rehabilitation intervention that includes patient-directed strategies and health care services.

The lived experience by patients and family members of extracorporeal membrane oxygenation: A qualitative study

OBJECTIVE

To examine the lived experience of extracorporeal membrane oxygenation (ECMO) by patients and their families, and their relationship with intensive care clinicians.

RESEARCH METHODOLOGY

Semi-structured interviews were conducted with six patients who had received ECMO and with four of their family members. The data were analysed narratively using a constant comparative method.

SETTING

Patients were treated at a major acute care hospital in British Columbia between 2014 and 2021. ECMO was used either as a bridge to recovery or to organ transplant. Four had family members bedside throughout, while two had virtual visits due to COVID-19 infection control measures.

FINDINGS

ECMO was experienced through a triad of relationships between the patient, key family members and key clinicians. The strength, directionality and focus of these relationships shifted during therapy and realigned once ECMO was removed. The largest shift involved family members. Post-ECMO, patients relied almost entirely on spouses, adult children and clinical team members to reconstruct their experience. The connection between families and clinical team members was limited and changed little.

CONCLUSIONS

The lived experience of ECMO was complex in ways yet to be comprehensively reported in the literature. This technology had particular impact on family members when ECMO was used as a bridge to transplant and where run times extended to multiple weeks. COVID-19 infection control restrictions further complicated how this technology was experienced. Findings from this study highlight the importance of intensive care nurses recognising the critical role family members play as witnesses whose experiences later allow patients to make sense of their journey post-discharge.

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.

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.