1
|
Heim R, Satink T, van Nes F. "Standing alone": understanding the self-management of family caregivers of persons post-stroke at the time of acute care. Disabil Rehabil 2024; 46:2871-2879. [PMID: 37461245 DOI: 10.1080/09638288.2023.2236020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 07/07/2023] [Indexed: 06/20/2024]
Abstract
PURPOSE To support family caregivers of persons post-stroke adequately from the start and to develop self-management interventions, we aim to gain a better understanding of family caregivers experiences at the time of acute care and therefore achieve a better understanding of how they manage their new situation. METHODS AND MATERIALS We chose a qualitative descriptive methodology using individual semi-structured interviews with eleven family caregivers of persons post-stroke. We conducted interviews retrospectively, between 2 and 10 months post-stroke, and analysed transcripts using thematic analysis. RESULTS The themes (1) being in survival mode, (2) feeling supported by family and friends, (3) feeling left alone by the treatment team and (4) insisting on information emerged from the data. CONCLUSION During acute care, many self-management skills are required from family caregivers but are just starting to be developed. This development can first be observed as co-management with the social network and is often combined with shared decision-making. Information-sharing, foundational for developing self-management, is essential for family caregivers and should be supported proactively by health professionals from the beginning. Further, from the start, health professionals should raise awareness about role changes and imbalances of activities among family caregivers to prevent negative influences on their health.
Collapse
Affiliation(s)
- Romana Heim
- Cantonal Hospital Winterthur, Institute of Therapy and Rehabilitation, Occupational Therapy, Winterthur, Switzerland
- Faculty of Health, European Master of Science in Occupational Therapy, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Ton Satink
- Faculty of Health, European Master of Science in Occupational Therapy, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Researchgroup Neurorehabilitation - Self-regulation and Participation, HAN_University of Applied Sciences, Nijmegen, Netherlands
| | - Fenna van Nes
- Faculty of Health, European Master of Science in Occupational Therapy, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| |
Collapse
|
2
|
Wendlandt B, Edwards T, Hughes S, Gaynes BN, Carson SS, Hanson LC, Toles M. Novel Definitions of Wellness and Distress among Family Caregivers of Patients with Acute Cardiorespiratory Failure: A Qualitative Study. Ann Am Thorac Soc 2024; 21:782-793. [PMID: 38285875 PMCID: PMC11109912 DOI: 10.1513/annalsats.202310-904oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/24/2024] [Indexed: 01/31/2024] Open
Abstract
Rationale: Family caregivers of patients with acute cardiorespiratory failure are at high risk for distress, which is typically defined as the presence of psychological symptoms such as anxiety, depression, or posttraumatic stress. Interventions to reduce caregiver distress and increase wellness have been largely ineffective to date. An incomplete understanding of caregiver wellness and distress may hinder efforts at developing effective support interventions. Objectives: To allow family caregivers to define their experiences of wellness and distress 6 months after patient intensive care unit (ICU) admission and to identify moderators that influence wellness and distress. Methods: Primary family caregivers of adult patients admitted to the medical ICU with acute cardiorespiratory failure were invited to participate in a semistructured interview 6 months after ICU admission as part of a larger prospective cohort study. Interview guides were used to assess caregiver perceptions of their own well-being, record caregiver descriptions of their experiences of family caregiving, and identify key stress events and moderators that influenced well-being during and after the ICU admission. This study was guided by the Chronic Traumatic Stress Framework conceptual model, and data were analyzed using the five-step framework approach. Results: Among 21 interviewees, the mean age was 58 years, 67% were female, and 76% were White. Nearly half of patients (47%) had died before the caregiver interview. At the time of the interview, 9 caregivers endorsed an overall sense of distress, 10 endorsed a sense of wellness, and 2 endorsed a mix of both. Caregivers defined their experiences of wellness and distress as multidimensional and composed of four main elements: 1) positive versus negative physical and psychological outcomes, 2) high versus low capacity for self-care, 3) thriving versus struggling in the caregiving role, and 4) a sense of normalcy versus ongoing life disruption. Postdischarge support from family, friends, and the community at large played a key role in moderating caregiver outcomes. Conclusions: Caregiver wellness and distress are multidimensional and extend beyond the absence or presence of psychological outcomes. Future intervention research should incorporate novel outcome measures that include elements of self-efficacy, preparedness, and adaptation and optimize postdischarge support for family caregivers.
Collapse
Affiliation(s)
- Blair Wendlandt
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine
| | | | | | - Bradley N. Gaynes
- Department of Psychiatry, UNC School of Medicine
- Department of Epidemiology, Gillings School of Global Public Health, and
| | - Shannon S. Carson
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine
| | - Laura C. Hanson
- Division of Geriatric Medicine and Palliative Care Program, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | |
Collapse
|
3
|
Cheng F, Yan H, Zhong J, Yang H, Nan R, Wang X, Wei Z, Dou X. Knowledge, attitude and practice of registered nurses toward ICU patients' transfer anxiety in China: A cross-sectional study. Heliyon 2024; 10:e29318. [PMID: 38660287 PMCID: PMC11040039 DOI: 10.1016/j.heliyon.2024.e29318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 03/19/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Transfer anxiety has effect many critically ill patients in ICU around the world. Nurses must take care of the psychological adjustments that patients and families face when ICU patients transferred to general ward. During this period, basic knowledge, positive attitude, and correct practice are necessary for nurses to address the issue of transfer anxiety and seek to reduce it whenever possible. However, there were few investigations have been performed the knowledge, attitudes, and practice of registered nurses toward ICU patients' transfer anxiety. Aim The purpose of the paper is to explore the level and influencing factors of knowledge, attitude and practice of registered nurses toward ICU patients' transfer anxiety in China. Methods From February 1 to March 17, 2023, a cross-sectional study was adopted in China. An electronic questionnaire was used to collect data. Registered nurses' knowledge, attitudes and practice toward ICU patients' transfer anxiety were assessed using The Knowledge, Attitude and Practice Questionnaire for Chinese Registered nurses in ICU regarding the prevention of transfer anxiety. In the end, in this study involved 381 registered nurses from Lanzhou University Second Hospitals in China. SPSS 26.0 for mac, independent T-test, one-way ANOVA test, Scheffe's test, Pearson correlation coefficient and multiple linear regression tests were used for data analysis. Results The scores of total KAP, knowledge, attitude, and practice are 135.21 ± 24.504, 45.58 ± 13.903, 56.94 ± 10.690 and 32.87 ± 6.393 separately. Study results show that there was a statistically significant correlation among the three variables. According to the results of independent t-test or one-way ANOVA test, there is a correlation between gender(P = 0.001), highest educational attainment (P = 0.005) and knowledge; type of department(P = 0.003) and attitude; gender (P = 0.003), marital status (P = 0.002), clinical work experience (P = 0.002), type of department (P = 0.005) and practice. According to the results of linear regression analysis in this study, the variables of gender (P = 0.006), highest educational attainment (P = 0.032), scores of attitudes (P = 0.006), and scores of practice (P = 0.000) were associated with the scores of knowledge; the variables of scores of knowledge (P = 0.004), and scores of practice (P = 0.000) were associated with the scores of attitudes; the variables of scores of knowledge (P = 0.000), and scores of attitudes (P = 0.000) were associated with the scores of practice. Conclusion The findings of the study emphasize that comprehensive measures of knowledge, attitude and practice should be taken to improve nurses' knowledge, attitudes, and practices regarding transfer anxiety in intensive care unit patients in order to reduce its adverse effects on ICU patients.
Collapse
Affiliation(s)
- Feiran Cheng
- School of Nursing, Lanzhou University, Lanzhou, Gansu, PR China
| | - Hui Yan
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| | - Juanping Zhong
- Department of Outpatient, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| | - Hong Yang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, PR China
| | - Ruiling Nan
- Department of Critical Care Medicine, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| | - Xinglei Wang
- Department of Liver Diseases Branch, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| | - Zhengyong Wei
- Department of Neurosurgical Intensive Care Unit, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| | - Xinman Dou
- School of Nursing, Lanzhou University, Lanzhou, Gansu, PR China
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| |
Collapse
|
4
|
van Grootel JWM, Collet RJ, Major ME, Wiertsema S, van Dongen H, van der Leeden M, Geleijn E, Ostelo R, van der Schaaf M. Engaging patients in designing a transmural allied health pathway: A qualitative exploration of hospital-to-home transitions. Health Expect 2024; 27:e13996. [PMID: 38491738 PMCID: PMC10943249 DOI: 10.1111/hex.13996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/17/2024] [Accepted: 02/11/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION The transition from hospital to home is often suboptimal, resulting in patients not receiving the necessary allied healthcare after discharge. This may, in turn, lead to delayed recovery, a higher number of readmissions, more emergency department visits and an increase in mortality and healthcare costs. This study aimed to gain insight into patients' experiences, perceptions, and needs regarding hospital-to-home transition, focusing on allied healthcare as a first step towards the development of a transitional integrated allied healthcare pathway for patients with complex care needs after hospital discharge. METHODS We conducted semistructured interviews with patients. Participants were recruited from universities and general hospitals in the Amsterdam region between May and July 2023. They were eligible if they (1) were discharged from the hospital minimally 3 and maximally 12 months after admission to an oncologic surgery department, internal medicine department, intensive care unit, or trauma centre, (2) received hospital-based care from at least one allied healthcare provider, who visited the patient at least twice during hospital admission, (3) spoke Dutch or English and (4) were 18 years or older. Interviews were audio-recorded and transcribed verbatim. We performed a thematic analysis of the interview data. RESULTS Nineteen patients were interviewed. Three themes emerged from the analysis. 'Allied healthcare support during transition' depicts patients' positive experiences when they felt supported by allied health professionals during the hospital-to-home transition. 'Patient and family involvement' illustrates how much patients value the involvement of their family members during discharge planning. 'Information recall and processing' portrays the challenges of understanding and remembering overwhelming amounts of information, sometimes unclear and provided at the wrong moment. Overall, patients' experiences of transitional care were positive when they were involved in the discharge process. Negative experiences occurred when their preferences for postdischarge communication were ignored. CONCLUSIONS This study suggests that allied health professionals need to continuously collaborate and communicate with each other to provide patients and their families with the personalized support they need. To provide high-quality and person-centred care, it is essential to consider how, when, and what information to provide to patients and their families to allow them to contribute to their recovery actively. PATIENT OR PUBLIC CONTRIBUTION The interview guide for this manuscript was developed with the assistance of patients, who reviewed it and provided us with feedback. Furthermore, patients provided us with their valuable lived experiences by participating in the interviews conducted for this study.
Collapse
Affiliation(s)
- Juul W. M. van Grootel
- Department of Rehabilitation Medicine, Amsterdam University Medical CentersUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
- Amsterdam Movement Sciences, Ageing and VitalityAmsterdamThe Netherlands
- Amsterdam Movement Sciences, Musculoskeletal HealthAmsterdamThe Netherlands
| | - Romain J. Collet
- Department of Rehabilitation Medicine, Amsterdam University Medical CentersUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
- Amsterdam Movement Sciences, Ageing and VitalityAmsterdamThe Netherlands
- Amsterdam Movement Sciences, Musculoskeletal HealthAmsterdamThe Netherlands
- Department of Health Sciences, Faculty of ScienceVrije University AmsterdamThe Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Mel E. Major
- Amsterdam Movement Sciences, Ageing and VitalityAmsterdamThe Netherlands
- Department of Physical Therapy, Faculty of HealthAmsterdam University of Applied SciencesAmsterdamThe Netherlands
- Department of Physical Therapy, Centre of Expertise Urban Vitality, Faculty of HealthAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - Suzanne Wiertsema
- Department of Rehabilitation Medicine, Amsterdam University Medical CentersUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
- Amsterdam Movement Sciences, Musculoskeletal HealthAmsterdamThe Netherlands
| | - Hanneke van Dongen
- Amsterdam Movement Sciences, Musculoskeletal HealthAmsterdamThe Netherlands
- Department of Health Sciences, Faculty of ScienceVrije University AmsterdamThe Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Marike van der Leeden
- Department of Rehabilitation Medicine, Amsterdam University Medical CentersUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
- Department of Physical Therapy, Centre of Expertise Urban Vitality, Faculty of HealthAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - Edwin Geleijn
- Department of Rehabilitation Medicine, Amsterdam University Medical CentersUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
- Amsterdam Movement Sciences, Rehabilitation and DevelopmentAmsterdamThe Netherlands
| | - Raymond Ostelo
- Amsterdam Movement Sciences, Musculoskeletal HealthAmsterdamThe Netherlands
- Department of Health Sciences, Faculty of ScienceVrije University AmsterdamThe Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam University Medical CentersUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
- Amsterdam Movement Sciences, Ageing and VitalityAmsterdamThe Netherlands
- Department of Physical Therapy, Centre of Expertise Urban Vitality, Faculty of HealthAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| |
Collapse
|
5
|
Major ME, Sommers J, Horrevorts E, Buist CM, Dettling-Ihnenfeldt DS, van der Schaaf M. Inspiratory muscle training for mechanically ventilated patients in the intensive care unit: Obstacles and facilitators for implementation. A mixed method quality improvement study. Aust Crit Care 2024:S1036-7314(24)00021-3. [PMID: 38320925 DOI: 10.1016/j.aucc.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/05/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Mechanically ventilated patients are at risk of developing inspiratory muscle weakness (IMW), which is associated with failure to wean and poor outcomes. Inspiratory muscle training (IMT) is a recommended intervention during and after extubation but has not been widely adopted in Dutch intensive care units (ICUs). OBJECTIVES The objective of this study was to explore the potential, barriers, and facilitators for implementing IMT as treatment modality for mechanically ventilated patients. METHODS This mixed-method, proof-of-concept study was conducted in a large academic hospital in the Netherlands. An evidence-based protocol for assessing IMW and training was applied to patients ventilated for ≥24 h in the ICU during an 8-month period in 2021. Quantitative data on completed measurements and interventions during and after ICU-stay were collected retrospectively and were analysed descriptively. Qualitative data were collected through semistructured interviews with physiotherapists executing the new protocol. Interview data were transcribed and thematically analysed. FINDINGS Of the 301 screened patients, 11.6% (n = 35) met the inclusion criteria. Measurements were possible in 94.3% of the participants, and IMW was found in 78.8% of the participants. Ninety-six percent started training in the ICU, and 88.5% continued training after transfer to the ward. Follow-up measurements were achieved in 73.1% of the patients with respiratory muscle weakness. Twelve therapists were interviewed, of whom 41.7% regularly worked in the ICU. When exploring reasons for protocol deviation, three themes emerged: "professional barriers", "external factors", and "patient barriers". CONCLUSIONS Implementation of measurements of and interventions for IMW showed to be challenging in this single centre study. Clinicians' willingness to change their handling was related to beliefs regarding usefulness, effectiveness, and availability of time and material. We recommend that hospitals aiming to implement IMT during or after ventilator weaning consider these professional and organisational barriers for implementation of novel, evidence-based interventions into daily clinical practice.
Collapse
Affiliation(s)
- Mel E Major
- Department of Physical Therapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Ageing and Vitality, Amsterdam, the Netherlands.
| | - Juultje Sommers
- Amsterdam Movement Sciences, Ageing and Vitality, Amsterdam, the Netherlands; Amsterdam University Medical Centers, Location AMC, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, Netherlands
| | - Esther Horrevorts
- European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Carmen M Buist
- Amsterdam University Medical Centers, Location AMC, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, Netherlands
| | - Daniela S Dettling-Ihnenfeldt
- Amsterdam Movement Sciences, Ageing and Vitality, Amsterdam, the Netherlands; Amsterdam University Medical Centers, Location AMC, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, Netherlands
| | - Marike van der Schaaf
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Ageing and Vitality, Amsterdam, the Netherlands; Amsterdam University Medical Centers, Location AMC, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, Netherlands
| |
Collapse
|
6
|
Zhang F, Chen Z, Xue DD, Zhang R, Cheng Y. Barriers and facilitators to offering post-intensive care follow-up services from the perspective of critical care professionals: A qualitative study. Nurs Crit Care 2023. [PMID: 38146140 DOI: 10.1111/nicc.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Various programmes and models for post-intensive care unit (ICU) follow-up services have been developed worldwide. In China, post-ICU follow-up remains in the exploratory stage and little is known regarding the appropriate form and challenges of implementation, which need to be further explored. AIM This study aimed to explore and describe the barriers to and facilitators of post-ICU follow-up services from the perspective of critical care professionals. DESIGN This was a descriptive qualitative study. Semi-structured interviews were conducted with 21 health care workers whose units had offered ICU survivors different forms of follow-up services; the data were analysed by qualitative content analysis during August 2022 and December 2022. SETTING The study was conducted at 14 ICUs in 11 tertiary hospitals in Shanghai, China. FINDINGS Seventeen subthemes were extracted as barriers and facilitators in the follow-up of ICU survivors. In the initiating process, the barriers included the restriction of decision-making rights and scope of practice, indifferent attitude towards survivors and repeated work. The facilitators included admitted significance, the needs of ICU survivors, the conscientiousness of professionals and the pioneers and leadership support. In the implementation process, lack of confidence, lack of cooperation in medical consortium, distrusted relationships, restrictions of medical insurance, ageing problems and insufficient human resources acted as barriers, whereas lessons learned, positive feedback and digital support served as facilitators. Furthermore, recommendations and tips were identified for offering follow-up services. CONCLUSION Medical personnel can better utilize available resources and develop strategies to overcome constraints by gaining insights into the abovementioned barriers and facilitators. The findings of this study can provide a useful reference for structured and systematic follow-ups to ameliorate post-intensive care syndrome in low- and middle-income countries. RELEVANCE TO CLINICAL PRACTICE Publicity and educational measures play a crucial role in enhancing the awareness of survivors and the consensus of health care professionals from medical consortium regarding impairments after critical care. Leadership and policy support can address numerous obstacles to guiding follow-up services.
Collapse
Affiliation(s)
- Feng Zhang
- Intensive Care Unit, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
- School of Nursing, Fudan University, Shanghai, People's Republic of China
| | - Zhen Chen
- Intensive Care Unit, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
| | - Dan-Dan Xue
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Rui Zhang
- Intensive Care Unit, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
- School of Nursing, Fudan University, Shanghai, People's Republic of China
| | - Yun Cheng
- Nursing Department, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
| |
Collapse
|
7
|
van Oorsouw R, Oerlemans A, van Oorsouw G, van den Boogaard M, van der Wees P, Koenders N. Patients' lived body experiences in the intensive care unit and beyond - a meta-ethnographic synthesis. Physiother Theory Pract 2023:1-33. [PMID: 37498170 DOI: 10.1080/09593985.2023.2239903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023]
Abstract
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.
Collapse
Affiliation(s)
- Roel van Oorsouw
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anke Oerlemans
- IQ healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gijs van Oorsouw
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Philip van der Wees
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
- IQ healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Niek Koenders
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
8
|
Eggmann S, Verra ML, Stefanicki V, Kindler A, Schefold JC, Zante B, Bastiaenen CHG. Predictive validity of the Chelsea Critical Care Physical Assessment tool (CPAx) in critically ill, mechanically ventilated adults: a prospective clinimetric study. Disabil Rehabil 2023; 45:111-116. [PMID: 34994664 DOI: 10.1080/09638288.2021.2022785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate the predictive validity of the Chelsea Critical Care Physical Assessment tool (CPAx) at intensive care unit (ICU) discharge in critically ill adults for their 90-day outcomes. MATERIALS AND METHODS This prospective clinimetric study investigated four theory-driven, a-priori hypotheses in critically ill adults recruited within 72-144 h of mechanical ventilation. The primary hypothesis was a moderate accuracy (AUROC = 0.750) in predicting residence at home within 90 days. Secondary hypotheses included discrimination between hospital discharge destinations, correlation with subsequent health-related quality of life and length of ICU stay. RESULTS We observed a good accuracy (AUROC = 0.778) of the CPAx at ICU discharge in predicting a return to home within 90 days. The CPAx score significantly increased between the discharge groups "undesirable" ≤ "rehabilitation" ≤ "home" (p < 0.001), but was not associated with 90-day health-related quality of life (physical: r = 0.261, mental: r = 0.193). Measured at baseline, CPAx scores correlated as expected with length of ICU stay (r = -0.443). CONCLUSIONS The CPAx at ICU discharge had a good predictive validity in projecting residence at home within 90 days and general discharge destinations. The CPAx might therefore have clinical value in prediction, though it does not seem useful to predict subsequent health-related quality of life. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) identification number: DRKS00012983, registered on September 20, 2017IMPLICATIONS FOR REHABILITATIONThe CPAx is a valid and reliable measurement instrument to evaluate critically ill adults' physical function and activity, in addition the CPAx might be useful to predict rehabilitation needs.The CPAx had a moderate to good predictive validity with three out of four a-priori hypotheses accepted.A CPAx score of ≥18 at critical care discharge has a sensitivity of 80% and a specificity of 70% in predicting a return to home within 90 days.The CPAx might consequently be valuable to identify critically ill adults' rehabilitation needs, to advise on their potential trajectory of recovery or to screen patients for follow-up after hospital discharge.
Collapse
Affiliation(s)
- Sabrina Eggmann
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland.,Department of Epidemiology, Research Line Functioning, Participation and Rehabilitation CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Martin L Verra
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Angela Kindler
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Caroline H G Bastiaenen
- Department of Epidemiology, Research Line Functioning, Participation and Rehabilitation CAPHRI, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
9
|
Gonçalves A, Williams A, Koulouglioti C, Leckie T, Hunter A, Fitzpatrick D, Richardson A, Hardy B, Venn R, Hodgson L. Surviving severe COVID-19: Interviews with patients, informal carers and health professionals. Nurs Crit Care 2022; 28:80-88. [PMID: 35561020 PMCID: PMC9348004 DOI: 10.1111/nicc.12779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The COVID-19 pandemic has been associated with an unprecedented number of critical care survivors. Their experiences through illness and recovery are likely to be complex, but little is known about how best to support them. AIM This study aimed to explore experiences of illness and recovery from the perspective of survivors, their relatives and professionals involved in their care. STUDY DESIGN In-depth qualitative interviews were conducted with three stakeholder groups during the first wave of the pandemic. A total of 23 participants (12 professionals, 6 survivors and 5 relatives) were recruited from 5 acute hospitals in England and interviewed by telephone or video call. Data analysis followed the principles of Reflexive Thematic Analysis. FINDINGS Three themes were generated from their interview data: (1) Deteriorating fast-a downhill journey from symptom onset to critical care; (2) Facing a new virus in a hospital-a remote place; and (3) Returning home as a survivor, maintaining normality and recovering slowly. CONCLUSIONS Our findings highlight challenges in accessing care and communication between patients, hospital staff and relatives. Following hospital discharge, patients adopted a reframed 'survivor identity' to cope with their experience of illness and slow recovery process. The concept of survivorship in this patient group may be beneficial to promote and explore further. RELEVANCE TO CLINICAL PRACTICE All efforts should be made to continue to improve communication between patients, relatives and health professionals during critical care admissions, particularly while hospital visits are restricted. Adapting to life after critical illness may be more challenging while health services are restricted by the impacts of the pandemic. It may be beneficial to promote the concept of survivorship, following admission to critical care due to severe COVID-19.
Collapse
Affiliation(s)
- Ana‐Carolina Gonçalves
- School of SportHealth and Exercise Science, University of PortsmouthPortsmouthUK,Department of Intensive Care medicineUniversity Hospitals SussexWorthingUK
| | - Annabel Williams
- Department of Sport, Health Sciences and Social WorkOxford Brookes UniversityOxfordUK
| | | | - Todd Leckie
- Department of Intensive Care medicineUniversity Hospitals SussexWorthingUK
| | - Alexander Hunter
- Department of Intensive Care medicineUniversity Hospitals SussexWorthingUK
| | - Daniel Fitzpatrick
- School of Sport and Health SciencesUniversity of BrightonBrightonUK,General Practice training programmeSt George's University Hospitals NHS Foundation TrustLondonUK
| | - Alan Richardson
- School of Sport and Health SciencesUniversity of BrightonBrightonUK
| | - Benjamin Hardy
- Department of Intensive Care medicineUniversity Hospitals SussexWorthingUK
| | - Richard Venn
- Department of Intensive Care medicineUniversity Hospitals SussexWorthingUK
| | - Luke Hodgson
- Department of Intensive Care medicineUniversity Hospitals SussexWorthingUK,School of Biosciences and MedicineUniversity of SurreyGuildfordUK
| |
Collapse
|
10
|
Dammann M, Staudacher S, Simon M, Jeitziner MM. Insights into the challenges faced by chronically critically ill patients, their families and healthcare providers: An interpretive description. Intensive Crit Care Nurs 2021; 68:103135. [PMID: 34736830 DOI: 10.1016/j.iccn.2021.103135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 08/03/2021] [Accepted: 08/15/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To describe and understand the challenges of patients with chronic critical illness (CCI), their families and healthcare providers during the disease trajectory. METHODOLOGY/DESIGN This qualitative study follows Thorne's methodology of interpretive description and was guided by the ethnographic method of observation and participation. Five cases, each comprising one patient with chronic critical illness their family members and several healthcare providers, were followed from the intensive care unit of a university hospital in Switzerland across different settings. In total, five patients with chronic critical illness, 12 family members and 92 healthcare providers (nurses, nursing students, care assistants, physiotherapists and occupational therapists and physicians) were observed. FINDINGS Regardless of the medical diagnoses and disease trajectories of the patients with chronic critical illness, all cases faced three main challenges: 1. Dealing with the unpredictability of the disease trajectory beyond the underlying disease. 2. Coping with the complexity of care. 3. Perceiving communication challenges despite all involved parties' dependency on it. CONCLUSION Unpredictability is not only a unique characteristic of the prolonged disease trajectory of patients with chronic critical illness, but also one of the main challenges of the participants. Therefore, the way unpredictability is handled is dependent on changes in the complexity of care and communication, highlighting the need for participation, information, empathy, clarity and honesty among all participants.
Collapse
Affiliation(s)
- Maria Dammann
- Department of Nephrology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Sandra Staudacher
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Michael Simon
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Nursing Research Unit, Department of Nursing, University Hospital Bern (Inselspital), Freiburgstrasse 4, 3010 Bern, Switzerland.
| | - Marie-Madlen Jeitziner
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Department of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, Freiburgstrasse 4, 3010 Bern, Switzerland.
| |
Collapse
|
11
|
Falvey JR, Cohen AB, O’Leary JR, Leo-Summers L, Murphy TE, Ferrante LE. Association of Social Isolation With Disability Burden and 1-Year Mortality Among Older Adults With Critical Illness. JAMA Intern Med 2021; 181:1433-1439. [PMID: 34491282 PMCID: PMC8424527 DOI: 10.1001/jamainternmed.2021.5022] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/18/2021] [Indexed: 12/27/2022]
Abstract
Importance Disability and mortality are common among older adults with critical illness. Older adults who are socially isolated may be more vulnerable to adverse outcomes for various reasons, including fewer supports to access services needed for optimal recovery; however, whether social isolation is associated with post-intensive care unit (ICU) disability and mortality is not known. Objectives To evaluate whether social isolation is associated with disability and with 1-year mortality after critical illness. Design, Setting, and Participants This observational cohort study included community-dwelling older adults who participated in the National Health and Aging Trends Study (NHATS) from May 2011 through November 2018. Hospitalization data were collected through 2017 and interview data through 2018. Data analysis was conducted from February 2020 through February 2021. The mortality sample included 997 ICU admissions of 1 day or longer, which represented 5 705 675 survey-weighted ICU hospitalizations. Of these, 648 ICU stays, representing 3 821 611 ICU hospitalizations, were eligible for the primary outcome of post-ICU disability. Exposures Social isolation from the NHATS survey response in the year most closely preceding ICU admission, which was assessed using a validated measure of social connectedness with partners, families, and friends as well as participation in valued life activities (range 0-6; higher scores indicate more isolation). Main Outcomes and Measures The primary outcome was the count of disability assessed during the first interview following hospital discharge. The secondary outcome was time to death within 1 year of hospital admission. Results A total of 997 participants were in the mortality cohort (511 women [51%]; 45 Hispanic [5%], 682 non-Hispanic White [69%], and 228 non-Hispanic Black individuals [23%]) and 648 in the disability cohort (331 women [51%]; 29 Hispanic [5%], 457 non-Hispanic White [71%], and 134 non-Hispanic Black individuals [21%]). The median (interquartile range [IQR]) age was 81 (75.5-86.0) years (range, 66-102 years), the median (IQR) preadmission disability count was 0 (0-1), and the median (IQR) social isolation score was 3 (2-4). After adjustment for demographic characteristics and illness severity, each 1-point increase in the social isolation score (from 0-6) was associated with a 7% greater disability count (adjusted rate ratio, 1.07; 95% CI, 1.01-1.15) and a 14% increase in 1-year mortality risk (adjusted hazard ratio, 1.14; 95% CI, 1.03-1.25). Conclusions and Relevance In this cohort study, social isolation before an ICU hospitalization was associated with greater disability burden and higher mortality in the year following critical illness. The study findings suggest a need to develop social isolation screening and intervention frameworks for older adults with critical illness.
Collapse
Affiliation(s)
- Jason R. Falvey
- Department of Physical Therapy and Rehabilitation Science and Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Andrew B. Cohen
- Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut
| | - John R. O’Leary
- Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut
| | - Linda Leo-Summers
- Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut
| | | | - Lauren E. Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
12
|
Vijayan A, Abdel-Rahman EM, Liu KD, Goldstein SL, Agarwal A, Okusa MD, Cerda J. Recovery after Critical Illness and Acute Kidney Injury. Clin J Am Soc Nephrol 2021; 16:1601-1609. [PMID: 34462285 PMCID: PMC8499012 DOI: 10.2215/cjn.19601220] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AKI is a common complication in hospitalized and critically ill patients. Its incidence has steadily increased over the past decade. Whether transient or prolonged, AKI is an independent risk factor associated with poor short- and long-term outcomes, even if patients do not require KRT. Most patients with early AKI improve with conservative management; however, some will require dialysis for a few days, a few weeks, or even months. Approximately 10%-30% of AKI survivors may still need dialysis after hospital discharge. These patients have a higher associated risk of death, rehospitalization, recurrent AKI, and CKD, and a lower quality of life. Survivors of critical illness may also suffer from cognitive dysfunction, muscle weakness, prolonged ventilator dependence, malnutrition, infections, chronic pain, and poor wound healing. Collaboration and communication among nephrologists, primary care physicians, rehabilitation providers, physical therapists, nutritionists, nurses, pharmacists, and other members of the health care team are essential to create a holistic and patient-centric care plan for overall recovery. Integration of the patient and family members in health care decisions, and ongoing education throughout the process, are vital to improve patient well-being. From the nephrologist standpoint, assessing and promoting recovery of kidney function, and providing appropriate short- and long-term follow-up, are crucial to prevent rehospitalizations and to reduce complications. Return to baseline functional status is the ultimate goal for most patients, and dialysis independence is an important part of that goal. In this review, we seek to highlight the varying aspects and stages of recovery from AKI complicating critical illness, and propose viable strategies to promote recovery of kidney function and dialysis independence. We also emphasize the need for ongoing research and multidisciplinary collaboration to improve outcomes in this vulnerable population.
Collapse
Affiliation(s)
- Anitha Vijayan
- Division of Nephrology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Emaad M. Abdel-Rahman
- Division of Nephrology and Center for Immunity, Inflammation, and Regenerative Medicine, University of Virginia, Charlottesville, Virginia
| | - Kathleen D. Liu
- Division of Nephrology, Department of Medicine and Critical Care Medicine, Department of Anesthesia, University of California, San Francisco, San Francisco, California
| | - Stuart L. Goldstein
- Division of Nephrology and Hypertension, University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Anupam Agarwal
- Division of Nephrology, Nephrology Research and Training Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark D. Okusa
- Division of Nephrology and Center for Immunity, Inflammation, and Regenerative Medicine, University of Virginia, Charlottesville, Virginia
| | - Jorge Cerda
- Department of Medicine, Albany Medical College, Albany, New York
| | | |
Collapse
|
13
|
O'Neill B, Linden M, Ramsay P, Darweish Medniuk A, Outtrim J, King J, Blackwood B. Development of the support needs after ICU (SNAC) questionnaire. Nurs Crit Care 2021; 27:410-418. [PMID: 34387920 PMCID: PMC9290803 DOI: 10.1111/nicc.12695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/01/2022]
Abstract
Aims To develop a questionnaire to identify Intensive Care survivor needs at key transitions during the recovery process, and assess its validity and reliability in a group of ICU survivors. Methods Development of the Support Needs After ICU (SNAC) questionnaire was based on a systematic scoping review, and analysis of patient interviews (n = 22). Face and content validity were assessed by service users (n = 12) and an expert panel of healthcare professionals (n = 6). A pilot survey among 200 ICU survivors assessed recruitment at one of five different stages after ICU discharge [(1) in hospital, (2) < 6 weeks, (3) 7 weeks to 6 months, (4) 7 to 12 months, or (5) 12 to 24 months post‐hospital discharge]; to assess reliability of the SNAC questionnaire; and to conduct exploratory data analysis. Reliability was determined using Cronbach's alpha for internal consistency; intraclass correlation coefficients for test–retest reliability. We explored correlations with sociodemographic variables using Pearson's correlation coefficient; differences between questionnaire scores and patient demographics using one‐way ANOVA. Results The SNAC questionnaire consisted of 32 items that assessed five categories of support needs (informational, emotional, instrumental [e.g. practical physical help, provision of equipment or training], appraisal [e.g. clinician feedback on recovery] and spiritual needs). ICU survivors were recruited from Northern Ireland, England and Scotland. From a total of 375 questionnaires distributed, 202 (54%) were returned. The questionnaire had high internal consistency (0.97) and high test–retest reliability (r = 0.8) with subcategories ranging from 0.3 to 0.9. Conclusions The SNAC questionnaire appears to be a comprehensive, valid, and reliable questionnaire. Further research will enable more robust examination of its properties e.g. factor analysis, and establish its utility in identifying whether patients' support needs evolve over time. Relevance to clinical practice The SNAC questionnaire has the potential to be used to identify ICU survivors' needs and inform post‐hospital support services.
Collapse
Affiliation(s)
- Brenda O'Neill
- Centre for Health and Rehabilitation Technologies, Ulster University, Newtownabbey, Northern Ireland, UK
| | - Mark Linden
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Pam Ramsay
- School of Health Sciences, University of Dundee, Dundee, Scotland, UK
| | | | - Joanne Outtrim
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Judy King
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK
| |
Collapse
|
14
|
Major ME, Dettling-Ihnenfeldt D, Ramaekers SPJ, Engelbert RHH, van der Schaaf M. Feasibility of a home-based interdisciplinary rehabilitation program for patients with Post-Intensive Care Syndrome: the REACH study. Crit Care 2021; 25:279. [PMID: 34353341 PMCID: PMC8339801 DOI: 10.1186/s13054-021-03709-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Survivors of critical illness experience long-term functional challenges, which are complex, heterogeneous, and multifactorial in nature. Although the importance of rehabilitation interventions after intensive care unit (ICU) discharge is universally recognized, evidence on feasibility and effectiveness of home-based rehabilitation programs is scarce and ambiguous. This study investigates the feasibility of an interdisciplinary rehabilitation program designed for patients with Post-Intensive Care Syndrome (PICS) who are discharged home. METHODS A mixed method, non-randomized, prospective pilot feasibility study was performed with a 6-month follow-up, comparing the intervention (REACH) with usual care. REACH was provided by trained professionals and included a patient-centered, interdisciplinary approach starting directly after hospital discharge. Primary outcomes were patient safety, satisfaction, adherence, referral need and health care usage. Secondary outcomes, measured at 3 timepoints, were functional exercise capacity, self-perceived health status, health-related quality of life (HRQoL), return to work and psychotrauma. Risk of undernutrition was assessed at baseline. RESULTS 43 patients with a median mechanical ventilation duration of 8 (IQR:10) days, were included in the study and 79.1% completed 6-month follow-up. 19 patients received the intervention, 23 received usual care. Groups were similar for gender distribution and ICU length of stay. No adverse events occurred. REACH participants showed higher satisfaction with treatment and reported more allied health professional visits, while the usual care group reported more visits to medical specialists. Qualitative analysis identified positive experiences among REACH-professionals related to providing state-of-the-art interventions and sharing knowledge and expertise within an interprofessional network. Similar recovery was seen between groups on all secondary outcomes, but neither group reached reference values for HRQoL at 6 months. Larger return to work rates were seen in the REACH group. Prevalence of undernutrition at hospital discharge was high in both groups (> 80%), warranting the need for careful tuning of physical therapy and nutritional interventions. CONCLUSIONS This study shows that providing early, home-based rehabilitation interventions for patients with PICS-related symptoms is feasible and perceived positively by patients and professionals. When provided in an interdisciplinary collaborative network state of the art, person-centered interventions can be tailored to individual needs potentially increasing patient satisfaction, adherence, and efficacy. Registered in the Dutch Trial register: NL7792: https://www.trialregister.nl/trial/7792 , registered 7-06-2019.
Collapse
Affiliation(s)
- Mel E Major
- European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Daniela Dettling-Ihnenfeldt
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Stephan P J Ramaekers
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marike van der Schaaf
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| |
Collapse
|
15
|
Optimizing Critical Illness Recovery: Perspectives and Solutions From the Caregivers of ICU Survivors. Crit Care Explor 2021; 3:e0420. [PMID: 34079948 PMCID: PMC8162533 DOI: 10.1097/cce.0000000000000420] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: To understand the unmet needs of caregivers of ICU survivors, how they accessed support post ICU, and the key components of beneficial ICU recovery support systems as identified from a caregiver perspective. Design: International, qualitative study. Subjects: We conducted 20 semistructured interviews with a diverse group of caregivers in the United States, the United Kingdom, and Australia, 11 of whom had interacted with an ICU recovery program. Setting: Seven hospitals in the United States, United Kingdom, and Australia. Interventions: None. Measurements and Main Results: Content analysis was used to explore prevalent themes related to unmet needs, as well as perceived strategies to improve ICU outcomes. Post-ICU care was perceived to be generally inadequate. Desired caregiver support fell into two main categories: practical support and emotional support. Successful care delivery initiatives included structured programs, such as post discharge telephone calls, home health programs, post-ICU clinics, and peer support groups, and standing information resources, such as written educational materials and online resources. Conclusions: This qualitative, multicenter, international study of caregivers of critical illness survivors identified consistently unmet needs, means by which caregivers accessed support post ICU, and several care mechanisms identified by caregivers as supporting optimal ICU recovery.
Collapse
|
16
|
Hauschildt KE, Seigworth C, Kamphuis LA, Hough CL, Moss M, McPeake JM, Harrod M, Iwashyna TJ. Patients' Adaptations After Acute Respiratory Distress Syndrome: A Qualitative Study. Am J Crit Care 2021; 30:221-229. [PMID: 34161982 DOI: 10.4037/ajcc2021825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Many patients confront physical, cognitive, and emotional problems after acute respiratory distress syndrome (ARDS). No proven therapies for these problems exist, and many patients manage new disability and recovery with little formal support. Eliciting patients' adaptations to these problems after hospitalization may identify opportunities to improve recovery. OBJECTIVES To explore how patients adapt to physical, cognitive, and emotional changes related to hospitalization for ARDS. METHODS Semistructured interviews were conducted after hospitalization in patients with ARDS who had received mechanical ventilation. This was an ancillary study to a multicenter randomized controlled trial. Consecutive surviving patients who spoke English, consented to follow-up, and had been randomized between November 12, 2017, and April 5, 2018 were interviewed 9 to 16 months after that. RESULTS Forty-six of 79 eligible patients (58%) participated (mean [range] age, 55 [20-84] years). All patients reported using strategies to address physical, emotional, or cognitive problems after hospitalization. For physical and cognitive problems, patients reported accommodative strategies for adapting to new disabilities and recuperative strategies for recovering previous ability. For emotional issues, no clear distinction between accommodative and recuperative strategies emerged. Social support and previous familiarity with the health care system helped patients generate and use many strategies. Thirty-one of 46 patients reported at least 1 persistent problem for which they had no acceptable adaptation. CONCLUSIONS Patients employed various strategies to manage problems after ARDS. More work is needed to identify and disseminate effective strategies to patients and their families.
Collapse
Affiliation(s)
- Katrina E. Hauschildt
- Katrina E. Hauschildt is an advanced fellow in health services research at the Veterans Affairs Center for Clinical Management Research and a research associate in the Pulmonary and Critical Care Division at the University of Michigan, Ann Arbor
| | - Claire Seigworth
- Claire Seigworth is research health science specialist at the Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, Ann Arbor, Michigan
| | - Lee A. Kamphuis
- Lee A. Kamphuis is research health science specialist at the Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, Ann Arbor, Michigan
| | - Catherine L. Hough
- Catherine L. Hough is a professor of medicine and chief of the Division of Pulmonary and Critical Care Medicine at the Oregon Health & Science University in Portland
| | - Marc Moss
- Marc Moss is the Roger S. Mitchell Professor of Medicine and division head of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Joanne M. McPeake
- Joanne M. McPeake is a nurse consultant, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, United Kingdom, a senior honorary clinical lecturer at the University of Glasgow School of Medicine, Dentistry & Nursing, Glasgow, and a THIS Institute research fellow at the University of Cambridge
| | - Molly Harrod
- Molly Harrod is research health science specialist at the Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, Ann Arbor, Michigan
| | - Theodore J. Iwashyna
- Theodore J. Iwashyna is the co-director of the research core at the Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, and the Alpheus W. Tucker, MD, Collegiate Professor of Internal Medicine at the University of Michigan, Ann Arbor
| |
Collapse
|
17
|
Post-Intensive Care Unit Care. A Qualitative Analysis of Patient Priorities and Implications for Redesign. Ann Am Thorac Soc 2021; 17:221-228. [PMID: 31726016 DOI: 10.1513/annalsats.201904-332oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Rationale: Although survival during critical illness is improving, little evidence exists to guide post-intensive care unit (ICU) care. Understanding patients' needs and priorities is fundamental to improving care quality.Objectives: To describe the evolution of patients' priorities for recovery across the spectrum of post-ICU care.Methods: This was a secondary analysis of 39 semistructured interviews conducted from 2005 to 2006 in participants' homes 19 days to 11 years after hospital discharge after critical illness. Adult critical illness survivors (N = 39) aged 20 years or older from multiple ICUs across the United Kingdom were purposively selected to maximize diversity with respect to time since diagnosis, disease severity, sex, age, ethnicity, socioeconomic group/status, region. age, ICU admitting diagnoses, and length of stay. We used the method of qualitative description to characterize patients' priorities for recovery and their evolution within and between individual patients across three post-ICU periods: ICU transition to wards, early period (approximately the first 2 mo) after discharge to home, and late period (>2 mo) after discharge to home.Results: The analysis revealed 12 core patient priorities during recovery: feeling safe, being comfortable, engaging in mobility, participating in self-care, asserting personhood, connecting with people, ensuring family well-being, going home, restoring psychological health, restoring physical health, resuming previous roles and routines, and seeking new life experiences. In general, priorities evolved from those pertaining to basic survival during the stay on wards to being broader and more aspirational by the late postdischarge period.Conclusions: Understanding patients' priorities for post-ICU care is critical for developing stakeholder-driven clinical guidelines. Engaging other stakeholders (e.g., family members, healthcare providers, and institutionalized and frail older adults) to inform the development of clinical guidelines for post-ICU care, together with the barriers and facilitators faced in achieving patient- and family-centered care, is an important next step.
Collapse
|
18
|
Felten-Barentsz KM, van Oorsouw R, Klooster E, Koenders N, Driehuis F, Hulzebos EHJ, van der Schaaf M, Hoogeboom TJ, van der Wees PJ. Recommendations for Hospital-Based Physical Therapists Managing Patients With COVID-19. Phys Ther 2020; 100:1444-1457. [PMID: 32556323 PMCID: PMC7337861 DOI: 10.1093/ptj/pzaa114] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/05/2020] [Accepted: 06/07/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The COVID-19 pandemic is rapidly evolving and has led to increased numbers of hospitalizations worldwide. Hospitalized patients with COVID-19 experience a variety of symptoms, including fever, muscle pain, tiredness, cough, and difficulty breathing. Elderly people and those with underlying health conditions are considered to be more at risk of developing severe symptoms and have a higher risk of physical deconditioning during their hospital stay. Physical therapists have an important role in supporting hospitalized patients with COVID-19 but also need to be aware of challenges when treating these patients. In line with international initiatives, this article aims to provide guidance and detailed recommendations for hospital-based physical therapists managing patients hospitalized with COVID-19 through a national approach in the Netherlands. METHODS A pragmatic approach was used. A working group conducted a purposive scan of the literature and drafted initial recommendations based on the knowledge of symptoms in patients with COVID-19 and current practice for physical therapist management for patients hospitalized with lung disease and patients admitted to the intensive care unit. An expert group of hospital-based physical therapists in the Netherlands provided feedback on the recommendations, which were finalized when consensus was reached among the members of the working group. RESULTS The recommendations include safety recommendations, treatment recommendations, discharge recommendations, and staffing recommendations. Treatment recommendations address 2 phases of hospitalization: when patients are critically ill and admitted to the intensive care unit, and when patients are severely ill and admitted to the COVID ward. Physical therapist management for patients hospitalized with COVID-19 comprises elements of respiratory support and active mobilization. Respiratory support includes breathing control, thoracic expansion exercises, airway clearance techniques, and respiratory muscle strength training. Recommendations toward active mobilization include bed mobility activities, active range-of-motion exercises, active (assisted) limb exercises, activities-of-daily-living training, transfer training, cycle ergometer, pre-gait exercises, and ambulation.
Collapse
Affiliation(s)
- Karin M Felten-Barentsz
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Nijmegen 6500 HB, the Netherlands
| | - Roel van Oorsouw
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center
| | - Emily Klooster
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center and Department of Rehabilitation, Deventer Ziekenhuis, Deventer, the Netherlands
| | - Niek Koenders
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center
| | - Femke Driehuis
- Department of Guideline Development, Royal Dutch Society for Physical Therapy (KNGF), Amersfoort, the Netherlands
| | - Erik H J Hulzebos
- Child Development and Exercise Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands, and Faculty of Health, ACHIEVE-Centre of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Thomas J Hoogeboom
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center and IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center
| | - Philip J van der Wees
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center and IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center
| |
Collapse
|
19
|
Arabi YM, Mallampalli R, Englert JA, Bosch NA, Walkey AJ, Al-Dorzi HM. Update in Critical Care 2019. Am J Respir Crit Care Med 2020; 201:1050-1057. [PMID: 32176850 DOI: 10.1164/rccm.202002-0285up] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Yaseen M Arabi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Rama Mallampalli
- Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State Wexner Medical, Center, Columbus, Ohio; and
| | - Joshua A Englert
- Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State Wexner Medical, Center, Columbus, Ohio; and
| | - Nicholas A Bosch
- Department of Medicine, Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Allan J Walkey
- Department of Medicine, Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Hasan M Al-Dorzi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
20
|
|
21
|
Patarroyo Aponte MM, Manrique C, Kar B. Systems of Care in Cardiogenic Shock. Methodist Debakey Cardiovasc J 2020; 16:50-56. [PMID: 32280418 DOI: 10.14797/mdcj-16-1-50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cardiogenic shock presents a significant challenge to the medical community, and there is much debate as to the best classification system and treatment mechanisms. As interventions and technologies improve, systems of care for patients with cardiogenic shock must evolve as well. This review describes the current treatment models for cardiogenic shock, including the "hub-and-spoke" model, and defines specific characteristics of the ideal system of care for this patient population.
Collapse
Affiliation(s)
| | - Carlos Manrique
- UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON, HOUSTON, TEXAS
| | - Biswajit Kar
- UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON, HOUSTON, TEXAS
| |
Collapse
|
22
|
Learning from Discharge Experiences of Intensive Care Unit Survivors and Their Families: Is Consistency a Solution? Ann Am Thorac Soc 2020; 16:1369-1371. [PMID: 31674819 DOI: 10.1513/annalsats.201908-603ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|