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AIM: To explore nurses' and physicians' experiences of simulation-based training in a crisis resource management quality improvement intervention on intensive care admission. BACKGROUND: Quantitative studies have documented that staffs' non-technical skills are improved after simulation-based training in crisis resource management interventions. Experienced-based consensus led to development of a quality improvement intervention based on principles of crisis resource management and tested in simulation-based training to enhance staffs' non-technical skills. However, the impact on staff is unexplored, leaving little understanding of the relationship between simulation-based training in crisis resource management interventions and changes in non-technical skills. DESIGN: A qualitative study with a hermeneutical approach. METHODS: Data consisted of semi-structured interviews with physicians (n = 5) and nurses (n = 15) with maximum variation in work experience. Data were collected 3 months after implementation and analysed using thematic analysis. The COREQ guideline was applied. RESULTS: The analysis revealed three themes: prioritising core clinical activities and patient centredness; transition into practice; and reflection on patient safety. These themes reflected staff's experiences of the intervention and implementation process, which evolved through prioritising core clinical activities that facilitated the transition into clinical practice and staff's reflection on patient safety. CONCLUSIONS: Prioritising core clinical activities were facilitated by clear communication, predefined roles and better teamwork. Transition into practice stimulated professional growth through feedback. Reflection on patient safety created a new understanding on how a new structure of intensive care admission could be implemented. Collectively, this indicated a joint understanding of admissions. IMPLICATIONS FOR PRACTICE: Findings enables health care professionals to understand how the intervention can contribute to improve quality of care in management of intensive care admission. Improving non-technical skills are vital in high-quality admissions, which supported a structured process and a collaborative professional standard of admissions. PATIENT AND PUBLIC CONTRIBUTION: None.
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Médicos , Treinamento por Simulação , Humanos , Pesquisa Qualitativa , Pessoal de Saúde , ComunicaçãoRESUMO
OBJECTIVE: The aim of this integrative review was to identify facilitators and barriers to patients' well-being when being cared for in an ICU setting, from the perspective of the patients. BACKGROUND: To become critically ill and hospitalised in an ICU is a stressful, chaotic event due to the life-threatening condition itself, as well as therapeutic treatments and the environment. A growing body of evidence has revealed that patients often suffer from physical, psychological and cognitive problems after an ICU stay. Several strategies, such as sedation and pain management, are used to reduce stress and increase well-being during ICU hospitalisation, but the ICU experience nevertheless affects the body and mind. DESIGN; METHODS: Since research exploring patients' sense of well-being in an ICU setting is limited, an integrative review approach was selected. Searches were performed in CINAHL, Medline, Psych Info, Eric and EMBASE. After reviewing 66 studies, 12 studies were included in the integrative review. Thematic analysis was used to analyse the studies. The PRISMA checklist for systematic reviews was used. RESULTS: The results are presented under one main theme, 'Well-being as a multidimensional experience-interwoven in barriers and facilitators' and six sub-themes representing barriers to and facilitators of well-being in an ICU. Barriers identified were physical stressors, emotional stressors, environmental disturbances and insecurity relating to time and space. Facilitators were meeting physical needs and activities that included dimensions of a caring and relational environment. CONCLUSION: Our main findings were that experiences of well-being were multidimensional and included physical, emotional, relational and environmental aspects, and they were more often described through barriers than facilitators of well-being. RELEVANCE FOR CLINICAL PRACTICE: This integrative review has shown that it is necessary to adopt an individual focus on patient well-being in an ICU setting since physical, emotional, relational and environmental stressors might impact each patient differently.
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Estado Terminal , Unidades de Terapia Intensiva , Hospitalização , HumanosRESUMO
AIMS AND OBJECTIVES: To explore critical care nurses' experiences of research participation during a one-year recovery programme for intensive care survivors. BACKGROUND: Nurse-led postintensive care follow-up consultations have emerged to help patients to recover and overcome problems related to critical illness and admission at the intensive care unit (ICU). Previous research exploring post-ICU follow-up programmes have shown inconclusive evidence of their effectiveness on patient-reported outcome measurements, and provider evaluation is scarce. The context of this study is the Recovery and Aftercare in Postintensive care Therapy (RAPIT) trial. DESIGN: A qualitative descriptive telephone interview study. METHODS: Data were collected after completion of the RAPIT trial. Participants (n = 14) were trained intensive care nurses, who delivered the post-ICU recovery programme, representing nine out of ten sites from the RAPIT trial. Two focus group discussions were used to construct a semistructured interview guide. A thematic data analysis was performed using Braun and Clark's six-step method. This study conforms to the COREQ Research Reporting Guidelines for qualitative studies. RESULTS: Our study indicated that nurses considered participation in research as a positive experience. The main finding "Stimulated by insight" described how nurses' engagement and professional growth was gained by reflection, patient feedback and research competencies acquired in the clinical setting. The research programmes stimulated to new knowledge, broaden their perspectives and enhanced critical reflection of ICU nursing practice. CONCLUSIONS: The study indicates that nurses developed research competencies and enhanced their job satisfaction by using critical reflection and patient feedback. However, there is still a substantial need for support to strengthen nurses' competencies in collaboration with colleagues, managers and researchers. RELEVANCE TO CLINICAL PRACTICE: This study can contribute to the development of recommendations supporting nurses doing research and to optimise implementation of clinical research.
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Assistência ao Convalescente/métodos , Enfermagem de Cuidados Críticos/métodos , Pesquisa em Enfermagem , Adulto , Feminino , Grupos Focais , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Relações Enfermeiro-Paciente , Pesquisa Qualitativa , Sobreviventes/psicologiaRESUMO
AIM: The aim of the study was to evaluate intervention fidelity of nurses' delivery of the RAPIT recovery program for postintensive care patients. BACKGROUND: Interventions addressing patient problems after intensive care lack description of the process of delivery and the evidence of their effectiveness. This is needed to understand how these interventions work. DESIGN: Multistage intervention framework in a mixed-methods design. Intervention fidelity strategies were assessed for intervention design, training, delivery, receipt, and enactment with quantitative and qualitative methods inspired by the Medical Research Council and the National Institutes of Health Fidelity Framework. METHODS: Data collection was embedded in a multicenter randomized controlled trial to explore intervention fidelity of a recovery program (December 2012-February 2017). Ten Danish intensive care units participated in the RAPIT-trial including 386 patients and 27 nurses. Quantitative data covered training and delivery. Qualitative data explored design, quality of delivery, receipt, and enactment seen from nurses' and patients' perspectives. Data were analysed statistically and by systematic deductive-inductive thematic analysis. FINDINGS: A framework for participatory enactment of a complex intervention was developed and demonstrated delivery with high consistent fidelity across sites. Low delivery doses and variations were related to the program, patient, provider nurses and context. CONCLUSION: Our study provides insight into the process of intervention fidelity of a nurse-led postintensive care recovery program and potentially enables professionals to understand key factors in cross-site implementation. Although we demonstrate consistent delivery and variations suggest that some patients may benefit more than others.
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Assistência ao Convalescente/normas , Enfermagem de Cuidados Críticos/normas , Cuidados Críticos/normas , Atenção à Saúde/normas , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Qualidade de VidaRESUMO
AIMS AND OBJECTIVES: To describe the patient experience of ICU recovery from a longitudinal perspective by analysing follow-up consultations at three time-points. BACKGROUND: After a stay in the intensive care unit, patients risk physical and psychological problems during recovery. Follow-up after intensive care has emerged to aid psychological recovery, and improve health-related quality of life. More insight is needed into the mechanisms of intensive care recovery. DESIGN: A descriptive multicenter longitudinal qualitative design. METHODS: A subsample of 36 consultations with 12 patients strategically selected from a randomised controlled trial on intensive care recovery from 10 Danish intensive care units. Data were generated during an ICU recovery programme including three consultations (at 1-3, 4-5, 9-11 months). First consultation was face-to-face using patient photographs to aid memory. Second and third consultations were by telephone using reflection sheets to focus dialogue. Thematic analysis and narrative theory were used to explore mechanisms of recovery using audio-recordings of consultations, patient photographs and reflection sheets as the sources of data. RESULTS: The basic narrative of recovery was 'toward a trajectory of new orientation'. This narrative contained the chronological narratives of being 'at death's door', 'still not out of the woods' and 'on the road to recovery'. The road to recovery was described as downhill, steady-state or progressive. New orientation was obtained in steady-state or progressive recovery. CONCLUSIONS: This study provides a contemporary understanding of the process of intensive care recovery. Recovery evolves through narratives of mortal danger, risk of relapse and moving forward towards a new orientation in life. RELEVANCE TO CLINICAL PRACTICE: These findings enable health care professionals to understand what patients experience during stages of recovery. This is important to improve health care professionals in the assessment of long-term outcome, and management of patients after intensive care.
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Cuidados Críticos/psicologia , Memória , Orientação , Recuperação de Função Fisiológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Unidades de Terapia Intensiva , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade de Vida , Encaminhamento e Consulta , TelefoneRESUMO
AIM: To understand the lived experience of body image in young women after obesity surgery. BACKGROUND: Quantitative studies have documented that health-related quality of life and body image are improved after bariatric surgery, probably due to significant weight loss. Female obesity surgery candidates are likely to be motivated by dissatisfaction regarding physical appearance. However, little is known about the experience of the individual woman, leaving little understanding of the association between bariatric surgery and changes in health-related quality of life and body image. DESIGN: A qualitative descriptive phenomenological study. METHODS: Data were collected over 4 months during 2010. Selection for interview was carried out through purposeful sampling. The participants were five young women who underwent bariatric surgery (range: 1-12 months). In-depth, semi-structured interviews were analysed by systematic text condensation influenced by Giorgi's phenomenological method and supplemented by elements from narrative analysis. FINDINGS: The analysis revealed three concepts: solution to an unbearable problem, learning new boundaries and hopes of normalization. These revelatory concepts were synthesized into one major theme: on the edge of control, that is describing these women's feelings of being on the edge of balance between control and loss of control. CONCLUSION: Perception of control may be an essential aspect of body image and the key to understanding these young women's feelings of empowerment and quality of life through body control postbariatric surgery. Future studies should focus on how body control is an essential aspect of body image, which may contribute to long-term weight loss maintenance and improve quality of life.
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Cirurgia Bariátrica , Imagem Corporal , Obesidade/cirurgia , Adulto , Feminino , Humanos , Obesidade/psicologia , Adulto JovemRESUMO
BACKGROUND: Life-threatening illness can be devastating for patients as they experience shifting levels of consciousness, recurrent delirium, and repeated setbacks. Narrative Medicine and its sub-discipline Narrative Critical Care increase healthcare professionals' understanding of the patient perspective, and interpretation of their stories is a means to improving practice. PURPOSE: We aimed to investigate book length first-person accounts of critical illness to gain a deeper understanding of universal and individual patient responses and to provide an example of Narrative Critical Care. METHOD: We performed a comparative literary analysis of five books supported by the Biographical Narrative Interpretive Method (BNIM) that moves through stages of structural analysis, thematic analysis, and cross-case theoretisation. FINDINGS: Universal patient responses evolved through five existential dichotomies of life/death, sanity/madness, before/after, gain/loss and inner strength/external support. Individual patient responses were expressed as turning points along the illness trajectory, and biographical continuity was restored by integration of new self and old self. CONCLUSION: We uncovered commonalities and differences in storied accounts of critical illness and survival. New insights might enable healthcare professionals to personalize patient care. More consistency is needed during transitions and rehabilitation of intensive care survivors.
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Cuidados Críticos , Medicina Narrativa , Estado Terminal , Humanos , Unidades de Terapia Intensiva , Narração , Projetos de Pesquisa , SobreviventesRESUMO
BACKGROUND: Relatives of intensive care patients are at risk of developing symptoms of anxiety, depression and posttraumatic stress resulting in reduced health-related quality of life. Recovery programmes for patients have been implemented, but their effect on relatives is uncertain. AIM: To determine whether relatives benefit from a recovery programme intended for intensive care survivors. RESEARCH DESIGN: A randomised controlled trial of 181 adult relatives: intervention group (nâ¯=â¯87), control group (nâ¯=â¯94). SETTING: Ten intensive care units in Denmark. MAIN OUTCOME MEASURES: Primary outcome: health-related quality of life (HRQOL). SECONDARY OUTCOMES: Sense of coherence (SOC), and symptoms of anxiety, depression and posttraumatic stress, compared to standard care at 12â¯months after intensive care discharge. RESULTS: No difference in HRQOL between groups was observed at 12â¯months (mean difference in mental component summary score, 1.35 [CI 95%: -3.13; 5.82], pâ¯=â¯0.55; and physical component summery score, 1.86 [CI 95%: -1.88; 5.59], pâ¯=â¯0.33). No differences were found in secondary outcomes. CONCLUSION: The recovery programme intended for intensive care survivors did not have an effect on the relatives. Future recovery programmes should be targeted to help both patient and family, and future research should be conducted on a larger scale to make conclusions with higher probability.
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Qualidade de Vida/psicologia , Grupos de Autoajuda/tendências , Sobreviventes/psicologia , Adulto , Idoso , Ansiedade/complicações , Ansiedade/psicologia , Estado Terminal/psicologia , Dinamarca , Depressão/complicações , Depressão/psicologia , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodosRESUMO
BACKGROUND: Relatives of intensive care patients are at risk of developing symptoms of anxiety, depression and posttraumatic stress resulting in reduced health-related quality of life. Recovery programmes for patients have been implemented, but their effect on relatives is uncertain. AIM: To determine whether relatives benefit from a recovery programme intended for intensive care survivors. RESEARCH DESIGN: A randomised controlled trial of 181 adult relatives: intervention group (nâ¯=â¯87), control group (nâ¯=â¯94). SETTING: Ten intensive care units in Denmark. MAIN OUTCOME MEASURES: Primary outcome: health-related quality of life (HRQOL). SECONDARY OUTCOMES: Sense of coherence (SOC), and symptoms of anxiety, depression and posttraumatic stress, compared to standard care at 12â¯months after intensive care discharge. RESULTS: No difference in HRQOL between groups was observed at 12â¯months (mean difference in mental component summary score, 1.35 [CI 95%: -3.13; 5.82], pâ¯=â¯0.55; and physical component summery score, 1.86 [CI 95%: -1.88; 5.59], pâ¯=â¯0.33). No differences were found in secondary outcomes. CONCLUSION: The recovery programme intended for intensive care survivors did not have an effect on the relatives. Future recovery programmes should be targeted to help both patient and family, and future research should be conducted on a larger scale to make conclusions with higher probability.
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Família/psicologia , Qualidade de Vida/psicologia , Adulto , Idoso , Estado Terminal/psicologia , Dinamarca , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Reabilitação , Inquéritos e Questionários , Sobreviventes/psicologiaRESUMO
PURPOSE: The aim of this randomized controlled trial (RCT) was to test the effectiveness of a post-ICU recovery program compared to standard care during the first year after ICU discharge. METHODS: A pragmatic, non-blinded, multicenter, parallel-group RCT was conducted between December 2012 and December 2015, at ten intensive care units (ICUs) in Denmark. We randomly assigned 386 adult patients (≥18 years) after receiving mechanical ventilation (≥48 h) to standard care (SC) plus a nurse-led intensive care recovery program or standard care alone after ICU discharge (190 intervention, 196 SC). Primary outcome was health-related quality of life (HRQOL) at 12 months. Secondary outcomes were sense of coherence (SOC), anxiety, depression, and post-traumatic stress disorder (PTSD) assessed at 3 and 12 months after ICU discharge including utilization of healthcare services at 12 months. RESULTS: At 12 months, we found no differences in HRQOL between groups (mean difference in the Physical Component Summary score, 1.41 [95 % CI, -1.53 to 4.35; p = 0.35] (n = 235); and in the Mental Component Summary score, 1.92 [95 % CI, -1.06 to 4.90; p = 0.11] (n = 235). No differences were found on self-reported SOC (p = 0.63), anxiety (p = 0.68), depression (p = 0.67), PTSD (p = 0.27), or the utilization of healthcare services including rehabilitation. We found a difference on anxiety, when a cut-off point ≥11 was applied, in per protocol analysis of complete cases at 3 months favoring the intervention (8.8 % vs. 16.2 %, p = 0.04). CONCLUSIONS: The tested recovery program was not superior to standard care during the first 12 months post-ICU. TRIAL REGISTRATION: The trial is registered at Clinicaltrials.gov, identification no. NCT01721239.