Understanding the Course of Critical Illness Through a Lifeworld Approach

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Abstract

An increasing number of individuals receive and survive intensive care treatment; however, several individuals experience problems afterward, which may threaten recovery. Grounded in a lifeworld approach, the aim of this study was to explore and describe what intensive care patients experience as limiting and strengthening throughout their illness trajectories. Ten former intensive care patients were interviewed three to eight months after hospital discharge. Using Giorgi’s phenomenological analysis, a general structure of gaining strength through a caring interaction with others was revealed. The structure consisted of three constituents: feeling safe through a caring presence, being seen and met as a unique person, and being supported to restore capacity. Being met with a humanistic approach and individualized care appeared to be important, and the findings are discussed within the framework of lifeworld-led care. To facilitate improved aftercare of the critically ill, more tailored support throughout the illness trajectory is needed.

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Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Nathaniel E. Brummel, Waleed Alhazzani, Ken Kiedrowski … (2018)

To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU.

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Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference.

Dale M Needham, Judy R. Davidson, Henry Cohen … (2012)

Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge. To report on a 2-day Society of Critical Care Medicine conference aimed at improving the long-term outcomes after critical illness for patients and their families. Thirty-one invited stakeholders participated in the conference. Stakeholders represented key professional organizations and groups, predominantly from North America, which are involved in the care of intensive care survivors after hospital discharge. Invited experts and Society of Critical Care Medicine members presented a summary of existing data regarding the potential long-term physical, cognitive and mental health problems after intensive care and the results from studies of postintensive care unit interventions to address these problems. Stakeholders provided reactions, perspectives, concerns and strategies aimed at improving care and mitigating these long-term health problems. Three major themes emerged from the conference regarding: (1) raising awareness and education, (2) understanding and addressing barriers to practice, and (3) identifying research gaps and resources. Postintensive care syndrome was agreed upon as the recommended term to describe new or worsening problems in physical, cognitive, or mental health status arising after a critical illness and persisting beyond acute care hospitalization. The term could be applied to either a survivor or family member. Improving care for intensive care survivors and their families requires collaboration between practitioners and researchers in both the inpatient and outpatient settings. Strategies were developed to address the major themes arising from the conference to improve outcomes for survivors and families.

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Post‐intensive care syndrome: its pathophysiology, prevention, and future directions

Shigeaki Inoue, Junji Hatakeyama, Yutaka Kondo … (2019)

Expanding elderly populations are a major social challenge in advanced countries worldwide and have led to a rapid increase in the number of elderly patients in intensive care units (ICUs). Innovative advances in medical technology have enabled lifesaving of patients in ICUs, but there remain various problems to improve their long‐term prognoses. Post‐intensive care syndrome (PICS) refers to physical, cognition, and mental impairments that occur during ICU stay, after ICU discharge or hospital discharge, as well as the long‐term prognosis of ICU patients. Its concept also applies to pediatric patients (PICS‐p) and the mental status of their family (PICS‐F). Intensive care unit‐acquired weakness, a syndrome characterized by acute symmetrical limb muscle weakness after ICU admission, belongs to physical impairments in three domains of PICS. Prevention of PICS requires performance of the ABCDEFGH bundle, which incorporates the prevention of delirium, early rehabilitation, family intervention, and follow‐up from the time of ICU admission to the time of discharge. Diary, nutrition, nursing care, and environmental management for healing are also important in the prevention of PICS. This review outlines the pathophysiology, prevention, and future directions of PICS.

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Author and article information

Journal

Journal ID (nlm-ta): Qual Health Res

Journal ID (iso-abbrev): Qual Health Res

Journal ID (hwp): spqhr

Journal ID (publisher-id): QHR

Title: Qualitative Health Research

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Print): 1049-7323

ISSN (Electronic): 1552-7557

Publication date (Electronic): 27 December 2021

Publication date (Print): February 2022

Volume: 32

Issue: 3

Pages: 531-542

Affiliations

[1 ]Faculty of Health Studies, Ringgold 3459, universityVID Specialized University; , Bergen, Norway

[2 ]Department of Health and Caring Sciences, Ringgold 366044, universityWestern Norway University of Applied Sciences; , Bergen, Norway and Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Ringgold 60498, universityHaukeland University Hospital; , Bergen, Norway

[3 ]Department of Global Public Health and Primary Care, Ringgold 1658, universityUniversity of Bergen; , Bergen, Norway

Author notes

[*]Stine Irene Flinterud, Faculty of Health Studies, VID Specialized University, Ulriksdal 10, Bergen 5009, Norway. Email: Stine.flinterud@ 123456vid.no

Author information

Stine Irene Flinterud https://orcid.org/0000-0002-3625-4091

Sidsel Ellingsen https://orcid.org/0000-0003-2675-8541

Article

Publisher ID: 10.1177_10497323211062567

DOI: 10.1177/10497323211062567

PMC ID: 9150141

PubMed ID: 34955043

SO-VID: c518484b-5ac7-4a21-b24a-6722e9074cdb

License:

This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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Funding

Funded by: VID Specialized University, Norway and Norwegian Nurses Organisation, Norway;

Award ID: Grant ID 15/0031

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ScienceOpen disciplines: Medicine

Keywords: aftercare,critical care,follow-up,intensive care,illness trajectory,lifeworld-led care,patient experience,phenomenology,support

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ScienceOpen disciplines: Medicine

Keywords: aftercare, critical care, follow-up, intensive care, illness trajectory, lifeworld-led care, patient experience, phenomenology, support

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Understanding the Course of Critical Illness Through a Lifeworld Approach

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Most cited references 35

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference.

Post‐intensive care syndrome: its pathophysiology, prevention, and future directions

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