Intensive Care Experiences of Patients in Medical ICU: a Mixed-Method Study
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Abstract
This mixed-method study aimed to study the level and characteristics of intensive care experiences of patients in the medical ICU. Timing It Right (TIR) was employed as a conceptual framework. Seventy participants, who met the inclusion criteria, were enrolled in the study. Data collection involved questionnaires inquiring about the patients’ personal information and intensive care experiences (four dimensions—awareness of surroundings, frightening experiences, experience recall, and satisfaction with care) as well as interviews with open-ended questions. Descriptive statistics were used to analyses the quantitative data and content analyses were used to scrutinize qualitative information. Then, interpretation together both the data with the aim of describing the phenomena related to the experiences of medical ICU patients.
The findings revealed that 97.1% of the participants perceived intensive care experiences having a high awareness level of their surroundings (mean 37.4; SD 4.3), they always knew what was happening and felt safe with being in ICU were the most mentioned. Meanwhile, the intensive care experiences regarding the frightening experiences dimension were found to be of a low level (mean 12.5; SD 4.6), the patients tended to feel helpless and think they would die were the largest number. Concerning recall of experience, a high-level perception score was found among 58.6% of the participants (mean 15.8; SD 4.7), most patients remembered a lot of their ICU experiences and knew whether it was day or night. Finally, a high satisfaction level with care was reported by 85.7% of the participants (mean 16.1; SD 2.9), the most they perceived the care in ICU was as good as it could have been, and that it was not noisy.
The results of this study could guide the healthcare team in improving the clinical practice guidelines related to caring for critically-ill patients with the aims of ensuring the provision of holistic care, supporting family engagement, and improving the satisfaction with care of medical ICU patients.
Article Details
เนื้อหาและข้อมูลในบทความที่ลงตีพิมพ์ในวชิรสารการพยาบาลถือเป็นข้อคิดเห็นและความรับผิดชอบของผู้เขียนบทความโดยตรง ซึ่งกองบรรณาธิการไม่จำเป็นต้องเห็นด้วย หรือร่วมรับผิดชอบใด ๆ ทั้งสิ้น
บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการตีพิมพ์ในวชิรสารการพยาบาล ถือเป็นลิขสิทธิ์ของวชิรสารการพยาบาล หากบุคคลใดหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่งส่วนใดไปเผยแพร่ต่อหรือเพื่อกระทำการใด ๆ จะต้องได้รับอนุญาตเป็นลายลักอักษรจากวชิรสารการพยาบาลก่อนเท่านั้น
References
Alasad, J. A., Abu Tabar, N., & Ahmad, M.M. (2015). Patients’ experience of being in intensive careunits. Journal of Critical Care, 30(4), 859.e7-859.e11.
Ariffin, S. M., Pinyokham, N., & Tachaudomdach, C. (2018). Intensive care experience among intensive care unit survivors. Nursing Journal, 45(4), 181-191.
Atramont, A., et al. (2019). "Association of Age With Short-term and Long-term Mortality Among patients discharged from intensive care units in France." JAMA Network Open, 2(5), e193215-e193215.
Brame, A. L., & Singer, M. (2010). Stressing the obvious? An allostatic look at critical illness. Critical care medicine, 38(10 Suppl), S600–S607. https://doi.org/10.1097/CCM.0b013e3181f23e92
Brinkman, S., Abu-Hanna, A., de Jonge, E., & de Keizer, N. F. (2013). Prediction of long-term mortality in ICU patients: model validation and assessing the effect of using in-hospital versus long-term mortality on benchmarking. Intensive Care Medicine, 39(11), 1925-1931. doi:10.1007/s00134-013-3042-5
Brislin, R. W., Lonner, W. J., & Thorndike, R. M. (1973). Cross-cultural research methods. New York: John Wiley & Sons.
Cameron, J. I., & Gignac, M. A. (2008). "Timing It Right": a conceptual framework for addressing the support needs of family caregivers to stroke survivors from the hospital to the home. Patient Education and Counseling, 70(3), 305-314. doi:10.1016/j.pec.2007.10.020
Chaiweeradet, M., Ua-Kit, N., & Oumtanee, A. (2013). Experiences of being an adult patient receiving mechanical ventilator. Boromrajonani College of Nursing Songkhla Journal, 33(2), 31-46.
Creswell, J. W, & Plano Clark, V. L. (2018). Designing and conducting mixed-methods research (3rd ed. ). California: Sage.
Cuthbertson, B. H, Roughton S, Jenkinson D, & MacLennan G, Vale G. (2010). Quality of life in the five years after intensive care: A cohortstudy. Critical Care, 14, 1-12.
Czerwonka, A. I., Herridge, M. S., Chan, L., Chu, L. M., Matte, A., & Cameron, J. I. (2015). Changing support needs of survivors of complex critical illness and their family caregivers across the care continuum: a qualitative pilot study of towards recover. Journal of Critical Care, 30(2), 242-249. doi:10.1016/j.jcrc.2014.10.017
Davidson, J. E., & Harvey, M. A. (2016). Patient and family post-Intensive care syndrome. American Advanced Critical Care Nursing, 27(2), 184-186. doi:10.4037/aacnacc2016132
Desai, S. V., Law, T. J., & Needham, D. M. (2011). Long-term complications of critical care. Critical Care Medicine, 39(2), 371-379. doi:10.1097/CCM.0b013e3181fd66e5
Dexheimer Neto, F. L., Rosa, R. G., Duso, B. A., Haas, J. S., Savi, A., Cabral, C., . . . Teixeira, C. (2016). Public versus private healthcare systems following discharge from the ICU: A propensity score-Matched comparison of outcomes. BioMed Research International, 2016 Mar 30. 1-8. doi: 10.1155/2016/6568531
Erdogan, Z., & Atik, D. (2017). Complementary health approaches used in the intensive care unit. Holistic Nursing Practice, 31, 325-342. doi: 10.1097/HNP.0000000000000227
Esmaeili, M., Cheraghi, M.A., & Salsali, M. (2017). Explaining the context of patient-center care in critical care unit. Journal of Holistic Nursing and Midwifery, 27(3), 17-26.
Foa, C., Cavalli, L., Maltoni, A., Tosello, N., Sangilles, C., Maron, I., . . . Artioli, G. (2016). Communications and relationships between patient and nurse in Intensive Care Unit: Knowledge, knowledge of the work, knowledge of the emotional state. ACTA BIOMEDICA for Health Professions, 87(suppl), 71-82.
Fredriksen, S.T.D., & Ringsberg, K.C. (2007). Living the situation stress experience among intensive care patients. Intensive and Critical Care Nursing, 23(3), 124 – 131.
Hashem, M. D., Nallagangula, A., Nalamalapu, S., Nunna, K., Nausran, U., Robinson, K. A., . . . Eakin, M. N. (2016). Patient outcomes after critical illness: a systematic review of qualitative studies following hospital discharge. Critical Care, 20(1), 345. doi:10.1186/s13054-016-1516-x
Hatprakob, P, & Surit, P. (2013). Experience of elderly who depend on mechanical ventilation in surgical ICU, tertery care hospital. (2013). Journal of Nurses’ Association of Thailand, North-Eastern Division, 31(4), 70-79.
Huang, M., Parker, A. M., Bienvenu, O. J., Dinglas, V. D., Colantuoni, E., Hopkins, R. O., & Needham, D. M. (2016). Psychiatric symptoms in acute respiratory distress syndrome survivors: A 1-Year national multicenter study. Critical Care Medicine, 44(5), 954-965. doi:10.1097/ccm.0000000000001621
Jackson, J. C., Pandharipande, P. P., Girard, T. D., Brummel, N. E., Thompson, J. L., Hughes, C. G., . . . Ely, E. W. (2014). Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: A longitudinal cohort study. Lancet Respiratory Medicine, 2(5), 369-379. doi:10.1016/s2213-2600(14)70051-7
Jezierska, N. (2014). Psychological reactions in family members of patients hospitalised in intensive care units. Anaesthesiology Intensive Therapy, 46(1), 42-45. doi:10.5603/ait.2014.0009
Jones, C., Humphris, G., & Griffiths, R. D. (2000). Preliminary validation of the ICUM tool: A tool for assessing memory of the intensive care experience. Clinical Intensive Care, 11(5), 251-255.
Kaukonen, K. M., Bailey, M., Suzuki, S., Pilcher, D., & Bellomo, R. (2014). Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. Journal of the American Medical Association, 311(13), 1308-1316. doi:10.1001/jama.2014.2637
Kleinpell, R., Zimmerman, J., Vermoch, K. L., Harmon, L. A., Vondracek, H., Hamilton, R., . . . Hwang, D. Y. (2019). Promoting family engagement in the ICU: Experience from a national collaborative of 63 ICUs. Critical Care Medicine, 47(12). 1692-1698.
Kluge, G. H., Brinkman, S., van Berkel, G., van der Hoeven, J., Jacobs, C., Snel, Y. E., . . . Boon, E. S. (2015). The association between ICU level of care and mortality in the Netherlands. Intensive Care Medicine, 41(2), 304-311. doi:10.1007/s00134-014-3620-1
Linder, A., Guh, D., Boyd, J. H., Walley, K. R., Anis, A. H., & Russell, J. A. (2014). Long-term (10 -year) mortality of younger previously healthy patients with severe sepsis/septic shock is worse than that of patients with nonseptic critical illness and of the general population. Critical Care Medicine, 42(10), 2211-2218. doi:10.1097/ccm.0000000000000503
Luangasanatip, N., Hongsuwan, M., Lubell, Y., Limmathurotsakul, D., Teparrukkul, P., Chaowarat, S., . . . Cooper, B. S. (2013). Long-term survival after intensive care unit discharge in Thailand: A retrospective study. Critical Care, 17(5), R219. doi:10.1186/cc13036
Medrzycka-Dabrowska, W., Lewandowska, K., Kwiecien-Jagus, K., & Czyz-Szypenbajl, K. (2018). Sleep deprivation in intensive care unit - systematic review. Open Medicine (Warsaw, Poland), 13, 384–393. Retrived August 2 2020, from https://doi.org/10.1515/med-2018-0057
Mehlhorn, J., Freytag, A., Schmidt, K., Brunkhorst, F. M., Graf, J., Troitzsch, U., . . . Gensichen, J. (2014). Rehabilitation interventions for postintensive care syndrome: A systematic review. Critical Care Medicine, 42(5), 1263-1271. doi:10.1097/ccm.0000000000000148
Molina, J. A., Seow, E., Heng, B. H., Chong, W. F., & Ho, B. (2014). Outcomes of direct and indirect medical intensive care unit admissions from the emergency department of an acute care hospital: a retrospective cohort study. British Medical Journal Open, 4(11), e005553. doi:10.1136/bmjopen-2014-005553
Olsen, K. D., Nester, M., & Hansen, B. S. (2017). Evaluating the past to improve the future - A qualitative study of ICU patients' experiences. Intensive and Critical Care Nursing, 43, 61-67. doi:10.1016/j.iccn.2017.06.008
Pattison, N, Gara, O. G, & Rattray, J. (2015). After critical care: Patient support after critical care.
A mixed method longitudinal study using email interviews and questionnaires. Intensive and Critical Care Nursing, 31, 213-222.
Peerakavee, N., & Udchumpisai, M. (2020). Decision making experiences of critical care nurses during transition from advanced life support to end-of-life care: Hermeneutic phenomenology. Journal of Nursing Science & Health, 43(2), 13-24.
Prescott, H. C., Langa, K. M., & Iwashyna, T. J. (2015). Readmission diagnoses after hospitalization for severe sepsis and other acute medical conditions. Journal of the American Medical Association, 313(10), 1055-1057. doi:10.1001/jama.2015.1410
Prescott, P. A. (1987). Multiple regression analysis with small samples: Cautions and suggestions. Nursing Research, 36(2), 130–133. https://doi.org/10.1097/00006199-198703000-00015
Rattray, J. E., Johnston, M., & Wildsmith, J. A. W. (2004). The intensive care experience: Development of the ICE questionnaire. Journal of Advanced Nursing, 47(1), 64-73. Retrieved January, 9 2019, from http://www.ncbi.nlm.nih.gov/pubmed/15186469
Rovatti, K. B., Teodoro, M., & Kern de Castro, E. (2012). Memories and prevalence of posttraumatic stress disorder in intensive care units. Psicologia: Reflexao e Critica, 25(3), 499-505. doi:10.1590/S0102-79722012000300009
Ruhl, A. P., Huang, M., Colantuoni, E., Karmarkar, T., Dinglas, V. D., Hopkins, R. O., & Needham, D. M. (2017). Healthcare utilization and costs in ARDS survivors: a 1-year longitudinal national US multicenter study. Intensive Care Medicine, 43(7), 980-991. doi:10.1007/s00134-017-4827-8
Rydingsward, J. E., Horkan, C. M., Mogensen, K. M., Quraishi, S. A., Amrein, K., & Christopher, K. B. (2016). Functional status in ICU survivors and out of hospital outcomes: A cohort study. Critical Care Medicine, 44(5), 869-879. doi:10.1097/ccm.0000000000001627
Schreier, M. (2012). Qualitative content analysis in practice. London: Sage. Society of Critical Care Medicine. (2018). Critical care statistics. . Retrieved October, 18 2018, from http://sccm.org/Communications/Pages/CriticalCareStats.aspx
Soh, K.L, Soh, K.G., Noor Aini, I., & Nor Zehan, A., Salimah, J., Rosna, A.R. (2014). Recalling ICU experiences: Patients’ perspectives. Middle-East Journal of Scientific Research 19 (Innovation Challenges in Multidisciplinary Research and Practice), 106-111.
Svenningsen, H., Langhorn, L., Agard, A. S., & Dreyer, P. (2017).Post-ICU symptoms, consequences,
and follow-up:An integrative review. Nursing in Critical Care, 22(4), 212-220. doi:10.1111/nicc.12165
Torheim, H., & Kvangarsnes, M. (2014). How do patients with exacerbated chronic obstructive pulmonary disease experience care in the intensive care unit?. Scandinavian Journal of Caring Sciences, 28(4), 741–748. Retrived August 6 2020, from https://doi.org/10.1111/scs.12106
Wade, D., Als, N., Bell, V., Brewin, C., D’Antoni, D., Harrison, D. A., . . . Rowan, K. M. (2018). Providing psychological support to people in intensive care: Development and feasibility study of a nurse-led intervention to prevent acute stress and long-term morbidity. British Medical Journal Open, 8(7), 1-12. doi: 10.1136/bmjopen-2017-021083
Wolters, A. E., Slooter, A. J., van der Kooi, A. W., & van Dijk, D. (2013). Cognitive impairment after intensive care unit admission: A systematic review. Intensive Care Medicine, 39(3), 376-386. doi:10.1007/s00134-012-2784-9