Insights into the unique and vital health-promoting influence of family participation indicate the responsibility of the ICU team to provide support for families.

Aims and objectives To explore aspects that promote and challenge long‐term ICU patients’ inner strength and willpower. Background Considerable research has been devoted to ICU patients’ experiences; however, research on long‐term ICU patients is limited. Studies in a health‐promoting perspective focusing on long‐term ICU patients’ inner strength and willpower are scarce. Design A qualitative, hermeneutic‐phenomenological approach, using in‐depth interviews. Methods Seventeen long‐term Norwegian ICU patients were interviewed once, at 6–18 months after ICU discharge. The consolidated criteria for reporting qualitative research was used (Data S1). Results The lived experience of the phenomenon “inner strength and willpower” and what promotes and challenges this phenomenon in long‐term ICU patients were represented by four main themes and nine subthemes. Promoting aspects comprised of two main themes and five subthemes: (a) “No doubt about coming back to life” with subthemes; “Strong connectedness to life; feeling alive and present,” “Meaning and purpose; feeling valuable to somebody.” (b) “How to ignite and maintain the spark of life,” with the subthemes: “Practical solutions, coping skills from previous life experiences,” “Provocative and inspiring experiences” and “Vivid dream experiences that ignite the willpower.” Two main categories and four subcategories represented challenging aspects: (a) Exhaustion, weakness and discomfort; subthemes; “Physical challenges” and “Mental discomfort” and (b) “Tiring delusions,” subthemes; “Living in the worst horror movie” and “Feeling trapped.” Conclusion This study expands on previous studies by providing insights about what promotes and challenges long‐term ICU patients’ inner strength and willpower during their recovery trajectory. Relevance to clinical practice Insights into the variety of long‐term ICU patients’ experiences during the recovery trajectory are important for ICU nurses to support and facilitate ICU patients’ inner strength and willpower.

Aims and objectives:To provide insights into what promotes and challenges inner strength and willpower in formerly critically ill patients back home after a long-term ICU stay. Background:Critically ill patients demand great resources during an ICU stay, some experience great challenges after discharge from hospital. Knowledge about how health professionals can promote former long-term critically ill patients' inner strength and willpower after discharge is essential, but still missing. Design:A qualitative, hermeneutic-phenomenological approach using in-depth interviews with former long-term ICU patients.Methods: Seventeen long-term ICU patients were interviewed 6-20 months after ICU discharge. The consolidated criteria for reporting qualitative research was used (COREQ,2007).Results: Back home after hospital discharge, some former patients coped well while others suffered heavy burdens mentally and physically, along with economic problems. They handled their challenges differently: some found comfort and insight by reading their diary written by their ICU nurses, while several were struggling alone experiencing a lonesome silent suffering; these called for a follow-up support by the healthcare system. Conclusion:Long-term ICU patients' inner strength and willpower are vital salutogenic resources supporting the fight back to one's former independent life. However, physical, mental and economic challenges drain their inner strength to go on and succeed. Several long-term ICU patients need health-promoting follow-up support after hospital discharge.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Aims and objectives To explore how the presence of family and health professionals influences long‐term critically ill patients' inner strength and willpower as an incitement to keep fighting for recovery. Background This study reports long‐term critically ill patients' experiences of family and health professionals as health‐promoting resources in terms of significance for their inner strength and willpower. Earlier research on this topic is scarce. Design A qualitative, hermeneutic‐phenomenological approach, within the context of Antonovsky's salutogenic theory. Methods Seventeen long‐term critically ill patients were interviewed once, at 6–18 months after ICU discharge. The consolidated criteria for reporting qualitative research (COREQ) were used (Supplementary File 1). Results Four main themes identified how family and staff promoted and challenged the patient's inner strength and willpower: (a) the importance of family and friends; my family was surrounding me, (b) staff contributions, (c) challenges to inner strength and willpower in relation to family and (d) loneliness and indifferent care. Conclusion This study brings new knowledge from the long‐term critically ill patient's view about the impact of family, friends and nurses on the patient's inner strength and willpower. All impact is experienced positively and negatively. Relevance to clinical practice Knowledge from the long‐term critically ill patient's view is vital in nurse–patient interactions to facilitate liberation of inner strength and willpower.