Longing for homelikeness: A hermeneutic phenomenological analysis of patients' lived experiences in recovery from COVID‐19‐associated intensive care unit acquired weakness

Abstract

Aims:To explore lived experiences of patients recovering from COVID-19-associated intensive care unit acquired weakness and to provide phenomenological descriptions of their recovery.Design: A qualitative study following hermeneutic phenomenology.Methods: Through purposeful sampling, 13 participants with COVID-19-associated intensive care unit acquired weakness were recruited with diversity in age, sex, duration of hospitalization and severity of muscle weakness. Semi-structured in-depth interviews were conducted from 4 to 8 months after hospital discharge, between July 2020 and January 2021. Interviews were transcribed verbatim and analysed using hermeneutic phenomenological analysis. Results:The analysis yielded five themes: 'waking up in alienation', 'valuing human contact in isolation', 'making progress by being challenged', 'coming home but still recovering' and 'finding a new balance'. The phenomenological descriptions reflect a recovery process that does not follow a linear build-up, but comes with moments of success, setbacks, trying new steps and breakthrough moments of achieving mobilizing milestones. Conclusion: Recovery from COVID-19-associated intensive care unit acquired weakness starts from a situation of alienation. Patients long for familiarity, for security and for recognition. Patients want to return to the familiar situation, back to the old, balanced, bodily self. It seems possible for patients to feel homelike again, not only by changing their outer circumstances but also by changing the understanding of themselves and finding a new balance in the altered situation. Impact: Muscle weakness impacts many different aspects of ICU recovery in critically ill patients with COVID-19-associated intensive care unit acquired weakness. Their narratives can help nurses and other healthcare professionals, both inside and outside of the intensive care unit, to empathize with patient experiences. When healthcare | 3359 van OORSOUW et al.

Experiences of isolation in patients in the intensive care unit during the COVID‐19 pandemic

“…Other qualitative studies have high‐lighted augmented feelings of anxiety, concerns relating to over‐crowding, and social stigmatization 5,6 . Oorsouw et al focused on the experiences relating to recovery following severe COVID‐19 7 . Finally, studies have investigated specific sub‐themes, such as the application of a diary during ICU admission, 27 and the use of telephone‐ and videoconferences to counteract negative effects of isolation 28 …”

“…The novelty of our study consists in the methods applied 8,9 . Contrary to shorter phone‐ or video‐based interviews, 4,7 our methods employed highly structured and frontloaded interviews, conducted in‐person over several encounters. This approach allows for richer and more detailed descriptions of experiences.…”

“…5,6 Oorsouw et al focused on the experiences relating to recovery following severe COVID-19. 7 Finally, studies have investigated specific sub-themes, such as the application of a diary during ICU admission, 27 and the use of telephone-and videoconferences to counteract negative effects of isolation. 28 Studies in ICU patients before the COVID-19 pandemic also document serious existential impact of ICU admission.…”

“…Furthermore, previous studies document that being admitted to the ICU is characterized by significant alterations in the patient's mode of experience in itself 3 . Despite this extreme situation, the experience of isolation in COVID‐19 positive patients admitted to the ICU has only been investigated to a limited extend 4–7 . Hence, further investigations are needed, to shed a light on this extreme circumstance, and to provide knowledge of both similarities and potential differences in patient experience, compared to patients subjected to isolation for reasons other than COVID‐19, and between isolated patients in the ICU and in standard wards.…”

Exploring critically ill patients' and their relatives' experiences of intensive care unit during COVID‐19: A qualitative study

“…10,13 They experienced memory gaps and waking up after a period of being sedated with a feeling of alienation, weakness and isolation as they were separated from their families. 10,14 The daily routines in ICU were changed, due to isolation of patients with confirmed COVID-19, and staff had to deal with an unknown illness, new treatment strategies, personal protective equipment, and changes in staffing and visiting restrictions. 15 The restrictions to visiting hours were suggested to compromise opportunities for, and quality of, family nursing.…”