Patient and spouses experiences with transition from intensive care unit to hospital ward – qualitative study

Abstract

Background and purpose of study Transition from the intensive care unit to the hospital ward can be considered as a vulnerable period for patients as nursing care changes hands. How the transition is experienced by the ICU patient and the family is influenced by how it is organised, communicated and executed. The transition may positively or negatively affect patient recovery. Aim To explore the experiences of intensive care unit patients and their relatives during the transition to hospital ward in order to find ways of supporting them during the transition process. Methods Eligible participants were asked for participation from April to September 2016 from a mixed medical and surgical intensive care unit (Level II) at a university hospital. We conducted six semi‐structured interviews with former intensive care unit patients and four dyad interviews with patients and spouses. Data were analysed according to the methodology Interpretive Description with the aim to discover associations, relationships and patterns within the phenomenon. Results Our analysis revealed the following three themes: (1) Taking up the mantel (2) Adjusting to ‘being one in the crowd’ and (3) Integrated spouses became visitors. It was a change from an environment with high dependence to increasing independence and a shift from attention to loneliness. Focus moved from the bodily functions to basic activities of living. Spouses experienced that their position was reduced from integrated relatives in the intensive care unit to visitors of the hospital ward. Conclusions This article shows that it is important to mentally prepare patients and their family for transfer and a gradual withdrawal of intense nursing observation and monitoring. Discharge planning should begin early and involve spouses to a higher extent as they have a major role in the recovery process far beyond hospitalisation.

Challenges of the patient transition process from the intensive care unit: a qualitative study

“…Patients experienced the shift from being the center of all attention to being just ‘one in the crowd’. The ICU patient had to share the attention of fewer staff with other patients with similar needs [ 11 ]. In the study by de Grood et al [ 18 ], communication and organizational culture were among the main factors involved in sensations of care break during the patient transition from the ICU to a ward, and the application of multiple communication standards and methods was effective in improving the quality of care.…”

“…Information is key in the movement toward empowerment. Patients must have information and knowledge of their disease and health to make the best decisions on actions and must be considered throughout the transition from the ICU to the hospital ward [ 11 ]. Information and teaching are aimed at relatives with a focus on specific transfer plans, ward information, staff information, expectations in the hospital ward, and support services for the family [ 33 ].…”

“…This may be related to various factors such as the high number of patients with complex needs, reduced monitoring outside the ICU, staff with different competencies and skills, and communication failure [ 10 ]. How the transition from the ICU to the hospital ward is experienced by the patient and the family is influenced by how it is organized, communicated, and executed [ 11 ].…”

Family members' lived experiences when a loved one undergoes an interhospital intensive care unit‐to‐unit transfer: A phenomenological hermeneutical study

“…In recent years, the interest in studying different types of transfers in intensive care has increased (Bergman, Pettersson, Chaboyer, Carlstrom, & Ringdal, 2017;Eiding, Kongsgaard, & Braarud, 2019;Herling et al, 2020). Despite this development, interhospital intensive care unit-to-unit transfers from the family members' perspective have been sparsely investigated (Burns & Petrucka, 2020).…”

Family caregivers' experiences and needs of transitional care during the transfer from intensive care unit to a general ward: A qualitative study

“…Similar to the caregivers situating with other types of ICU, participants reported that their care efficiency of family members during the process of ICU transition was more affected by the internal and external environment, such as varied degrees of mental burdens and mixed emotional response, which led to their inactive, and even negative care activities (de Grood et al, 2018;Herling et al, 2020). These findings are consistent with reported experiences of participants who were in a state of care shock and sometimes disturbed during ICU transition (Ghorbanzadeh et al, 2021).…”