A protocol for exploring patients' and support peoples' experiences after prolonged critical illness

Abstract

Background: Improved survival of critically ill people has increased the number of patients who experience an extended stay in intensive care units (ICU). Evidence suggests the complexities, vulnerabilities, and traumas created by critical illness are substantial for both patients and their support people with a number experiencing devastating impairments across multiple domains of health and function including physical, mental, cognitive, and social health. However, research on survivors predominantly focuses on those who have experienced a relatively short length of stay; only a limited number of studies seek to explore the experiences of survivors and their support people who have had a prolonged stay in intensive care.Aims: To describe the experiences of survivors of prolonged critical illness (invasively mechanically ventilated in ICU for ≥eight days) and their support people during the first 12 months following hospital discharge in New Zealand.Study design: This research will be a multi-centre study recruiting from three intensive care units in New Zealand. A narrative inquiry methodology will be used to interview 6-8 former long stay patients and 6-8 support people of a former long stay patient. Each participant will be interviewed at 3-, 6-, 9-, and 12-months following hospital discharge. Data will be collected via narrative inquiry interviews. Data analysis will combine two theoretical frameworks: the Clandinin and Connelly narrative inquiry threedimensional space and the Fairclough situation, discourse and context framework. Results:The phenomenon of investigation will be experiences after prolonged critical illness explored longitudinally across the first-year post-hospital discharge.Relevance to clinical practice: This protocol provides a methodological framework for exploring the lived experiences of survivors of prolonged critical illness and their support people. Data analysis will support understanding of the human journey of ICU survivorship and add to the body of knowledge on how to support post-ICU recovery in this population. The barriers and enablers of survivorship at the micro, meso, and macro levels of the health service will also be illuminated.

Introduction to this special issue on rehabilitation during and after critical care

“…In this special issue, Best et al present their protocol for a longitudinal qualitative study that will explore experiences of prolonged critical illness during the first 12 months after hospital discharge. 21 The findings of this study will add to the knowledge base of how to support recovery and rehabilitation following a prolonged ICU stay.…”

“…It is encouraging to see future studies being proposed to investigate the experiences of survivors of prolonged critical illness and their carers in the long term. In this special issue, Best et al present their protocol for a longitudinal qualitative study that will explore experiences of prolonged critical illness during the first 12 months after hospital discharge 21 . The findings of this study will add to the knowledge base of how to support recovery and rehabilitation following a prolonged ICU stay.…”