Identifying patients’ support needs following critical illness: a scoping review of the qualitative literature

Judy King, B O'Neill, Pam Ramsay, Mark A Linden, Alia Darweish Medniuk , Joanne Outtrim, Bronagh Blackwood

Research output: Contribution to journalArticle

Abstract

Background: Intensive care survivors suffer chronic and potentially life-changing physical, psychosocial and cognitive sequelae, and supporting recovery is an international priority. As survivors' transition from the intensive care unit to home, their support needs develop and change. Methods: In this scoping review, we categorised patients' support needs using House's Social Support Needs framework (informational, emotional, instrumental, appraisal) and mapped these against the Timing it Right framework reflecting the patient's transition from intensive care (event/diagnosis) to ward (stabilisation/preparation) and discharge home (implementation/adaptation). We searched electronic databases from 2000 to 2017 for qualitative research studies reporting adult critical care survivors' experiences of care. Two reviewers independently screened, extracted and coded data. Data were analysed using a thematic framework approach. Results: From 3035 references, we included 32 studies involving 702 patients. Studies were conducted in UK and Europe (n = 17, 53%), Canada and the USA (n = 6, 19%), Australasia (n = 6, 19%), Hong Kong (n = 1, 3%), Jordan (n = 1, 3%) and multi-country (n = 1, 3%). Across the recovery trajectory, informational, emotional, instrumental, appraisal and spiritual support needs were evident, and the nature and intensity of need differed when mapped against the Timing it Right framework. Informational needs changed from needing basic facts about admission, to detail about progress and treatments and coping with long-term sequelae. The nature of emotional needs changed from needing to cope with confusion, anxiety and comfort, to a need for security and family presence, coping with flashbacks, and needing counselling and community support. Early instrumental needs ranged from managing sleep, fatigue, pain and needing nursing care and transitioned to needing physical and cognitive ability support, strength training and personal hygiene; and at home, regaining independence, strength and return to work. Appraisal needs related to obtaining feedback on progress, and after discharge, needing reassurance from others who had been through the ICU experience. Conclusions: This review is the first to identify the change in social support needs among intensive care survivors as they transition from intensive care to the home environment. An understanding of needs at different transition periods would help inform health service provision and support for survivors.

LanguageEnglish
Article number187
JournalCritical Care
Volume23
Issue number1
DOIs
Publication statusPublished - 24 May 2019

Fingerprint

Critical Care
Critical Illness
Survivors
Social Support
Australasia
Patient Transfer
Confusion
Jordan
Aptitude
Return to Work
Resistance Training
Qualitative Research
Hong Kong
Nursing Care
Hygiene
Health Services
Canada
Fatigue
Intensive Care Units
Counseling

Keywords

  • Critical illness
  • qualitative scoping review
  • support needs
  • Qualitative research
  • Support needs
  • Scoping review
  • Recovery

Cite this

King, J., O'Neill, B., Ramsay, P., Linden, M. A., Darweish Medniuk , A., Outtrim, J., & Blackwood, B. (2019). Identifying patients’ support needs following critical illness: a scoping review of the qualitative literature. 23(1), [187]. https://doi.org/10.1186/s13054-019-2441-6
King, Judy ; O'Neill, B ; Ramsay, Pam ; Linden, Mark A ; Darweish Medniuk , Alia ; Outtrim, Joanne ; Blackwood, Bronagh. / Identifying patients’ support needs following critical illness: a scoping review of the qualitative literature. 2019 ; Vol. 23, No. 1.
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King, J, O'Neill, B, Ramsay, P, Linden, MA, Darweish Medniuk , A, Outtrim, J & Blackwood, B 2019, 'Identifying patients’ support needs following critical illness: a scoping review of the qualitative literature', vol. 23, no. 1, 187. https://doi.org/10.1186/s13054-019-2441-6

Identifying patients’ support needs following critical illness: a scoping review of the qualitative literature. / King, Judy; O'Neill, B; Ramsay, Pam; Linden, Mark A; Darweish Medniuk , Alia; Outtrim, Joanne; Blackwood, Bronagh.

Vol. 23, No. 1, 187, 24.05.2019.

Research output: Contribution to journalArticle

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AU - Outtrim, Joanne

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AB - Background: Intensive care survivors suffer chronic and potentially life-changing physical, psychosocial and cognitive sequelae, and supporting recovery is an international priority. As survivors' transition from the intensive care unit to home, their support needs develop and change. Methods: In this scoping review, we categorised patients' support needs using House's Social Support Needs framework (informational, emotional, instrumental, appraisal) and mapped these against the Timing it Right framework reflecting the patient's transition from intensive care (event/diagnosis) to ward (stabilisation/preparation) and discharge home (implementation/adaptation). We searched electronic databases from 2000 to 2017 for qualitative research studies reporting adult critical care survivors' experiences of care. Two reviewers independently screened, extracted and coded data. Data were analysed using a thematic framework approach. Results: From 3035 references, we included 32 studies involving 702 patients. Studies were conducted in UK and Europe (n = 17, 53%), Canada and the USA (n = 6, 19%), Australasia (n = 6, 19%), Hong Kong (n = 1, 3%), Jordan (n = 1, 3%) and multi-country (n = 1, 3%). Across the recovery trajectory, informational, emotional, instrumental, appraisal and spiritual support needs were evident, and the nature and intensity of need differed when mapped against the Timing it Right framework. Informational needs changed from needing basic facts about admission, to detail about progress and treatments and coping with long-term sequelae. The nature of emotional needs changed from needing to cope with confusion, anxiety and comfort, to a need for security and family presence, coping with flashbacks, and needing counselling and community support. Early instrumental needs ranged from managing sleep, fatigue, pain and needing nursing care and transitioned to needing physical and cognitive ability support, strength training and personal hygiene; and at home, regaining independence, strength and return to work. Appraisal needs related to obtaining feedback on progress, and after discharge, needing reassurance from others who had been through the ICU experience. Conclusions: This review is the first to identify the change in social support needs among intensive care survivors as they transition from intensive care to the home environment. An understanding of needs at different transition periods would help inform health service provision and support for survivors.

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