ICU survivors’ and caregivers’ experiences of in-patient care: Exploratory qualitative study / Nur Nabila Qaisha Aswandi

Nur Nabila Qaisha , Aswandi (2024) ICU survivors’ and caregivers’ experiences of in-patient care: Exploratory qualitative study / Nur Nabila Qaisha Aswandi. Masters thesis, Universiti Malaya.

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Abstract

INTRODUCTION: A greater number of patients are surviving to ICU discharge with the advancement in intensive care and medical field these days. However, the nature of these admissions with strict isolations with no visitation policies and protracted course of illness is unprecedented and contributes to great anxiety for both patients and families. The voices and experiences of ICU survivors are missing from the policy development. Hence, we conducted this study to explore patients’ and caregivers’ experiences from ICU admission until discharge from the hospital. Apart from that, we aimed to explore the interactions between patients and caregivers with various hospital staff including specialists, medical officers, nurses, and allied health professionals as well to propose interventions including patients and family educational materials, ICU staff training and ICU workflow as well to improve the quality of ICU care. METHOD: This qualitative study involved ICU patients and their caregivers which was conducted in-depth interviews based on a semi-structured interview guide. All interviews were audio-recorded and transcribed verbatim. The NVivo qualitative software package was used to manage the data. The themes and subthemes were generated and confirmed by literature and expert opinion. RESULT: Data was collected from 24 interviewees which comprised of 12 patients and 12 caregivers whose age ranging from 28 to 82 years old. Two main themes emerged from the analysis: (I) Recognition of potential sources of discomfort, (II) Intensive care services. From the potential source of discomfort, two subthemes which include physical and psychological source of discomfort were mentioned. Pain, sleep disturbances, immobility and noise were among the most concerning discomforts being highlighted. While for psychological discomfort often associated with worry, ineffective communication, experience of loss of memory and fear were mentioned. By recognition of the potential source of discomfort, patients’ and caregivers’ perspectives on intensive care services were gathered as well. Three subthemes were developed for intensive care services: (I) Medical requisite, (II) Social requisite, (III)Psychological requisite. Medical aspect of care such as effective communication, good nursing care, excellent pain management and conducive ICU environment were highly appreciated. Social aspect of care such as multicultural sensitivity, favourable waiting area and longer visiting hours were mentioned. Healthcare workers play a vital role in psychological needs such as providing emotional support as part of routine care. ICU support or counselling group could be beneficial for some cases. CONCLUSION: This study uncovered patients’ and caregivers’ experiences on the potential source of discomforts and the intensive care services. Potential discomforts were classified into physical, psychological and social discomforts which include pain, immobility as well as ineffective communication and worry. Further exploration on the intensive care received in ICU were further classified into medical, social and psychological requisites. These include effective communication, good nursing care, excellent pain management, conducive ICU environment, ICU emotional support and counselling group, multicultural sensitivity, longer visiting hours as well as more seats at waiting room were mentioned. With the recognition of potential source of discomforts as highlighted in this study, as well as through patients’ and caregivers’ first hand experiences as recorded, together with the current literatures regarding ICU experiences, these will be useful references on establishing patients-centred and family centred intensive care services.

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