‘Intensive care unit survivorship’ - a constructivist grounded theory of surviving critical illness

Kean, Susanne; Salisbury, Lisa G; Rattray, Janice; Walsh, Timothy S; Huby, Guro; Ramsay, Pamela

Abstract

Aims & objective
To theorise ICU survivorship after a critical illness based on longitudinal qualitative data.
Background
Increasingly patients survive episodes of critical illness. However, the short and long term impact of critical illness include physical, psychological, social and economic challenges long after hospital discharge. An appreciation is emerging that care needs to extend beyond critical illness to enable patients to reclaim their lives post-discharge with the term ‘Survivorship’ being increasingly used in this context. What constitutes critical illness survivorship has, to date, not been theoretically explored.
Design
Longitudinal-qualitative and constructivist Grounded Theory. Interviews (n = 46) with 17 participants were conducted at four time points: (1) before discharge from hospital, (2) 4-6 weeks post-discharge, (3) 6 months and (4) 12 months post-discharge across two adult intensive care setting.
Method
Individual face-to-face interviews. Data analysis followed the principles of Charmaz's Constructivist Grounded Theory. ‘ICU survivorship’ emerged as the core category and was theorised using concepts such as Status Passages, Liminality and Temporality to understand the various transitions participants made post-critical illness.
Findings
Intensive care survivorship describes the unscheduled status passage of falling critically ill and being taken to the threshold of life and the journey to a life post-critical illness. Surviving critical illness goes beyond recovery; surviving means ‘moving on’ to life post-critical illness. ‘Moving on’ incorporates a re-definition of self that incorporates any lingering intensive care legacies and being in control of one's life again.
Relevance to clinical practice
For healthcare professionals and policy makers it is important to realise that recovery and transitioning through to survivorship happens within an individual's time frame, not a schedule imposed by the healthcare system. Currently there are no care pathways or policies in place for critical illness survivors that would support ICU survivors and their families in the transitions to survivorship.

Citation

Kean, S., Salisbury, L. G., Rattray, J., Walsh, T. S., Huby, G., & Ramsay, P. (2017). ‘Intensive care unit survivorship’ - a constructivist grounded theory of surviving critical illness. Journal of Clinical Nursing, 26(19-20), 3111-3124. https://doi.org/10.1111/jocn.13659

• Journal Article Type: Article
• Acceptance Date: Nov 12, 2016
• Online Publication Date: Nov 22, 2016
• Publication Date: 2017-10
• Deposit Date: Feb 23, 2017
• Publicly Available Date: Nov 23, 2017
• Journal: Journal of Clinical Nursing
• Print ISSN: 0962-1067
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 26
• Issue: 19-20
• Pages: 3111-3124
• DOI: https://doi.org/10.1111/jocn.13659
• Keywords: Longitudinal; constructivist grounded theory; interviews; critical illness; intensive care; survivorship; recovery; status passages; liminality; temporality
• Public URL: http://researchrepository.napier.ac.uk/Output/688522
• Contract Date: Feb 23, 2017