Exploring Patients' Goals Within the Intensive Care Unit Rehabilitation Setting.

Am J Crit Care

Joanne M. McPeake is a nurse consultant, clinical research in innovation, National Health Service (NHS) Greater Glasgow and Clyde, and honorary senior clinical lecturer, University of Glasgow School of Medicine, Dentistry and Nursing, Glasgow, Scotland. Michael O. Harhay is an instructor, Department of Biostatistics, Epidemiology and Informatics, and Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Helen Devine is a senior physiotherapist and Pamela MacTavish is a highly specialized pharmacist in the intensive care unit, Glasgow Royal Infirmary, Glasgow, Scotland. Theodore J. Iwashyna is a professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor and a research scientist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health System, Ann Arbor, Michigan. Mark Mikkelsen is an associate professor of medicine and chief of the Section of Medical Critical Care, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania Health System, and director of the medical intensive care unit, Penn Presbyterian Medical Center, Perelman School of Medicine, University of Pennsylvania. Martin Shaw is an honorary lecturer, School of Medicine, Dentistry and Nursing, University of Glasgow and principal clinical physicist, NHS Greater Glasgow and Clyde. Tara Quasim is a senior clinical lecturer, University of Glasgow School of Medicine, Dentistry and Nursing and an intensive care unit consultant, NHS Greater Glasgow and Clyde.

Published: September 2019

Background: The number of patients surviving critical care is increasing. Quality of life after critical care is known to be poor for some patients. The evidence base for effective rehabilitation interventions in the period following a stay in an intensive care unit is limited.

Objectives: To understand what rehabilitation goals are important to patients after critical care discharge.

Methods: This prospective study, which was undertaken during an intensive care unit recovery program, explored the recovery goals of 43 patients. Framework analysis was used to extract prevalent themes and identify the important components of recovery from the patients' perspective.

Results: Participants described diverse goals for their post-intensive care unit recovery. Most goals were about health-related quality of life, including physical goals and rehabilitation. Although health was central to many of the participants' individual recovery aims, themes of family and social engagement and adopting appropriate goal trajectories also emerged within patient goals. Individual strategies for reaching these goals varied, and patients had different aspirations about what they could achieve.

Conclusions: Patients' aspirations for their intensive care unit recovery are diverse. Design of postdischarge care can be informed by this greater understanding of the heterogeneous starting points and goal trajectories of survivors of critical illness.

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Source
http://dx.doi.org/10.4037/ajcc2019436DOI Listing

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