Exploring Patients’ Goals Within the Intensive Care Unit Rehabilitation Setting

1. Joanne M. McPeake, PhD⇑,

2. Michael O. Harhay, PhD,

3. Helen Devine, MSc,

4. Theodore J. Iwashyna, PhD, MD,

5. Pamela MacTavish, MSc,

6. Mark Mikkelsen, MD, MSCE,

7. Martin Shaw, PhD and

8. Tara Quasim, MD

+Author Affiliations

1. 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.

Abstract

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.

 ©2019 American Association of Critical-Care Nurses

Menjelajahi Tujuan Pasien dalam Pengaturan Rehabilitasi Unit Perawatan Intensif

1. Joanne M. McPeake , PhD ⇑ ,

2. Michael O. Harhay , PhD ,

3. Helen Devine , MSc ,

4. Theodore J. Iwashyna , PhD, MD ,

5. Pamela MacTavish , MSc ,

6. Mark Mikkelsen , MD, MSCE ,

7. Martin Shaw , PhD dan

8. Tara Quasim , MD

+Afiliasi Penulis

1. Joanne M. McPeake adalah konsultan perawat, penelitian klinis dalam inovasi, National Health
Service (NHS) Greater Glasgow dan Clyde, dan dosen klinis senior kehormatan, Fakultas
Kedokteran Gigi, Kedokteran Gigi dan Keperawatan Universitas Glasgow, Glasgow,
Skotlandia. Michael O. Harhay adalah seorang instruktur, Departemen Biostatistik, Epidemiologi
dan Informatika, dan Pusat Penelitian Penyakit Paliatif dan Lanjut, Sekolah Kedokteran
Perelman, Universitas Pennsylvania, Philadelphia. Helen Devine adalah fisioterapis senior
dan Pamela MacTavish adalah seorang apoteker yang sangat terspesialisasi di unit perawatan
intensif, Glasgow Royal Infirmary, Glasgow, Skotlandia. 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 Shawadalah dosen kehormatan, Fakultas Kedokteran,
Kedokteran Gigi dan Keperawatan, Universitas Glasgow dan ahli fisika klinis utama, NHS Greater
Glasgow dan Clyde. Tara Quasim adalah dosen klinis senior, Fakultas Kedokteran, Kedokteran
Gigi dan Perawatan Universitas Glasgow, dan konsultan unit perawatan intensif, NHS Greater
Glasgow dan Clyde

Abstrak

Latar Belakang Jumlah pasien yang selamat dari perawatan kritis meningkat. Kualitas hidup setelah
perawatan kritis diketahui buruk untuk beberapa pasien. Basis bukti untuk intervensi rehabilitasi yang
efektif dalam periode setelah tinggal di unit perawatan intensif terbatas.

Tujuan Untuk memahami tujuan rehabilitasi apa yang penting bagi pasien setelah perawatan kritis.

Metode Penelitian prospektif ini, yang dilakukan selama program pemulihan unit perawatan intensif,
mengeksplorasi tujuan pemulihan dari 43 pasien. Analisis kerangka kerja digunakan untuk
mengekstraksi tema yang lazim dan mengidentifikasi komponen penting dari pemulihan dari perspektif
pasien.

Hasil Peserta menggambarkan beragam tujuan untuk pemulihan unit perawatan pasca-intensif
mereka. Sebagian besar tujuan adalah tentang kualitas hidup yang berhubungan dengan kesehatan,
termasuk tujuan fisik dan rehabilitasi. Meskipun kesehatan adalah pusat dari banyak tujuan pemulihan
individu peserta, tema-tema keterlibatan keluarga dan sosial dan mengadopsi lintasan tujuan yang tepat
juga muncul dalam tujuan pasien. Strategi individu untuk mencapai tujuan-tujuan ini beragam, dan
pasien memiliki aspirasi yang berbeda tentang apa yang dapat mereka capai.

Kesimpulan Aspirasi pasien untuk pemulihan unit perawatan intensif mereka beragam. Desain
perawatan pascabedah dapat diinformasikan oleh pemahaman yang lebih besar tentang titik-titik awal
yang heterogen dan lintasan sasaran penyintas penyakit kritis.

 © 2019 American Association of Critical-Care Nurses