Implications for research and practice of the biographic approach for storytelling

Background Intensive care unit survivors face many physical and psychological difficulties during their recovery following discharge from hospital. These difficulties can significantly affect their quality of life. Healthcare providers and survivors’ families often do not understand what recovery means in this population, which may affect the support provided. Aim To consider the potential of the biographical method in helping to create stories that illustrate recovery in intensive care survivors and other populations. Discussion This paper identifies how the biographical approach has provided survivors with a way to uncover the hidden parts of their lives through diaries and interviews, and reveal the hidden stories of intensive care survivorship and recovery. Conclusion The application of the biographical method enabled stories to be created that identified the disruption survivors encounter as they struggle to appear recovered. Implications for practice The biographical method can illuminate experiences uncaptured by other methods. This insight into recovery journeys can help healthcare practitioners and family members to understand and recognise the need for support during recovery

ICU survivors’ utilisation of diaries post discharge: A qualitative descriptive study

Background: A growing body of evidence has confirmed that intensive care unit survivors encounter myriad of physical and psychological complications during their recovery. The incidence of psychological morbidity in intensive care survivors is increasingly being recognised. The causes of psychological morbidity are multi-factorial but may be associated with a complete lack of, or delusional recall of events in intensive care. Intensive care unit diaries are an initiative designed to enable survivors to help restore factual memories and differentiate those from delusional. Purpose: To explore survivors’ and family members’ perceptions and utilisation of diaries following discharge from hospital. Method: A single centre qualitative descriptive study was undertaken in a general intensive care unit in Western Australia. Participants were surveyed 3, 6 and 12 months following discharge from hospital. Eighteen participants completed one or more surveys. Findings: Many of the participants who completed the surveys read their diaries but few made entries in them following discharge. Reading the diaries evoked mixed emotions for these participants; however they still viewed the diaries as a positive initiative in their recovery. Diaries enabled survivors to fill the memory gaps, make sense of their experience and reinforced the human connection when they were immersed in a technological environment. Conclusion: Use of patient diaries was received positively by the participants in this study. Diaries are a simple, cost effective initiative which enabled survivors to piece together the time they had lost, concreted their experience in reality and enabled them to retain a connection with their loved ones whilst immersed in a technological environment

A web-based recovery program (ICUTogether) for intensive care survivors: Protocol for a randomized controlled trial

Background: Those who experience a critical illness or condition requiring admission to an intensive care unit (ICU) frequently experience physical and psychological complications as a direct result of their critical illness or condition and ICU experience. Complications, if left untreated, can affect the quality of life of survivors and impact health care resources. Explorations of potential interventions to reduce the negative impact of an ICU experience have failed to establish an evidence-based intervention. Objective: The aim of this study is to evaluate the impact of a Web-based intensive care recovery program on the mental well-being of intensive care survivors and to determine if it is a cost-effective approach. Methods: In total, 162 patients that survived an ICU experience will be recruited and randomized into 1 of 2 groups. The intervention group will receive access to the Web-based intensive care recovery program, ICUTogether, 2 weeks after discharge (n=81), and the control group will receive usual care (n=81). Mental well-being will be measured using the Hospital Anxiety and Depression Scale, The Impact of Events Scale-Revised and the 5-level 5-dimension EuroQoL at 3 time points (2 weeks, 6 months, and 12 months post discharge). Family support will be measured using the Multidimensional Scale of Perceived Social Support at 3 time points. Analysis will be conducted on an intention-to-treat basis using regression modeling. Covariates will include baseline outcome measures, study allocation (intervention or control), age, gender, length of ICU stay, APACHE III score, level of family support, and hospital readmissions. Participants’ evaluation of the mobile website will be sought at 12 months postdischarge. A cost utility analysis conducted at 12 months from a societal perspective will consider costs incurred by individuals as well as health care providers. Results: Participant recruitment is currently underway. Recruitment is anticipated to be completed by December 2020. Conclusions: This study will evaluate a novel intervention in a group of ICU survivors. The findings from this study will inform a larger study and wider debate about an appropriate intervention in this population