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Custom Follow-up Visits to an ICU Essay

The modern mass media provide medical professionals with a great variety of publications concerning new methods of treatment, medications, advancements in medicine, and so forth. However, despite a constant increase in the quantity of research studies on healthcare issues,  attitudes and experiences of those who were critically ill and their preferences for care after discharge appear to be under-researched and less from a qualitative perspective. The article ‘Re-visiting the ICU  experiences of follow-up visits to an ICU after discharge: a qualitative study’ published by  Engström, Andersson, and Söderberg (2008) describes and examines perceptions of post-discharge follow-up visits to the intensive care unit (ICU)  experienced by those who have been critically ill and their close relatives.

The title of the publication clearly indicates its content. The article includes the abstract, which concisely summarizes objectives, methods, sample, and findings of the research. The goal of this qualitative study is to examine discharged patients and their family members’ experiences and preferences for follow-up visits and health care provided in the intensive care unit (ICU). Although the researchers do not precisely indentify the target group, physicians, critical care nurses, healthcare policymakers, and administrators of clinical settings appear to be the intended audience.

The publication involves the solid theoretical grounding. The research process entailed the review of 47 peer review journals, dissertations, monographs, and scholarly research from reputable national and international healthcare organizations, which were used to gather pertinent information. Previously published studies on psychological characteristics and experiences of former critically ill patients, their perceptions of treatment and relationships with the ICU staff, issues related to post-discharge services, and research methodology were analysed by the authors. All the sources were evaluated for the quality of methodology, relevance, and importance of results. The article provides 22 sources published in last 10 years, whereas 7 items of them were published during the last 5 years (2001 – 2006). The following key words were used in the study to examine scholarly sources that pertain to intensive care, follow-up visits, critical illness, qualitative thematic content analysis.

The researchers consider their study to be significant due to existing gaps in the literature in regard to individual experiences of those who were critically ill and their family members. In addition, investigating former patients’ understanding of follow-up visits to the intensive care unit (ICU) from a public health perspective provides a deeper insight of the implications this has for critical health care. Testifying to the importance of their research, Engström, Andersson, and Söderberg emphasize that there is little evidence available on individual perceptions of post-discharge visits to the ICU specific to discharged patients and their close relatives.

 The purpose of qualitative research studies is to explore social and cultural phenomena. A qualitative research design was implemented in order to clarify and describe individual experiences and perceptions on the basis of the research participant's own individual perspective. In accordance with the definition provided by Creswell, qualitative research studies explore patterns or themes in data that are not necessarily in numerical format to answer the driving research questions and fill a knowledge gap. Although the research did not involve statistical procedures, it provides numerical information concerning participants’ characteristics such as age, gender, medical diagnoses, and length of their treatment in the ICU. The qualitative data were obtained from interviews, relevant scientific studies, participants’ personal written diaries, and documented reports. This study was designed to answer questions of a phenomenological nature summarizing participants’ perceptions about their stay in the ICU, follow–up visits, and possible improvements that could be made in the care provided in the ICU. Thus, a qualitative research design was appropriate for this study.

The researchers adequately describe the data collection process and interview techniques. However, they only provide the two questions designed for interviews. The lived experiences of the participants were audio taped during the interviews and then transcribed verbatim for accuracy. In order to reduce bias, “The interview texts were analysed by the first and third author using qualitative thematic content analysis” (Engström et al. 2008, p. 235). The research involves individual textural descriptions, which provide literal examples of the participants’ thoughts and perceptions related to the investigated issues. Interview location (participants’ work places or a public building near their home) was decided upon by every participant, ensuring they felt comfortable and at ease.

The general problem of the study caused the necessity to assess the contents of patients’ personal written diaries from their stay in the ICU, conduct interviews with the ICU medical staff, and involve family members of those who were critically ill.  The publication includes descriptions of the research participants as well as rationales for involving them.  The sample consisted of 18 participants, “nine people who had been critically ill and nine close relatives”.  The publication provides respondents’ average data on age, gender, medical diagnoses for those who had been critically ill, and length of stay in the ICU.  It is essential to ensure that those who take part in research comprehensively understand what the study involves for them. The participants were advised that the interviews would be tape-recorded, that participation was voluntary, and withdrawal would not incur any punitive measures. Although the study was approved by the Regional Ethical Review Board, the researchers do not mention informed consent of respondents; freely given informed consent is obligatory to research studies involving human participants.  

 According to Engström et al., measurement strategies were designed in conformity with recommendations on qualitative thematic content analysis developed by Downe-Wamboldt. The authors briefly identified the guidelines and theoretical base of their study. Thus, the data analysis procedure is insufficiently elaborated by the authors. However, triangulation increased the reliability and validity of findings. The researchers independently checked the analysis the interview texts and then compared their conclusions. While conducting thematic analysis four dominant themes emerged from the interviews. They were categorized under the following headings: 1) receiving strength from returning together, 2) making sense of the critical-illness experience, 3) feeling grateful to have survived, 4) the possibility of improving the care.

Engström, Andersson, and Söderberg critically evaluate validity of their study and admit limitations of their findings caused by specific demographic characteristics. Moreover, experiences of discharged patients cannot equal those of their family members. Different medical diagnoses of those who were critically ill evoke different emotions and perceptions and, thus, cannot be generalized.

The researchers summarized the findings in the final part of the study and compared them with results of previous research on post-discharge follow-up visits to an ICU and individual experiences of former patients. The interviews with the participants, documented studies, reports, written diaries, and the review of relevant literature revealed the themes that identified the contributing factors to preference for care provided in the intensive care unit (ICU). Although post-discharge follow-up visits to an ICU were identified as a positive practice of communication, the respondents suggested such improvements as involvement close relatives in the critical care and participation in follow-up visits those physicians and nurses who “who had been with them most in the ICU and who was aware of different events that had happened during their stay in the ICU”. 

 In conclusion, the background to the study, objectives, and significance of the research identify crucial aspects of this issue. Being based on the study data, new models of follow-up visits to an ICU after discharge can be designed and the process of rehabilitation of those who were critically ill can be facilitated.

Code: Sample20

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