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A Nurse-Managed Follow-Up Practice for Patients After Discharge from the Intensive Care Unit: Development, Testing and Implementation

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Abstract

Intensive care nursing is a relatively new specialty area in nursing. The need for highly sophisticated nursing care of patients in life-threatening conditions is expanding. Knowledge to illuminate the care is growing, but still there are areas where evidence is limited. One of these areas is aftercare of patients with a compromised physical and psychological health status due to consequences of critical illnesses and intensive care stay. With positive, but limited, findings of the nature and effectiveness of aftercare and our clinical experience, we decided to embark on an implementation research project to improve post-intensive care of these patients at Landspitali—the National University Hospital of Iceland. This idea matured and evolved into a doctoral thesis in nursing. The aims of this chapter are to describe the development of a nurse-led follow-up intervention for critically ill patients post-intensive care stay and highlight findings of the testing of the intervention, along with an illustration of how the findings have been adjusted and implemented in the practice of an intensive care clinical nurse specialist.

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References

  1. Jónasdóttir RJ. Health and well-being of patients after discharge from the intensive care unit. [Heilsa og líðan eftir útskrift af gjörgæslu]. Faculty of Nursing University of Iceland; 2010. https://skemman.is/bitstream/1946/4250/1/pd_fixed.pdf.

  2. Desai SV, Law TJ, Needham DM. Long-term complications of critical care. Crit Care Med. 2011;39(2):371–9. https://doi.org/10.1097/CCM.0b013e3181fd66e5.

    Article  PubMed  Google Scholar 

  3. Jones C, Griffiths RD. Physical and psychological recovery. In: Griffiths RD, Jones C, editors. Intens care aftercare. Oxford: Butterworth-Heineman; 2002. p. 53–65.

    Google Scholar 

  4. National Institute for Health and Clinical Excellence (NICE). Rehabilitation after critical illness; 2009. https://www.nice.org.uk/guidance/cg83.

  5. Needham DM, Davidson J, Cohn H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholder’ conference. Crit Care Med. 2012;40:502–9. https://doi.org/10.1097/CCM.0b013e318232da75.

    Article  PubMed  Google Scholar 

  6. Feemster LC, Cooke CR, Rubenfeld GD, Hough CL, Ehlenbach WJ, Aul DH, et al. The influence of hospitalization or intensive care unit admission on declines in health-related quality of life. Ann Am Thorac Soc. 2015;12(1):35–45. https://doi.org/10.1513/AnnalsATS.201404-172OC.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cuthbertson BH, Roughton S, Jenkinson D, Maclennan G, Vale L. Quality of life in the five years after intensive care: a cohort study. Crit Care. 2010;14(1):R6. https://doi.org/10.1186/cc8848.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–304. https://doi.org/10.1056/NEJMoa1011802.

    Article  CAS  PubMed  Google Scholar 

  9. Angus DC, Carlet J. Surviving intensive care: a report from the 2002 Brussels roundtable. Intensive Care Med. 2003;29(3):368–77. https://doi.org/10.1007/s00134-002-1624-8.

    Article  PubMed  Google Scholar 

  10. Field K, Prinjha S, Rowan K. ‘One patient amongst many’: a qualitative analysis of intensive care unit patients’ experiences of transferring to the general ward. Crit Care. 2008;12(1):R21. https://doi.org/10.1186/cc6795.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Samuelson KAM. Unpleasant and pleasant memories of intensive care in adult mechanically ventilated patients—findings from 250 interviews. Intensive Crit Care Nurs. 2011;27(2):76–84. https://doi.org/10.1016/j.iccn.2011.01.003.

    Article  PubMed  Google Scholar 

  12. Meriläinen M, Kyngäs H, Ala-Kokko T. Patients’ interactions in an intensive care unit and their memories of intensive care: a mixed method study. Intensive Crit Care Nurs. 2013;29:78–87. https://doi.org/10.1016/j.iccn.2012.05.003.

    Article  PubMed  Google Scholar 

  13. Burry L, Cook D, Herridge M, Devlin JW, Fegusson D, Meade M, et al. Recall of ICU stay in patients managed with a sedation protocol or a sedation protocol with daily interruption. Crit Care Med. 2015;43(10):2181–90. https://doi.org/10.1097/CCM.0000000000001196.

    Article  Google Scholar 

  14. Elliott R, McKinley S, Cistulli P, Fien M. Characterisation of sleep in intensive care using 24-hour polysomnography: an observational study. Crit Care. 2013;17(2):R46. https://doi.org/10.1186/cc12565.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Engström Å, Nyström N, Sundelin G, Rattray J. People’s experiences of being mechanically ventilated in an ICU: a qualitative study. Intensive Crit Care Nurs. 2013;29(2):88–95. https://doi.org/10.1016/j.iccn.2012.07.003.

    Article  PubMed  Google Scholar 

  16. Karlsson V, Bergbom I, Forsberg A. The lived experiences of adult intensive care patients who were conscious during mechanical ventilation: a phenomenological-hermeneutic study. Intensive Crit Care Nurs. 2012;28(1):6–15. https://doi.org/10.1016/j.iccn.2011.11.002.

    Article  PubMed  Google Scholar 

  17. Löf L, Berggren L, Ahlström G. ICU patients’ recall of emotional reactions in the trajectory from falling critically ill to hospital discharge: follow-ups after 3 and 12 months. Intensive Crit Care Nurs. 2008;24(2):108–21. https://doi.org/10.1016/j.iccn.2007.08.001.

    Article  PubMed  Google Scholar 

  18. Almerud S, Alapack RJ, Fridlund B, Ekebergh M. Of vigilance and invisibility: being a patient in technologically intense environments. Nurs Crit Care. 2007;12(3):151–8. https://doi.org/10.1111/j.1478-5153.2007.00216.x.

    Article  PubMed  Google Scholar 

  19. Chahraoui K, Laurent A, Bioy A, Quenot JP. Psychological experience of patients 3 months after a stay in the intensive care unit: a descriptive and qualitative study. J Crit Care. 2015;30(3):599–605. https://doi.org/10.1016/j.jcrc.2015.02.01.

    Article  PubMed  Google Scholar 

  20. Zetterlund P, Plos K, Bergbom I, Ringdal M. Memories from intensive care unit persist for several years-a longitudinal prospective multi-centre study. Intensive Crit Care Nurs. 2012;28(3):159–67. https://doi.org/10.1016/j.iccn.2011.11.010.

    Article  PubMed  Google Scholar 

  21. Jones C, Griffiths RD, Humphris G, Skirrow PM. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med. 2001;29(3):573–80. https://www.researchgate.net/publication/11965727.

    Article  CAS  PubMed  Google Scholar 

  22. Granja C, Gomes E, Amaro A, Ribeiro O, Jones C, Carneiro A, et al. Understanding posttraumatic stress disorder-related symptoms after critical care: the early illness amnesia hypothesis. Crit Care Med. 2008;36(10):2801–9. https://doi.org/10.1097/CCM.0b013e318186a3e7.

    Article  PubMed  Google Scholar 

  23. Samuelson KA, Lundberg D, Fridlund B. Stressful memories and psychological distress in adult mechanically ventilated intensive care patients—a 2-month follow-up study. Acta Anaesthesiol Scand. 2007;51(6):671–8. https://doi.org/10.1111/j.1399-6576.2007.01292.x.

    Article  CAS  PubMed  Google Scholar 

  24. Truong AD, Fan E, Brower RG, Needham DM. Bench-to-bedside review: mobilizing patients in the intensive care unit—from pathophysiology to clinical trials. Crit Care. 2009;13:216. https://doi.org/10.1186/cc7885.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Chaboyer W, Grace J. Following the path of ICU survivors: a quality-improvement activity. Nurs Crit Care. 2003;8(4):149–55. https://doi.org/10.1046/j.1478-5153.2003.00020.x.

    Article  PubMed  Google Scholar 

  26. van der Schaaf M, Beelen A, Dongelmans DA, Vroom MB, Nollet F. Poor functional recovery after a critical illness: a longitudinal study. J Rehabil Med. 2009;41(13):1041–8. https://doi.org/10.2340/16501977-0443.

    Article  PubMed  Google Scholar 

  27. Fan E, Dowdy DW, Colantuoni E, Mendez-Tellez PA, Sevransky JE, Shanholtz C, et al. Physical complications in acute lung injury survivors: a two-year longitudinal prospective study. Crit Care Med. 2014;42:849–59. https://doi.org/10.1097/CCM.0000000000000040.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Elliott D, McKinley S, Alison J, Aitken LM, King M, Leslie GD, et al. Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program. Crit Care. 2011;15(3):R142. https://doi.org/10.1186/cc10265.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Davydow DS, Zatzick D, Hough CL, Katon WJ. A longitudinal investigation of posttraumatic stress and depressive symptoms over the course of the year following medical-surgical intensive care unit admission. Gen Hosp Psychiatry. 2013;35(3):226–32. https://doi.org/10.1016/j.genhosppsych.2012.12.005.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Wade DM, Howell DC, Weinman JA, Hardy RJ, Mythen MG, Brewin CR, et al. Investigating risk factors for psychological morbidity three months after intensive care: a prospective cohort study. Crit Care. 2012;16(5):R192. https://doi.org/10.1186/cc11677.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Rattray J, Crocker C, Jones M, Connaghan J. Patients’ perceptions of and emotional outcome after intensive care: results from a multicentre study. Nurs Crit Care. 2010;15(2):86–93. https://doi.org/10.1111/j.1478-5153.2010.00387.x.

    Article  PubMed  Google Scholar 

  32. Girard TD, Shintani AK, Jackson JC, Gordon SM, Pun BT, Henderson MS, et al. Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: a prospective cohort study. Crit Care. 2007;11(1):R28. https://doi.org/10.1186/cc5708.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Nickel M, Leiberich P, Nickel C, Tritt K, Mitterlehner F, Rother W, et al. The occurrence of posttraumatic stress disorder in patients following intensive care treatment: a cross-sectional study in a random sample. J Intensive Care Med. 2004;19:285–90. https://doi.org/10.1177/0885066604267684.

    Article  PubMed  Google Scholar 

  34. Ratzer M, Romano E, Elklit A. Posttraumatic stress disorder in patients following intensive care unit treatment: a review of studies regarding prevalence and risk factors. J Trauma Treat. 2014;3(190). https://doi.org/10.4172/2167-1222.1000190.

  35. Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM. Posttraumatic stress disorder in critical illness survivors: a meta-analysis. Crit Care Med. 2015;43:1121–9. https://doi.org/10.1097/CCM.0000000000000882.

    Article  PubMed  Google Scholar 

  36. Kowalczyk M, Nestorowicz A, Fijalkowska A, Kwiatosz-Muc M. Emotional sequelae among survivors of critical illness: a long-term retrospective study. Eur J Anaesthesiol. 2013;30:111–8. https://doi.org/10.1097/EJA.0b013e32835dcc45.

    Article  PubMed  Google Scholar 

  37. Paparrigopoulos T, Melissaki A, Txavellas E, Karaiskos D, Ilias I, Kokras N. Increased co-morbidity of depression and post-traumatic stress disorder symptoms and common risk factors in intensive care unit survivors: a two-year follow-up study. Int J Psychiat Clin Pract. 2014;18(1):25–31. https://doi.org/10.3109/13651501.2013.855793.

    Article  Google Scholar 

  38. Stevenson JE, Colantuoni E, Bienvenu OJ, Sricharoenchai T, Wozniak A, Shanholtz C, et al. General anxiety symptoms after acute lung injury: predictors and correlates. J Psychosom Res. 2013;75(3):287–93. https://doi.org/10.1016/j.jpsychores.2013.06.002.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Nikayin S, Rabiee A, Hashem MD, Huang M, Bienvenu OJ, Turnbull AE, et al. Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis. Gen Hosp Psychiatry. 2016;43:23–9. https://doi.org/10.1016/j.genhosppsych.2016.08.005.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Rabiee A, Nikayin S, Hashem MD, Huang M, Dinglas VD, Bienvenu OJ, et al. Depressive symptoms after critical illness: a systematic review and meta-analysis. Crit Care Med. 2016;44:1744–53. https://doi.org/10.1097/CCM.0000000000001811.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Davydow DS, Hough CL, Zatzick D, Katon WJ. Psychiatric symptoms and acute care service utilization over the course of the year following medical-surgical ICU admission: a longitudinal investigation. Crit Care Med. 2014;42:2473–81. https://doi.org/10.1097/CCM.0000000000000527.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Rattray JE, Johnston M, Wildsmith JA. Predictors of emotional outcomes of intensive care. Anaesthesia. 2005;60(11):1085–92. https://doi.org/10.1111/j.1365-2044.2005.04336.x.

    Article  CAS  PubMed  Google Scholar 

  43. Griffiths RD, Jones C. Introduction—why is ICU follow-up needed? In: Intensive care aftercare. Oxford: Butterworth-Heineman; 2002. p. 1–4.

    Google Scholar 

  44. Department of Health. Comprehensive critical care. A review of adult critical care services. London: Department of Health; 2000.

    Google Scholar 

  45. Chaboyer W, Foster MM, Foster M, Kendall E. The intensive care unit liaison nurse: towards a clear role description. Intensive Crit Care Nurs. 2004;20:77–786. https://doi.org/10.1016/j.iccn.2003.12.004.

    Article  PubMed  Google Scholar 

  46. Russell S. Life after life-support. Aust Nurs J. 1999;6(7):16–9. http://www.research-matters.com.au/publications.html.

    CAS  PubMed  Google Scholar 

  47. Russell S. Reducing readmissions to the intensive care unit. Heart Lung. 1999;28(5):365–72. http://www.sciencedirect.com/science/article/pii/S0147956399000758?via%3Dihub.

    Article  CAS  PubMed  Google Scholar 

  48. Jónasdóttir RJ, Klinke ME, Jónsdóttir H. Integrative review of nurse-led follow-up after discharge from the ICU. J Clin Nurs. 2016;25(1–2):20–37. https://doi.org/10.1111/jocn.12939.

    Article  PubMed  Google Scholar 

  49. Jónasdóttir RJ, Jones C, Sigurdsson GH, Jónsdóttir H. Structured nurse led follow-up for patients after discharge from the intensive care unit: prospective quasi-experimental study. J Adv Nurs. 2018;74(3):709–23. https://doi.org/10.1111/jan.13485.

    Article  PubMed  Google Scholar 

  50. Bench S, Day T, Griffiths P. Involving users in the development of effective critical care discharge information: a focus group study with patients, relatives and health care staff. Am J Crit Care. 2011;20(6):443–52. https://doi.org/10.4037/ajcc2011829.

    Article  PubMed  Google Scholar 

  51. Odell M, Gerber K, Gager M. Call 4 concern: patient and relative activated critical care outreach. Br J Nurs. 2010;19(22):1390–5. http://www.heal-trust.org/wpontent/uploads/2012/11/C4C.pdf.

    Article  PubMed  Google Scholar 

  52. Ball C, Kirkby M, Williams S. Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study. Br Med J. 2003;327:1–4. https://doi.org/10.1136/bmj.327.7422.1014.

    Article  Google Scholar 

  53. Garcea G, Thomaseet S, Mcclelland L, Leslie A, Berry DT. Impact of a critical care outreach team on critical care readmissions and mortality. Acta Anaesthesiol Scand. 2004;48:1096–100. https://doi.org/10.1111/j.1399-6576.2004.00509.x.

    Article  CAS  PubMed  Google Scholar 

  54. Samuelson K, Corrigan I. A nurse-led intensive care after-care programme—development, experiences and preliminary evaluation. Nurs Crit Care. 2009;14(5):254–63. https://doi.org/10.1111/j.1478-5153.2009.00336.x.

    Article  PubMed  Google Scholar 

  55. Jónasdóttir RJ, Jónsdóttir H, Gudmundsdottir B, Sigurdsson GH. Psychological recovery after intensive care: outcomes of a long-term quasi-experimental study of structured nurse-led follow-up. Intensive Crit Care Nurs. 2018;44:59–66. https://doi.org/10.1016/j.iccn.2017.06.001.

    Article  PubMed  Google Scholar 

  56. Möhler R, Köpke S, Meyer G. Criteria for reporting the development and evaluation of complex interventions in healthcare: revised guideline (CReDECI 2). Trials. 2015;16(204):1–9. https://doi.org/10.1186/s13063-015-0709-y.

    Article  Google Scholar 

  57. Cuthbertson BH, Scott J, Strachan M, Kilonzo M, Vale L. Quality of life before and after intensive care. Anaesthesia. 2005;60(4):332–9. https://doi.org/10.1111/j.1365-2044.2004.04109.x.

    Article  CAS  PubMed  Google Scholar 

  58. Kaarlola A, Tallgren M, Pettilä V. Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients. Crit Care Med. 2006;34(8):2120–6. https://doi.org/10.1097/01.CCM.0000227656.31911.2E.

    Article  PubMed  Google Scholar 

  59. Montuclard L, Garrouste-Orgeas M, Timsit JF, Misset B, de Jonghe B, Carlet J. Outcome, functional autonomy, and quality of life of elderly patients with a long-term intensive care unit stay. Crit Care Med. 2000;28(10):3389–95. https://www.ncbi.nlm.nih.gov/pubmed/11057791.

    Article  CAS  PubMed  Google Scholar 

  60. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.

    Article  CAS  PubMed  Google Scholar 

  61. Bienvenu OJ, Williams JB, Yang A, Hopkins RO, Needham DM. Posttraumatic stress disorder in survivors of acute lung injury. Evaluating the impact of event scale-revised. Chest. 2013;144(1):24–31. https://doi.org/10.1378/chest.12-0908.

    Article  PubMed  Google Scholar 

  62. Myhren H, Ekeberg Ø, Stokland O. Health-related quality of life and return to work after critical illness in general intensive care unit patients: a 1-year follow-up study. Crit Care Med. 2010;38(7):1554–61. https://doi.org/10.1097/CCM.0b013e3181e2c8b1.

    Article  PubMed  Google Scholar 

  63. ICU steps. Intensive Care. A guide for patients and relatives. Available from: https://icusteps.org/guide.

  64. Crowell DM. Complexity leadership: nursing’s role in health care delivery. 2nd ed. Philadelphia: F.A. Davis Comp; 2016.

    Google Scholar 

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Jónasdóttir, R.J., Jónsdóttir, H. (2019). A Nurse-Managed Follow-Up Practice for Patients After Discharge from the Intensive Care Unit: Development, Testing and Implementation. In: Hafsteinsdóttir, T., Jónsdóttir, H., Kirkevold, M., Leino-Kilpi, H., Lomborg, K., Rahm Hallberg, I. (eds) Leadership in Nursing: Experiences from the European Nordic Countries. Springer, Cham. https://doi.org/10.1007/978-3-030-10964-6_13

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