Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Assessment and tools for follow-up of patients' recovery after Intensive Care
Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to describe and explore the use and content of ICU-diaries and to develop and psychometrically test a questionnaire to detect physical and psychosocial problems for ICU patients in their recovery process.

 Methods: This thesis is based on four studies. Study I had an explorative descriptive design with a quantitative and qualitative approach. Data were collected by telephone interviews with staff at Swedish ICUs (n = 65) which kept ICU-diaries. One question “what was the purpose of keeping ICU-diaries” was analysed with latent content analysis, and the other data were analysed with descriptive and comparative statistics. Study II had an explorative descriptive cohort design with a concurrent mixed method approach. The sample in study II was a part of the sample in study IV in which 421 former ICU patients responded to a new developed questionnaire 3-set 4P two months after discharge from ICU. Patients from this sample who have had an ICU-diary (n = 115) responded to a questionnaire six months after discharge from ICU. Fifteen patients were interviewed about the content and usefulness of the ICU-diary. Data were analysed with descriptive statistics, descriptively by content and interviews with manifest content analysis and then combined at the interpretive level to seek convergence, as enable by the mixed method approach. Study III had a methodological design. In this study, the questionnaire 3-set 4P was developed and psychometrically tested in a pilot setting. In study IV, the questionnaire was further developed and tested based on psychometric evaluation of the 3-set 4P. In study III the questionnaire was responded by 39 patients and in study IV by 421 patients. Data in study III and IV were analysed with descriptive statistics and psychometrical tests.

 Results: The main purpose for keeping ICU-diaries was to provide a tool in the recovery by helping the patient remember and give time back. Keeping ICU-diaries was common although there was a difference in practice and patient recruitment among different hospitals (study I). An ICU-diary with content and photos in a chronological order describing the whole picture of critical illness and ICU stay could be a tool for the patient to construct a coherent individual story. The ICU-diary could be one piece to give a deeper understanding and meaning in the personal story and to give a realistic expectation of the recovery process. Absence of guidelines for keeping ICU-diaries could affect the possibility for the ICU-diary to be a helpful tool during the recovery process (study II). In study III, the 3-set 4P was developed to be used for identifying and evaluating former ICU patients’ physical, psychosocial problems and outcome during follow-up. The psychometrical tests showed acceptable validity and internal consistency reliability. The stability reliability was acceptable in two of three sets. The psychometrical tests of the further modified version of 3-set 4P in study IV showed good construct validity and internal consistency but it needs some modification before it can be used in clinical practice (study IV).

 Conclusion: Recovery can be a difficult process where different tools can be useful. Today there is no evidence about tools to use during follow-up. To promote high quality of the follow-up there is a need for evidence-based guidelines. The ICU-diary is one tool but this thesis shows that guidelines for keeping ICU-diaries have to be developed to meet the patients’ wishes in order for the ICU-diary to become a useful tool during the process to recovery. The 3-set 4P can after some modification be used at the follow-up clinic to identify the individual patient’s problems and create an individual program for recovery.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences Jönköping University , 2012. , 88 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 30
National Category
Medical and Health Sciences Nursing
Identifiers
URN: urn:nbn:se:hj:diva-17969ISBN: 978-91-85835-29-4 (print)OAI: oai:DiVA.org:hj-17969DiVA: diva2:516896
Public defence
2012-05-11, Skånes Universitetssjukhus Kvinnokliniken i Malmö, Malmö, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2012-04-20 Created: 2012-04-20 Last updated: 2012-04-20Bibliographically approved
List of papers
1. Use and practice of patient diaries in Swedish intensive care units: a national survey
Open this publication in new window or tab >>Use and practice of patient diaries in Swedish intensive care units: a national survey
Show others...
2010 (English)In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 15, no 1, 26-33 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: To describe and compare the extent and application of patients' diaries in Sweden.

Background: Since 1991, patient diaries have been used in intensive care unit (ICU) follow-up in Sweden. There is paucity of relevant data evaluating the effect of this tool and also on what premises patients are enrolled. Likewise, data are sparse on the diaries' design, content structure and the use of photographs.

Design: Descriptive explorative design by a semi-structured telephone interview.

Methods: The interview results were analysed with descriptive statistics and differences between the ICU levels were explored by χ2 analysis. Qualitative manifest content analysis was performed to explore the purpose of diary writing.

Results: Of all ICUs (n = 85), 99% responded and 75% used diaries. The source of inspiration was collegial rather than from scientific data. The main reason for keeping a diary was to help the patient to recapitulate the ICU stay. Discrepancies between the different levels of ICUs were detected in patient selection, dedicated staff for follow-up and the use of photographs. Comparison between the χ2 analysis and the content analysis outcome displayed incongruence between the set unit-goals and the activities for achievement but did not explain the procedural differences detected.

Conclusion: The uses of diaries in post ICU follow up were found to be common in Sweden. A majority used defined goals and content structure. However, there were differences in practice and patient recruitment among the levels of ICUs. These discrepancies seemed not to be based on evidence-based data nor on ongoing research or evaluation but merely on professional judgement. As ICU follow-up is resource intense and time consuming, it is paramount that solid criteria for patient selection and guidelines for the structure and use of diaries in post-ICU follow-up are defined.

Keyword
Critical care nursing, ICU follow-up, Intensive care
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-11895 (URN)10.1111/j.1478-5153.2009.00364.x (DOI)
Available from: 2010-03-31 Created: 2010-03-31 Last updated: 2012-04-20Bibliographically approved
2. Preferred content and usefulness of a photodiary as described by ICU-patients-A mixed method analysis
Open this publication in new window or tab >>Preferred content and usefulness of a photodiary as described by ICU-patients-A mixed method analysis
2013 (English)In: Australian Critical Care, ISSN 1036-7314, Vol. 26, no 1, 29-35 p.Article in journal (Refereed) Published
Abstract [en]

Many ICU-patients have memory-gaps which may affect their recovery. A tool in the recovery can be an ICU-diary to explain and clarify thoughts and events from the ICU-period. There are different standards for the content in the ICU-diary. The aim of this study was to identify the preferred content and usefulness of an ICU-diary as described by ICU-patients.

Method: a descriptive, exploratory cohort design with a mixed method approach. The patients answered a questionnaire (n=115) and participated in an interview (n=15) six months after the ICU-stay. Data analysis was carried out in three stages; the questionnaire was analysed by descriptive statistics and categorized by content (four open-ended questions) and the interviews were analysed by manifest content analysis.

Results: The patients explained that detailed information about daily activities and medical facts had to be included to understand and give a sense of coherence of what had happened. The content in the ICU-diary had to be chronological in order to follow the process in which photos were an important part. The patients re-read the ICU-diary during the recovery which helped them to fill in the memory gaps and used it as a tool for communication.

Conclusion; To construct a coherent story, it was essential that the ICU-diary was complete and were amplified by photos, all appearing in a chronological order. The results of this study could form a basis for further developments of standards and guidelines for ICU-diaries

Keyword
ICU-diary; ICU-patients; preferred content; usefulness; mixed method
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:hj:diva-17967 (URN)10.1016/j.aucc.2012.04.002 (DOI)
Available from: 2012-04-20 Created: 2012-04-20 Last updated: 2013-09-11Bibliographically approved
3. Development of the 3-SET 4P questionnaire for evaluating former ICU patients´physical and psychosocial problems over time: a pilot study
Open this publication in new window or tab >>Development of the 3-SET 4P questionnaire for evaluating former ICU patients´physical and psychosocial problems over time: a pilot study
2009 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 2, 80-89 p.Article in journal (Refereed) Published
Abstract [en]

Background: Current studies reveal a lack of consensus for the evaluation of physical and psychosocial problems after ICU stay and their changes over time.

Objectives: The aim was to develop and evaluate the validity and reliability of a questionnaire for assessing physical and psychosocial problems over time for patients following ICU recovery.

Patients: Thirty-nine patients completed the questionnaire, 17 were retested.

Methods and results: The questionnaire was constructed in three sets: physical problems, psychosocial problems and follow-up care. Face and content validity were tested by nurses, researchers and patients. The questionnaire showed good construct validity in all three sets and had strong factor loadings (explained variance >70%, factor loadings >0.5) for all three sets. There was good concurrent validity compared with the SF 12 (rs > 0.5). Internal consistency was shown to be reliable (Cronbach's α 0.70–0.85). Stability reliability on retesting was good for the physical and psychosocial sets (rs > 0.5).

Conclusion: The 3-set 4P questionnaire was a first step in developing an instrument for assessment of former ICU patients’ problems over time. The sample size was small and thus, further studies are needed to confirm these findings.

National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-11271 (URN)10.1016/j.iccn.2008.06.004 (DOI)
Available from: 2010-01-11 Created: 2010-01-11 Last updated: 2012-07-26Bibliographically approved
4. Psychometric evaluation of 3-set 4P questionnarie
Open this publication in new window or tab >>Psychometric evaluation of 3-set 4P questionnarie
Show others...
2013 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 29, no 1, 40-47 p.Article in journal (Refereed) Published
Abstract [en]

This is a further development of a specific questionnaire, the 3-set 4P, to be used for measuring former ICU patients’ physical and psychosocial problems after ICU and the need for follow-up. The aim was to psychometrically test and evaluate the 3-set 4P questionnaire in a larger population. The questionnaire consists of three sets: “physical”, “psychosocial” and “follow-up”. The questionnaires were sent by mail to all patients with >24 hour length of stay at four ICUs in Sweden. Construct validity was measured with exploratory factor analysis with varimax rotation resulting in “physical set” three factors, “psychosocial set” five factors and “follow-up set” four factors with strong factor loadings and a total explained variance of 62 - 77.5%. Thirteen questions in the SF-36 were used for concurrent validity showing Spearman’s rs 0.3-0.6 in eight and <0.2 in five questions. Test-retest was used for stability reliability. In set follow-up the correlation was strong to moderate and in physical and psychosocial sets the correlations were moderate to fair. This could be due to that the physical and psychosocial status changed rapidly during the test period. All three sets had good homogeneity. In conclusion, the 3-set 4P showed overall acceptable results, but it has to be further modified in different cultures before being an instrument which may be fully operational in clinical practice.

 

Place, publisher, year, edition, pages
Elsevier, 2013
Keyword
intensive care, physical problems, psychosocial problems, follow-up, questionnaire development
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-17968 (URN)10.1016/j.iccn.2012.06.002 (DOI)
Available from: 2012-04-20 Created: 2012-04-20 Last updated: 2012-12-10Bibliographically approved

Open Access in DiVA

fulltext(1390 kB)6185 downloads
File information
File name FULLTEXT01.pdfFile size 1390 kBChecksum SHA-512
2654f7d6193521955339ace57fec19fa932917829eaed72450d092f15991673ad83b53f406c4bf1197bc084d0e9d44b54186abbc9cfd49be348e18ae8c1f2ba9
Type fulltextMimetype application/pdf

Search in DiVA

By author/editor
Åkerman, Eva
By organisation
HHJ, Dep. of Nursing Science
Medical and Health SciencesNursing

Search outside of DiVA

GoogleGoogle Scholar
Total: 6185 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 1040 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf