Leaving the intensive care unit: a phenomenological study of the patients’ experience

doi:10.1016/S0964-3397(02)00069-1

Intensive and Critical Care Nursing

Volume 18, Issue 6, December 2002, Pages 320-331

https://doi.org/10.1016/S0964-3397(02)00069-1 Get rights and content

Abstract

Discharge from intensive care (ICU), is said to pose difficulties for patients; a phenomenon referred to as “relocation stress”. However, this phenomenon has not been fully examined, particularly from the critical care patients’ perspective. This study, therefore, explored the lived experience of transfer from ICU to the ward. Phenomenology, based on the interpretative Heideggerian approach was used to guide the study. A purposive sample of six participants was selected. Open interviews were used to collect data. Participants were interviewed twice; once in ICU, prior to transfer, and once in the ward following transfer. The findings revealed that pre-transfer, participants were mainly accepting of their impending transfer. Participants discussed a desire for normality and identified that leaving the ICU staff was the most negative component of transfer. In the post-transfer period, findings revealed mixed feelings regarding the actual transfer. Participants were still suffering from physical complaints, which led to feelings of despondency. Differences between ICU and the ward were also highlighted. Finally, the enormity of the ICU experience appeared to have an impact post-transfer. The results of this study indicate that transfer from ICU can be problematic for some individuals. However, caution is required regarding the use of the nursing diagnosis of relocation stress without obtaining an individual perspective on experiences. Recommendations include the need for greater continuity of care for those recovering from critical illness.

Introduction

With an increase in the ageing population and advances in medicine, there is an acute awareness that critical care beds are a finite resource. The decision to transfer individuals to a general ward therefore depends not only upon the individuals’ physical condition but also on the demand for beds (Gibson 1997). Consequently, individuals are being discharged more rapidly from intensive care, which in turn, increases the pressure on staff to prepare for the next new admission and less time to plan the discharge. As a result, the transfer procedure may be carried out abruptly and without adequate patient preparation. Thus, although transfer to the ward is a positive step in terms of physical recovery, it is apparent that individuals may exhibit stress associated with relocation from intensive care, particularly in this current climate of rapid patient turnover. It is, therefore, time to revisit this phenomenon in order to fully appreciate what the experience of relocation means to the individual. Greater understanding of the individuals’ experience is necessary in order to plan more effective and efficient transfers. Furthermore, knowledge related to their experiences may enhance opportunities to display empathy and provide support. There is a need for fresh inquiry that begins with the description and analysis of the individual’s lived experience of transfer. It is only in this way can we fully detect and attempt to minimise the occurrence of stress following transfer and improve the quality of care our patients are entitled to receive.

Section snippets

Review of the literature

The literature has referred to problems associated with relocation in numerous ways, such as “translocation syndrome”, “transfer stress”, and “transfer anxiety”. More recently, the North American Nursing Diagnosis Association (NANDA) formally approved the nursing diagnosis “relocation stress”. The major defining characteristics included: loneliness, depression, anger, apprehension and anxiety. Other minor characteristics consisted of changes in former eating and sleeping habits, dependency,

Design and methodology

In an effort to explore the lived experiences of individuals who have been transferred from intensive care, the phenomenological approach was employed. In contrast to experimental methods, where control and prediction of behaviour are emphasised, phenomenology focuses on description of human experience (Streubert & Carpenter 1999). According to Oiler (1982), this approach shifts allegiance to a valuing of enlargement rather than reduction. Thus, the method is holistic in perspective and aims to

Sample

This study was designed to investigate the lived experience of being transferred from intensive care. Thus, the sample for this study consisted of six participants, all of whom had been patients in intensive care. Their ages ranged from 42 to 75 years and length of time spent in ICU ranged from 4 to 10 days.

The sampling strategy utilised in this study was that of purposive sampling. As noted by Coyne (1997), in purposive sampling, participants are individually selected according to their

Informed consent

With regard to the issue of consent, it was imperative that participants only became involved in the study after they had received adequate information regarding the research. An initial information letter outlining the purpose of the study and what was expected of the participants was given to the patient and their relatives at least 24 hours prior to undertaking the first interview. This was reiterated with a verbal explanation by the researcher. Written consent was then requested just prior

Data collection

The method of data collection utilised in this study was that of open-ended interviews. Participants were interviewed on two occasions. Once in the intensive care unit after they had been informed of their impending transfer, and in the ward, approximately 48 hours following transfer.

According to Koch (1995), implicit in interpretative phenomenological research is the notion of “situated meaning”. In other words, hermeneutic phenomenology seeks to study the person in the situation, rather than

Data analysis

Heideggerian phenomenology is concerned with explicating the meanings embedded in lived experience (Nehls et al. 1997). Some phenomenological researchers, such as Colaizzi (1978) and Giorgi (1985), apply a step-wise set of procedures when interpreting data from conversations (Van der Zalm & Bergum 2000). However, according to Koch (1995), these analysis frameworks tend to follow the Husserlian tradition and are based on decontextualising and recontextualising. In other words, transcripts are

Findings and discussion

Following data analysis, examination of phenomena revealed commonalties in experiences, which were organised into themes. Themes were organised under two sections; those relating to experiences pre-transfer and those post-transfer (Table 1, Table 2). Table 1, Table 2 illustrate the process of data analysis and how the major themes in the structure of the experience were arrived at. For ease of presentation, a few examples of cluster groups and units of meaning are presented. Further examples

Pre-transfer

This section refers to the interviews that were conducted prior to the participants transfer to the general ward. Three main themes emerged: acceptance, desire for normality and relationships with ICU staff.

Post-transfer

This section provides an insight into the lived experiences of participants in the post-transfer period. Analysis of the post-transfer interviews revealed four major themes:

1.
Mixed feelings regarding transfer;
2.
Perceptions of well-being;
3.
Differences between ICU and ward;
4.
Restoring meaning.

Recommendations

From the data analysis and discussion several recommendations have become apparent which will be outlined below.

1.
Intensive care nurses should discuss transfer with individuals in the pre-transfer period and provide information about the changes the individual can expect.
2.
Promoting a more gradual transition in the level of care and observation prior to actual transfer may also prove beneficial. ICU nurses could perhaps remove monitor leads and reduce the level of attention given as soon as the

Limitations

It is difficult to establish whether the themes proposed by the researcher are valid. The aim of phenomenological research is to present the individuals’ perspective but it was difficult to maintain this during the interpretation of data. While the researcher did attempt to remain true to the participants’ experiences, it is acknowledged that the need to identify themes dictated what units of discourse would be included or excluded. This may unknowingly have influenced the findings. The

Conclusion

The findings of this study indicated that for some participants transfer from intensive care was not perceived as problematic. Rather it was viewed as a positive step towards regaining normality. Others, however, experienced physical complaints and described underlying psychological issues that impacted them following their transfer to the ward. Therefore, while it would appear that the phenomenon of relocation stress could be said to exist for some participants, this was not necessarily the

Aidin A. McKinney RN, BSc(Hons), MSc, Lecturer in Nursing, School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK. Tel: +44 (0) 28 9027 2233; E-mail: [email protected]

(Requests for offprints to AAMcK)

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Pat Deeny RN, BSc(Hons), Adv. Dip. Ed., Senior Lecturer in Nursing, School of Nursing, University of Ulster, Magee Campus, Londonderry

View full text

Original articleLeaving the intensive care unit: a phenomenological study of the patients’ experience

Abstract

Introduction

Section snippets

Review of the literature

Design and methodology

Sample

Informed consent

Data collection

Data analysis

Findings and discussion

Pre-transfer

Post-transfer

Recommendations

Limitations

Conclusion

Intensive and Critical Care Nursing

Intensive and Critical Care Nursing

Intensive and Critical Care Nursing

Intensive and Critical Care Nursing

Lancet

Intensive and Critical Care Nursing

Journal of Obstetric, Gynaecologic and Neonatal Nursing

Intensive and Critical Care Nursing

Heart and Lung

Intensive Care Nursing

Intensive and Critical Care Nursing

Intensive Care Nursing

Intensive and Critical Care Nursing

Evaluating phenomenology: usefulness, quality and philosophical foundations

Nurse Researcher

Hermeneutic phenomenology: philosophical perspectives and current use in nursing research

Journal of Advanced Nursing

Patients’ and relatives’ experiences and perspectives of “good” and “not so good” quality care

Journal of Advanced Nursing

Bracketing in phenomenological research

Nurse Researcher

Ethical issues in research

British Journal of Nursing

Family conferences: a method to diminish transfer anxiety

Journal of Neuroscience Nursing

Application of a transactional model of stress and coping with critically ill patients

Dimensions of Critical Care Nursing

Critical illness and intensive care: what it means to the client

Critical Care Nurse

Misusing phenomenology in nursing research: identifying the issues

Nurse Researcher

Sampling in qualitative research. Purposeful and theoretical sampling merging or clear boundaries?

Journal of Advanced Nursing

Original article
Leaving the intensive care unit: a phenomenological study of the patients’ experience