Ramsay Pam, Huby Guro, Thompson Andrew, Walsh Tim
University of Edinburgh/NHS Lothian, Edinburgh, UK.
J Clin Nurs. 2014 Mar;23(5-6):605-15. doi: 10.1111/jocn.12452. Epub 2013 Dec 20.
To explore the psychosocial needs of patients discharged from intensive care, the extent to which they are captured using existing theory on transitions in care and the potential role development of critical care outreach, follow-up and liaison services.
Intensive care patients are at an increased risk of adverse events, deterioration or death following ward transfer. Nurse-led critical care outreach, follow-up or liaison services have been adopted internationally to prevent these potentially avoidable sequelae. The need to provide patients with psychosocial support during the transition to ward-based care has also been identified, but the evidence base for role development is currently limited.
Twenty participants were invited to discuss their experiences of ward-based care as part of a broader study on recovery following prolonged critical illness. Psychosocial distress was a prominent feature of their accounts, prompting secondary data analysis using Meleis et al.'s mid-range theory on experiencing transitions.
Participants described a sense of disconnection in relation to profound debilitation and dependency and were often distressed by a perceived lack of understanding, indifference or insensitivity among ward staff to their basic care needs. Negotiating the transition between dependence and independence was identified as a significant source of distress following ward transfer. Participants varied in the extent to which they were able to express their needs and negotiate recovery within professionally mediated boundaries.
These data provide new insights into the putative origins of the psychosocial distress that patients experience following ward transfer.
Meleis et al.'s work has resonance in terms of explicating intensive care patients' experiences of psychosocial distress throughout the transition to general ward-based care, such that the future role development of critical care outreach, follow-up and liaison services may be more theoretically informed.
探讨重症监护病房出院患者的心理社会需求，现有护理过渡理论对这些需求的涵盖程度，以及重症监护外展、随访和联络服务的潜在作用发展。
重症监护患者在转至普通病房后发生不良事件、病情恶化或死亡的风险增加。国际上已采用由护士主导的重症监护外展、随访或联络服务来预防这些可能避免的后遗症。人们也已认识到在向普通病房护理过渡期间为患者提供心理社会支持的必要性，但目前角色发展的证据基础有限。
作为一项关于长期危重症后康复的更广泛研究的一部分，邀请了20名参与者讨论他们在普通病房护理的经历。心理社会困扰是他们描述中的一个突出特征，促使使用梅莱伊斯等人关于经历过渡的中程理论进行二次数据分析。
参与者描述了与严重虚弱和依赖相关的脱节感，并且常常因感到病房工作人员对其基本护理需求缺乏理解、冷漠或麻木不仁而苦恼。在转至普通病房后，在依赖与独立之间进行过渡被认为是困扰的一个重要来源。参与者在能够在专业调解的范围内表达需求并协商康复的程度上存在差异。
这些数据为患者在转至普通病房后经历的心理社会困扰的假定根源提供了新的见解。
梅莱伊斯等人的工作在解释重症监护患者在向普通病房护理过渡过程中的心理社会困扰经历方面具有共鸣，因此重症监护外展、随访和联络服务未来的角色发展可能会在理论上更有依据。
