幸存者但未完全康复：脓毒症存活一年后的生活经历

Survivor But Not Fully Recovered: The Lived Experience After 1 Year of Surviving Sepsis.

作者信息

Umberger Reba A, Thomas Sandra P

机构信息

Reba A. Umberger, PhD, RN, CCRN-K, is assistant professor of nursing, Department of Acute and Tertiary Care, College of Nursing, The University of Tennessee Health Science Center, Memphis. Dr. Umberger's program of research is focused on improving long-term outcomes after sepsis for survivors and their informal caregivers. Her current research is focused on recovery and immune function after sepsis among sepsis dyads within a high-risk sepsis readmission period to better understand the mechanisms involved in subsequent infections after sepsis. Sandra P. Thomas, PhD, RN, FAAN, is professor of nursing, College of Nursing, The University of Tennessee, Knoxville. Dr. Thomas chairs the PhD program at the College of Nursing in Knoxville. She also chairs the transdisciplinary phenomenology research group that meets weekly there. Her primary research foci are women's mental health issues and recovery from abuse. Dr. Thomas has served as Editor of "Issues in Mental Health Nursing" since 1997. She serves on the board of the International Society of Psychiatric-Mental Health Nurses Foundation and the Expert Panel on Violence of the American Academy of Nursing. She is a Fellow of the Society of Behavioral Medicine.

出版信息

Dimens Crit Care Nurs. 2019 Nov/Dec;38(6):317-327. doi: 10.1097/DCC.0000000000000381.

DOI:10.1097/DCC.0000000000000381

PMID:31593071

Abstract

BACKGROUND

Hospital mortality rates related to sepsis have decreased over the last decade, increasing the number of survivors of sepsis who may experience long-term consequences. Yet, little is known about how they perceive their illness experience and its aftermath.

OBJECTIVE

This study explores the experiences of sepsis survivors after 1 year of their index intensive care unit (ICU) stay.

METHODS

This phenomenological study was guided by Merleau-Ponty's philosophy. Participants were adult patients admitted directly to the medical ICU with sepsis who had an ICU stay of at least 48 hours and had been discharged from their index ICU stay for at least 1 year. Participants were invited by letter to participate in face-to-face or telephone interviews and a brief survey. Interviews were audio recorded, transcribed verbatim, and verified. An interpretive group read transcripts aloud to increase rigor of identifying meaning units, existential grounds, and thematic structure.

RESULTS

Eight participants were recruited over 20 months. Participants were primarily white (87.5%) females (75%) with an age range of 37 to 74 years who were interviewed between 1 and 2 years following an index sepsis ICU stay. Five major themes emerged from the transcripts: (1) how they survived, (2) blurring of time versus counting time by events, (3) helpful help versus unhelpful help, (4) powerless versus striving for control, and (5) survivor but not fully recovered.

DISCUSSION

Findings reflected a long trajectory of chronic illness in which the index episode of sepsis was not necessarily what stood out as figural to participants. The meaning of participant experiences must be considered in the context of a health care system that offers little to no systematic follow-up care after sepsis and little prevention. Participants expressed a need for advocacy and follow-up support.

摘要

背景

在过去十年中，与脓毒症相关的医院死亡率有所下降，这使得脓毒症幸存者的数量增加，而这些幸存者可能会经历长期后果。然而，对于他们如何看待自己的患病经历及其后果，我们知之甚少。

目的

本研究探讨脓毒症幸存者在其首次入住重症监护病房（ICU）一年后的经历。

方法

本现象学研究以梅洛-庞蒂的哲学为指导。研究对象为直接入住内科ICU且患有脓毒症的成年患者，他们在ICU至少停留了48小时，并且自首次入住ICU出院至少已有1年。通过信件邀请研究对象参加面对面或电话访谈以及一项简短调查。访谈进行了录音，逐字转录并进行了核实。一个解释小组大声朗读转录本，以提高识别意义单元、存在基础和主题结构的严谨性。

结果

在20个月内招募了8名研究对象。研究对象主要为白人（87.5%）女性（75%），年龄在37至74岁之间，在首次脓毒症ICU住院后的1至2年接受访谈。从转录本中出现了五个主要主题：（1）他们如何幸存下来，（2）时间的模糊与按事件计算时间，（3）有益的帮助与无益的帮助，（4）无力感与努力争取控制，（5）幸存者但未完全康复。