Ghorbanzadeh Kobra, Ebadi Abbas, Hosseini Mohammadali, Madah Sadat Seyed Bagher, Khankeh Hamidreza
Ph.D. Candidate in Nursing, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Department of Nursing, Khalkhal University of Medical Sciences, Khalkhal, Iran.
Acute Crit Care. 2021 May;36(2):133-142. doi: 10.4266/acc.2020.00626. Epub 2021 Jan 28.
The transition of patients from the intensive care unit (ICU) to the general ward is challenging. This study aimed to explain the challenges that patients face during the transition process.
In this qualitative research of conventional content analysis, data collection was conducted between February 2018 and July 2019 in educational hospitals. After obtaining informed consent, purposive sampling was performed with 22 nurses, intensive care physicians, anesthesiologists, and patients and their families using in-depth semi-structured interviews until data saturation.
The content analysis yielded three main themes in the challenges patients face during the transition process from the ICU: mixed feelings regarding transition (happiness/hope, worry/uncertainty, abandonment); care break (different atmosphere, the difference between the program and the quality of care, assigning care to the patient and family, and care culture and beliefs); and search for support and information (ineffective communication, self-care capacity of patient and family, ineffective and disrupted training, and weak follow-up programs), which inflicts care shock in the patients.
The results showed that patients and their families were in a state of care shock during the ICU transition process and were sometimes disconcerted. It is necessary to design and implement care models according to the needs and challenges patients face during the transition period from ICU (patient-centered), based on the evidence available, and after considering the field of medicine and the accessibility of care in the country. The transition process can be improved and enhanced by obtaining knowledge about ICU care and related challenges as well as organizing a learning environment.
患者从重症监护病房（ICU）转至普通病房是一项具有挑战性的工作。本研究旨在阐释患者在转科过程中所面临的挑战。
在这项采用传统内容分析法的定性研究中，于2018年2月至2019年7月期间在教学医院开展数据收集工作。在获得知情同意后，对22名护士、重症监护医师、麻醉医师以及患者及其家属进行了目的抽样，采用深度半结构化访谈直至数据饱和。
内容分析得出患者在从ICU转科过程中面临的挑战主要有三个主题：转科时的复杂感受（喜悦/希望、担忧/不确定、被遗弃感）；护理中断（氛围不同、护理计划与质量存在差异、将护理工作交由患者及家属承担、护理文化与理念）；寻求支持与信息（沟通不畅、患者及家属的自我护理能力、培训无效且中断、后续跟进计划薄弱），这些给患者带来了护理冲击。
结果表明，患者及其家属在ICU转科过程中处于护理冲击状态，有时会感到困惑。有必要根据现有证据，在考虑医学领域及该国护理可及性的基础上，依据患者在从ICU转科期间所面临的需求和挑战（以患者为中心）设计并实施护理模式。通过获取有关ICU护理及相关挑战的知识以及营造学习环境，可改善和加强转科过程。
