Division of Geriatric Medicine and Gerontology in the Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Division of Pulmonary, Allergy, and Critical Care Medicine in the Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
BMJ Open. 2022 Apr 26;12(4):e050592. doi: 10.1136/bmjopen-2021-050592.
To identify critical illness survivors' perceived barriers and facilitators to resuming performance of meaningful activities when transitioning from hospital to home.
Secondary content analysis of semistructured interviews about patients' experiences of intensive care (primary analysis disseminated on the patient-facing website www.healthtalk.org). Two coders characterised patient-perceived barriers and facilitators to resuming meaningful activities. To facilitate clinical application, we mapped the codes onto the Person-Task-Environment model of performance, a patient-centred rehabilitation model that characterises complex interactions among the person, task and environment when performing activities.
United Kingdom, 2005-2006.
39 adult critical illness survivors, sampled for variation among demographics and illness experiences.
included negative mood or affect, perceived setbacks; weakness or limited endurance; pain or discomfort; inadequate nutrition or hydration; poor concentration/confusion; disordered sleep/hallucinations/nightmares; mistrust of people or information; and altered appearance. included miscommunication and managing conflicting priorities. included non-supportive health services and policies; challenging social attitudes; incompatible patient-family coping (emotional trauma and physical disability); equipment problems; overstimulation; understimulation; and environmental inaccessibility. included motivation or attitude; experiencing progress; and religion or spirituality. included communication. included support from family, friends or healthcare providers; supportive health services and policies; equipment; community resources; medications; and accessible housing. Barriers decreased and facilitators increased over time. Six barrier-facilitator domains dominated based on frequency and emphasis across all performance goals: mood/motivation, setbacks/progress, fatiguability/strength; mis/communication; lack/community support; lack/health services and policies.
Critical illness survivors described a comprehensive inventory of 18 barriers and 11 facilitators that align with the Person-Task-Environment model of performance. Six dominant barrier-facilitator domains seem strong targets for impactful interventions. These results verify previous knowledge and offer novel opportunities for optimising patient-centred care and reducing disability after critical illness.
确定从医院过渡到家庭时，重病幸存者恢复有意义活动表现的障碍和促进因素。
对关于患者重症监护体验的半结构化访谈的次要内容分析（主要分析发表在面向患者的网站 www.healthtalk.org 上）。两位编码员描述了患者恢复有意义活动的障碍和促进因素。为了便于临床应用，我们将这些代码映射到表现的人与任务环境模型上，这是一种以患者为中心的康复模型，它描述了在执行活动时人与任务和环境之间的复杂相互作用。
英国，2005-2006 年。
39 名成年重症幸存者，根据人口统计学和疾病经历的差异进行抽样。
包括负面情绪或情绪、感知挫折；虚弱或耐力有限；疼痛或不适；营养或水合不足；注意力不集中/困惑；睡眠紊乱/幻觉/噩梦；不信任他人或信息；以及外观改变。包括沟通不畅和管理优先级冲突。包括不支持的卫生服务和政策；具有挑战性的社会态度；不兼容的患者-家庭应对方式（情感创伤和身体残疾）；设备问题；过度刺激；刺激不足；以及环境不可及性。包括动机或态度；体验进展；以及宗教或精神信仰。包括沟通。包括来自家人、朋友或医疗保健提供者的支持；支持性卫生服务和政策；设备；社区资源；药物；以及可及性住房。随着时间的推移，障碍减少，促进因素增加。基于所有表现目标的频率和重点，六个障碍-促进因素域占主导地位：情绪/动机、挫折/进展、疲劳/力量；沟通不畅/沟通；缺乏/社区支持；缺乏/卫生服务和政策。
重病幸存者描述了一个由 18 个障碍和 11 个促进因素组成的综合清单，这些障碍和促进因素与表现的人与任务环境模型一致。六个主要的障碍-促进因素域似乎是具有影响力的干预措施的有力目标。这些结果验证了先前的知识，并为优化以患者为中心的护理和减少重症后残疾提供了新的机会。
