危重病后驾驶决策：重症监护恢复诊所评估期间患者-提供者审查的定性分析。
Driving decisions after critical illness: Qualitative analysis of patient-provider reviews during ICU recovery clinic assessments.
机构信息
Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX, USA; School of Nursing, University of Texas at Austin, Austin, TX, USA.
College of Engineering, University of Wisconsin at Madison, Madison, WI, USA. Electronic address: https://twitter.com/hfml_lab.
出版信息
Int J Nurs Stud. 2023 Oct;146:104560. doi: 10.1016/j.ijnurstu.2023.104560. Epub 2023 Jul 4.
BACKGROUND
Driving a vehicle is a functional task requiring a threshold of physical, behavioral and cognitive skills.
OBJECTIVE
To report patient-provider evaluations of driving status and driving safety assessments after critical illness.
DESIGN
Qualitative secondary analysis of driving-related dialog drawn from a two-arm pilot study evaluating telemedicine delivery of Intensive Care Unit Recovery Clinic assessments. Multidisciplinary providers assessed physical, psychological, and cognitive recovery during one-hour telemedicine ICU-RC assessments. Qualitative secondary analysis of patient-provider dialog specific to driving practices after critical illness.
SETTING AND PATIENTS
Multidisciplinary Intensive Care Unit Recovery clinic assessment dialog between 17 patients and their providers during 3-week and/or 12-week follow-up assessments at a tertiary academic medical center in the Southeastern United States.
MAIN MEASURES AND KEY RESULTS
Thematic content analysis was performed to describe and classify driving safety discussion, driving status and driving practices after critical illness. Driving-related discussions occurred with 15 of 17 participants and were clinician-initiated. When assessed, driving status varied with participants reporting independent decisions to resume driving, delay driving and cease driving after critical illness. Patient-reported driving practices after critical illness included modifications to limit driving to medical appointments, self-assessments of trip durations, and inclusion of care partners as a safety measure for new onset fatigue while driving.
CONCLUSION
We found that patients are largely self-navigating this stage of recovery, making subjective decisions on driving resumption and overall driving status. These results highlight that driving status changes are an often underrecognized yet salient social cost of critical illness.
TRIAL REGISTRATION
Clinicaltrials.gov: NCT03926533.
背景
驾驶车辆是一项需要一定身体、行为和认知技能的功能任务。
目的
报告患者与提供者对驾驶状况和重症后驾驶安全性评估的评估。
设计
对一项评估重症后远程医疗 ICU 恢复诊所评估的两臂试点研究中与驾驶相关的对话进行定性二次分析。多学科提供者在一小时的远程医疗 ICU-RC 评估中评估身体、心理和认知恢复情况。对重症后与驾驶实践相关的患者与提供者对话进行定性二次分析。
地点和患者
在美国东南部的一家三级学术医疗中心，在 3 周和/或 12 周的随访评估中，对 17 名患者及其提供者进行了多学科 ICU 恢复诊所评估的对话。
主要措施和结果
采用主题内容分析法描述和分类重症后驾驶安全性讨论、驾驶状况和驾驶实践。17 名参与者中有 15 名进行了与驾驶相关的讨论，且均由临床医生发起。评估时，驾驶状况因参与者而异，他们报告了独立决定恢复驾驶、延迟驾驶和重症后停止驾驶的情况。患者报告的重症后驾驶实践包括修改限制驾驶至医疗预约、自我评估行程持续时间以及在新出现疲劳时包括护理伙伴作为驾驶安全措施。
结论
我们发现患者在很大程度上是自主恢复这一阶段的，对恢复驾驶和整体驾驶状况做出主观决定。这些结果强调，驾驶状况的变化是重症后常被低估但明显的社会成本之一。
试验注册
Clinicaltrials.gov：NCT03926533。
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