Zhang Zeyi, Yang Longshan, Cao Heng
Department of Surgical Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, #246 JingWu Road, Jinan, 250021, China.
Department of General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China.
BMC Nurs. 2024 Dec 18;23(1):895. doi: 10.1186/s12912-024-02542-3.
The post-ICU home recovery period requires patients and caregivers to confront recovery challenges and adopt coping strategies as a family dyad, necessitating effective dyadic interaction patterns. Existing qualitative research shows that the dyads face interactive or independent challenges and employs varying coping strategies, which may include strong communication or, conversely, avoidance. However, a single qualitative study alone might offer limited generalizability, and there is a lack of broader, more nuanced understanding about the recovery challenge and copings among ICU survivors and caregivers. This meta-synthesis aims to figure out the interactivity and independence of challenges and coping strategies during the recovery process for ICU survivors and caregivers.
This is a meta-synthesis of qualitative studies, which was guided by the Stress and Coping Framework. We systematically reviewed six electronic databases, including PubMed, Medline, the Cochrane Library, CINAHL, PsycArticles, and PsycInfo, for relevant qualitative studies published from inception to January, 2024. We utilized a content analysis approach for data analysis. Presentation of this synthesis adhered to the PRISMA guideline and the ENTREQ guideline.
After full-text screening, 49 studies were included. Four themes with 16 sub-themes emerged from this synthesis including, interactivity of recovery challenges for ICU survivors and caregivers (subthemes: Life was turned upside down, Situational overstrain, Isolation without compassion, Empowerment conflicts, Marginalized support), independence of recovery challenges for ICU survivors and caregivers (subthemes: Recovery means silent suffering, Gap in memory, Sacrificing to caregiving), interactivity of recovery coping strategies for ICU survivors and caregivers (subthemes: Reorientation of mindset, Cultivating inner power, Sharing burden with an open-ear, Going through thick and thin together, Negotiating care level), and independence of recovery coping strategies for ICU survivors and caregivers (subthemes: Wearing a faked smile, Developing daily routine, Seeking respite).
The findings suggest that ICU survivors and caregivers experience overlapping yet distinct challenges during recovery, often involving shared coping strategies, alongside a need for individual space. These results support the presence of both interactivity and independence in recovery challenges and coping strategies for ICU survivors and their caregivers. Therefore, we call for future dyadic or family interventions to target both ICU survivors and caregivers, taking advantage of their interactivity and desire for gradual independence, so that fostered individualized coping strategies adapted to flexible contexts.
重症监护病房（ICU）后的家庭恢复期要求患者及其照护者作为一个家庭二元组应对康复挑战并采取应对策略，这需要有效的二元互动模式。现有的定性研究表明，二元组面临互动或独立的挑战，并采用不同的应对策略，其中可能包括积极沟通，或者相反，选择回避。然而，仅一项定性研究的普遍性可能有限，对于ICU幸存者及其照护者在康复过程中面临的挑战和应对方式，缺乏更广泛、更细致入微的理解。本元综合研究旨在明确ICU幸存者及其照护者在康复过程中挑战与应对策略的交互性和独立性。
这是一项基于压力与应对框架指导的定性研究的元综合研究。我们系统检索了六个电子数据库，包括PubMed、Medline、Cochrane图书馆、CINAHL、PsycArticles和PsycInfo，以查找从数据库建立至2024年1月发表的相关定性研究。我们采用内容分析法进行数据分析。本综合研究的呈现遵循PRISMA指南和ENTREQ指南。
经过全文筛选，纳入了49项研究。本综合研究得出了四个主题，包含16个子主题。其中包括，ICU幸存者及其照护者康复挑战的交互性（子主题：生活天翻地覆、情境性过度劳累、缺乏同情的孤立、赋权冲突、边缘化支持），ICU幸存者及其照护者康复挑战的独立性（子主题：康复意味着默默承受、记忆缺失、为照护做出牺牲），ICU幸存者及其照护者康复应对策略的交互性（子主题：思维重新定位、培养内在力量、敞开心扉分担负担、同甘共苦、协商照护水平），以及ICU幸存者及其照护者康复应对策略的独立性（子主题：强颜欢笑、养成日常生活习惯、寻求喘息机会）。
研究结果表明，ICU幸存者及其照护者在康复过程中经历了重叠但又不同的挑战，通常涉及共同的应对策略，同时也需要个人空间。这些结果支持了ICU幸存者及其照护者在康复挑战和应对策略中存在交互性和独立性。因此，我们呼吁未来针对ICU幸存者及其照护者的二元或家庭干预措施，利用他们的交互性和对逐步独立的渴望，从而培养适应灵活情境的个性化应对策略。
