Case study research in education

A critical review and synthesis of qualitative research on patient experiences of critical illness.

The user experience of critical care discharge: A meta-synthesis of qualitative research

This study assesses the prevalence of workplace bullying in a sample of US workers, using a standardized measure of workplace bullying (Negative Acts Questionnaire, NAQ), and compares the current study's prevalence rates with those from other bullying and aggression studies. The article opens by defining bullying as a persistent, enduring form of abuse at work and contrasting it with other negative workplace actions and interactions. Through a review of the current literature, we propose and test hypotheses regarding bullying prevalence and dynamics relative to a sample of US workers. After discussing research methods, we report on the rates of bullying in a US sample, compare these to similar studies, and analyse the negative acts that might lead to perceptions of being bullied. Based upon past conceptualizations, as well as research that suggests bullying is a phenomenon that occurs in gradations, we introduce and provide statistical evidence for the construct and impact of bullying degree. Finally, the study explores the impact of bullying on persons who witnessed but did not directly experience bullying in their jobs.

Burned by bullying in the American workplace: Prevalence, perception, degree and impact

Intensive care survivors suffer chronic and potentially life-changing physical, psychosocial and cognitive sequelae, and supporting recovery is an international priority. As survivors’ transition from the intensive care unit to home, their support needs develop and change. In this scoping review, we categorised patients’ support needs using House’s Social Support Needs framework (informational, emotional, instrumental, appraisal) and mapped these against the Timing it Right framework reflecting the patient’s transition from intensive care (event/diagnosis) to ward (stabilisation/preparation) and discharge home (implementation/adaptation). We searched electronic databases from 2000 to 2017 for qualitative research studies reporting adult critical care survivors’ experiences of care. Two reviewers independently screened, extracted and coded data. Data were analysed using a thematic framework approach. From 3035 references, we included 32 studies involving 702 patients. Studies were conducted in UK and Europe (n = 17, 53%), Canada and the USA (n = 6, 19%), Australasia (n = 6, 19%), Hong Kong (n = 1, 3%), Jordan (n = 1, 3%) and multi-country (n = 1, 3%). Across the recovery trajectory, informational, emotional, instrumental, appraisal and spiritual support needs were evident, and the nature and intensity of need differed when mapped against the Timing it Right framework. Informational needs changed from needing basic facts about admission, to detail about progress and treatments and coping with long-term sequelae. The nature of emotional needs changed from needing to cope with confusion, anxiety and comfort, to a need for security and family presence, coping with flashbacks, and needing counselling and community support. Early instrumental needs ranged from managing sleep, fatigue, pain and needing nursing care and transitioned to needing physical and cognitive ability support, strength training and personal hygiene; and at home, regaining independence, strength and return to work. Appraisal needs related to obtaining feedback on progress, and after discharge, needing reassurance from others who had been through the ICU experience. This review is the first to identify the change in social support needs among intensive care survivors as they transition from intensive care to the home environment. An understanding of needs at different transition periods would help inform health service provision and support for survivors.

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Identifying patients' support needs following critical illness: a scoping review of the qualitative literature.

A multicase study of prolonged critical illness in the intensive care unit: Families' experiences.

Aims and objectives

With consideration of an environmental concept, this paper explores evidence related to the negative impacts of the intensive care unit environment on patient outcomes and explores the potential counteracting benefits of ‘nature-based’ nursing interventions as a way to improve care outcomes.



Background

The impact of the environment in which a patient is nursed has long been recognised as one determinant in patient outcomes. Whilst the contemporary intensive care unit environment contains many features that support the provision of the intensive therapies the patient requires, it can also be detrimental, especially for long-stay patients.



Design

This narrative review considers theoretical and evidence-based literature that supports the adoption of nature-based nursing interventions in intensive care units.



Methods

Research and theoretical literature from a diverse range of disciplines including nursing, medicine, psychology, architecture and environmental science were considered in relation to patient outcomes and intensive care nursing practice.



Conclusion

There are many nature-based interventions that intensive care unit nurses can implement into their nursing practice to counteract environmental stressors. These interventions can also improve the environment for patients’ families and nurses.



Relevance to clinical practice

Intensive care unit nurses must actively consider and manage the environment in which nursing occurs to facilitate the best patient outcomes.

Rethinking the intensive care environment: considering nature in nursing practice

New Zealand nursing students’ experience of bullying/harassment while on clinical placement: A cross-sectional survey

Aims and objectives To explore patients', families' and health professionals' experiences of a long-stay patient in an intensive care unit. Background The fast-paced technologically driven intensive care unit environment, designed for a short patient stay, supports the provision of complex physiologically focused care for those with life-threatening illnesses. Long-stay patients with pronounced fundamental care needs fall outside predicted patient pathways, and nurses can find caring for these patients challenging. Design and methods A longitudinal, qualitative, multicase study of six cases from four New Zealand units. Case participants were patients, family members, nurses and other health professionals. Data collection methods included observation, conversations, interviews and document review. Data were analysed using thematic analysis, vignette development and trajectory mapping. Results Challenges and successes of providing fundamental care for long-stay ICU patients are attributed to two interlinked factors. First, the biomedical model influences ICU nursing practices, resulting in prioritising tasks and technology for patient survival while simultaneously devaluing relational and comfort work. Fundamental psychosocial needs such as family presence, comfort, relationships and communication may be unmet. Second, the unit environment and culture have a significant impact on long-stay patients' ICU experiences and form physical and psychological barriers to families being present and involved. Some nurses negotiated these challenges to provide fundamental, patient- and family-centred care by adopting an approach of knowing the patient and these nurses reported satisfaction when seeing patients' positive responses. Conclusion The care environment and culture provide challenges to the provision of patient- and family-centred care for long-stay patients; however, when nurses prioritise knowing their patient these challenges can be overcome and patient and family distress reduced with the potential to improve patient outcomes. Relevance to clinical practice Recognition that patients have fundamental care needs irrespective of the setting where they receive care. Intensive care environments and cultures create challenges for nurses when there is such a heavy burden of physiological needs to be met and technological tasks to be undertaken, with a focus on acuity; however, improving provision fundamental care can result in positive patient outcomes.

Claire Minton

Papers

A multicase study of prolonged critical illness in the intensive care unit: Families' experiences.

Rethinking the intensive care environment: considering nature in nursing practice

New Zealand nursing students’ experience of bullying/harassment while on clinical placement: A cross-sectional survey

The impact of a prolonged stay in the ICU on patients' fundamental care needs.

“You can't escape it”: Bullying experiences of New Zealand nursing students on clinical placement