OAR@UM Collection:

Life after intensive care : identity, recovery, and the evolving needs of post-ICU patients

Wed, 01 Jan 2025 00:00:00 GMT

Title: Life after intensive care : identity, recovery, and the evolving needs of post-ICU patients Abstract: Objectives: This study aimed to explore how former Intensive Care Unit (ICU) patients interpreted their critical care experiences and how these influenced their evolving identity, emotional recovery, and reintegration into everyday life following discharge. Research Design: A qualitative research design was employed, using narrative inquiry (NI) as its methodological framework. The study was underpinned by Clandinin and Connelly’s three-dimensional narrative structure: temporality, sociality, and spatiality. Identity Theory (IT) provided a framework to understand how participants’ sense of self changed after ICU. Narrative inquiry and Identity Theory guided both data collection and interpretation. Settings: The study was conducted within the community setting in Malta. All interviews took place after the participants had returned home from their ICU stay. Participants: Six former ICU patients who had spent a minimum of four days in intensive care were recruited through purposive and snowball sampling. All participants had been discharged home, fluent in Maltese or English and able to reflect on their experience. Methods: Data were collected through semi-structured, in-depth interviews conducted in Maltese. The interviews were transcribed, translated, and analysed thematically using Braun and Clarke’s approach. Results: 1) Emotional and Psychological Struggles, including vivid memories and coping strategies like faith and inner strength; 2) Interpersonal Support and Recovery, highlighting the role of family and continuity of care in emotional healing and validating survivors’ experiences; 3) Transformations through Survival, reflecting changes in self-perception, priorities, and identity, with a renewed sense of purpose. Discussion: The study highlights that ICU recovery extends beyond physical healing. Survivors undergo a complex emotional and identity reconstruction process, influenced by both personal resilience and the quality of support received. Recommendations: Post-ICU care should adopt trauma-informed, identity-sensitive, and person-centred approaches. Structured follow-up, family engagement, and opportunities for narrative expression may enhance long-term recovery. Further research is recommended to explore gendered identity shifts and relational aspects of survivorship. Description: M.Sc.(Melit.)

Mapping emergency medical calls : a retrospective spatiotemporal analysis of ambulance calls in Malta

Wed, 01 Jan 2025 00:00:00 GMT

Title: Mapping emergency medical calls : a retrospective spatiotemporal analysis of ambulance calls in Malta Abstract: Background: Emergency medical services (EMS) represent a critical component of Malta’s healthcare system, yet little research has examined the spatial and temporal dynamics of ambulance demand. Understanding when, where, and under what conditions emergency calls occur is essential to improving operational efficiency, equitable service coverage, and data driven resource allocation. Objectives: This study aimed to analyse the spatiotemporal and environmental patterns of emergency ambulance calls in Malta between 2022 and 2024. Specifically, it sought to (1) identify spatial and temporal trends in EMS demand, (2) explore their interaction across geographic and temporal dimensions, and (3) assess the relationship between ambulance call volumes and daily maximum temperature. Design and Methods: A retrospective, observational, and quantitative design was employed. Anonymised ambulance dispatch data were obtained from the national Computer-Aided Dispatch (CAD) system and processed into a dataset of 132,500 unique calls. Descriptive and inferential statistics were performed using SPSS, while spatial and spatiotemporal mapping were conducted in ArcGIS Pro. Correlations with environmental variables were tested using Pearson’s r. Participants: All emergency ambulance calls originating from mainland Malta between 1 January 2022 and 31 December 2024 were included. Calls with incomplete locality data or representing outbound inter-facility transfers were excluded. Results: Ambulance demand increased by approximately 22% across the study period, with consistent mid-morning peaks (around 10:00am) and dual seasonal surges in summer (July– August) and winter (December). Spatially, the Northern Harbour and Southern Harbour districts accounted for over half of all calls. A moderate, statistically significant correlation was found between daily maximum temperature and call volume (r = 0.297, p < 0.001). Conclusions: Ambulance demand in Malta is shaped by identifiable spatial, temporal, and environmental patterns. These findings provide a foundation for predictive modelling, targeted resource allocation, and evidence-based EMS planning in small-island health systems. Description: M.Sc.(Melit.)

Development and feasibility testing of a multi-component smoking cessation intervention for smokers living with diabetes mellitus

Wed, 01 Jan 2025 00:00:00 GMT

Title: Development and feasibility testing of a multi-component smoking cessation intervention for smokers living with diabetes mellitus Abstract: Background: Tobacco smoking increases the risk of macro- and micro-vascular complications for individuals living with diabetes. While smoking cessation has been recognised as an integral part of diabetes management, evidence of effective interventions is limited, and often this is overlooked by diabetes educators. Smokers with diabetes tend to be less motivated to stop, leading to low participation and abstinence rates. Aim: To develop a multi-component smoking cessation intervention grounded in theory and evidence, tailored for smokers with diabetes, and to assess its feasibility, acceptability, and potential effectiveness in preparation for a future definitive trial. Methods: In the development phase, a scoping review on the smoking cessation interventions that have been utilised amongst individuals with diabetes, and the faced challenges, and barriers was undertaken. A systematic review of effectiveness of the identified promising interventions followed, for identifying the components of the successful interventions. A qualitative descriptive study on the views of Maltese individuals living with diabetes of the identified components and their needs to quit smoking led to the development of the intervention. In the feasibility phase, a feasibility trial and its pilot were undertaken. A randomised trial with a nested qualitative descriptive study was undertaken to assess the feasibility and acceptability of the intervention amongst individuals with type 1 and type 2 diabetes (n=91) and two diabetes nurse educators (intervention providers) at a Maltese acute public hospital, comparing intervention acceptability and potential effectiveness to standard care. Results: A unique multi-component smoking cessation intervention consisting of 3-4 behavioural support sessions and a 6-week provision of Nicotine Replacement Therapy (NRT) was developed. Minor revisions were required following the pilot study, mainly the addition of a final follow-up session for continuing smokers. While treatment discontinuation was high in both groups in the feasibility trial, the intervention was found to be feasible, acceptable to the individuals with diabetes and the diabetes nurse educators, and potentially effective. The provision of NRT was identified as a crucial component of the intervention. Conclusions: The developed intervention is feasible and acceptable and may improve smoking quit rates when compared to standard care. To improve participation rates for a definitive trial, telephone-based follow-up support should be provided to those who struggle to attend further. Given NRT’s contributing role, the cost coverage or provision of NRT to smokers with diabetes is also recommended. Description: Ph.D.(Melit.)

An evaluation of critical care nurses' perceived knowledge and practices of venous thromboembolism

Wed, 01 Jan 2025 00:00:00 GMT

Title: An evaluation of critical care nurses' perceived knowledge and practices of venous thromboembolism Abstract: Background: Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a significant contributor to hospital in-patients’ morbidity and mortality, particularly in critical care settings. Patients in these environments face increased risks due to immobility, surgical procedures, and multiple comorbidities. Nurses are integral to the prevention, assessment, and management of VTE, yet gaps in their knowledge and actual practices may compromise patient outcomes. This study evaluates the knowledge and practices of critical care nurses in Malta concerning VTE care. Methodology: A cross-sectional, quantitative research design was employed. Data was collected from critical care nurses (n=98) via a structured, validated questionnaire adapted from an existing validated tool, aligned with updated VTE guidelines. Descriptive and inferential statistics were used to assess demographic variables, self-rated and actual knowledge, VTE-related practices, self-efficacy, and perceived barriers to VTE risk assessment. Findings: The study revealed moderate knowledge and practice scores among participants. Nurses demonstrated stronger knowledge of common VTE risk factors but struggled to identify less familiar or complex ones. Confidence was highest in patient education and lowest in technical interventions such as mechanical prophylaxis application. Training attendance was low, though positively rated by those who had received it. No significant correlations were observed between demographic variables and knowledge or practice scores. Barriers such as workload, limited training, and unclear protocols were more strongly associated with practice variability. Conclusion: The research highlights that while knowledge of VTE was moderate among participants, it did not necessarily translate into consistent VTE care practices. Effective practice requires institutional support, structured and context-specific training, and the integration of clear, accessible protocols. Addressing systemic and environmental barriers is essential to improving patient safety and nursing performance in critical care settings. Description: M.Sc.(Melit.)