Lived experience of patients transitioning from intensive care to general wards : an interpretative phenomenological analysis

Abstract

Background: Extant literature has demonstrated how Intensive Therapy Unit (ITU) discharge can be a challenging process, with patients often facing physical and psychological difficulties as they progress to standard inpatient care. A deeper understanding of what patients go through and their multifaceted needs while they transition from the ITU to a general ward may shed light on how to improve patient-centred care and, ultimately, contribute to a more positive experience. While international studies have explored this topic to an extent, an absence of local research exploring patients’ experience of transitioning from an ITU to general wards can be noted. Aim: The research study aims to explore the lived experience of patients transitioning from an ITU to a general ward. This aim comprises achieving a better understanding of how patients make sense of the transition experience, taking into consideration personal and situational aspects related to the transition. This, thus, allows for patients’ interpretation of events to be recognised within the local socio-cultural context. Design: A qualitative research design was adopted, guided by Interpretative Phenomenological Analysis (IPA). Five participants (three females, two males, aged: > 25 years but <85 years) with an ITU stay of between twenty-four and seventy-two hours, who were transferred to a general medical or surgical ward for aftercare were recruited from a general hospital in Malta. Method: Purposive sampling was utilised to recruit participants and semi-structured, one-to-one interviews were conducted between one to three weeks post-discharge, in a convenient location chosen by participants. All five interviews were audio-recorded, transcribed verbatim and analysed in accordance with Smith et al.’s (2022) seven-step analytic process for IPA. All ethical issues were considered, including the obtainment of all necessary ethical approvals, informed consent and the preservation of participants’ confidentiality. Findings: Four Group Experiential Themes (GETs) were identified: (1) News of transfer eliciting conflicting emotions (2) Struggling to adapt to an unfamiliar state of dependency (3) Confronting environmental changes presented upon relocation to a general ward (4) Maintaining focus on the overarching goal of recovery. Conclusion: This study demonstrated how the transition from an ITU to a general ward can be a distressing experience for patients, leading to the emergence to cope with several unanticipated personal and situational adjustments. Moreover, participants’ account of lived experiences elucidated several societal, environmental, and cultural conditions impacting their emotional and psychological well-being along the transition trajectory, ultimately influencing participants’ perception of the transition experience. Despite this, commitment towards recovery amidst deliberate efforts at sustaining a positive outlook was shared amongst participants. Recommendations for practice and management include better patient anticipatory preparation in the pre-transfer period and improved person-centred integrated care approaches in the post-transfer period, through the implantation of targeted education and training programmes for nurses.