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BMJ open. 2022 Apr 26;12(4):e050592. doi:10.1136/bmjopen-2021-050592.
OBJECTIVE: To identify critical illness survivors’ perceived barriers and facilitators to resuming meaningful activities when transitioning from hospital to home.
DESIGN: Secondary content analysis of semi-structured interviews about patient experiences in critical care (primary analysis disseminated on the patient-facing website www.healthtalk.org). Two coders characterized patients’ perceived barriers and facilitators to resuming meaningful activities. To facilitate clinical application, we mapped the codes to the Person-Task-Environment Performance Model, a patient-centered rehabilitation model that characterizes the complex person-task-environment interactions during rehabilitation. execution of activities.
SETTING: United Kingdom, 2005-2006.
PARTICIPANTS: 39 adult survivors of critical illness, sampled for variation between demographics and experiences of illness.
RESULTS: Person-related barriers included negative mood or affect, perceived setbacks; weakness or limited stamina; pain or discomfort; inadequate nutrition or hydration; lack of concentration/confusion; sleep disturbances/hallucinations/nightmares; distrust of people or information; and altered appearance. Task Barriers included poor communication and the management of conflicting priorities. Environmental Barriers included unsupportive health services and policies; challenge social attitudes; incompatible patient-family adjustment (emotional trauma and physical disability); equipment problems; overstimulation; understimulation; and the inaccessibility of the environment. Person-related facilitators included motivation or attitude; experiencing progress; and religion or spirituality. Task-related facilitators communications included. Environment-related facilitators included support from family, friends or healthcare providers; supporting health services and policies; equipment; community resources; medications; and accessible housing. Barriers have decreased and enablers have increased over time. Six barrier-facilitator domains dominated based on frequency and emphasis across all performance goals: mood/motivation, setback/progress, fatigability/strength; miscommunication; community lack/support; lack/health services and policies.
CONCLUSIONS: Critical illness survivors described a comprehensive inventory of 18 barriers and 11 enablers that align with the Person-Task-Environment performance model. Six dominant barrier-facilitator domains seem strong targets for impactful interventions. These results confirm previous knowledge and offer new opportunities to optimize patient-centered care and reduce disability after critical illness.
PMID:35473739 | DOI:10.1136/bmjopen-2021-050592