City Research Online

Abstract

Background
As greater numbers of individuals survive critical care, critical care nurses require an understanding of patients’ memories of this experience. This is important because the critical care that nurses deliver may contribute to patients’ memories of this episode in their life which irrespective of their objective accuracy and may have implications for patients’ emotional well-being and longer-term critical care survivorship. This involves moving on with life, with individuals’ often needing to redefine themselves as a result of the legacies of a critical care stay and regaining control of their life.

Aims of the research
Through the theoretical lens of Bartlett’s (1932) theory of reconstructive memory, this research aimed to explore patients’ reconstructive memories of critical care and to develop an understanding of how nursing practice may contribute to these and patients’ longer term critical care survivorship. Through identifying similarities and differences between patients’ reconstructive memories of critical care and nurses’ understandings of these, this research also aimed to make recommendations for nursing practice, research and education.

Research design and methods
Drawing upon the work of Creswell and Plano Clark (2011) this qualitative research adopted an exploratory sequential design entailing one study with separate phases. Phase one involved interviews with former critical care patients (n=15) to collect qualitative data that were analysed through the constant comparative analysis method. A second phase involving focus groups collected and analysed further qualitative data from nurses (n=33) who all practised on critical care units (CCUs). A final phase explored convergence and divergence between patients’ reconstructive memories of receiving critical care and the understanding of these demonstrated by critical care nurses.

Findings
Critical care patients reported missing memories of critical care. They demonstrated a need to address these and make sense of their situation and experiences. They felt only then could they achieve closure on this episode of their life and move on with their survivorship and the second chance of life that critical care had provided. To try to address these gaps in memories, patients developed rich reconstructive memories of critical care. To do this, they placed extreme value on family members experiences, understanding and support along with those provided through critical care follow-up services. In contrast, the critical care nurses demonstrated a limited understanding of patients’ memories of critical care, confining their considerations to the CCU stay. There was a lack of awareness of the value patients place on family members to support their memories and critical care survivorship. Instead, nurses drew heavily upon the medical model to explain patients’ memories of critical care.

Conclusion
Nurses working within CCUs demonstrated an overreliance on the medical model which focuses on organ dysfunction and disease, to understand patients’ memories of critical care. In contrast, patients’ focus was more on their personal experience of receiving care on the CCU and then their recovery and ability to achieve closure on this episode and to move on with their life. Central to this for patients, was the role their family members played to help them address their missing memories of critical care and make sense of and understand their experience. Thus it is recommended that critical care nursing practice moves towards a holistic, patient family-centred approach to care which supports the development of patients’ reconstructive memories. This may contribute to patients’ ability to achieve closure on this period of their life and move on with their critical care survivorship.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine > RT Nursing
Departments:	Doctoral Theses School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses School of Health & Psychological Sciences > Healthcare Services Research & Management

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