Transitional Care for Intensive Care Unit Patients and Their Families

Abstract

Patients admitted to the intensive care unit (ICU), including patients with prolonged mechanical ventilation (PMV), make multiple, healthcare transitions within and between settings throughout their recovery trajectory; transitional care is needed to support these numerous transitions. Early ICU transitional care planning is recommended to begin as soon as the patient is admitted to the ICU. However, there are no U.S. transitional care standards and transitional care planning is often delayed until the patient is about to be transferred to another location or level of care. Despite the complexity of transitions and the increasing need for transitional care for ICU patients, ICU patients and their families are without support across the care continuum as they navigate fragmented environments that do not bridge inpatient and outpatient settings. Nurses are essential in caring for patients and their families improving communication and coordinating care transitions. In ICU settings, nurses play a crucial role in facilitating information-sharing, providing support, and enhancing communication between families of ICU patients and the healthcare team. Yet, nurses’ role in ICU transitional care remains unclear, particularly for ICU patients transitioning home from acute hospital care and their families. This dissertation aimed to develop foundational knowledge on transitional care planning and prognostic estimates for ICU patients and their families to inform future work to improve their outcomes and care standards across the treatment continuum. Chapter 1 introduces the problem and significance of transitional care for ICU patients , including patients with PMV, transitioning home after acute hospital care and their family members.. Chapter 2, which is informed by Meleis’ Transitions Theory, provides a theoretical model that can be used to guide the transition to home after acute hospital care for ICU patients and their families. Using secondary data from a clinical trial on a decision support tool for patients with PMV, Chapter 3 explores the role of nurses in transitional care planning during family meetings for patients with PMV using a directed content analysis; and Chapter 4 examines the levels of understanding of family-reported prognostic estimates (FPE) and clinician perceptions of FPE (C-FPE) regarding one-year survival of patients with PMV among family members, ICU physicians, and nurses, using latent profile analysis. Lastly, Chapter 5 concludes the dissertation by synthesizing the findings, exploring implications, and recommending future research on improving the standards of care for ICU patients and their families across the treatment continuum. The findings of this dissertation will contribute new knowledge on the role of nurses in patient- and family-centered transitional care planning for ICU patients and their families.