Exploring patients’ experiences in intensive care units (ICU): A cross-sectional study in Pakistan

Cardiovascular Surgery Patients: Intensive Care Experiences and Associated Factors

ABSTRACTObjective:To describe the meaning attributed to nurses’ clinical experience in a medical-surgical intensive care unit in Northern Cyprus.Method:The qualitative study was conducted in two medical-surgical intensive care units at a university hospital. Data were collected through in-depth interviews with 17 nurses. Giorgi’s descriptive phenomenological approach was used to analyze nurses’ experiences. The consolidated criteria for reporting a qualitative research checklist were followed in this study.Results:The data analysis led to the extraction of the 5 themes and 19 subthemes. The themes identified for the study were competence, the emotional universe, stress resources, the meaning of nursing care, and profoundly affecting events. The study results show that the nurses expressed that having gained much experience in intensive care units and working there has contributed significantly to their professional development.Conclusion:It was indicated that the nurses had meaningful, caring experiences in intensive care units, which were perceived, however, as stressful experiences as well. The study has important implications for nurses, faculty members, and administrators to gain positive care experiences in terms of intensive care units.

BackgroundClinical practicum provides nursing students with more opportunities to learn their professional knowledge and develop basic nursing skills. Intensive care unit (ICU) is often used as one of the clinical practicum departments for nursing students. Due to the characteristic fast-paced working environments, high acuity of patient care, and technical complexities of an ICU, nursing students are more susceptible to experiencing stress and lack of confidence in these settings, which hinders their professionalization and affects patient care.ObjectiveThe study aimed to summarize and evaluate the nursing students' experience in an ICU during their practicum and to provide a supportive ICU clinical practicum environment for them. One of the main objectives was to increase the ICU specialty nurse reserve and improve nursing care in the ICU.MethodsThe following databases were searched for related qualitative publications in Chinese and English by systematic searches across January 2022, including the nursing students' experience in ICU during their practicum: PubMed, Cochrane Library, Web of Science, and so on. The qualitative meta-synthesis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Two reviewers independently selected these studies and carefully evaluated the quality of each study. Meta-synthesis was then used to summarize the results.ResultsEleven sub-themes and 3 themes were revealed in 9 studies: challenges of clinical practicum in the ICU, the expectation of support from multiple sources, and the importance and necessity of practicum in the ICU.ConclusionPerforming one's practicum in ICU was considered by the nursing students in this review as a beneficial practicum despite the challenges involved. The appropriate guidance and monitoring should be given by hospital managers and college educators.

This issue celebrates a collection of papers examining how we can enhance patient well-being whilst in the intensive care unit (ICU) and post discharge on their recovery trajectories. Well-being is a concept that relates to mental health and wellness and also relates to how well we can adapt and cope with the dynamics of everyday life. However, well-being is a concept with nebulous features, multiple layers and individualised meaning. It applies to both patients and staff and this collection of papers helps us to reflect on how we can strive to improve not only the patient experience but also our own well-being so we might thrive and be energized to sustain the highest standards of care. ‘Bouncing back’ from bad experiences is known as resilience and is inextricably linked to well-being. Heather Baid's (2018) editorial examines the relationship between resilience and sustainability. She challenges the assumption that resilience is the sole responsibility of an individual practitioner: organisations have a responsibility to provide conditions in which individuals can flourish whilst navigating the maelstrom of competing demands inherent within contemporary health care practice. Organisations do not exist in a vacuum. Macro political conditions and financial circumstances create turbulence that challenges the sustainability and resilience of the health care service. Therefore, interventions at every level are required to ensure the well-being of the service as well as the staff who work within it. She discusses the collective voice to influence the political agenda and the critical importance of caring for one another and not only noticing when things get tough for others, but acting to provide support and care for colleagues as well as our patients and their families. Reducing the risk of delirium in critical care patients is essential to their recovery and long-term well-being. Luther and McCleod (2018) present a text book systematic review examining chronotherapeutic interventions to reduce the prevalence of delirium in adult patients admitted to critical care. Their initial search revealed 99 articles; however, the procedure to determine eligibility meant six articles were included in the narrative synthesis. Noise and light control to establish a clear day/night cycle were identified to have a positive impact on the reduction of delirium and may improve the quality of sleep. However, the authors are quick to point out that the factors that can cause delirium in critical care patients are multifactorial. The maintenance of circadian rhythm can help to reduce the likelihood of delirium and that can improve the patient experience as well as patient outcomes. Consciously attending to clinical practice that might cause iatrogenic sleep disturbance should be a constant, but possibly easy to forget when responding to emergencies, having to admit or transfer patients in the night. The solution might be to create greater sensory ‘isolation’ for the patients to protect them by using on-pharmacological interventions such as eye shades and ear plugs for light and noise control at night but only if a patient can tolerate them (Richardson et al., 2007). Improving the quality of sleep for patients in critical care requires a range of interventions including aromatherapy (Karadag et al., 2017), massage (Gélinas et al., 2013), environmental temperature control and patient body temperature (Parker et al., 2007), comfort and positioning (Richardson et al., 2007): all components of humanising the patient experience that requires intensive (and thoughtful) care. Thus, illustrating that although you isolate variables when narrowing the search in a systematic review to inform best practice, real world application requires the synthesis of multiple sources of evidence. Ventilator acquired pneumonia (VAP) is another iatrogenic disease that compromises the patient's recovery and well-being. Jam et al. (2018) report on a cross-sectional observational study conducted in two adult general ICUs in Spain, to examine compliance with non-pharmacological procedure to reduce VAP. A one-hour lecture on non-pharmacological technique was delivered prior to the observational study and this lecture supplemented a national quality initiative to reduce VAP across Spain the year before. The nurses completed a knowledge questionnaire of five items with a binary answer. Therefore, the nurses were alert to the measures to be set in place and also aware an observational study was on-going, but not when the observation of their practice was being recorded. The observational schedule listed nine procedures associated with suctioning endotracheal secretions. These included: handwashing before and after the technique, use of sterile equipment, aseptic technique, the use of a face mask and goggles, headboard angle, checking endotracheal cuff measurement and oral hygiene. The authors conclude that knowledge of preventive measures did not guarantee compliance nor did the nurse to patient ratio. Jam et al. (2018) suggest compliance requires interventions associated with work climate and professionals' attitude and that requires a deeper understanding of the contextual factors affecting clinical practice. Indeed, such insight might illuminate beyond the statistics derived from observational schedules whether there is a gap between ‘adequate’ performance and exacting criteria to determine ‘compliance’. Critical care patient diaries have been in use since the 1990s. They serve as a tool to prompt memory and reconstruct delusional memories of a critical care experience. In the past two decades, researchers have measured how patient outcome and recovery are affected by diaries. Alert to the risks and emotional stresses associated with awakening uncomfortable memories for patients reading their ICU diaries, Petersson et al. (2018) designed a study to determine what memories were awakened by a diary, whether these memories differed to ICU patients who had no diary to read and whether discussion with staff about the contents of the diary affected their reconstructive narrative of that experience. Two months after their ICU experience, they recruited 96 patients to their study, and of these, 40 diary reading participants completed the ICU memory tool whilst 34 who had no diary to read also returned the memory tool. The authors found that diaries help to trigger conversations about what happened to the patients during their ICU stay with relatives and friends but diaries did not necessarily raise different memories of their ICU experience to the non-diary readers. The authors argue that nurses should attend to how they can reduce negative emotional stress for patients during an ICU experience and call for further research to determine the impact of follow-up contact with ICU staff post discharge on longer-term recovery and patient outcomes. However, Engström et al. (2018) argue that follow-up visits for patients with their relatives facilitated by staff who cared for the patients during their stay on ICU offers an opportunity to create a context and coherence for the time the patient spent in ICU. Memory gaps can be filled using the patient diary, especially when staff explained to them, supported by relatives' accounts of their experience, what happened to them during their stay in the ICU. Engström et al. (2018) conclude that opportunity to read the diary with staff is important whereas the patients in the Petersson et al. (2018) study read the diary without staff being present. Engström et al. (2018) advocate the facilitation by staff to put meaning to altered memories, and gaps in time. They concluded from their interview data with nine patients, follow-up clinics had a positive impact on the health and well-being of both the patient and their relative. They do not provide long-term measures to determine how much and for how long that impact had on the quality of life for patients and their families but they do provide insights of what should be addressed to make that follow-up intervention purposive and meaningful. So if we are informed of ways to alleviate patient suffering, can it only be applied to a service if the impact is quantified? Allum et al. (2018) discuss ways to support patients post discharge from ICU. They construct the patient experience through the survivorship lens and on a recovery trajectory. Telephone interviewing 12 people (5 men and 7 women) who had an admission of no less than 48 h on ICU but whose survivorship journey ranged from less than a year up to 10 years (mean 4·9 years) post ICU discharge. Participants were recruited from Patient and Public Involvement (PPI) groups and a post-ICU charity demonstrating how the team accessed patients with stories of longer as well as shorter-term recovery timelines. This is an important contribution as they provide insight into how long the psychological recovery phase can take. Key events in the post-discharge experience occurred at transfer out of the ICU and then again home, the need for specialist information and help addressing post-ICU issues (general physicians did not necessarily have knowledge of or access to appropriate resources and help), timely referral and access to support services (e.g. counselling services) and the importance of a supportive social network were key to helping the patient re-establish their health and well-being. Critically, the authors identify how the survivors' experiences differed and at what time difficulties might have occurred in their recovery. Therefore, providing flexible and timely support face to face, on line and building an on-line peer support group is one strategy to broaden accessibility to specialist follow-up advice. Importantly, they indicate that exclusion of patients in ICU follow-up studies with greater than 2 years post-discharge experience because of potential for ‘recall bias’ is an error as many patients in this study were still experiencing problems many years after discharge. Early recognition of psychological consequences of an ICU admission and timely referral and access to appropriate intervention services is also critical for effective follow-up care. The final paper by Jarden et al. (2018) examines critical care nurses (CCNs) construct of workplace well-being. The methodology for this study was prototype analysis, an approach more largely seen in organisational psychology to examine language and meaning associated with concepts with ‘fuzzy features’ such as well-being. The study was conducted in three phases, in which 65 CCNs participated and were randomly allocated to one phase of the study only. In the first exploratory phase, 23 CCNs listed features of workplace well-being. Another 25 CCNs then rated those features and the final 17 participants, rated the inductively derived concepts to be either central or peripheral to the concept of well-being. ‘Appropriate workload’ and ‘work-life balance’ were cited most frequently as core to work well-being, whilst CCNs rated ‘respect’, ‘feeling valued’ and ‘support’ as most important to them for work well-being. It could be argued that each of these terms is as open to individual interpretation and meaning as ‘well-being’. The authors conclude that no single approach to work well-being could be identified from this prototype analysis with CCNs in New Zealand that differed from the theoretical constructs reported elsewhere in the literature on workplace well-being. We need to reflect on how we can continue to provide high-quality care without depleting our compassion, however unstable and challenging the circumstances in which our care takes place. It is within our gift to demonstrate to colleagues respect, value and support. We can use our collective voice to ensure our work place and the patient's therapeutic environment remains sustainable. To keep adapting to new demands, facing challenges requires us to reflect on how we can attend to our own well-being so we in turn can attend to the well-being of others and most importantly, our patients.

The intensive care unit (ICU) experience has been reported to cause adverse health effects in families during and after the ICU stay. The objective of this study was to evaluate health-related quality of life (HRQOL) in relatives of patients 90 days after ICU discharge or death. Multicenter observational study. Twenty-one ICUs in France. Among 459 eligible relatives of ICU patients, 284 (62%) were included in the study. None. During a telephone interview, the SF-36 was completed to assess HRQOL 90 days after ICU discharge or death. The physical component summary score of the SF-36 was normal (89/100 [66-94]) but the mental component summary score showed substantial impairments (emotional role, 67 [50-80]; social functioning, 70 [60-90]; vitality, 60 [45-70]; and mental health, 60 [48-2]). Moreover, 35.9% of relatives were taking anxiolytic or antidepressant drugs, and 8.4% were taking psychotropic agents prescribed since the discharge or death of the patient. Among factors independently associated with a worse mental score, 2 were patient-related (admission for shock or implementation of end-of-life decision), 6 were family-related (older age, female gender, child of the patient, low income, chronic disease, and newly prescribed psychotropic medications), and 1 was related to the ICU experience (perceived conflicts between ICU staff and relatives). The SF-36 showed evidence of impaired mental health in relatives of ICU patients 90 days after discharge. Better end-of-life care, psychiatric support after the ICU experience, and better conflict prevention and resolution are potential targets for improvement.

Intensive care unit (ICU) experiences after cardiac surgery significantly influence patient outcomes, including psychological disorders, quality of life and overall comfort. The existing literature emphasises psychological impacts and transitions from ICU to general wards, but there is a paucity of qualitative research focussing specifically on post-cardiac surgery ICU experiences. This study aimed to explore the lived experiences of patients in the ICU following major cardiac surgery, providing a comprehensive understanding of their emotional and psychological challenges. Utilising Cohen's phenomenological approach, we conducted in-depth interviews with 20 patients from a cardiothoracic ICU in Southern Italy. Participants were chosen through purposive sampling. Data were analysed using thematic analysis to identify recurring themes. Five main themes emerged from the data: (1) 'Closing the eyes and not opening them', highlighting pervasive fear and anxiety; (2) 'Confusion upon awakening', marked by disoriented memories and the fear of not being able to breathe; (3) 'Time stood still', describing a distorted perception of time; (4) 'The closeness of my angels: the nurses', underscoring the critical role of nursing support; and (5) 'The other side: exclusion from care', reflecting feelings of marginalisation during the care process. The study underscores the complex experiences of ICU patients' post-cardiac surgery, emphasising the need for psychological support and inclusive communication strategies to enhance patient outcomes. Further research should focus on developing tailored interventions to support these patients through their recovery process. There is a clear need for enhanced psychological support for patients before, during and after the ICU stay. Preoperative education programmes that set realistic expectations and provide coping strategies can significantly reduce anxiety and improve patient outcomes. Additionally, enhancing the role of nurses in offering emotional support and involving patients in care decisions can lead to a more positive ICU experience. Psychological interventions can optimise preoperative expectations and reduce hospital stays, offering significant cost-benefit advantages for healthcare systems.

Measuring family satisfaction in an Indian Intensive Care Unit.

Measuring the intensive care experience of intensive care unit patients: A cross-sectional study in western China

RATIONALE: Clinicians typically encourage family presence in the Intensive Care Unit (ICU) as a way to improve both patient and family outcomes. To limit the spread of the disease, families were typically prohibited from visiting the ICU during the COVID-19 pandemic. Little is known about the approach clinicians should take when engaging with families in times when they cannot visit the hospital. METHODS: Surrogates of critically ill patients with COVID-19 who participated in a clinical trial at a single academic center were contacted after ICU discharge to participate in a follow up study dealing with their ICU experience. Upon enrollment in this post-ICU discharge study, the subject (surrogate of the ICU patient) completed the Critical Care Family Needs Inventory (CCFNI) questionnaire and participated in a semi-structured telephone interview. The CCFNI questionnaire includes 14 questions dealing with aspects of the ICU experience that are important to family members. The answers to each question range from 1 (almost all the time) to 4 (none of the time), with lower scores indicating a better experience. Telephone interviews were transcribed and coded using thematic content analysis. RESULTS: Of the 58 subjects enrolled from September 2020 to December 2020, 23 (40%) respective patients were deceased. Subjects of deceased patients had higher median CCFNI scores than subjects of surviving patients, reflecting greater dissatisfaction with the ICU experience (1.82 [1.45-2.00] vs 1.45 [1.27-1.72], respectively, p=0.009). Subjects recollected that they typically received at least one medical update from the patient's ICU team each day. While many subjects felt that telephone communication with the ICU team was adequate, some believed they were unable to fully understand the patient's condition. In addition, some subjects feared the patient was clinically worsening when they did not receive frequent updates, which had a negative impact on their experience. Nearly all subjects reported that visitor restrictions made the ICU experience more difficult. Some subjects believed that the medical decisions that were made and the care the patient received were negatively impacted by not having family present at the bedside. CONCLUSION: During the COVID-19 pandemic, families of critically ill patients typically received medical updates by phone daily because they were unable to visit. These aspects of ICU care delivery had differential effects on the ICU experience of families, with more negative experiences among families of deceased patients. These data suggest that more individualized approach to family engagement is needed during times of visitor restrictions.

BackgroundGuidelines for diabetic ketoacidosis (DKA) management are limited, resulting in varied practices. This study assessed Intensive Care Unit (ICU) admission criteria, fluid resuscitation, insulin therapy, and metabolic management in adult patients with DKA.MethodsAn international survey of ICU clinicians consisted of 39 items that focused on management of DKA and was endorsed by the European Society of the Intensive Care Medicine. An experienced ICU was defined as a unit admitting > 20 patients with DKA per year.ResultsA total of 522 respondents from 57 different countries participated: 295(57%) worked in Europe, 86(16%) in North America, 25(5%) in South America, 52(10%) in Africa, 52(10%) in Asia and 12(2%) in Oceania. Among respondents, 377(72%) worked in teaching hospitals, 355(68%) in medical-surgical ICUs, and 204(39%) in experienced ICUs. The pH value (< 7.20), arterial or venous bicarbonate concentration (< 15 mmol/L), and the need for continuous intravenous insulin (regardless of the dose) were considered criteria for ICU admission by 362(69%), 240(46%) and 264(51%) respondents, respectively. A protocol for fluid resuscitation was available for 290(63%) respondents, 135(29%) administered isotonic saline only, 173(38%) administered balanced solutions only, and 153(33%) administered both. A protocol for insulin therapy was available for 355(77%) respondents. An initial bolus of intravenous insulin was administered by 228(49%) respondents, 221(48%) used an initial continuous intravenous insulin dose of 0.1 UI/kg/h, 42(9%) used an initial predefined fixed dose, 159(35%) based the initial dose on blood glucose and 39(8%) on blood and/or urine ketones. Fluid choice and modalities of intravenous insulin administration did not differ between experienced and non-experienced ICUs. Intravenous insulin administration was more likely to be initiated upon ICU admission (57%vs.45%, p = 0.04) and less likely after initial fluid resuscitation (27%vs.35%, p = 0.04) in experienced ICUs. Arterial or venous pH was monitored by 408(90%) respondents. Arterial blood gases were favored by 236(52%) respondents and venous blood gases were more likely to be performed in experienced ICUs (30%vs.18%,p < 0.01).ConclusionsThe management of patients with DKA remains heterogeneous worldwide. Future randomized trials are needed, especially regarding fluid resuscitation and insulin therapy.Trial registrationNot applicable.

BACKGROUND Psychological distress among ICU and ED nurses: the infulance of emotional intelligence By Daliah Ahmad Almuhdi Background and Objective: Nurses in Intensive Care Units (ICUs) and Emergency Department (ED) often contend with elevated psychological distress (stress, anxiety, and depression), impacting patient care and personal well-being. Despite the known negative association between Emotional Intelligence (EI) and these psychological disorders, limited research in Jordan has explored this relationship. This study aims to examine the relationship between Emotional Intelligence (EI) and psychological distress (stress, anxiety, and depression) among acute care nurses in Jordan. Method: The study utilized a cross-sectional descriptive and predictive design, targeting ICU and ED nurses (n=296) from University Hospital (JUH) and King Abdullah University Hospital (KAUH). Eligible participants included registered nurses with a minimum of one year of experience in ICU or ED settings. A self-administered questionnaire consisting of a sociodemographic data sheet, the Wong and Law Emotional Intelligence Scale (WLIES), and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were employed. Descriptive and inferential statistics were applied for data analysis. Linear regression analysis was used to examine the predictors of EI with social demographics were tested as predictor variables. Also SPSS’s PROCESS macro (Hayes, 2013) was used to determine if EI significantly moderates the relationship between stress and depression as well as between stress and anxiety. Results: Despite nurses exhibiting high EI levels (5.34 ±1.0), 65.9%, 10.1%, and 14.9% of participating nurses experienced extremely severe stress, anxiety, and depression, respectively. Negative but non-significant correlations were observed between EI and stress, anxiety, or depression. No moderation effects of EI were detected. Stress has a significant positive effect on anxiety (b=.547, p=.035, but not EI (b= -1.488, p=.187). The interaction between stress and EI was not significant as well (b = .047, p =.304), indicating that EI did not moderate the relationship between stress and anxiety. On regression analysis, higher education level (B.s degree) was a significant predictor, higher education level (Bs degree) was a significant predictor, and higher education level (Bs degree) was a significant predictor of EI, explaining 5.3% of the variance. Conclusion: The study highlights the mental health challenges faced by acute care nurses in Jordan, emphasizing the need for targeted interventions to reduce psychological distress (stress, anxiety, and depression) in these settings. This research provides valuable insights for healthcare providers and policymakers to improve the overall well-being of nurses. OBJECTIVE This study aims to examine the relationship between Emotional Intelligence (EI) and psychological distress (stress, anxiety, and depression) among acute care nurses in Jordan. METHODS The study utilized a cross-sectional descriptive and predictive design, targeting ICU and ED nurses (n=296) from University Hospital (JUH) and King Abdullah University Hospital (KAUH). Eligible participants included registered nurses with a minimum of one year of experience in ICU or ED settings. A self-administered questionnaire consisting of a sociodemographic data sheet, the Wong and Law Emotional Intelligence Scale (WLIES), and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were employed. Descriptive and inferential statistics were applied for data analysis. Linear regression analysis was used to examine the predictors of EI with social demographics were tested as predictor variables. Also SPSS’s PROCESS macro (Hayes, 2013) was used to determine if EI significantly moderates the relationship between stress and depression as well as between stress and anxiety. RESULTS Despite nurses exhibiting high EI levels (5.34 ±1.0), 65.9%, 10.1%, and 14.9% of participating nurses experienced extremely severe stress, anxiety, and depression, respectively. Negative but non-significant correlations were observed between EI and stress, anxiety, or depression. No moderation effects of EI were detected. Stress has a significant positive effect on anxiety (b=.547, p=.035, but not EI (b= -1.488, p=.187). The interaction between stress and EI was not significant as well (b = .047, p =.304), indicating that EI did not moderate the relationship between stress and anxiety. On regression analysis, higher education level (B.s degree) was a significant predictor, higher education level (Bs degree) was a significant predictor, and higher education level (Bs degree) was a significant predictor of EI, explaining 5.3% of the variance. CONCLUSIONS The study highlights the mental health challenges faced by acute care nurses in Jordan, emphasizing the need for targeted interventions to reduce psychological distress (stress, anxiety, and depression) in these settings. This research provides valuable insights for healthcare providers and policymakers to improve the overall well-being of nurses.

Patients in intensive care units (ICUs) face many physical and psychological stressors because of the environment of these units and their own critical conditions and experience stress in various degrees. Each stressor may affect patients' experiences in ICUs differently. This study aimed to examine the relationship between stressors and patients' experiences in an ICU. This descriptive, cross-sectional study was conducted between September 2014 and June 2015 in a university hospital and included 116 patients who were admitted to the general ICU for at least 24 hours. Data were collected using the Intensive Care Experience Scale and a questionnaire that included questions about socio-demographic and disease-related characteristics of patients and their stressors. The mean age of the patients was 57.81 ± 13.81 years, and the mean duration of ICU stay was 2.28 ± 3.88 days. There was a moderate positive relation between the stressors noise (r = .534; P < .01), thirst (r = .438; P < .01), loneliness (r = .410; P < .01), and pain (r = .404; P < .01) and the subscale frightening experiences. However, there was a moderate, negative relation between the stressors inability to speak (r = -.444; P < .01), surrounding speeches (r = -.458; P < .01), equipment noise (r = -.490; P < .01), and physical exercise (r = -.546; P < .01) and the subscale satisfaction with care. The patients associated stressors with satisfaction and frightening experiences in the early period of their discharge from the ICU. As stressors increases, so do frightening experiences, and satisfaction with care is affected negatively. Currently, stressors to which patients discharged from ICU are exposed during their admission to wards are not evaluated in practice. This study is important in that it can help health professionals be aware of effects of stressors on patients in the early period of their discharge.

To illuminate and compare the perceptions of registered nurses (n = 243) and physicians (n = 29) in medical and surgical ICUs for adults on the needs of significant others. Previous studies have established the necessity for healthcare professionals in Intensive Care Units (ICUs) to identify and meet the needs of critically ill adult patients' significant others. A survey was conducted and data from the Critical Care Family Needs Inventory were analysed using descriptive and inferential statistics. The findings revealed four factors: 'attentiveness and assurance', 'taking care of themselves', 'involvement', and 'information and predictability'. Nurses scored higher than physicians on 'attentiveness and assurance'. Nurses with experience of being a patient or a significant other in an ICU placed a higher value on 'involvement' compared with nurses without such experience, while physicians with such experience scored higher on 'information and predictability' compared with those without such experience. Older physicians and those with extensive professional and ICU experience had a low score on 'involvement', but scored higher on 'information and predictability' compared with physicians with less experience. Nurses with extensive ICU and professional experience also scored higher on 'information and predictability' than nurses with less experience. Women placed a higher value on each of the four factors than men. The study revealed variations in ICU professionals' perceptions of significant others' needs. There is a need for nurses and physicians to acknowledge that varying perceptions on significant others needs could lead to different ways of conducting themselves in encounters with significant others in ICUs. There is also a risk that the patients' significant others could be forced to adapt themselves to professionals' different and perhaps contradictory perceptions of their needs in ICUs.

To describe the long-term outcomes of intensive care unit (ICU) survivors of mechanical ventilation, and investigate the views of survivors on ICU rehabilitation clinics. A single-center cross-sectional descriptive study was designed. ICU survivors of mechanical ventilation admitted to the First Affiliated Hospital of Guangzhou Medical University from January to December 2016 were enrolled. Data were collected from August 2017 to March 2018. The general information questionnaire, Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and ICU rehabilitation clinics questionnaire were used to evaluate ICU survivors social-demographic factors, social and economic outcomes, clinical data, quality of life and the views on ICU rehabilitation clinics. A total of 248 ICU survivors of mechanical ventilation were included in the study, 130 (52.4%) of them were followed up successfully. The mean time from ICU discharge to follow-up day was (19.64±3.20) months. The average age of the survivors was (60.09±15.42) years old, and 55.4% of them were over 60 years old. Among 130 ICU survivors, severe pneumonia was the dominant ICU admission diagnosis (23.1%), followed by surgical operations (cardiac surgery 16.9%, other surgical operations 20.8%), lung transplantation (13.1%), and acute exacerbation of chronic obstructive pulmonary disease (AECOPD, 12.3%), etc. The first APACHE II score after ICU admission was 16.88±7.37, the mechanical ventilation time was (12.52±12.34) days, and the length of ICU stay was (16.71±15.11) days. In terms of social and economic outcomes, the proportion of having full-time or part-time jobs decreased from 32.3% (42/130) before ICU admission to 25.4% (33/130) by the date of follow-up, while the unemployed rate increased from 6.9% (9/130) to 18.5% (24/130). Only 45.1% (23/51) of the ICU survivors returned to the post before ICU admission. 36.2% (47/130) of the ICU survivors reported that they needed care from others, and 86.9% (113/130) reported that their treatment experiences in ICU had an impact on their lives. In terms of quality of life, physiological function dimension, which was 34.62±33.15, scored the lowest and suffered the most. The physical pain dimension and mental health dimension suffered the least, and the scores were 90.19±16.98 and 75.28±15.15, respectively. Furthermore, physical component summary (PCS) score was 61.12±17.09, and mental component summary (MCS) score was 65.97±21.85. In terms of the views of ICU rehabilitation clinics, 68.5% (89/130) of the subjects believed that the establishment of ICU rehabilitation clinics was very helpful or helpful. The long-term outcomes of ICU survivors of mechanical ventilation are not optimistic. Their quality of life is lower than that of general people. It is necessary to set up ICU rehabilitation clinics.

Neuro-orthopedics disorders in intensive care unit (ICU): Perceptions of teams