Nurse-led Follow-up Research Articles

Development, integration and evaluation of nurse-led follow-up across five tumour sites at a cancer unit in Northern Ireland

The traditional model of medical oncology follow-up clinics has been challenged in recent years, partly because it cannot meet the individual needs of the growing cancer survivor population. Greater personalisation of follow-up care is required to manage cancer survivors’ clinical, psychosocial, and practical care, and many organisations are attempting to achieve this through nurse-led follow-up services. This article describes a service development project, in a cancer unit in Northern Ireland, that developed, integrated, and evaluated nurse-led follow-up clinics for five tumour groups. Evaluation was undertaken through a focus group and surveys, and the article discusses the findings that suggest successful integration of nurse-led clinics requires comprehensive planning and preparation, including professional development, and risk stratification of patients, and that nurse-led clinics enhance continuity of care, and promote patient empowerment and self-management strategies. The article concludes that nurses can deliver cancer follow-up services effectively, and are well placed to provide comprehensive survivorship care for patients.

Nurse-led follow up replaces consultant outpatient clinic

Increasingly, hospitals are adopting a nurse-led follow-up service (NLFU), aimed at improving post operative community care following total hip/knee arthroplasty. This article hypothesises that it is feasible for NLFU services to replace traditional 6-week consultant-led hospital follow-up. The experience of implementing domiciliary 6-week NLFU, an approach previously unreported by any other UK centre is reported upon. This article presents the NLFU pathway protocol and a retrospective analysis of total hip arthroplasty (n=347) and total knee arthroplasty patients (n=356) the year after its introduction in September 2015. The pathway's utilisation, safety, and patient satisfaction from a postal survey are detailed. During the study period, the 6-week NLFU pathway utilisation rates were 30% for total hip arthroplasty (n=103) and 27% for total knee arthroplasty (n=96). NLFU was deemed safe, with a 10% re-referral to consultant clinic rate and no reported adverse outcomes related to process. Patients reported high levels of satisfaction. This article demonstrates that domiciliary NLFU at 6 weeks provides a feasible follow-up mechanism for primary hip and knee total joint arthroplasty, with high patient satisfaction levels. This offers clear benefits to healthcare Trusts in reducing follow-up appointments, in turn releasing capacity for new referrals and freeing staff for other duties.

Hospital recruitment for a pragmatic cluster-randomized clinical trial: Lessons learned from the COMPASS study

BackgroundPragmatic randomized clinical trials are essential to determine the effectiveness of interventions in “real-world” clinical practice. These trials frequently use a cluster-randomized methodology, with randomization at the site level. Despite policymakers’ increased interest in supporting pragmatic randomized clinical trials, no studies to date have reported on the unique recruitment challenges faced by cluster-randomized pragmatic trials. We investigated key challenges and successful strategies for hospital recruitment in the Comprehensive Post-Acute Stroke Services (COMPASS) study.MethodsThe COMPASS study is designed to compare the effectiveness of the COMPASS model versus usual care in improving functional outcomes, reducing the numbers of hospital readmissions, and reducing caregiver strain for patients discharged home after stroke or transient ischemic attack. This model integrates early supported discharge planning with transitional care management, including nurse-led follow-up phone calls after 2, 30, and 60 days and an in-person clinic visit at 7–14 days involving a functional assessment and neurological examination. We present descriptive statistics of the characteristics of successfully recruited hospitals compared with all eligible hospitals, reasons for non-participation, and effective recruitment strategies.ResultsWe successfully recruited 41 (43%) of 95 eligible North Carolina hospitals. Leading, non-exclusive reasons for non-participation included: insufficient staff or financial resources (n = 33, 61%), lack of health system support (n = 16, 30%), and lack of support of individual decision-makers (n = 11, 20%). Successful recruitment strategies included: building and nurturing relationships, engaging team members and community partners with a diverse skill mix, identifying gatekeepers, finding mutually beneficial solutions, having a central institutional review board, sharing published pilot data, and integrating contracts and review board administrators.ConclusionsAlthough we incorporated strategies based on the best available evidence at the outset of the study, hospital recruitment required three times as much time and considerably more staff than anticipated. To reach our goal, we tailored strategies to individuals, hospitals, and health systems. Successful recruitment of a sufficient number and representative mix of hospitals requires considerable preparation, planning, and flexibility. Strategies presented here may assist future trial organizers in implementing cluster-randomized pragmatic trials.Trial registrationClinicaltrials.gov, NCT02588664. Registered on 23 October 2015.

P499 A comparison of health-related quality of life in nurse-led vs. conventional inflammatory bowel disease follow-up

P499 A comparison of health-related quality of life in nurse-led vs. conventional inflammatory bowel disease follow-up

Effects of a Nurse-Led Phone Follow-up Education Program Based on the Self-efficacy Among Patients With Cardiovascular Disease.

The integration of self-efficacy (SE) theory within a nurse-led telephone follow-up education program (NP-FEP) has not been extensively evaluated for patients with cardiovascular disease. The aim of this study is to determine the effectiveness of an NP-FEP in improving SE (primary outcome) and achieving goals related to cardiovascular risk (secondary outcome) for patients with cardiovascular disease. In June and July 2013, a total of 403 patients with cardiovascular disease in Shanghai were randomized into the intervention and control groups. Personalized end goals were established for improving cardiovascular risk for each patient. The control group received conventional follow-up education, whereas the intervention group was contacted by telephone 11 times over a 6-month period with staged goals developed based on SE theory. Self-efficacy scores and goals for reducing cardiovascular risk were assessed at baseline, at the end of the 6-month intervention, and 12 months after enrollment. The SE scores in both groups increased at 6 months and decreased slightly at 12 months. The baseline SE scores were similar between the groups (P > .05), but the average SE scores were increased more for the intervention group than for the control group at 6 (P < .05) and 12 (P < .05) months. In addition, the final goal achievement rates for the intervention group were significantly higher than for the control group (P < .05). The difference between the 2 groups was reflected by differences in cardiac disease risk factors defined by the World Health Organization. The NP-FEP improved SE and facilitated achievement of goals related to risk factors in patients with cardiovascular disease for at least 1 year.

A study to evaluate the feasibility of a nurse-led follow-up clinic among postmyocardial infarction patients attending the Cardiology Outpatient Department at CN Centre, AIIMS, New Delhi

Introduction: Nurse-led clinics are a model of care indicated where there are service gaps due to high demand or workforce shortages. Objective: The objective of this study was to evaluate the feasibility of a nurse-led follow-up clinic among postmyocardial infarction (MI) patients by inter-rater agreement of selected clinical variables with cardiologist clinic and to assess the satisfaction among post-MI patients related to assessment and recommendations done in a nurse-led follow-up clinic. Materials and Methods: Quasi-experimental evaluation design – only posttest using a comparison group was used. Convenience sampling was done. From three follow-up clinics, 79 participants were included, and the interventions were post-MI patients' assessment, documentation, and recommendations, which were done in both nurse-led and cardiologist follow-up clinics using post-MI clinical pro forma. Results: The overall inter-rater agreement ranges from 87.34% to 99.8%. The kappa score obtained was found to be highly significant (P = 0.0001). 86% of patients were highly satisfied and only 14% were moderately satisfied, and the total mean score was 34.47 ± 6.15. Conclusion: The nurse-led clinic was feasible among post-MI patients after proper training of nurse.

Patient’s level of satisfaction with nurse-led telephone follow-up after cataract surgery at a private eye specialist centre in Penang

Patient’s level of satisfaction with nurse-led telephone follow-up after cataract surgery at a private eye specialist centre in Penang

Structured nurse-led follow-up for patients after discharge from the intensive care unit: Prospective quasi-experimental study.

The aim of this study was to describe a structured 3-month nurse-led follow-up of patients after discharge from intensive care and measure its effects on health status. Patients requiring intensive care stay frequently have lengthy and incomplete recovery suggesting need for additional support. The effects of intensive care nurse-led follow-up have not been sufficiently elucidated. A prospective, quasi-experimental study of patients who received structured nurse-led follow-up from intensive care nurses after discharge from intensive care until 3months afterwards. The control group received usual care. Of 574 patients assessed for eligibility, from November 2012 - May 2015, 168 were assigned to the experimental group (N=73) and the control group (N=75). Primary outcome was health status, measured with eight scales of Short Form-36v2, before the intensive care admission and at four time points until 12months after intensive care. A mixed effect model tested differences between the groups over time. Criteria for Reporting Development and Evaluation of Complex Interventions 2 guideline, guided the reporting of the intervention. The structured nurse-led follow-up did not improve patients' health status compared with usual care (mixed effect model, p=.078-.937). The structured nurse-led follow-up did not reveal an effect on the intensive care patients studied. Further examination of intensive care nurse-led follow-up is needed, taking into account the heterogeneity of the patient population, variations in length of ward stay, patients' health care needs during the first week at home after discharge from general ward and health status before intensive care admission.

Efficacy of embedded nurse-led versus conventional physician-led follow-up in rheumatoid arthritis: a systematic review and meta-analysis

ObjectiveTo compare the efficacy of embedded nurse-led versus conventional physician-led follow-up on disease activity in patients with rheumatoid arthritis (RA).MethodsIn a systematic literature search, we identified randomised controlled trials (RCTs)...

Psychological recovery after intensive care: Outcomes of a long-term quasi-experimental study of structured nurse-led follow-up

ObjectivesTo compare psychological recovery of patients receiving structured nurse-led follow-up and patients receiving usual care after intensive care discharge. DesignQuasi-experimental study. SettingSingle centre, university hospital, mixed intensive care patient population. Main outcome measuresSymptoms of post-traumatic stress disorder, anxiety and depression measured three and four times over 12 months after intensive care discharge. Disturbing memories of the intensive care stay and psychological reactions (that one’s life was in danger, threat to physical integrity, intense fear, helplessness, horror) three months after intensive care. A mixed effect model tested differences between the groups over time and regression model predicted post-traumatic stress at three months. ResultsThe experimental group had significantly more symptoms of post-traumatic stress and anxiety than the control group over the 12 months. Patients from both groups had severe symptoms of post-traumatic stress. Patients with post-traumatic stress at three months had disturbing memories and psychological reactions. ConclusionThe structured nurse-led follow-up did not improve patients’ measured outcomes of psychological recovery after intensive care. Patients with severe symptoms of post-traumatic stress are of concern. Emphasis needs to be placed on disturbing memories of the intensive care stay and psychological reactions when constructing intensive care nurse-led follow-up.

Nurse-Led Phone Call Follow-Up Clinics Are Effective for Patients With Prostate Cancer.

Introduction:The rising cost of healthcare requires rethinking in terms of resource utilisation care delivery. Nurse-led PSA phone follow-up clinics may provide a suitable option.Materials and methods:815 patients were recruited for the nurse-led stable prostate cancer telephone follow-up service. A convenience sample was selected for postal questionnaire assessment of their satisfaction.Results:815 patients had 3683 phone-call follow ups over 10 years. Patients’ own understanding of condition varied from average (76.3%) and good (9.2%) in the majority. 87.2% found the service convenient and 75.6% informative. 95.3% found the telephone assessment preferable to attending the outpatient department. 87.2% were keen on savings on transport/travel. 53.5% found it more reassuring. 91.9% of patients felt that everything they wanted to talk about was covered.Discussion:This service can be delivered in a high volume nurse-led service, with high levels of patient satisfaction, as an innovative service development.

The effect of nurse-led telephone follow-up on anxiety in cancer patients: A systematic review

Introduction: The number of cancer patients has been continuously increasing due to early diagnosis and the developments in cancer treatment. At the same time, psychosocial problems due to diagnosis and treatment are also increasing. Anxiety is emphasized to be one of the most frequently observed psychological symptoms in cancer patients and nurse-led telephone follow-up can help reduce the anxiety of patients. This systematic review aimed to determine the effect of nurse-led telephone follow-up on anxiety in cancer patients. Methods: This systematic review was prepared in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) protocol. Akdeniz University center electronic databases including PubMed, CINAHL, ScienceDirect, Web of Science, Cochrane Library, Ulakbim Turkish Medical Index, and Turk Medline were searched studies with “nurse-led telephone follow-up and cancer”, “nurse-led telephone follow-up and anxiety” and “nurse-led telephone follow-up and anxiety in cancer patients” key words. Search results reached in the 5.519 articles. Also references of the determined studies had reviewed. Investigation of the articles published between 2007-2017, which can be accessed in full text, the original six randomized control studies have been sampled. Results: A randomized control study was conducted by Badger and colleagues (2007). According to the study, anxiety reduced for telephone interpersonal counseling (TIP-C) and self-managed exercise group with a statistically significant difference according to control group. In other study, Beaver et al. (2012) reported that mean scores (hospital group: 36.0±17.4; telephone group: 27.9±9.8) for State-Trait Anxiety Inventory (STAI) state anxiety were appreciably higher in the hospital arm at follow-up but there were no significant differences between groups at follow-up in STAI. The remaining four studies (Kimman et al. 2011, Beaver et al, 2009, Livingston et al. 2010, Beaver et al, 2017) indicated no significant difference between the groups. Conclusion: Nurse-led telephone follow-up can reduce anxiety. However, this review indicated that a limited number of studies existed on this subject.

Assessing patient outcomes and cost‐effectiveness of nurse‐led follow‐up for women with breast cancer – have relevant and sensitive evaluation measures been used?

To explore how interventions using nurse-led follow-up in breast cancer care have been evaluated with a focus on patient outcomes and cost-effectiveness. As part of the advancement of breast care, nurse-led follow-up is increasingly used as an alternative to routine hospital follow-up in outpatient clinics. There is evidence suggesting that patients appear to be satisfied with the nurse-led follow-up, but there is a lack of evidence of whether this perception equates to patients' satisfaction with the model of physician-led follow-up. Systematic review. Three databases were searched, and 29 RCT were initially screened. Finally, 13 articles were critically appraised. Searches included articles between 2005-2013. The quality of appraisal assessment was inspired by the GRADE system. The results show that there are many different instruments used when evaluating nurse-led follow-up, which makes it difficult to compare the studies. Several of the studies used QoL as an outcome measure; this is a broad concept that includes several aspects ranging from social role and psychosocial issues to symptoms and therefore difficult to use as an outcome measure. Only two of the studies made any cost-effective analyses, and the results are hard to interpret. Nurse-led follow-up can potentially result in better continuity of care and the availability of more time to provide psychosocial support and address patients' information needs. However, more well-conducted research is needed before equivalence to physician-led follow-up can be assessed in terms of survival, recurrence, patient well-being and cost-effectiveness. Results from well-conducted evaluation studies of nurse-led services based on theory are needed so that relevant interventions can be implemented in clinical practice. There is a need to in future studies include cost-effectiveness analyses to compare nurse-led services with other types of follow-up.

Influences of Resilience and Social Support on Postoperative Recovery among Patients with Gastrointestinal Cancer

Purpose: The purpose of this study was to investigate patients’ perceived postoperative recovery over time and to identify the influences of resilience and social support on postoperative recovery among patients with gastrointestinal cancer. Methods: 101 patients with GI cancer who underwent surgery at S tertiary hospital were recruited from October 29th, 2015 to January 19th, 2016. Data was collected 3 times at postoperative day (POD)3, and POD5 in the hospital and at POD14 at home. Statistical analyses used were descriptive statistics, t-test, ANOVA, ANCOVA, correlation, and linear mixed model. Results: The patients’ perceived postoperative recovery(reverse cording) decreased at home rather than time during hospital stay (POD3: 16.70, POD5: 15.74, POD14: 17.08). Postoperative recovery at POD5 showed negative correlation with resilience (r=-.36, p=.002). Postoperative recovery scores at POD14 were negatively correlated with resilience (r=-.60, p<.001) and social support (r=-.34, p=.019). There was a positive correlation (r=-.36, p=.002) between resilience and social support. Resilience was a significant associated factor with postoperative recovery over time (β=-0.29, p=.001). Conclusion: Since the degree of postoperative recovery after hospital discharge was perceived lower than that of during hospital stay, nursing interventions such as nurse-led telephone follow-up programs should be applied during the transition period.

Post-Percutaneous Coronary Intervention Patients’ Perceptions and Management of Femoral Arterial Access Sites After Attending a Nurse-Led Clinic: A Pilot Study

Background: After undergoing a percutaneous coronary intervention (PCI), patients are discharged home and expected to self-manage all aspects of their post-discharge care, while awaiting cardiology review. This wait-time can be stressful for both first and repeat revascularisation patients in light of potential post-discharge complications which may be experienced. Patients may also have health misconceptions regarding their access site and management. Aim: To explore patients’ perceptions and management of arterial access sites post- nurse-led clinic attendance. Methods: Participants were part of a randomised controlled clinical trial. Intervention group participants received face-to-face nurse-led education and support. Standard care participants received follow-up telephone calls. As a duty of care the researcher engaged with some standard care group participants. Follow-up occurred at four time-points. Data were collected via participant self-report. Participants in both groups discussed their access sites and provided images to reflect their perception of healing at each time-point. Results: Overall, for all participants, minor vascular complications occurred post-procedurally and included bruising and small haematomas. Descriptions of participants’ access sites and healing were accurately reflected by photographic and/or diagrammatic images provided. All participants reported engaging in regular wound-site observation. Repeat revascularisation patients highlighted paying greater attention to their wound site than on previous occasions given the study's requirements to provide access site images. Conclusion: Overall, nurse-led follow-up demonstrated that regular contact and reinforcement of patient education facilitated greater access site observation and confidence to self-manage. Despite intervention group participants receiving additional education, all participants, based on having nurse contact reported better site care.

Determining cancer survivors' preferences to inform new models of follow-up care.

Background:Specialist-led cancer follow-up is becoming increasingly expensive and is failing to meet many survivors' needs. Alternative models informed by survivors' preferences are urgently needed. It is unknown if follow-up preferences differ by cancer type. We conducted the first study to assess British cancer survivors' follow-up preferences, and the first anywhere to compare the preferences of survivors from different cancers.Methods:A discrete choice experiment questionnaire was mailed to 1201 adults in Northeast Scotland surviving melanoma, breast, prostate or colorectal cancer. Preferences and trade-offs for attributes of cancer follow-up were explored, overall and by cancer site.Results:668 (56.6%) recipients (132 melanoma, 213 breast, 158 prostate, 165 colorectal) responded. Cancer survivors had a strong preference to see a consultant during a face-to-face appointment when receiving cancer follow-up. However, cancer survivors appeared willing to accept follow-up from specialist nurses, registrars or GPs provided that they are compensated by increased continuity of care, dietary advice and one-to-one counselling. Longer appointments were also valued. Telephone and web-based follow-up and group counselling, were not considered desirable. Survivors of colorectal cancer and melanoma would see any alternative provider for greater continuity, whereas breast cancer survivors wished to see a registrar or specialist nurse, and prostate cancer survivors, a general practitioner.Conclusions:Cancer survivors may accept non-consultant follow-up if compensated with changes elsewhere. Care continuity was sufficient compensation for most cancers. Given practicalities, costs and the potential to develop continuous care, specialist nurse-led cancer follow-up may be attractive.

Patient Satisfaction With Nurse-Led Telephone Follow-up in an Ambulatory Setting.

We studied our practice of using nurse telephone follow-up under physician direction to assess symptom improvement and patient satisfaction. Women were recruited when their clinical care merited nurse telephone follow-up in the opinion of the attending physician. Women specified a preferred telephone number and completed a symptom questionnaire at the time of enrollment. Nursing telephone follow-up was completed at an interval prescribed by the attending physician to answer specified clinical questions. Approximately 3 months after the initial in-office visit, a satisfaction questionnaire and repeat symptom measure were mailed to the subjects. A convenience sample of 83 women was analyzed. Of those, 91.6% were reached by telephone, and 47.0% returned the follow-up questionnaire. Mean (SD) age was 56.8 (16.6) years (range, 20-89 years). Younger women were less likely to be able to be contacted by telephone (P = 0.02) and less likely to return the questionnaire (P = 0.02). Most common diagnoses were overactive bladder and mixed urinary incontinence. Satisfaction rates were high, and level of convenience for patients was high. Women indicated an ease of speaking over the telephone about their condition and confidence in the treatment plan. Satisfaction with telephone follow-up did not significantly differ based on age or diagnosis. Patient satisfaction was high for nurse telephone follow-up to replace in-office visits for selected diagnoses. This care strategy deserves further consideration for reimbursement purposes as health care evolves.

Follow-up of patients who are clinically disease-free after primary treatment for fallopian tube, primary peritoneal, or epithelial ovarian cancer: a Program in Evidence-Based Care guideline adaptation.

A need for follow-up recommendations for survivors of fallopian tube, primary peritoneal, or epithelial ovarian cancer after completion of primary treatment was identified by Cancer Care Ontario's Program in Evidence-Based Care. We searched for existing guidelines, conducted a systematic review (medline, embase, and cdsr, January 2010 to March 2015), created draft recommendations, and completed a comprehensive review process. Outcomes included overall survival, quality of life, and patient preferences. The Cancer Australia guidance document Follow Up of Women with Epithelial Ovarian Cancer was adapted for the Ontario context. A key randomized controlled trial found that the overall survival rate did not differ between asymptomatic women who received early treatment based on elevated serum cancer antigen 125 (ca125) alone and women who waited for the appearance of clinical symptoms before initiating treatment (hazard ratio: 0.98; 95% confidence interval: 0.80 to 1.20; p = 0.85); in addition, patients in the delayed treatment group reported good global health scores for longer. No randomized studies were found for other types of follow-up. We recommend that survivors be made aware of the potential harms and benefits of surveillance, including a discussion of the limitations of ca125 testing. Women could be offered the option of no formal follow-up or a follow-up schedule that is agreed upon by the woman and her health care provider. Education about the most common symptoms of recurrence should be provided. Alternative models of care such as nurse-led or telephone-based follow-up (or both) could be emerging options. The recommendations provided in this guidance document have a limited evidence base. Recommendations should be updated as further information becomes available.

The effect of a nurse led telephone supportive care programme on patients’ quality of life, received information and health care contacts after oesophageal cancer surgery—A six month RCT-follow-up study

BackgroundFollowing oesophagectomy, a major surgical procedure, it is known that patients suffer from severely reduced quality of life and have an unmet need for postoperative support. Still, there is a lack of research testing interventions aiming to enhance the patients’ life situation after this surgical procedure. AimThe aim of the study was to evaluate the effect of a nurse led telephone supportive care programme on quality of life (QOL), received information and the number of healthcare contacts compared to conventional care following oesophageal resection for cancer. MethodThe study was designed as a randomized controlled trial (RCT) aiming to test the effect of a nurse led telephone supportive care program compared to conventional care. Patient assessments were conducted at discharge, 2 weeks, 2, 4 and 6 months after discharge and comprised evaluation of QOL, received information and the number of health care contacts. Statistical testing were conducted with repeated measurements analysis of variance to test if there were differences between the groups during follow-up. ResultThe results show that the intervention group was significantly more satisfied with received information for items concerning the information they received about things to do to help yourself, written information and for the global information score. The control group scored significantly higher on the item regarding wishing to receive more information and wish to receive less information. No effect of the intervention was shown on QOL or number of health care contacts. ConclusionProactive nurse-led telephone follow-up has a significant positive impact on the patients’ experience of received information. This is likely to have a positive effect on their ability to cope with a life that may include remaining side effects and adverse symptoms for a long time after surgery.

Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur's interpretation theory.

To describe the content of former intensive care unit patients' memories of delusions. Intensive care unit patients often have strange and frightening experiences during the critical stage of illness. Earlier studies have provided small-sample in-depth descriptions of patient experiences in intensive care unit, but large-scale studies are also needed to inform intensive care unit follow-up. The study had a qualitative design using phenomenological hermeneutic analysis inspired by Ricoeur's interpretive theory. Patients were assessed with Confusion Assessment Method of the Intensive Care Unit for delirium in intensive care unit, and after discharge, memories of delusions were described by 114 of 325 patients in face-to-face (after two weeks) and telephone interviews (after two and six months) using the Intensive Care Unit Memory Tool. Four themes emerged: the ever-present family, dynamic spaces, surviving challenges and constant motion. Memories of delusions were a vivid mix of fact and fiction, demonstrating dynamic shifts in time, place and motion, but not dependent on the presence of delirium assessed by Confusion Assessment Method of the Intensive Care Unit. Analysis based on Ricoeurian phenomenological hermeneutics provided insights into themes in intensive care unit patients' memories of delusions. More studies are needed to understand the meaning of memories of delusions, the commonality of themes and the association between delusions and delirium after an intensive care unit stay. Understanding patients' memories of delusions is beneficial to nurses caring for patients that are anxious, upset or agitated. It opens a window to the world of the patient who is unable to communicate due to intubation and general weakness. We recommend the provision of nurse-led intensive care unit follow-up enabling patients to describe and discuss their intensive care unit experiences.