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O'Neill B1, Ramsay P2, King J3, Howes S1, Linden M4, Darweish Medniuk A5, Outtrim J6, Rogan A1, Blackwood B7
1Ulster University, Centre for Health and Rehabilitation Technologies, INHR, Newtownabbey, United Kingdom, 2Napier University, Such of Health and Social Care, Edinburgh, United Kingdom, 3University of Ottawa, School of Rehabilitation Sciences, Faculty of Health Sciences, Ottawa, Canada, 4Queens University Belfast, School of Nursing and Midwifery, Belfast, United Kingdom, 5Southmeade Hospital, North Bristol NHS Trust, Department of Anaesthesia, Bristol, United Kingdom, 6University of Cambridge, Division of Anaesthesia, Department of Medicine, Cambridge, United Kingdom, 7Queens University Belfast, Centre of Experimental Medicine (CEM), School of Medicine, Dentistry and Biomedical Sciences, Belfast, United Kingdom
Background: People can suffer from physical, psychosocial and cognitive sequelae after critical illness. Investigating ways healthcare professionals, including physiotherapists, can support patients as they transition across different phases of recovery after critical illness is a key priority (Needham et al 2012). The Timing It Right (TIR) framework may be useful in identifying patients' support needs within and throughout the continuum of care: the Intensive Care Unit (“event” phase), the hospital wards (“stabilisation/preparation” phase) and after hospital discharge (“implementation/adaptation” phase), for the purpose of informing service development. TIR needs are informational, emotional, instrumental (e.g. physical, training, equipment), and appraisal (e.g. feedback/reassurance on progress) (Cameron 2008).
Purpose: The use of a needs assessment questionnaire could help to identify what support or care patients need during recovery. This review aims to identify any existing questionnaires that have been developed to assess patient support needs after a stay in the ICU. Objectives were to describe the characteristics of the tools, the TIR phase they relate to and the support needs they aimed to capture, and to summarise their clinimetric properties.
Methods: Key databases were searched for publications between 2000 and November 2017 to identify questionnaires for assessing patient supports needs after an ICU admission. Search words included intensive care, needs assessment, support needs, questionnaires. Data extraction identified: aims and development of the tool, and timing of administration across the recovery continuum (TIR phase) and content, according to the TIR needs.
Results: The search retrieved 677 records, with 17 full papers reviewed. We identified four questionnaires. When mapped to the TIR phases, the Needs of Adult Patients in Intensive Care Unit (NAPICU) (Aro et al 2012) and the Intensive Care Experience questionnaire (Rattray et al. 2004) aimed to capture information about support needs during the ICU event. The Patient Experience Questionnaire (Ramsay 2016) explored support needs on the hospital ward (stabilisation/preparation phase), and the 3-SET 4P questionnaire (Akerman et al 2013) captures information about support needs during the implementation/adaptation (after hospital discharge) phases. None identify patient support needs across all TIR phases of recovery. While content validity was reported as acceptable for each questionnaire, there was variable evidence of this. Content varied; for example, the ICE and 3SET4P questionnaires focus on information and emotional needs in ICU, the PEQ focuses on informational, instrumental and appraisal needs on the ward, and the NAPICU includes assessing some instrumental (physical) needs after discharge home.
Conclusion(s): Patients' support needs change over time, and their ongoing assessment across the care continuum, including after hospital discharge is important. However, the four questionnaires we identified appear to assess different support needs; each focuses on a specific phase of recovery and there was limited evidence of their clinimetric or psychometric validity. Future work should develop and validate a robust questionnaire that could provide a comprehensive assessment of ICU survivors' evolving needs as they transition towards recovery.
Implications: The use of an ICU needs assessment questionnaire could enable better provision of physiotherapy, nursing and other treatments and support services to meet the changing needs of patients recovering after critical illness.
Keywords: ICU, Critical illness, Patient needs
Funding acknowledgements: Intensive Care Society
Purpose: The use of a needs assessment questionnaire could help to identify what support or care patients need during recovery. This review aims to identify any existing questionnaires that have been developed to assess patient support needs after a stay in the ICU. Objectives were to describe the characteristics of the tools, the TIR phase they relate to and the support needs they aimed to capture, and to summarise their clinimetric properties.
Methods: Key databases were searched for publications between 2000 and November 2017 to identify questionnaires for assessing patient supports needs after an ICU admission. Search words included intensive care, needs assessment, support needs, questionnaires. Data extraction identified: aims and development of the tool, and timing of administration across the recovery continuum (TIR phase) and content, according to the TIR needs.
Results: The search retrieved 677 records, with 17 full papers reviewed. We identified four questionnaires. When mapped to the TIR phases, the Needs of Adult Patients in Intensive Care Unit (NAPICU) (Aro et al 2012) and the Intensive Care Experience questionnaire (Rattray et al. 2004) aimed to capture information about support needs during the ICU event. The Patient Experience Questionnaire (Ramsay 2016) explored support needs on the hospital ward (stabilisation/preparation phase), and the 3-SET 4P questionnaire (Akerman et al 2013) captures information about support needs during the implementation/adaptation (after hospital discharge) phases. None identify patient support needs across all TIR phases of recovery. While content validity was reported as acceptable for each questionnaire, there was variable evidence of this. Content varied; for example, the ICE and 3SET4P questionnaires focus on information and emotional needs in ICU, the PEQ focuses on informational, instrumental and appraisal needs on the ward, and the NAPICU includes assessing some instrumental (physical) needs after discharge home.
Conclusion(s): Patients' support needs change over time, and their ongoing assessment across the care continuum, including after hospital discharge is important. However, the four questionnaires we identified appear to assess different support needs; each focuses on a specific phase of recovery and there was limited evidence of their clinimetric or psychometric validity. Future work should develop and validate a robust questionnaire that could provide a comprehensive assessment of ICU survivors' evolving needs as they transition towards recovery.
Implications: The use of an ICU needs assessment questionnaire could enable better provision of physiotherapy, nursing and other treatments and support services to meet the changing needs of patients recovering after critical illness.
Keywords: ICU, Critical illness, Patient needs
Funding acknowledgements: Intensive Care Society
Topic: Critical care; Cardiorespiratory; Outcome measurement
Ethics approval required: No
Institution: Ulster University
Ethics committee: Not Applicable
Reason not required: Ethical approval was not required as this is a review paper
All authors, affiliations and abstracts have been published as submitted.
