Understanding patients' psychological experience of critical care : patient and outreach nurse perspectives

Holmes, Helena

Clinical psychology
June 2021

Thesis or dissertation

© 2021 Helena Holmes. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

This portfolio thesis is comprised of three parts: a systematic literature review, an empirical paper and supporting appendices. Part one, the systematic literature review, focuses on patients’ psychological experiences of critical care across the illness-recovery process. Overall, 16 articles were critically reviewed, evaluated and quality assessed. Narrative Synthesis allowed for a coherent, underlying narrative shared among the articles to be elucidated. Themes derived from the synthesis included, “Losing and Striving to Regain Self-Determination and Independence”, “A Journey of Dynamic Psychological Challenges & Emotions”, “A Deep Desire for Humanisation: Acknowledging the Person within the Patient”, and “Transformation, Existential Realisations, & Re-Evaluation”. The narrative which emerged from the synthesis was summarised and discussed in the context of future implications for clinical practice and recommendations for future research. Part Two is an empirical research paper which used a qualitative methodology, Interpretative Phenomenological Analysis, to explore outreach nurses’ experiences and perceptions of how critical care psychologically influences ICU patients. The following superordinate themes were constructed, “It Alters Thinking & Perception: Confusing & Surreal”, “Powerlessness and Dependency”, “It Can Be Traumatic”, “Reorientation: Disrupting Life Narratives” and “Psychologically Impactful: An Individual Journey”; each superordinate theme was comprised of two or three subordinate themes. Participants perceived that patients exhibit a range of responses and emotions as a consequence of ICU experiences and critical illness, some of which connect to the ways in which patients are cared for across their critical care journeys. Consequently, participants experienced difficult professional dilemmas, strong emotional reactions, and incongruence with dissonance between participants’ desire to help patients psychologically and their perceived inability to enact helping behaviours around patients’ psychological difficulties. The research findings are discussed in the context of previous literature, implications for future research and implications upon clinical practice. Part three contains the supporting appendices for both the systematic literature review and the empirical paper. Included within the appendices, is a reflective statement which highlights the researcher’s experiences of the research process. Also included, is an epistemological statement to provide further context to the thesis portfolio.

Department of Psychological Health, Wellbeing and Social Work, The University of Hull
Beckett, Joanne; Clarke, Chris; Moorhouse, Jaswinder
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