Interhospital intensive care unit-to-unit transfers : The perspectives of patients, family members, and critical care nurses

Abstract: Aim: The overall aim of the current thesis was to investigate the interhospital intensive care unit-to unit transfer process from the perspective of patients, family members, and critical care nurses. Methods: Study I explores and interprets the observed nature of the patient’s situation during interhospital intensive care unit-to-unit transfers. Data collection consists of video recordings and participant observations throughout the transfer process, here using a hermeneutical approach. Study II utilises a phenomenological hermeneutical approach and focuses on exploring the critical care nurses’ lived experiences of transferring intensive care patients between hospitals. Using a phenomenological hermeneutical approach, Study III reveals the meanings of family members’ lived experiences when a loved one undergoes an interhospital intensive care unit-to-unit transfer. Study IV, which is based on a retrospective matched case-control chart review, investigates the occurrence of missed nursing care in a cohort of patients subjected to interhospital intensive care unit‐to‐unit transfers because of a lack of intensive care resources. Main findings: During interhospital intensive care unit-to-unit transfers, patients risk being objectified when drifting in and out of the health personnel’s focus and when caring is characterised by dehumanisation. The patient’s body exists in constant motion, which may create various bodily sensations without meaning that could create frightening memories. During transfers, critical care nurses experience themselves as being exposed and unprotected and torn between contradictory feelings and experiences. Being in non-caring situations while doing their utmost to provide dignified care for the patient and the family elicits a feeling that dedicated nursing care makes a difference. During transfers critical care nurses find themselves being on an ambivalent journey together with the patient, but also being on a journey of their own, leading to their own development. When a love done is being transferred, family members experience being in a fragile trust that is unexpectedly withdrawn and replaced with uncertainty. Facing the unknown, they experience a need to become seekers of meaning coherence. Being a family member means having a need to be close but being faced with loneliness while longing for proximity and participation in the care of your loved one. Patients undergoing intensive care unit-to-unit transfers because of lack of intensive care resources were exposed to missed nursing care in the form of a significantly less amount of mobilisation and oral care compared with a matched control group.  Conclusion: This thesis contributes new knowledge about what the interhospital intensive care unit to-unit transfer process can mean for patients, family members and critical care nurses. To transfer highly vulnerable patients safely between ICUs in a gentle and dignified way emerges as an extraordinary complex task for those involved. Such a contribution is important in our endeavour to make these transfers safer for vulnerable critically ill patients and their families.