Living after confronting death; story telling during the recovery trajectory of intensive care unit survivors: An interpretive biographical approach

Publication Year:
2015
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Repository URL:
https://ro.ecu.edu.au/theses/1734
Author(s):
Ewens, Beverley Anne
Tags:
Intensive care; recovery; intensive care diaries; storytelling; interpretive biography; diaries; critically ill; psychology; social aspects; Nursing
thesis / dissertation description
Aim: To create new meaning of the experiences of intensive care survivors during early recovery and the meaning of “self” during this time. To add to the understanding of how support should be focussed for survivors during recovery.Background: Survival from a critical event/illness and intensive care unit experience is increasing, as is associated physical and psychological complications. Complications are due to the severity of illness, the intensive care experience itself and the nature of the treatments which promote survival. If complications remain untreated increased health care service uptake and reduced quality of life can ensue. Despite the potential impact upon individuals and beleaguered health care systems, inadequate support service provision in Australia and across the world persists.Design and participants: An interpretive biographical exploration of intensive care survivors experiences of recovery following hospital discharge. Nine participants were recruited from a single centre in metropolitan Perth, Western Australia. All participants had been ventilated for a minimum period of twenty four hours following a critical event/illness.Methods: Data were collected from diaries, face to face interviews, memos and field notes. Participants diarised for three months commencing two months after hospital discharge. At five months following discharge participants were interviewed about the content of their diaries and the symbols and signifiers within them to create a shared meaning of their experiences. Analysis of diaries and interviews were undertaken using two frameworks. This process enabled the identification of themes throughout participants’ stories and offers a unique portrait of recovery through their individual lens.Findings: All of the participants considered their lives had irreparably changed as a result of their experience. The biographical methods provided a safe and creative way to reveal inner thoughts and feelings which may not have been revealed using other methods. This unique view through the lens of the survivor identified how unsupported by health care professionals they felt following discharge. Turmoil existed between survivors’ surface and inner worlds as they struggled to conform to the constraints of what recovery should be; imposed by the biomedical model. The process of constructing their stories enabled participants to reflect upon their experiences of recovery and bring a sense of coherence to their experiences.Conclusion: The use of the biographical method gave the participants a voice through which they could be heard and a way to bring clarity to their experiences. The process of constructing their stories was considered important to their recovery process, and in particular in enabling reflection on how far they had traversed. Often survivors are unable to articulate their inner most thoughts and experiences for fear of being misinterpreted. The methods reported here gave them an opportunity to do so through non-verbal techniques. Analysis of diary entries may also identify maladaptation in survivors and enable interventions to be individually targeted before chronicity is established. The findings from this study may lead to a greater awareness among health care providers of the problems survivors face, and improved support services more broadly, based on frameworks more appropriate for this population.