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Theoretical understanding of the coping approaches and social support experiences of relatives of critically ill patients during the intensive care unit stay and the recovery period at home
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Relatives may experience a difficult and demanding situation when the patient is critically ill. During the period in the intensive care unit (ICU), the relatives may be subject to strong emotions of an existential nature, and the situation may involve several stressors as a result of changed roles, responsibilities and routines. These emotional stress experiences may result in weakened mental and physical functioning on the part of the relatives. During the patient’s rehabilitation at home the relatives are expected to provide care-giving assistance, which may lead to a further deterioration in their already weakened mental and physical functioning.

The general aim of the thesis was to develop a theoretical understanding of coping approaches and social support experiences of relatives of critically ill patients, both in the ICU and at home. In order to gain an understanding of these areas it was deemed important to search for knowledge by means of qualitative methods, using grounded theory methodology, simultaneous concept analysis and qualitative content analysis. A total of 32 relatives of critical care patients participated in the studies.

The findings of study I revealed that relatives of critically ill patients coped with their situation by alleviating, recycling, mastering or excluding their feelings during the ICU stay. The critical factors behind their choice of coping approach were their social circumstances, previous experiences of care and/or caring and how they apprehended the situation. In study II, during the patients’ recovery period at home, the relatives coped with their situation by accepting, volunteering, sacrificing or modulating. The critical factors in this period were the physical and psychological state of the relatives, previous experiences of care and/or caring and the psychological condition of the patient. A coping model was developed in study III, based on the coping concepts generated in studies I and II. In this model, the characteristics of each coping approach were systematised into different determinants in order to highlight the inherent process. The analysis of the relationship between the various coping approaches revealed differences in adaptation to the stressful situation. In terms of coping effectiveness, adaptation was associated with social support and health outcome. In the extended version of the coping model, with its dual perspective of the maladaptive-adaptive coping continuum and the weak-strong social support continuum, the degree of effectiveness of each coping approach was illustrated in relation to the others as well as to social support. In study IV and its Addition, a theoretical understanding of the phenomenon of what relatives experienced as supportive was developed. Support was perceived as empowerment by means of internal and external resources in the form of trusting oneself, encountering charity and encountering professionalism. The sense of empowerment permitted the relatives to experience their situation as safer and easier to control. The three support dimensions with their components and characteristics were illustrated in the empowerment model.

These four studies have developed knowledge that may provide healthcare professionals with an understanding of the coping approaches and social support experiences of relatives during the critically ill patient’s ICU stay and recovery period at home. The association revealed between coping effectiveness, social support and health outcomes may draw attention to the relatives’ situation as well as to the possibility of enabling relatives to endure the patient’s entire illness and recovery period by enhancing the factors that promote effective coping. The three models may together form the basis for the development of a support programme for relatives of critically ill patients that encompasses the whole course of illness and recovery, which means that both institutional and community-based care would be involved.

Place, publisher, year, edition, pages
Institutionen för medicin och vård , 2006.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 944
Keyword [en]
coping, critical care, family, models, qualitative methods, social support
National Category
Nursing
Identifiers
URN: urn:nbn:se:liu:diva-7312ISBN: 91-85497-81-9 (print)OAI: oai:DiVA.org:liu-7312DiVA: diva2:22326
Public defence
2006-05-23, Ekensalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2006-09-07 Created: 2006-09-07 Last updated: 2010-07-08
List of papers
1. Coping strategies when an adult next-of-kin/close friend is in critical care: a grounded theory analysis
Open this publication in new window or tab >>Coping strategies when an adult next-of-kin/close friend is in critical care: a grounded theory analysis
2002 (English)In: Intensive and Critical Care Nursing, ISSN 0964-3397, Vol. 18, no 2, 96-108 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to generate a theoretical model of how relatives/close friends cope when faced with having an adult next-of-kin/close friend admitted to critical care. Using interviews, data were collected from 18 relatives/close friends of adult patients in thoracic surgical, neurosurgical, coronary, and general ICUs in south-west Sweden. The design incorporated grounded theory methodology. The results indicate the relatives/close friends tried to make the experience of their situation easier, but that the approaches used differed in accordance with the individual’s internal and external resources. Four coping strategies exhibiting different characteristics were identified: the relatives/close friends alleviated, recycled, mastered, or excluded their feelings. Factors determining the choice of coping strategy were social background, previous experience of ICU-care and how the situation was apprehended. The theoretical model described in this article can contribute to expanding nurses’ understanding of the coping strategies of relatives/close friends in critical care.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13957 (URN)10.1016/S0964-3397(02)00019-8 (DOI)
Available from: 2006-09-07 Created: 2006-09-07 Last updated: 2009-05-20
2. Coping strategies of relatives when an adult next-of-kin is recovering at home following critical illness
Open this publication in new window or tab >>Coping strategies of relatives when an adult next-of-kin is recovering at home following critical illness
2004 (English)In: Intensive and Critical Care Nursing, ISSN 0964-3397, Vol. 20, no 5, 281-291 p.Article in journal (Refereed) Published
Abstract [en]

The trend within the Swedish healthcare system is to reduce the duration of hospital care. This means that a patient who is discharged to their home after critical illness is highly likely to be functionally impaired, and therefore, requires care-giving assistance from a family member. The aim of this study was to generate a theoretical model with regard to relatives’ coping when faced with the situation of having an adult next-of-kin recovering at home after critical illness. The design incorporated grounded theory methodology. Four coping strategies exhibiting different characteristics were identified: volunteering, accepting, modulating and sacrificing. Factors determining the choice of coping strategy were the physical and psychological status of the relative, previous experience of ICU-care and the psychological status of the patient. The theoretical model described in this article can contribute to expanding healthcare professionals’ understanding of the coping strategies of relatives during recovery, but also provide inspiration for social action to be taken.

Keyword
Strategies of relatives, Psychological status, Critical illness
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13958 (URN)10.1016/j.iccn.2004.06.007 (DOI)
Available from: 2006-09-07 Created: 2006-09-07 Last updated: 2009-05-20
3. Theoretical model of coping among relatives of patients in intensive care units: A simultaneous concept analysis
Open this publication in new window or tab >>Theoretical model of coping among relatives of patients in intensive care units: A simultaneous concept analysis
Show others...
2006 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 56, no 5, 463-471 p.Article in journal (Refereed) Published
Abstract [en]

Aim. This paper reports the development of a theoretical model of relatives' coping approaches during the patient's intensive care unit stay and subsequent recovery at home by performing an analysis of concepts generated from two empirically grounded, theoretical studies in this area. Background. When supporting relatives of intensive care unit patients, it is important that nurses have access to evidence-based knowledge of relatives' coping approaches during the period of illness and recovery. Method. Simultaneous concept analysis was used to refine and combine multiple coping concepts into a theoretical model of coping. The concepts were generated in two previous empirical studies of relatives' coping approaches during mechanically ventilated patients' intensive care unit stays and recovery at home. Findings. The theoretical model was developed in 2004-2005 and illustrates the effectiveness of different coping approaches in relation to each other and to social support. Definitions summarizing each coping approach and containing the knowledge gained through the simultaneous concept analysis method were also formulated. Conclusion. This middle-range theory of relatives' coping approaches may make a valuable contribution to international intensive care unit nursing practice, especially as it is based on empirical studies and may therefore serve as a basis for the development of future clinical guidelines. However, the theoretical model needs to be empirically validated before it can be used. © 2006 The Authors.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-36817 (URN)10.1111/j.1365-2648.2006.04040.x (DOI)32682 (Local ID)32682 (Archive number)32682 (OAI)
Note
The original titel on the day of the defence date was "A model of coping approaches among relatives of critically ill patients: a simultaneous concept analysis".Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
4. What is supportive when an adult next-of-kin is in critical care?
Open this publication in new window or tab >>What is supportive when an adult next-of-kin is in critical care?
2005 (English)In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 10, no 6, 289-298 p.Article in journal (Refereed) Published
Abstract [en]

There is little documented knowledge about what is supportive from the perspective of relatives with a critically ill next-of-kin in the intensive care unit (ICU). The aim of the present study was to generate a theoretical understanding of what relatives experience as supportive when faced with the situation of having an adult next-of-kin admitted to critical care. The study was designed using a grounded theory methodology. Interviews were conducted with 29 adult relatives of adult ICU patients in southwest Sweden. Relatives described the need to be empowered and that support was needed to enable them to use both internal and external resources to cope with having a next-of-kin in critical care. To achieve empowerment, the relatives described the need to trust in oneself, to encounter charity and to encounter professionalism. The findings can contribute understanding and sensitivity to the situation of the relatives as well as indicating what form social support should take. It is essential that healthcare professionals understand how important it is for relatives to have control over their vulnerable situation and that they also reflect upon how they would like to be treated themselves in a similar situation. Recommendations for future practice are presented.

Keyword
Critical care, Empowerment, Family, Grounded theory, Resources, Support
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13960 (URN)10.1111/j.1362-1017.2005.00136.x (DOI)
Available from: 2006-09-07 Created: 2006-09-07 Last updated: 2017-12-13

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