'One patient amongst many': a qualitative analysis of intensive care unit patients' experiences of transferring to the general ward.
BACKGROUND
Many patients experience 'relocation stress' when they are transferred from an intensive care unit (ICU) to step-down (high dependency) or general ward care, and much has been written about the psychological causes. This qualitative analysis of in-depth, narrative interviews with former ICU patients explores and examines patients' accounts in order to identify additional causes of relocation stress.


METHODS
Forty former ICU patients were recruited throughout the UK, using maximum variation sampling, to achieve a broad range of experiences of intensive care. Interviews in people's homes were recorded on video and audio equipment as part of a study for the Database of Personal Experiences of Health and Illness (DIPEx) web resource. All interviews were transcribed, checked and returned to respondents. For this report, a qualitative thematic analysis was used to explore experiences of transfer.


RESULTS
We found that most people experienced relocation distress not only because of physical and emotional difficulties relating to their illness and treatment and the inevitable anxiety resulting from leaving a protected environment, but also from concrete, practical causes. These included specific concerns about communication, feeding, nursing care and support, as well as ward organization and environment. Written excerpts from the interviews and two video excerpts taken from the DIPEx website illustrate our findings.


CONCLUSIONS
We conclude that there are several aspects of care that deserve further examination by researchers and service providers, and that not all of the factors associated with relocation stress should be seen as an inevitable consequence of the psychological adjustment involved in transfer from an ICU.
Field
Kate
K
DIPEx Research Group, Department of Primary Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK. kate.field@dphpc.ox.ac.uk
Prinjha
Suman
S
Rowan
Kathy
K
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010360:Patient Transfer; D013315:Stress, Psychological / Q000209:etiology*