A systematic review of relocation stress following in-house transfer out of critical/intensive care units.
Objective The objective was to conduct a mixed methods systematic review to determine the occurrence and meaningfulness of relocation stress and the effectiveness of strategies for decreasing transfer anxiety in patients and their families upon transfer from an intensive care unit to a non-intensive care unit and to offer evidence-based recommendations for best practice.Inclusion criteria The review included quantitative and qualitative studies where the participants were adult intensive care patients, family members of adult intensive care patients, intensive care nurses caring for the adult critically ill patient, and ward/unit nurses receiving transfer patients from the ICU (intensive care unit). Studies examining the transfer experience for infants, children or psychiatric patients were excluded from this review.Search strategy The search strategy sought to find both published and unpublished studies and papers limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of text words contained in the title and abstract, and of index terms to describe the article. A second extensive search was then undertaken using identified key words and index terms.Methodological quality Each paper was assessed by two independent reviewers for quality prior to inclusion in the review using the Joanna Briggs Critical Appraisal Tools for experimental, cohort, descriptive, qualitative and expert text papers. Disagreements were discussed and resolved among the reviewers without needing to rely on a third reviewer.Data collection Information was extracted from each paper independently by two reviewers using the JBI extraction tools for quantitiative, qualitaitive and expert opinion papers and narrative table summaries were prepared.Data synthesis Data synthesis aimed to portray an accurate interpretation and synthesis of concepts arising from the experiences of patients and families transferring out of ICU and the nurses on the receiving and sending ends of the transfer.Results A total of 35 studies were identified and of those 25 were included in the review consisting of 15 qualitative studies, 9 quantitative studies and 1 clinical practice guideline. Qualitative papers were analyzed using JBI-QARI and involved categorizing findings and developing synthesized topics from the categories. Three syntheses were developed related to response to transfer, meaning of transfer, and strategies to facilitate successful transfer. Quantitative data could not be pooled and is presented in the narrative table.Conclusion For most, transfer to the general unit was not a traumatic or negative experience but viewed positively as a sign of recovery and sometimes the positive emotions coexisted with uncertainty or fear. The most negative experience was related to lack of observation and care on the general unit where nurses many times were unaware or unresponsive to functional deficits that the patients required assistance with. Patients were consequently challenged to do more for themselves and depending on their success or progress with independence resulted in growing confidence or frustration and embarrassment. The systems of care were not structured to effectively deal with the complex ICU transfer patient.Implications for practice Specific practice recommendations are made for pretransfer from ICU, system improvements to facilitate transfer and posttransfer care while on the general unit.Implications for research Additional research is needed to confirm the frequency of negative relocation stress, test efficacy of direct interventions and explore the meaning of transfer for family members.
1. University of Medicine and Dentistry of New Jersey, The New Jersey Center for Evidence-Based Nursing: a collaborating centre of the Joanna Briggs Institute 2. Bergen Pines Regional Medical Center.
Susan Warner
SW
Salmond
Benjamin
B
Evans
Hanaa A
HA
Hamdi
Marie K
MK
Saimbert