title: 'Intensive care unit survivorship' - a constructivist grounded theory of surviving critical illness.
abstract: OBJECTIVE
  To theorise intensive care unit survivorship after a critical illness based on longitudinal qualitative data.
  
  
  BACKGROUND
  Increasingly, patients survive episodes of critical illness. However, the short- and long-term impact of critical illness includes physical, psychological, social and economic challenges long after hospital discharge. An appreciation is emerging that care needs to extend beyond critical illness to enable patients to reclaim their lives postdischarge with the term 'survivorship' being increasingly used in this context. What constitutes critical illness survivorship has, to date, not been theoretically explored.
  
  
  METHODS
  Longitudinal qualitative and constructivist grounded theory. Interviews (n = 46) with 17 participants were conducted at four time points: (1) before discharge from hospital, (2) four to six weeks postdischarge, (3) six months and (4) 12 months postdischarge across two adult intensive care unit setting.
  
  
  METHODS
  Individual face-to-face interviews. Data analysis followed the principles of Charmaz's constructivist grounded theory. 'Intensive care unit survivorship' emerged as the core category and was theorised using concepts such as status passages, liminality and temporality to understand the various transitions participants made postcritical illness.
  
  
  RESULTS
  Intensive care unit survivorship describes the unscheduled status passage of falling critically ill and being taken to the threshold of life and the journey to a life postcritical illness. Surviving critical illness goes beyond recovery; surviving means 'moving on' to life postcritical illness. 'Moving on' incorporates a redefinition of self that incorporates any lingering intensive care unit legacies and being in control of one's life again.
  
  
  CONCLUSIONS
  For healthcare professionals and policymakers, it is important to realise that recovery and transitioning through to survivorship happen within an individual's time frame, not a schedule imposed by the healthcare system. Currently, there are no care pathways or policies in place for critical illness survivors that would support intensive care unit survivors and their families in the transitions to survivorship.
authors.affiliation: School of Health in Social Science, Nursing Studies, The University of Edinburgh, Edinburgh, UK.
authors.forename: Susanne
authors.identifier: http://orcid.org/0000-0002-3717-9740
authors.initials: S
authors.lastname: Kean
authors.affiliation: School of Health in Social Science, Nursing Studies, The University of Edinburgh, Edinburgh, UK.
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Salisbury
authors.affiliation: School of Nursing & Midwifery, University of Dundee, Dundee, UK.
authors.forename: Janice
authors.initials: J
authors.lastname: Rattray
authors.affiliation: School of Clinical Science, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, UK.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Walsh
authors.affiliation: Faculty of Health and Social Studies, Østfold University College, Halden, Norway.
authors.forename: Guro
authors.initials: G
authors.lastname: Huby
authors.affiliation: School of Nursing, Midwifery & Social Care, Edinburgh Napier University, Edinburgh, UK.
authors.forename: Pamela
authors.initials: P
authors.lastname: Ramsay
mesh_terms: D000328:Adult; D016638:Critical Illness / Q000523:psychology*; D005260:Female; D066296:Grounded Theory; D006801:Humans; D007362:Intensive Care Units; D008137:Longitudinal Studies; D008297:Male; D036301:Qualitative Research; D057566:Self Report; D017741:Survivors / Q000523:psychology*; D000073859:Survivorship
keywords: constructivist grounded theory; critical illness; intensive care; interviews; liminality; longitudinal; recovery; status passages; survivorship; temporality