A longitudinal qualitative exploration of healthcare and informal support needs among survivors of critical illness: the RELINQUISH protocol.

Introduction and background: Survival following critical illness is associated with a significant burden of physical, emotional and psychosocial morbidity. Recovery can be protracted and incomplete, with important and sustained effects upon everyday life, including family life, social participation and return to work. In stark contrast with other critically ill patient groups (eg, those following cardiothoracic surgery), there are comparatively few interventional studies of rehabilitation among the general intensive care unit patient population. This paper outlines the protocol for a sub study of the RECOVER study: a randomised controlled trial evaluating a complex intervention of enhanced ward-based rehabilitation for patients following discharge from intensive care. Methods and analysis: The RELINQUISH study is a nested longitudinal, qualitative study of family support and perceived healthcare needs among RECOVER participants at key stages of the recovery process and at up to 1 year following hospital discharge. Its central premise is that recovery is a dynamic process wherein patients’ needs evolve over time. RELINQUISH is novel in that we will incorporate two parallel strategies into our data analysis: (1) a pragmatic health services-oriented approach, using an a priori analytical construct, the ‘Timing it Right’ framework and (2) a constructivist grounded theory approach which allows the emergence of new themes and theoretical understandings from the data. We will subsequently use Qualitative Health Needs Assessment methodology to inform the development of timely and responsive healthcare interventions throughout the recovery process. Ethics and dissemination: The protocol has been approved by the Lothian Research Ethics Committee (protocol number HSRU011). The study has been added to the UK Clinical Research Network Database (study ID. 9986). The authors will disseminate the findings in peer reviewed publications and to relevant critical care stakeholder groups.

Learning from patterns during information technology configuration.

This paper asks how people can be assisted in learning from practice, as a basis for informing future action, when configuring information technology (IT) in organizations. It discusses the use of Alexanderian Patterns as a means of aiding such learning. Three patterns are presented that have been derived from a longitudinal empirical study that has focused on practices surrounding IT configuration. The paper goes on to argue that Alexanderian Patterns offer a valuable means of learning from past experience. It is argued that learning from experience is an important dimension of deciding “what needs to be done” in configuring IT with organizational context. The three patterns outlined are described in some detail, and the implications of each discussed. Although it is argued that patterns, per se, provide a valuable tool for learning from experience, some potential dangers in seeking to codify experience with a patterns approach are also discussed.