Intensive care survivors’ experiences of ward-based care: Meleis’ theory of nursing transitions and role development among critical care outreach services.

Aims and objectives. To explore the psychosocial needs of patients discharged from intensive care, the extent to which they are captured using existing theory on transitions in care and the potential role development of critical care outreach, follow-up and liaison services. Background. Intensive care patients are at an increased risk of adverse events, deterioration or death following ward transfer. Nurse-led critical care outreach, follow-up or liaison services have been adopted internationally to prevent these potentially avoidable sequelae. The need to provide patients with psychosocial support during the transition to ward-based care has also been identified, but the evidence base for role development is currently limited. Design and methods. Twenty participants were invited to discuss their experiences of ward-based care as part of a broader study on recovery following prolonged critical illness. Psychosocial distress was a prominent feature of their accounts, prompting secondary data analysis using Meleis et al.’s mid-range theory on experiencing transitions. Results. Participants described a sense of disconnection in relation to profound debilitation and dependency and were often distressed by a perceived lack of understanding, indifference or insensitivity among ward staff to their basic care needs. Negotiating the transition between dependence and independence was identified as a significant source of distress following ward transfer. Participants varied in the extent to which they were able to express their needs and negotiate recovery within professionally mediated boundaries. Conclusion. These data provide new insights into the putative origins of the psychosocial distress that patients experience following ward transfer. Relevance to clinical practice. Meleis et al.’s work has resonance in terms of explicating intensive care patients’ experiences of psychosocial distress throughout the transition to general ward–based care, such that the future role development of critical care outreach, follow-up and liaison services may be more theoretically informed.

Promoting Investment and Increasing Employment among the Economically Inactive - A Review of Best Practice.

Final report to the Department of Enterprise, Trade and Investment, Northern Ireland. This report sets out the findings from a study into strategies that link the promotion of investment and the employment of economically inactive groups. The aim is to ascertain current practice in 10 relevant countries (Australia; Belgium; Denmark; Finland; Germany; the Netherlands; New Zealand; Slovenia; Spain; USA plus Great Britain) and their transferability to the Northern Ireland (NI) policy and labour market context. The study was carried out by the Employment Research Institute at Edinburgh Napier University on behalf of the Department of Trade, Enterprise and Investment in NI (DETI). The study describes cases of good practice in securing investment in areas, sectors and occupations that provide accessible entry-level positions for economically inactive groups. It seeks to identify the ‘critical success factors’ common to effective strategies, drawing out lessons for future Northern Ireland policy. In this study ‘Investment’ includes foreign direct investment (FDI) and private investment that expands the ‘export’ capacity of the NI economy (i.e. excluding investment aimed at the NI market). ‘Economically inactive’ people are those excluded or seriously at risk of exclusion from the labour market.