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.

Dealing with affective needs in e-learning: Contrasting two cases in two cultures.

This chapter presents and contrasts descriptions of two cases of online affective support provided to support students engaged in higher level learning tasks. The cases are set in different cultures, centre upon different intended learning outcomes, and follow different tutorial styles. One (Eastern) tutor acted as a “shepherd leader” in response to needs arising in the Confucian Heritage Culture as the teacher promoted critical thinking, according to the Western model. The other (Western) tutor provided Rogerian facilitation of reflective learning journals, kept by students seeking to develop personal and professional capabilities. In both styles, affective support features strongly. The cultural and pedagogical comparisons between the cases have proved useful to the writers. These distinctions together with the similarities between the two online styles emerge in the comparisons. Keywords: affective needs, asynchronous discussion, Confucian Heritage Culture, constructivism, critical thinking, facilitation, reflection, reflective learning journals, Rogerian, shepherd leadership, social-constructivist, student-centred, support.