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To explore the qualitative literature regarding the experiences of survivors of critical illness re-engaging in activities of daily living.
Qualitative systematic review.
Databases were searched with three broad categories of search terms: (1) critical illness, (2) activities of daily living, and (3) participant experiences. Articles were included if they reported qualitative data on the experiences of adults who were re-engaging with activities of daily living after admission to an intensive care unit. The findings from these studies were thematically analysed.
A search of Medline, Embase, CINAHL, PsycINFO and AMED was conducted on the 9th September 2024.
After removing duplicates, the literature search identified 6267 articles. The full texts of 120 articles were reviewed, and 44 were included for data extraction. Thematic analysis identified three themes: (1) loss of autonomy, (2) striving to reclaim independence, and (3) shifting familial dynamics and imposing a burden.
Survivors of critical illness face significant challenges when re-engaging with daily activities. The effort to regain autonomy often leads to feelings of helplessness and a reluctance to engage in both daily tasks and social activities. The emotional burden of dependence and the perception of being a burden further complicate their recovery.
Health services should focus on integrating physical rehabilitation, mealtime support, and cognitive and psychological therapy to effectively cater to the diverse needs of critical illness survivors and their families.
This review highlights the complex challenges of re-engaging in activities of daily living after critical illness and emphasises the need for multidisciplinary rehabilitation to improve physical, cognitive, and emotional recovery.
Reporting of this review followed the ENTREQ checklist, in accordance with EQUATOR guidelines.
No Patient or Public Contribution.
To develop and psychometrically test a comprehensive Cancer Nurse Self-Assessment Tool (CaN-SAT).
Modified Delphi to assess content validity and cross-sectional survey to assess reliability and validity.
Phase 1: An expert group developed the tool structure and item content. Phase 2: Through a modified Delphi, cancer nursing experts rated the importance of each element of practice and assessed the relevance and clarity of each item. Content Validation Indexes (CVI) were calculated, and a CVI of ≥ 0.78 was required for items to be included. Phase 3: Cancer nurses participated in a survey to test internal consistency (using Cronbach's alpha coefficients) and known-group validity (through Mann–Whitney U tests). This study was reported using the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) checklist.
The CaN-SAT underwent two rounds of Delphi with 24 then 15 cancer nursing experts. All elements of practice were rated as important. Only three items achieved a CVI < 0.78 after round one; however, based on open-ended comments, 26 items were revised and one new item added. After round two, all items received a CVI above 0.78. The final tool consisted of 93 items across 15 elements of practice. Cronbach's alpha coefficients were between 0.92 and 0.98 indicating good reliability. Mann–Whitney U tests demonstrated significant differences between clinical nurses and advanced practice nurses across 13 out of 15 elements of practice.
The CaN-SAT is a comprehensive, valid and reliable tool that can be used for cancer nurses to self-assess current skill levels, identify their learning needs and inform decisions about educational opportunities to optimise cancer care provision.
The research team included three patient advocates from Cancer Voices NSW, who were actively involved in all aspects of the study and are listed as authors.
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