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Table 2 Summary of the qualitative results of former ICU patients, relatives, general ward and ICU nurses

From: Using an intervention mapping approach to develop a discharge protocol for intensive care patients

Main theme Units of meaning
Minimize or drop monitoring “It would have been reassuring if monitoring was paused while my husband was still in the ICU.” (ID#r2)
“If you don’t monitor the arterial catheter, then it must be removed. But it isn’t very comfortable for the patient if you need to have blood samples thereafter.” (ICU nurse)
“If I expect discharge, then I examine the last Ästrup and correct what is necessary. Then the arterial line is really taken out.” (ICU nurse)
“I think it is obligatory to monitor the patient during ICU admission. Therefore, I won’t drop down this because of safety reasons.” (ICU nurse)
Providing information “It is important to inform the patient that discharge is a transition from continuous monitoring to occasional rounds and that the situation is stable enough to allow for this downsizing.” (ID#r2)
“I always tell them [the ICU patients] that it is different in the general ward. A general ward nurse has to look after more than two patients, but it is suitable and safe care. Not everybody prepares the patient, I know.” (ICU nurse)
“It should occur both in the ICU and in the general ward. Our care doesn’t end at the doors; we should provide structured information about what is to be expected after discharge. However, they [the general ward nurses] should be more prepared.” (ICU nurse)
“A structured checklist can be a good tool to use.” (ICU nurse, general ward nurse)
“The information should be provided both orally and in written form for reading at their own pace and on their own time.” (general ward nurse)
“Without any monitoring, it took a little time to get used to. But more importantly, they had no idea! In the beginning, I was on Mars, and I came to Pluto thereafter.” (ID#p1)
“There is little knowledge among professionals. I would have greatly benefited from an informational brochure. I was very anxious about my condition, but I couldn’t talk to anyone.” (ID#p1)
“I’ve encountered so much ignorance, and I felt that I was not taken seriously. Providing more information and good communication, even a five-minute talk, could really make a difference.” (ID#r1)
Acquaintance visit “I would have appreciated meeting some of the professionals of the next ward, just to become a little more familiar with them. The reassurance of a nurse coming to the ICU would have helped me.” (ID#p1)
“Involving the relatives is a good idea if it is optional. They must not feel obliged to be present during the transition to the ward.” (ICU nurse)
“I think it is a great deal but that it isn’t reality. An acquaintance visit is too impractical for all of us, even if only relatives are involved. If they need to be here during transition, the general ward should provide this hospitality at the time, whereas in the ICU, we don’t know specific details of the visiting hours in all the different follow-up wards.” (ICU nurse)
“That isn’t ideal; for example, even if I come in today, I might not be working tomorrow, so it isn’t very useful then.” (general ward nurse)
Time and logistical constraints “Hurriedly and focusing on speed, the communication was very stormy. If there had been more time and opportunity to ask questions, then we would have been less stressed in the next ward.” (ID#r1)
“It goes far too quickly. I was just awoken and immediately discharged. There was barely time to prepare. I was also too ´groggy´ to listen to the information at that time.” (ID#p4)
“If we could work one-on-one, then we would have enough time for emotional support.” (general ward nurse, ICU nurse)
“Oh no, that is really absurd. There is no time, and it isn’t safe for the patient to have an acquaintance visit to the general ward prior to discharge. But if the relatives would like to be involved and go there, that would be useful.” (ICU nurse)
“I really haven’t the time to visit the patient in the ICU prior to admission to our ward!”. (general ward nurse)
Writing a lay summary “I had no idea what had happened, why I felt like this. I wished someone had told me, wrote down a timeline, explained what I had experienced in understandable words.” (ID#p4)
“Writing a lay summary, I think, it is too subjective. I wouldn’t know how to do that, how to go beyond ´patient slept well, no pain´ and still convey medical information. What is meaningful and not legally disputable or wrong? For example, we judge delirious behavior differently than the relatives do. That is difficult to describe.” (ICU nurse)
“On my first day of work, I’m too unfamiliar with the patient to that.” (ICU nurse)
“That will certainly help the patient and their relatives.” (general ward nurse)
Consultative ICU nurse “I never discussed my ICU experiences at the time. I missed that enormously, and I think it would have helped me to process my feelings, my insecurity, and my anxious thoughts.” (ID#p4)
“I have noticed that the patients appreciate that you’ve come. Some general attention provides confidence in their situation.” (ICU nurse)
“What I see is that we often just go by to check the physical condition. The emotional processing has not yet begun on the first day after discharge. Only after four or five days does the patient start thinking about what happened. So, that is not applicable to the consultative ICU service.” (ICU nurse)
“It would be nice if the ICU nurse could come for a longer time period to talk to the patient about their experiences.” (general ward nurse)
Liaison nurse “What I’ve missed is the feeling of enough knowledge in the general ward about the impact of an ICU admission, the understanding of my fears and anxieties. It would have been nice to talk about my emotions with an independent professional with profound knowledge of the ICU.” (ID#p2)
“They [the management team] should hire a special professional just to support the relatives. This is very useful and valuable work. A lot of benefit can be gained by providing deeper emotional support for the ICU patient and their relatives.” (ICU nurse)
“All this should be done by a nurse without direct patient care that day. Maybe a few dedicated nurses could work on this emotional support task.” (ICU nurse)
  1. ID Ideentification, # number, r relative, p former ICU patient