Aim: The present study aimed to explore lived experiences of critically ill patients with COVID-19 after discharge from intensive care units of hospitals in Iran.
Materials and Methods: The present study was qualitative research with a hermeneutic phenomenological approach. Participants were purposefully selected from critically ill patients with COVID-19 who were discharged from the intensive care unit (ICU) and transferred to the general ward. Data were mostly collected through in-depth, semi-structured, face-to-face interviews and, in some cases, telephone calls. Data were analyzed using the method of Dickelman et al. (1985). Guba and Lincoln's (1989) criteria were used to achieve data authenticity.
Results: Data were obtained from 16 COVID-19 recovered patients with a history of ICU admission. Twelve participants were female and four were male with a mean age of 35 years. The four main themes were identified along with their subthemes: perception of death before dying (worry, helplessness, and expecting a different death), social stigma (social isolation and stigma), a nurse as a symbol of rebirth (a compassionate and supportive nurse and the supportive role of others), and meaningful life (a change in outlook on life and the manifestation of spirituality).
Conclusion: The results of the present study indicated that personal thoughts such as thinking about death and social treatments such as stigma can lead to threatening physical and psychological problems in COVID-19 patients. Nurses and family members can prevent many of these problems by providing holistic care and psychological support. Apart from the challenges posed by the disease, post-recovery changes in patients' attitudes toward life can be considered as a positive point.
- World Health Organization. Novel coronavirus-China. Geneva: World Health Organization; 2020.
- Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43. doi: 10.1001/jamainternmed.2020.0994. [PubMed: 32167524].
- Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. doi: 10.1056/NEJMoa2001017. [PubMed: 31978945].
- Shrivastava SR, Shrivastava PS. Minimizing the risk of international spread of coronavirus disease 2019 (COVID-19) outbreak by targeting travelers. J Acute Dis. 2020;9(2):47. doi: 10.4103/2221-6189.278654.
- Bogoch II, Watts A, Thomas-Bachli A, Huber C, Kraemer MU, Khan K. Potential for global spread of a novel coronavirus from China. J Travel Med. 2020;27(2):taaa011. doi: 10.1093/jtm/taaa011. [PubMed: 31985790].
- Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al. Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med. 2020;382(21):2049-55. doi: 10.1056/NEJMsb2005114. [PubMed: 32202722].
- World Health Organization. Coronavirus disease (COVID-19) situation report–202. Geneva: World Health Organization; 2020.
- Struyf T, Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Leeflang MM, et al. Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID‐19 disease. Cochrane Database Syst Rev. 2020;7(7):CD013665. doi: 10.1002/14651858.CD013665. [PubMed: 32633856].
- Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20. doi: 10.1056/NEJMoa2002032.
- Abate SM, Ahmed Ali S, Mantfardo B, Basu B. Rate of Intensive Care Unit admission and outcomes among patients with coronavirus: a systematic review and Meta-analysis. PloS One. 2020;15(7):e0235653. doi: 10.1371/journal.pone.0235653. [PubMed: 32649661].
- Armstrong R, Kane A, Cook T. Outcomes from intensive care in patients with COVID‐19: a systematic review and meta‐analysis of observational studies. Anaesthesia. 2020;75(10):1340-9. doi: 10.1111/anae.15201. [PubMed: 32602561].
- Ministry of Health and Medical Education. Available at: URL: https://behdasht.gov.ir/; 2021.
- Davydow DS. The burden of adverse mental health outcomes in critical illness survivors. Crit Care. 2010;14(1):125. doi: 10.1186/cc8867. [PubMed: 20236473].
- Kiekkas P, Aretha D. Psychiatric long-term complications of intensive care unit survivors. Crit Care Med. 2011;39(7):1852-3. doi: 10.1097/CCM.0b013e318218546c. [PubMed: 21685763].
- Granja C, Lopes A, Moreira S, Dias C, Costa-Pereira A, Carneiro A. Patients' recollections of experiences in the intensive care unit may affect their quality of life. Crit Care. 2005;9(2):R96-109. doi: 10.1186/cc3026. [PubMed: 15774056].
- Abdalrahim MS, Zeilani RS. Jordanian survivors' experiences of recovery from critical illness: a qualitative study. Int Nurs Rev. 2014;61(4):570-7. doi: 10.1111/inr.12142. [PubMed: 25382166].
- Corrigan I, Samuelson KA, Fridlund B, Thomé B. The meaning of posttraumatic stress-reactions following critical illness or injury and intensive care treatment. Intensive Crit Care Nurs. 2007;23(4):206-15. doi: 10.1016/j.iccn.2007.01.004. [PubMed: 17449252].
- Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. 2020;7(3):228-9. doi: 10.1016/S2215-0366(20)30046-8. [PubMed: 32032543].
- Guo Q, Zheng Y, Shi J, Wang J, Li G, Li C, et al. Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: a mixed-method study. Brain Behav Immun. 2020;88:17-27. doi: 10.1016/j.bbi.2020.05.038. [PubMed: 32416290].
- Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res. 2020;288:112954. doi: 10.1016/j.psychres.2020.112954. [PubMed: 32325383].
- Samuelson KA. Unpleasant and pleasant memories of intensive care in adult mechanically ventilated patients--findings from 250 interviews. Intensive Crit Care Nurs. 2011;27(2):76-84. doi: 10.1016/j.iccn.2011.01.003. [PubMed: 21371888].
- Jeong YJ, Kang J. Development and validation of a questionnaire to measure post-intensive care syndrome. Intensive Crit Care Nurs. 2019;55:102756. doi: 10.1016/j.iccn.2019.102756. [PubMed: 31522829].
- Barreto BB, Luz M, de Oliveira Rios MN, Lopes AA, Gusmao-Flores D. The impact of intensive care unit diaries on patients’ and relatives’ outcomes: a systematic review and meta-analysis. Crit Care. 2019;23(1):411. doi: 10.1186/s13054-019-2678-0. [PubMed: 31842929].
- Tandon R. The COVID-19 pandemic, personal reflections on editorial responsibility. Asian J Psychiatr. 2020;50:102100. doi: 10.1016/j.ajp.2020.102100. [PubMed: 32354694].
- Sheehy LM. Considerations for postacute rehabilitation for survivors of COVID-19. JMIR Public Health Surveill. 2020;6(2):e19462. doi: 10.2196/19462. [PubMed: 32369030].
- Jaffri A, Jaffri UA. Post-Intensive care syndrome and COVID-19: crisis after a crisis? Heart Lung. 2020;49(6):883-4. doi: 10.1016/j.hrtlng.2020.06.006. [PubMed: 32690219].
- Diekelmann NL, Allen D, Tanner CA. The NLN criteria for appraisal of baccalaureate programs : a critical hermeneutic analysis. New York: National League for Nursing; 1989.
- Lincoln YS, Guba EG. Naturalistic Inquiry. Newbury Park, CA: Sage; 1985.
- Nasrabadi AN. Lived Experiences of Iranian ICU Nurses in the care of patients with Covid-19: a phenomenological study. Res Square. 2020;In Pess. doi: 10.21203/rs.3.rs-72171/v1.
- Shigemura J, Ursano RJ, Morganstein JC, Kurosawa M, Benedek DM. Public responses to the novel 2019 coronavirus (2019‐nCoV) in Japan: mental health consequences and target populations. Psychiatry Clin Neurosci. 2020;74(4):281-2. doi: 10.1111/pcn.12988. [PubMed: 32034840].
- Sahoo S, Mehra A, Dua D, Suri V, Malhotra P, Yaddanapudi LN, et al. Psychological experience of patients admitted with SARS-CoV-2 infection. Asian J Psychiatry. 2020;54:102355. doi: 10.1016/j.ajp.2020.102355. [PubMed: 33271684].
- Lagerdahl AS, Moynihan M, Stollery B. An exploration of the existential experiences of patients following curative treatment for cancer: reflections from a UK sample. J Psychosoc Oncol. 2014;32(5):555-75. doi: 10.1080/07347332.2014.936647. [PubMed: 25045924].
- Lo C, Hales S, Jung J, Chiu A, Panday T, Rydall A, et al. Managing cancer and living meaningfully (CALM): phase 2 trial of a brief individual psychotherapy for patients with advanced cancer. Palliat Med. 2014;28(3):234-42. doi: 10.1177/0269216313507757. [PubMed: 24170718].
- Jang J, Lee SA, Kim W, Choi Y, Park EC. Factors associated with mental health consultation in South Korea. BMC Psychiatry. 2018;18(1):17. doi: 10.1186/s12888-018-1592-3. [PubMed: 29357835].
- Li W, Yang Y, Ng CH, Zhang L, Zhang Q, Cheung T, et al. Global imperative to combat stigma associated with the coronavirus disease 2019 pandemic. Psychol Med. 2020;26:1-2. doi: 10.1017/S0033291720001993. [PubMed: 32450925].
- Peprah P, Gyasi RM. Stigma and COVID‐19 crisis: a wake‐up call. Int J Health Plann Manage. 2020;36(1):215-8. doi: 10.1002/hpm.3065. [PubMed: 32845533].
- Rahmatinejad P, Yazdi M, Khosravi Z, Shahisadrabadi F. Lived experience of patients with coronavirus (Covid-19): a phenomenological study. J Res Psychol Health. 2020;14(1):71-86.
- Stop the coronavirus stigma now. Nature. 2020;580(7802):165. doi: 10.1038/d41586-020-01009-0. [PubMed: 32265571].
- Egerod I, Bergbom I, Lindahl B, Henricson M, Granberg-Axell A, Storli SL. The patient experience of intensive care: a meta-synthesis of Nordic studies. Int J Nurs Stud. 2015;52(8):1354-61. doi: 10.1016/j.ijnurstu.2015.04.017. [PubMed: 25986960].
- Wendel PK, Stack RJ, Chisholm MF, Kelly MJ, Elogoodin B, Liguori GA, et al. Development of a communications program to support care of critically ill coronavirus disease 2019 (COVID-19) patients. J Patient Exp. 2020;7(5):673-676. doi: 10.1177/2374373520956865. [PubMed: 33294597].
- Gaulton J, Ziegler K, Chang E. Virtual practices transform the care delivery model in an intensive care unit during the coronavirus pandemic. Nejm Catalyst Innovat Care Deliv. 2020;In Press.
- da Silva Ribeiro CA, Trovo MM, Puggina AC. Life stories and photographs of sedated patients in the ICU: a possible humanization strategy? Enferm Glob. 2017;16(3):483-95. doi: 10.6018/eglobal.16.3.257291.
- Storli SL, Lindseth A, Asplund K. A journey in quest of meaning: a hermeneutic‐phenomenological study on living with memories from intensive care. Nurs Crit Care. 2008;13(2):86-96. doi: 10.1111/j.1478-5153.2007.00235.x. [PubMed: 18289187].
- Aslakson RA, Kweku J, Kinnison M, Singh S, Crowe TY 2nd, Ast K, et al. Operationalizing the measuring what matters spirituality quality metric in a population of hospitalized, critically ill patients and their family members. J Pain Symptom Manage. 2017;53(3):650-5. doi: 10.1016/j.jpainsymman.2016.12.323. [PubMed: 28042059].
- Weber SR, Pargament KI. The role of religion and spirituality in mental health. Curr Opin Psychiatry. 2014;27(5):358-63. doi: 10.1097/YCO.0000000000000080. [PubMed: 25046080].
- Noome M, Beneken Genaamd Kolmer DM, van Leeuwen E, Dijkstra BM, Vloet LC. The role of ICU nurses in the spiritual aspects of end‐of‐life care in the ICU: an explorative study. Scand J Caring Sci. 2017;31(3):569-78. doi: 10.1111/scs.12371. [PubMed: 27862140].