Readmission to intensive care: A qualitative analysis of nurses' perceptions and experiences

Journal article

Elliott, Malcolm, Crookes, Patrick, Worrall-Carter, Linda and Page, Karen. (2011). Readmission to intensive care: A qualitative analysis of nurses' perceptions and experiences. Heart & Lung: the journal of acute and critical care (print version). 40(4), pp. 299 - 309. https://doi.org/10.1016/j.hrtlng.2010.04.006
AuthorsElliott, Malcolm, Crookes, Patrick, Worrall-Carter, Linda and Page, Karen
Abstract

Objective: The purpose of this study was to identify and describe the experiences and perceptions of nurses regarding the factors that contribute to the readmission of patients to intensive care.

Methods: Twenty-one nurses participated in the study. Unstructured interviews were conducted to ascertain participants' perceptions and experiences. Interview transcripts were analyzed using a constant comparison method to identify major conceptual categories.

Results: Five main themes were identified that contributed to the readmission of patients to intensive care: premature discharge from intensive care, delayed medical care at the ward level, heavy nursing workloads, lack of adequately qualified staff, and clinically “challenging” patients who demanded a different skill set from the nurses.

Conclusion: Discharging patients early from the intensive care unit when they are clinically unstable creates issues around workload and significantly challenges ward staff. It also increases the likelihood of patients being readmitted to the intensive care unit. Hospital managers need to look at ways of increasing the knowledge and skills of ward staff or identify more appropriate environments for managing these acutely ill patients.

Year2011
JournalHeart & Lung: the journal of acute and critical care (print version)
Journal citation40 (4), pp. 299 - 309
ISSN0147-9563
Digital Object Identifier (DOI)https://doi.org/10.1016/j.hrtlng.2010.04.006
Scopus EID2-s2.0-79959852386
Page range299 - 309
Research GroupSchool of Nursing, Midwifery and Paramedicine
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Moser, Debra, Frazier, Susan, Worrall-Carter, Linda, Biddle, Martha, Chung, Misook, Lee, Kyoung Suk and Lennie, Terry. (2011). Symptom variability, not severity, predicts rehospitalization and mortality in patients with heart failure. European Journal of Cardiovascular Nursing. 10(2), pp. 124 - 129. https://doi.org/10.1016/j.ejcnurse.2010.05.006
Development of an evidence-based scoring system (HF-IS) to assess the quality of heart failure programmes for patients postdischarge from hospital
Driscoll, Andrea, Tonkin, Andrew, Stewart, Andrew, Thompson, David R., Worrall-Carter, Linda, Reigel, Barbara, Hare, David L., Davidson, Patricia M. and Stewart, Simon. (2011). Development of an evidence-based scoring system (HF-IS) to assess the quality of heart failure programmes for patients postdischarge from hospital. Journal of Clinical Nursing. 20(21-22), pp. 3011 - 3019. https://doi.org/10.1111/j.1365-2702.2010.03687.x
Triaging women with acute coronary syndrome :A review of the literature
Kuhn, Lisa, Page, Karen, Davidson, Patricia M. and Worrall-Carter, Linda. (2011). Triaging women with acute coronary syndrome :A review of the literature. Cardiovascular Nursing, The Journal of. 26(5), pp. 395 - 407. https://doi.org/10.1097/JCN.0b013e31820598f6
Literature review : Understanding nursing competence in dementia care
Traynor, Victoria, Inoue, Kumiyo and Crookes, Patrick. (2011). Literature review : Understanding nursing competence in dementia care. Journal of Clinical Nursing. 20(13-14), pp. 1948 - 1960. https://doi.org/10.1111/j.1365-2702.2010.03511.x
A model of adaptation of overseas nurses: Exploring the experiences of Japanese nurses working in Australia
Kishi, Yuka, Inoue, Kumiyo, Crookes, Patrick and Shorten, Allison. (2011). A model of adaptation of overseas nurses: Exploring the experiences of Japanese nurses working in Australia. Journal of Transcultural Nursing. 25(2), pp. 183 - 191. https://doi.org/10.1177/1043659613515716
Systematic review of cardiovascular disease in women :Assessing the risk
Worrall-Carter, Linda, Ski, Chantal, Scruth, Elizabeth, Campbell, Michelle and Page, Karen Nicola. (2011). Systematic review of cardiovascular disease in women :Assessing the risk. Nursing and Health Sciences. 13(4), pp. 529 - 535. https://doi.org/10.1111/j.1442-2018.2011.00645.x
Measuring 'magnetism' in Australian nursing environments
Joyce-McCoach, Joanne and Crookes, Patrick. (2011). Measuring 'magnetism' in Australian nursing environments. The Australian Journal of Advanced Nursing (online). 29(2), pp. 13 - 22.
Teaching critical appraisal skills for nursing research
Jones, Sandra, Crookes, Patrick and Johnson, Keryn. (2011). Teaching critical appraisal skills for nursing research. Nurse Education in Practice. 11(5), pp. 327 - 332. https://doi.org/10.1016/j.nepr.2011.03.002
Patients Assessment of Chronic Illness Care (PACIC) in two Australian studies : Structure and utility
Taggart, Jane, Chan, Bibiana, Jayasinghe, Upali, Christl, Bettina, Proudfoot, Judy, Crookes, Patrick, Beilby, Justin, Black, Deborah and Harris, Mark. (2011). Patients Assessment of Chronic Illness Care (PACIC) in two Australian studies : Structure and utility. Journal of Evaluation in Clinical Practice. 17(2), pp. 215 - 221. https://doi.org/10.1111/j.1365-2753.2010.01423.x
Patient and practice characteristics predict the frequency of general practice multidisciplinary referrals of patients with chronic diseases : A multilevel study
Harris, Mark, Jayasinghe, Upali, Chan, Bibiana, Proudfoot, Judy, Crookes, Patrick, Zwar, Nick and Powell Davies, Gawaine. (2011). Patient and practice characteristics predict the frequency of general practice multidisciplinary referrals of patients with chronic diseases : A multilevel study. Health Policy. 101(2), pp. 140 - 145. https://doi.org/10.1016/j.healthpol.2010.10.019
Symptom recognition in elders with heart failure
Riegel, Barbara, Dickson, Victoria, Cameron, Jan, Johnson, Jerry, Bunker, Stephen, Page, Karen and Worrall-Carter, Linda. (2010). Symptom recognition in elders with heart failure. Journal of Nursing Scholarship. 42(1), pp. 92 - 100. https://doi.org/10.1111/j.1547-5069.2010.01333.x
Self-Care Behaviours and Heart Failure: Does Experience with Symptoms Really Make a Difference?
Cameron, Janette, Worrall-Carter, Linda, Page, Karen and Stewart, Simon. (2010). Self-Care Behaviours and Heart Failure: Does Experience with Symptoms Really Make a Difference? European Journal of Cardiovascular Nursing. 9(2), pp. 92 - 100. https://doi.org/10.1016/j.ejcnurse.2009.10.004
The information and support needs of Faroese women hospitalised with an acute coronary syndrome
Askham, Jorun, Kuhn, Lisa, Frederiksen, Kirsten, Davidson, Patricia, Edward, Karen-Leigh and Worrall-Carter, Linda. (2010). The information and support needs of Faroese women hospitalised with an acute coronary syndrome. Journal of Clinical Nursing. 19(October), pp. 1352 - 1361. https://doi.org/10.1111/j.1365-2702.2009.03013.x
Does cognitive impairment predict poor self-care in patients with chronic heart failure?
Cameron, Janette, Worrall-Carter, Linda, Page, Karen, Riegel, Barbara, Lo, Sing Kai and Stewart, Simon. (2010). Does cognitive impairment predict poor self-care in patients with chronic heart failure? European Journal of Heart Failure. 12(5), pp. 508 - 515. https://doi.org/10.1093/eurjhf/hfq042
Theoretical considerations in reducing risk for cardiovascular diseases : Implications for nursing practice
Gholizadeh, Leila, Davidson, Patricia, Salamonson, Yenna and Worrall-Carter, Linda. (2010). Theoretical considerations in reducing risk for cardiovascular diseases : Implications for nursing practice. Journal of Clinical Nursing. 19(15-16), pp. 2137-2145. https://doi.org/10.1111/j.1365-2702.2009.03189.x
Gender-specific barriers and facilitators to heart failure self-care: A mixed methods study
Riegel, Barbara, Dickson, Victoria, Lisa, Kuhn,, Page, Karen and Worrall-Carter, Linda. (2010). Gender-specific barriers and facilitators to heart failure self-care: A mixed methods study. International Journal of Nursing Studies. 47(7), pp. 888 - 895. https://doi.org/10.1016/j.ijnurstu.2009.12.011
Recovering from an acute cardiac event- the relationship between the depression and life satisfaction.
Page, Karen, Davidson, Patricia, Edward, Karen-Leigh, Allen, Josh, Cummins, Robert, Thompson, David and Worrall-Carter, Linda. (2010). Recovering from an acute cardiac event- the relationship between the depression and life satisfaction. Journal of Clinical Nursing. 19(June), pp. 736 - 743. https://doi.org/10.1111/j.1365-2702.2009.03106.x
Awareness and causal attributions of risk factors for heart disease among immigrant women living in Australia
Gholizadeh, Leila, Salamonson, Yenna, Worrall-Carter, Linda, DiGiacomo, Michelle and Davidson, Patricia M.. (2009). Awareness and causal attributions of risk factors for heart disease among immigrant women living in Australia. Journal of Women's Health. 18(9), pp. 1385 - 1393. https://doi.org/10.1089/jwh.2008.0956
Gender differences in heart failure self-care : A multinational cross-sectional study
Lee, Christopher S., Reigel, Barbara, Driscoll, Andrea, Suwanno, Jom, Moser, Debra K., Lennie, Terry A., Dickson, Victoria V., Cameron, Jan and Worrall-Carter, Linda. (2009). Gender differences in heart failure self-care : A multinational cross-sectional study. International Journal of Nursing Studies. 46(11), pp. 1485-1495. https://doi.org/10.1016/j.ijnurstu.2009.04.004
Testing a model of patient characteristics, psychologic status, and cognitive function as predictors of self-care in persons with chronic heart failure
Cameron, Janette, Worrall-Carter, Linda, Riegel, Barbara, Lo, Sing Kai and Stewart, Simon. (2009). Testing a model of patient characteristics, psychologic status, and cognitive function as predictors of self-care in persons with chronic heart failure. Heart & Lung: the journal of acute and critical care. 38(5), pp. 410 - 418. https://doi.org/10.1016/j.hrtlng.2008.11.004
Evidence-based chronic heart failure management programs: Reality or myth?
Driscoll, Andrea, Worrall-Carter, Linda, Hare, David, Davidson, Patricia, Riegel, Barbara, Tonkin, Andrew and Stewart, Simon. (2009). Evidence-based chronic heart failure management programs: Reality or myth? BMJ Quality and Safety. 18(6), pp. 450 - 455. https://doi.org/10.1136/qshc.2008.028035
Measuring self-care in chronic heart failure: A review of the psychometric properties of clinical instruments
Cameron, Janette, Worrall-Carter, Linda, Driscoll, Andrea and Stewart, Simon. (2009). Measuring self-care in chronic heart failure: A review of the psychometric properties of clinical instruments. The Journal of Cardiovascular Nursing. 24(6), pp. E10 - E22. https://doi.org/10.1097/JCN.0b013e3181b5660f
The use of medical orders in acute care oxygen therapy
Wong, Ming and Elliott, Malcolm. (2009). The use of medical orders in acute care oxygen therapy. British Journal of Nursing. 18(8), pp. 462 - 464. https://doi.org/10.12968/bjon.2009.18.8.41808
Opting in and opting out: A grounded theory of nursing's contribution to inpatient rehabilitation
Pryor, Julie, Walker, Annette, O'Connell, Beverley and Worrall-Carter, Linda. (2009). Opting in and opting out: A grounded theory of nursing's contribution to inpatient rehabilitation. Clinical Rehabilitation. 23(12), pp. 1124 - 1135. https://doi.org/10.1177/0269215509343233
Relationship of heart failure patients' knowledge, perceived barriers, and attitudes regarding low-sodium diet recommendations to adherence
Lennie, Terry, Worrall-Carter, Linda, Hammash, M., Odom-Forren, J., Roser, L. P., Smith, C. S., Trupp, T., Chung, Misook and Moser, Debra. (2008). Relationship of heart failure patients' knowledge, perceived barriers, and attitudes regarding low-sodium diet recommendations to adherence. Progress in Cardiovascular Nursing. 23(1), pp. 6 - 11. https://doi.org/10.1111/j.1751-7117.2008.tb00525.x
Improving depression and anxiety screening of patients with heart disease: implementing a multidisciplinary Clinical Pathway
Rahman, Aziz and Worrall-Carter, Linda. (2008). Improving depression and anxiety screening of patients with heart disease: implementing a multidisciplinary Clinical Pathway [Dataset]. Australian Catholic University. https://doi.org/10.26199/acu.89yv4
The impact of an ICU liaison nurse service on patient outcomes
Elliott, Suzanne, Ernest, David, Doric, Andrea, Page, Karen, Worrall-Carter, Linda, Thalib, Lukman and Chaboyer, Wendy. (2008). The impact of an ICU liaison nurse service on patient outcomes. Critical Care and Resuscitation. 10(4), pp. 296 - 300.
Ethical dilemmas of a large national multi-centre study in Australia: Time for some consistency
Driscoll, Andrea, Currey, Judy, Worrall-Carter, Linda and Stewart, Simon. (2008). Ethical dilemmas of a large national multi-centre study in Australia: Time for some consistency. Journal of Clinical Nursing. 17(16), pp. 2212 - 2220. https://doi.org/10.1111/j.1365-2702.2007.02219.x
Returning to work: Exploring the experiences of women with acute coronary syndromes
Parry, A., Worrall-Carter, Linda, Page, Karen, Kuhn, Lisa, DiGiacomo, Michelle and Davidson, Patricia. (2007). Returning to work: Exploring the experiences of women with acute coronary syndromes. British Journal of Cardiac Nursing. 2(6), pp. 292 - 301.
Depression, anxiety and stress in women following acute coronary syndrome: Implications for secondary prevention
DiGiacomo, Michelle, Davidson, Patricia, Vanderpluym, A., Snell, R. and Worrall-Carter, Linda. (2007). Depression, anxiety and stress in women following acute coronary syndrome: Implications for secondary prevention. Australian Critical Care. 20(2), pp. 69 - 76. https://doi.org/10.1016/j.aucc.2007.03.002
Extent of heart failure self-care as an endpoint to patient education: A review of the literature
Cameron, Jan, Worrall-Carter, Linda, Driscoll, Andrea, New, G. and Stewart, Simon. (2007). Extent of heart failure self-care as an endpoint to patient education: A review of the literature. British Journal of Cardiac Nursing. 2(4), pp. 188 - 197.
Gender differences in adherence to the sodium-restricted diet in patients with heart failure
Chung, Misook, Moser, Debra, Lennie, Terry, Worrall-Carter, Linda, Bentley, B., Trupp, T. and Armentano, D.. (2006). Gender differences in adherence to the sodium-restricted diet in patients with heart failure. Journal of Cardiac Failure. 12(8), pp. 628 - 634. https://doi.org/10.1016/j.cardfail.2006.07.007
Do clinicians know how to use pulse oximetry? A literature review and clinical implications
Elliott, Malcolm, Tate, R. and Page, Karen. (2006). Do clinicians know how to use pulse oximetry? A literature review and clinical implications. Australian Critical Care. 19(4), pp. 139 - 144. https://doi.org/10.1016/S1036-7314(06)80027-5
Assessment of cognitive function in heart failure patients
Wolfe, R, Worrall-Carter, Linda, Foister, K., Keks, N. and Howe, V.. (2006). Assessment of cognitive function in heart failure patients. European Journal of Cardiovascular Nursing. 5(2), pp. 158 - 164. https://doi.org/10.1016/j.ejcnurse.2005.10.005
Heterogeneity of heart failure management programs in Australia
Driscoll, Andrea, Worrall-Carter, Linda, McLennan, Skye, Dawson, Anna, O'Reilly, J. and Stewart, Simon. (2006). Heterogeneity of heart failure management programs in Australia. European Journal of Cardiovascular Nursing. 5(1), pp. 75 - 82. https://doi.org/10.1016/j.ejcnurse.2005.08.001
Rationale and design of the national benchmarking and evidence-based national clinical guidelines for chronic heart failure management programs study
Driscoll, Andrea, Worrall-Carter, Linda and Stewart, Simon. (2006). Rationale and design of the national benchmarking and evidence-based national clinical guidelines for chronic heart failure management programs study. Journal of Cardiovascular Nursing. 21(4), pp. 276 - 282. https://doi.org/10.1097/00005082-200607000-00007
The experiences and adjustments of women following their first acute myocardial infarction
Worrall-Carter, Linda, Jones, T. and Driscoll, Andrea. (2005). The experiences and adjustments of women following their first acute myocardial infarction. Contemporary Nurse. 19(February), pp. 211 - 221.
Psychosocial issues facilitating recovery post-CABG surgery
Theobald, K, Worrall-Carter, Linda and McMurray, Anne. (2005). Psychosocial issues facilitating recovery post-CABG surgery. Australian Critical Care. 18(2), pp. 76 - 85. https://doi.org/10.1016/S1036-7314(05)80006-2
A historical review of the nurse practitioner role in Australia
Driscoll, Andrea, Worrall-Carter, Linda, O'Reilly, J. and Stewart, Simon. (2005). A historical review of the nurse practitioner role in Australia. Clinical Excellence for Nurse Practitioners. 9(3), pp. 141 - 152.
Mapping drug calculation skills in an undergraduate nursing curriculum
Elliott, Malcolm and Joyce, Joanne. (2005). Mapping drug calculation skills in an undergraduate nursing curriculum. Nurse Education in Practice. 5(4), pp. 225 - 229. https://doi.org/10.1016/j.nepr.2004.12.003
Nurse academics meeting the challenges of scholarship and research
Worrall-Carter, Linda and Snell, R.. (2003). Nurse academics meeting the challenges of scholarship and research. Contemporary Nurse. 16(February), pp. 40 - 50.