Interhospital intensive care unit-to-unit transfers are an increasing phenomenon, earlier mainly studied from a patient safety perspective. Using data from video recordings and participant observations, the aim was to explore and interpret the observed nature of the patient’s situation during interhospital intensive care unit-to-unit transfers. Data collection from eight transfers resulted in over 7 hours of video material and field notes. Using a hermeneutical approach, three themes emerged: being visible and invisible; being in a constantly changing space; and being a fettered body in constant motion. The patient’s situation can be viewed as an involuntary journey, one where the patient exists in a constantly changing space drifting in and out of the health personnel’s attention and where movements from the journey become part of the patient’s body. Interhospital transfers of vulnerable patients emerge as a complex task, challenging the health personnel’s ability to maintain a caring atmosphere around these patients.

Objective

To explore critical care nurses’ lived experiences of transferring intensive care patients between hospitals.

Methods

A phenomenological hermeneutic approach using data generated through individual interviews with 11 critical care registered nurses.

Setting

Two general intensive care units in Sweden.

Findings

Five themes were identified: it depends on me; your care makes a difference; being exposed; depending on interprofessional relationships; and sensing professional growth. These themes were synthesised into a comprehensive understanding showing how transferring intensive care patients between hospitals meant being on an ambivalent journey together with the patient but also on a journey within yourself in your own development and growth, where you, as a nurse, constantly are torn between contradictory feelings and experiences.

Conclusion

Interhospital intensive care unit-to-unit transfers can be a challenging task for critical care nurses but also an important opportunity for professional growth. During the transfer, nurses become responsible for the patient, their colleagues and the entire transfer process. In a time of an increasing number of interhospital intensive care unit-to-unit transfers, this study illuminates the risk for missed nursing care, showing that the critical care nurse has an important role in protecting the patient from harm and safeguarding dignified care.

Aims and objectives

To reveal meanings of family members' lived experiences when a loved one undergoes an interhospital intensive care unit‐to‐unit transfer.

Background

Interhospital intensive care unit‐to‐unit transfers take place between different hospitals and their respective intensive care units (ICUs). These types of transfers are an increasing phenomenon but are sparsely studied from the family members' perspective. Indeed, the patient's critical illness and care can have a major impact on family members. During the transfer process, there is a demand for the involved intensive care health personnel to make family members feel safe and cared for.

Design

A qualitative design based on phenomenological hermeneutics.

Methods

The study was conducted at two Swedish general ICUs. Data were generated through individual in‐depth interviews with seven family members and analysed using a phenomenological hermeneutical approach. The Criteria for Reporting Qualitative Research principles were applied in the conduct and reporting of this study.

Results

Four themes that reveal meanings of family members' lived experiences were developed: losing your safe haven, dealing with uncertainty, carrying your own and others' burdens and a wish to be close.

Conclusions

The study reveals that an interhospital intensive care unit‐to‐unit transfer affects the whole family and is characterised by family members experiencing many negative feelings. The findings also illustrate that being a family member when a loved one is transferred means being exposed to the core existential elements of being human, such as loneliness and searching for meaning.

Relevance to clinical practice

The study highlights the importance of maintaining a family‐centred approach during the transfer process. Our findings can provide deeper knowledge for intensive care health personnel, better preparing them for the delicate task of providing family‐centred care during the interhospital intensive care unit‐to‐unit transfer process.

Background

The number of patients undergoing an interhospital intensive care unit-to-unit capacity transferhas dramatically increased. These transfers are complex, pose a risk for the patients and havebeen linked to increased intensive care unit length of stay and mortality, but the reasons for thisare not known. We hypothesised that there was a difference in the incidence of missed nursingcare among patients subjected to capacity transfer compared with patients not subjected to anytransfer during their intensive care stay.

Methods

A retrospective case–control chart review was conducted on adult patients who betweenJanuary 1, 2009, and January 31, 2020, underwent an interhospital intensive care unit-to-unitcapacity transfer. We applied a matched control group by 1:2 matching. Missed nursing carewas based on four variables: mobilisation, tooth brushing, oral care and nutrition. Data wereretrieved from the local database and the patient’s medical charts at two general level 3 ICUs.

Results

The case group (n = 63) received significantly less mobilisation (p < 0.05), mean 5.94 (2.36),compared with the control group (n = 126), mean 7.74 (2.96). In a subanalysis of the patientstreated with invasive positive pressure ventilation and noninvasive positive pressure ventilation,the case group (n = 56) was found to receive significantly less oral care (p < 0.05), median 3.50(1.00–6.00), compared with the control group (n = 80), median 5.00 (2.00–7.75). None of theother variables were significantly related to interhospital intensive care unit-to-unit capacitytransfers.

Conclusion

In critically ill patients, interhospital intensive care unit-to-unit capacity transfers wereassociated with missed nursing care. Future studies, focusing on capacity transfers shouldconsider missed nursing care when the causes of increased intensive care unit length of stayand mortality are to be investigated.