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Title: Life after a critical incident in hospital: An exploration of impact
Author: Williams, Suasn Lecky
ISNI:       0000 0001 3569 5269
Awarding Body: University of Ulster
Current Institution: Ulster University
Date of Award: 2008
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Though the psychological outcome of various potentially traumatic medical events have been studied, as well as a plethora of critical incidents not occurring in hospital, no study has yet examined the psychological outcome of unanticipated life threats in hospital, irrespective of presumed cause. Furthermore, most of these other studies have been designed to use quantitative measures which fail to capture the overall nature of the psychological response to these potentially traumatic events. This investigation seeks to explore the nature of the impact of unanticipated life threats which occur after a patient is admitted into hospital for other non-life-threatening reasons. These participants were recruited through admissions summaries in a regional intensive care unit. After giving informed consent, patients were interviewed as soon as possible after the event, and around one year later offered the option of a follow-up interview. Although nine· patients were recruited, only six were deemed to meet the inclusion criteria. In the end, because of the superabundance of material entailed in the methodological approach, only five of those patients were included in the final presentation. Two of those five were not seen in follow-up interviews. Although a quantitative measure (the Impact of Event Scale) was used, in the end it played merely a facilitative role in the unstructured interviews which yielded a wealth of voice data for analysis. The methodological approach blended three qualitative methodologies to provide multiple lenses for analysis. Discourse analysis offered a critical approach which highlighted contextual influences from the interview on participant speech. While this approach focused on fragments of language, narrative 'analysis examined larger units of talk devoted to participants' accounts of events. Narrative identity processing theory illuminated the extent to which a story had developed in relation to various dimensions of coherence. Understandings gained from close attention to language and narrative construction were then deployed in the phenomenological rendering of the lived experience of each participant. This rendering facilitated an indwelling which further facilitated hermeneutical understandings, and so on, so that an iterative, dialectical process of interpretation was engaged. Although the five individuals selected had unique 'experiences expressed in distinctive data sets, clear patterns emerged. Firstly, significant life disruption in all cases was made evident in both the content and structure of narrative constructions of the meaning of experience. The ways they resolved that disruption were revealed in narrative processing which was illuminated by the narrative analysis. Major problems in constructing a narrative were caused by factors which typically affect intensive care patients. Firstly, they encountered obstacles in gathering the information they needed to begin the construction of their stories. But on top of that, unconsciousness as well as disorientation left patients with numerous gaps to fill. Secondly, because of the lack of an interpretive framework, patients found it difficult to make sense of what happened to them. These difficulties hindered narrative construction which meant the distress from their critical incidents could not in the first instance be properly understood and therefore could never be resolved or transformed. Those who successfully gathered information about what had occurred and then integrated that data with personal sensory material, went on to achieve temporal and causal coherence, and could further elaborate their stories into thematically and autobiographically coherent narratives. One participant then achieved a positive transformation of his narrative so that his profoundly 'traumatisin' experience' was reconstructed into an opportunity for personal growth and greater well-being. Two participants who failed to develop coherent narratives showed no signs of positive transformation one year and eighteen months after the event. Risk factors for poor psychological outcome, such as peritraumatic dissociation, were also identified in the data which further contributed to an understanding of the impact of these events. Two contributions in particular are suggested by these findings. Firstly, the novel blend of methodologies achieved a rich, multidimensional understanding of the impact of these events. Secondly, the application of narrative processing theory to these patients would suggest a wider application to intensive care patients in general who would characteristically struggle with the same obstacles to narrativisation found in this investigation. Future investigations could test the usefulness of that application for leU patients.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available