Finally going home! After a serious accident, the patient is able to leave the intensive care unit. Now the worst is over, and her old life is waiting for her - or so she thinks. But the old life is gone: the patient suffers from nightmares and can no longer sleep, and she can no longer cope at work because she is unable to concentrate. She tries to deal with her problems on her own - after all, she has been through so much, and now she is failing at everyday life? To better prepare patients for this situation in the future, nursing scientist Tabea Rosenthal is now launching a research project as part of her doctorate at Hamburg University of Applied Sciences (HAW Hamburg), in cooperation with BG Klinikum Hamburg.
Nothing Is the Same as Before
After a serious accident or severe illness requiring treatment in an intensive care unit, things are often no longer the same as they were before. Physical and psychological consequences frequently remain, making a return to everyday life difficult, if not impossible. And severely injured patients do not leave the hospital after just a few days - they often remain in intensive care for weeks or months. This time, too, leaves its mark. What exactly these effects look like has so far not been sufficiently researched. In her doctoral project, Tabea Rosenthal is therefore investigating the consequences of intensive care treatment and their impact on patients’ quality of life.
Rosenthal completed her master’s degree in the part-time nursing program at HAW Hamburg while simultaneously working as a nurse in the intensive care units of BG Klinikum. She is a qualified nurse and continues to care for patients during her doctorate. As a result, she is not only deeply rooted in the reality of the nursing profession and the everyday lives of intensive care patients, but also very close to the subject of her research project: over the next three years, she will survey former intensive care patients from BG Klinikum three times during the first year after their discharge.
The aim of Rosenthal’s work is to collect data on how patients’ health - psychological, cognitive, physical, and social - develops after discharge from intensive care. Based on these findings, she hopes to derive recommendations on what can be changed in intensive care units to better prepare people for their return to everyday life.
“I Want to Know: How Are People Doing?”
“Of course, it is crucial to save patients’ lives,” says Tabea Rosenthal. “But as a nurse, I also want to know: HOW do they live? How are they really doing?” She says that the long-term consequences associated with prolonged stays in intensive care cannot simply be ignored.
Rosenthal completed a dual-study bachelor’s degree in nursing science and qualified as a registered nurse at the University of Health in Bochum, and has worked in nursing ever since. “As nurses, we are close to our patients all day long. I found that very impressive from the very beginning,” she recalls of her motivation for choosing the profession. “And in intensive care medicine, I care for them so closely that at some point I know every movement, every blood value. Here, I always feel that I can be very effective as a nurse.” At the same time, she found academic work during her studies very fulfilling. After completing her bachelor’s degree, she wanted to further qualify and therefore enrolled in the master’s program in nursing at HAW Hamburg, where she was enthusiastic about “the close integration of science and clinical practice.” Her doctorate is part of the project “go-2-prof:in,” which aims to recruit and develop new candidates for professorships at HAW Hamburg (see info box at the end of the text).
“I Believe Many Patients Are Interested in Participating”
Post-Intensive Care Syndrome is the umbrella term for all the consequences that can result from prolonged intensive care treatment. “I had already completed three years of training and gained my first experience in intensive care before I heard for the first time that what we do here has long-term consequences for people,” Tabea Rosenthal explains. She now wants to examine this collective diagnosis more closely.
Her project is designed to run for three years. At present, she is developing questionnaires that will be sent to patients immediately after discharge, again after six months, and once more after twelve months. In addition, Rosenthal is planning interviews with discharged patients about their experiences: “I believe that many patients are interested in learning more about themselves and their symptoms. And by participating, they are also contributing to improvements.”
Rosenthal takes a realistic view of the scope for change in intensive care units: “You can’t optimize all factors. Much of what happens is simply necessary to ensure survival. But there are things that can be improved.” For example, intensive care patients often sleep poorly: “The lights are frequently on because of necessary treatments, and there are many noises. Of course, patients are also in pain. And often they can communicate only to a limited extent, for example because mechanical ventilation is required.”
“Friendships Change, Families Too”
The physical consequences of intensive care treatment can include muscle weakness due to prolonged physical inactivity, making it difficult, for example, to walk longer distances. Patients report problems with attention and memory and have difficulty concentrating. Anxiety, depression, and post-traumatic stress disorder can also occur.
“And then there are the social consequences,” Rosenthal adds. “Friendship circles change. Families change too. If former intensive care patients are no longer able to work as they did before - because they are no longer physically or psychologically capable, or simply cannot concentrate anymore - that affects their income. And if the person treated in intensive care was the main breadwinner of a family, this has financial consequences for the entire family. That, in turn, affects the role of the discharged person.”
Growing Awareness of Long-Term Consequences
Tabea Rosenthal hopes for solid data that can be used to prepare intensive care patients and their relatives for these potential challenges after discharge. “When I talk to patients in intensive care now, I still have little concrete support to offer them. I can only say: maybe this or that will happen.” Ideally, she would like to tell them that they can reach out if they actually experience difficulties: “It would be great if an interdisciplinary team could be put together and consultation hours offered so that patients can continue to receive care after discharge.”
At least, she says, this important topic is now receiving increasing attention. During the COVID-19 pandemic, large amounts of data on intensive care treatment began to be collected. The long-term consequences are also increasingly coming into focus: at the Charité in Berlin, for example, there is an outpatient clinic for patients after intensive care therapy. Rosenthal sees one reason for this in the fact that intensive care medicine has become increasingly effective. “We can now help people who would not have had a chance 20 or 30 years ago,” she explains. “But that also means there are more and more people with corresponding long-term complications.” And these complications generate costs: “That is certainly another factor why research in this area is attracting greater interest.”
