Doctoral Dissertation Research: A Syndrome of Care: The New Sciences of Survivorship at the Frontier of Medical Rescue

这项博士论文研究改进拨款支持一项专注于危重护理医学的研究。越来越多的美国人在重症监护病房(ICU)接受护理，ICU是专门为病情最严重的患者服务的医院区域，其工作人员是接受过重症监护医学高级培训的医疗团队。重症监护的科学和实践的进步提高了ICU患者的存活率。然而，一些患者在入住ICU后会经历一段较长的健康不良时期，这不仅是由于疾病造成的，也是由于干预的副作用造成的。例如，患者可能会因镇静中使用的麻痹药物或创伤后应激症状而遭受持续性肌肉无力。这些副作用跨越健康的身体、认知和情感领域，统称为重症监护后综合症。这种综合征可能会阻止前ICU患者重返工作场所和家庭生活。然而，目前仍不清楚如何以及由谁来处理危重护理的医疗和社会影响。该项目将产生以患者和家庭为中心的行动建议，以解决和减轻重症监护后综合症。该项目的首要目标是了解医疗专业人员和卫生系统如何应对ICU幸存者接受重症监护的后果。ICU中的医护人员如何将他们的目标和实践从短期救援扩展到解决与重症监护后综合征相关的长期结果？ICU后需要设计哪些新的纵向护理形式？这种综合症揭示了美国卫生系统背后的价值观、优先事项和挑战是什么？虽然临床医生和患者都希望康复，但对于康复意味着什么以及它是如何经历的，仍然存在不确定性。在追踪ICU生存如何通过护理实践、医疗保健政策和患者经验进行转变的过程中，该项目对医疗救援以外的恢复做出了新的理解，这将有助于为医疗保健的改善提供信息。该奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

This doctoral dissertation research improvement grant supports a study that focuses on critical care medicine. Increasing numbers of Americans are experiencing care within Intensive Care Units (ICUs), which are hospital areas dedicated to the sickest patients and staffed by healthcare teams with advanced training in critical care medicine. Progress in the science and practice of critical care has improved survival among ICU patients. Yet some patients experience an extended period of ill-health after their ICU stay that is caused not only by illness but also by side-effects of interventions. For example, patients can suffer lasting muscle weakness from paralytic medicines used in sedation or symptoms of post-traumatic stress. These side-effects, which span physical, cognitive, and emotional domains of health, are collectively called Post-Intensive Care Syndrome. This syndrome can prevent former ICU patients from returning to their workplaces and family lives. However, it remains unclear how and by whom the medical and social ramifications of critical care can be addressed. This project will result in patient- and family-centered proposals for action to address and mitigate Post-Intensive Care Syndrome. The overarching goal of this project is to understand how medical professionals and health systems can address the consequences of intensive medical care among ICU survivors. How do healthcare workers in ICUs expand their goals and practices from short-term rescue to address the longer-term outcomes associated with Post-Intensive Care Syndrome? What new forms of longitudinal care for patients after the ICU need to be engineered? What does this syndrome reveal about the values, priorities, and challenges that underlie American health systems? While clinicians and patients alike hope for recovery, uncertainty remains about what recovery means and how it is experienced. In tracing how ICU survivorship is transformed through care practices, healthcare policy, and patient experience, this project contributes new understandings of recovery beyond medical rescue that will help to inform healthcare improvement.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.