Critical Illness and Rurality: Interfacility Transfers to Urban Centres and the Impact on Rural Families

Abstract

A relative’s critical illness is an intensely stressful time for family members. In the past, it was generally assumed that family members were relatively unaffected by a relative’s admission to an intensive care unit. However, there has been increasing understanding and concern in the healthcare community that family members experience negative, long-term psychological, emotional, physical and financial consequences from this experience. In addition to these noted negative consequences, it has been suggested that the unique context of rural family members of critically ill patients may result in additional burdens. In rural areas, a critically ill patient’s healthcare needs at times exceed the service capacity of the local hospital, thereby necessitating an interfacility transfer of the patient to a distant urban centre for advanced critical care services. To date, the rural family member’s experience of this phenomenon is poorly understood, specifically within the context of North America. The purpose of this study was to gain an increased understanding of the meaning of the lived experiences for rural family members whose relative undergoes an interfacility transfer to an urban tertiary centre for advanced critical care services. Munhall’s method of interpretive phenomenology was used to guide this study. Purposive sampling strategies resulted in the recruitment of 11 participants who experienced this phenomenon. Data analysis revealed the common themes of a longing for home, a sacrifice of self, and a persistent need to be close to the critically ill patient. Unique, context-specific meanings were also revealed by analyzing data through the lenses of the four life-worlds: corporeality, relationality, spatiality, and temporality. These meanings included a sense of vulnerability in the urban centre, a reluctance to communicate with urban healthcare providers, a loss of connection to both the critically ill relative and other family members, and a need to maintain responsibilities at home while in the urban centre. Through this study, nurses may better understand the multiple possible, context-specific meanings of this experience for rural family members thereby enhancing the individualized nursing care of these family members. Specifically, rural nurses may advocate for family members to be provided telephone contact details of the transport team or be permitted to accompany their relative during transfer to maintain a sense of closeness during transport. Urban nurses may appreciate the uniqueness of both rurality as culture and the loss of supports experienced by family members during this event and, thus, offer additional supports to rural family members. This improved understanding is specifically important for urban and rural critical care nurses who are in a key position to implement interventions to mitigate additive burdens experienced by rural family members.