"A little brainpower goes a long way". Patient and family experience of early cognitive rehabilitation in critical illness: an interview study.

Résumé

BACKGROUND: As survival after critical illness improves, attention has shifted toward cognitive and functional recovery. Cognitive impairment affects a large proportion of ICU survivors and may persist for years. While early rehabilitation interventions show promise, little is known about how patients and families perceive cognitive rehabilitation.AIM: To describe the patient and family experience of early cognitive rehabilitation in and after ICU, their perceived understanding of the impact on recovery, and to describe perceived facilitators and barriers to early cognitive rehabilitation.DESIGN: A qualitative descriptive interview study.METHOD: This study was conducted at a tertiary university hospital ICU in Denmark. Seventeen patients and five family caregivers participated in semi-structured individual, dyad, or focus group interviews. Data were analysed using the Framework method. Patient and public involvement supported study design and analysis.FINDINGS: Two overarching themes were identified: Cognitive stimulation and Rehabilitation organisation. Participants described small, everyday actions, such as conversation, music, personal care, or sensory cues, supported orientation, cognition, and recovery. Cognitive rehabilitation was embedded in basic care and framed as a gradual reawakening of bodily and cognitive capacities. Rehabilitation efforts were often experienced as fragmented or invisible, particularly during transitions between care settings.CONCLUSION: Cognitive rehabilitation was experienced as embedded in everyday interactions that supported orientation, memory, and meaning-making. These findings highlight the need for integrated, person-centered approaches that extend from the ICU across the recovery trajectory.IMPLICATIONS FOR CLINICAL PRACTICE: This study shows that patients and family experience cognitive rehabilitation as part of everyday interactions and relational care in ICU. Strengthening person-centered approaches that foster orientation, memory, and meaning-making may improve continuity and recovery across the ICU trajectory. Cognitive rehabilitation embedded in routine nursing care could be more explicitly recognised. ICU education and orientation programmes may support nurses in identifying everyday care activities as opportunities for cognitive stimulation.