On recovery: re-directing the concept by differentiation of its meanings

Rethinking 'Recovery': A Comparative Qualitative Analysis of Experiences of Intensive Care With COVID and Long Covid in the United Kingdom

INTRODUCTION

Interpretations of 'recovery' from illness are complex and influenced by many factors, not least patient expectations and experiences. This paper examines meanings of 'recovery', and how it is strived towards, drawing on the example of COVID-19 infection.

METHODS

Drawing on qualitative interviews (n = 93) conducted in the UK between February 2021 and July 2022, we compare adults' accounts of being admitted to an Intensive Care Unit (ICU) with COVID-19 to accounts of being ill with Long COVID, defined as ongoing symptoms for at least 12 weeks postinfection. We conducted a multi-stage comparative analysis using Nvivo to organise and code the data.

RESULTS

We identified similarities and differences in participants' descriptions of their 'worlds of illness'. For both groups, perceptions of recovery were shaped by the novel, unknown nature of COVID-19. Participants questioned the achievability of full restoration of prior states of health, highlighted the heterogeneity of 'recovery trajectories' and described the hard physical and emotional work of adjusting to changed selves. Themes that revealed differences in 'worlds of illness' described included the different baselines, waymarkers, and pathways of illness experiences. Differences in other people's responses to their illness were also evident. For ICU participants, hospitalisation, and especially ICU admission, conferred legitimate patient status and authenticity to their symptoms. Family, friends and healthcare professionals acknowledged their illness, celebrated their survival, and granted them latitude to recover. For Long Covid participants, their patient status often lacked comparable authenticity in others' eyes. They reported encountering a lack of recognition and understanding of their ongoing need to recover.

CONCLUSIONS

This study highlights how the meanings of illness ascribed by others can influence how recovery is experienced. Our findings highlight the importance of ensuring people are made to feel their illness experiences are legitimate, regardless of hospitalisation status, formal diagnosis or lack of medical knowledge and pathways. They also indicate the value of emphasising the different permutations, and lack of linearity, that recovery can take. This may help to help to guard against a lack of understanding for experiences of recovery which do not meet idealised notions.

PATIENT OR PUBLIC CONTRIBUTION

Both studies were guided by an advisory panel that included patient and public involvement representatives with lived experience of Intensive Care/COVID experience and Long COVID respectively. Through regular meetings with the research teams, the advisory panel had input into all aspects of the study conduct, including recruitment methods and content of the interview topic guide and feedback on preliminary analyses. The Long COVID study also included a lived experience coinvestigator who contributed to data interpretation and analysis.

Conceptual scaffolding for the philosophy of medicine

This paper consists of two parts. In the first part, I will introduce a philosophical toolbox that I call 'conceptual scaffolding,' which helps to reflect holistically on phenomena and concepts. I situate this framework within the landscape of conceptual analysis and conceptual engineering, exemplified by the debate about the concept of disease. Within the framework of conceptual scaffolding, I develop the main idea of the paper, which is 'the binocular model of plural medicine', a holistic framework for analyzing medical concepts and phenomena. In the second part, I demonstrate the use and value of the binocular model by analyzing, through the lenses of the model, the phenomenon of health wearable devices and their effects on the concept of diagnosis.

Searching for a brighter future-Lived experiences of ongoing recovery processes following COVID-19 infection

BACKGROUND

Research in Denmark indicates that approximately 30% of people with confirmed COVID-19 infection experience at least one physical symptom 6-12 months after the acute infection. The lived experiences of undergoing prolonged recovery processes and how these processes unfold need further attention.

AIM

To contribute in-depth knowledge about recovery, as experienced over time by people living with the post COVID-19 condition.

METHODS

Within a qualitative research design, nine women and six men were interviewed. Ten of them gave a follow-up interview. Prompt cards and participant-generated photographs were included. A phenomenological-hermeneutic approach inspired by Ricoeur's theory of interpretation guided the data analysis.

FINDINGS

Living with long-term health problems associated with the post COVID-19 condition involved recovery processes where participants struggled with reduced capacity, new unpredictability and uncertainty in everyday life. Participants continuously searched for improvement and aimed for regaining former health and well-being. Lack of knowledge, acknowledgement and support made it difficult to find clear directions for improvement. Participants created a protective shield and struggled, often jointly with family and friends, to cope with bodily, cognitive, emotional, existential and social challenges. Over time, some participants realised that they might not be able to fully return to their earlier habitus. However, some of them gained a new foothold and sense of hope for the future.

CONCLUSION

This study provides in-depth insight into the experience of changing and open-ended recovery processes while living with the post COVID-19 condition. Over time, some participants learned to rebuild their lives, adapting to their reduced capacities. Future care and rehabilitation models for these patients must address the complex and challenging nature of recovery processes associated with living with post-COVID-19 condition.

Getting Back on Track: Meanings of Recovery After Critical Illness Caused by COVID-19

Introduction

Being critically ill in need of intensive care, lead to a challenging way back after survival, so also for survivors of COVID-19. The process to recovery can be long.

Objectives

The aim of our qualitative study was to elucidate meanings of recovery for people who were once critically ill with COVID-19.

Method

We conducted qualitative individual interviews with 13 individuals who had been critically ill with COVID-19, following a narrative approach. The data collected from the interviews, were analyzed according to phenomenological hermeneutic interpretation.

Results

The participants, although feeling alone in the process of recovery, had willpower to return to normal life but struggled to keep pace with others. They strived for balance in everyday life and to regain strength despite being exhausted after having COVID-19. The participants were grateful for their survival but displayed a need to understand what had happened. They longed for social contact, expressed feelings of abandonment, and wished for follow-up dialogues with healthcare professionals to better understand their situation. However, because support from healthcare was insufficient, the participants ultimately needed to develop their own strategies to cope with their questions, fears, and weakness.

Conclusion

Meanings of recovery for people once critically ill with COVID-19, is to strive for balance in everyday life. In their recovery process, healthcare professionals should seek to understand what the illness means for the ill person, and in mutual understanding support them based on their needs.

The Process of Home-Visiting Nurses Supporting People with Mental Disorders

The number of people with mental disorders (PMD) living in the community is increasing; however, it is unclear how home-visiting nurses (HVNs) supporting them in the community acquire their support skills. This study aimed to reveal the process of how HVNs learn support skills for PMD. Semi-structured interviews were conducted with 14 HVNs supporting PMD living in the community. The grounded theory approach was used for data analysis. As a result, two stages were present: "Explore the personal recovery of PMD" and "Believe in the potential of PMD and accompanying them". The first stage is further divided into two themes: "Overlapping the worlds of PMD and HVNs", and "Easing difficulty in living for PMD". In the first stage, HVNs gained a better understanding of PMD and obtained insight into the support they needed in their daily lives. In the second stage, HVNs became to provide the support that PMD truly needed. HVNs gained a deeper understanding of the reality of PMD through their support. After HVNs found the support PMD required, they sought to provide it, ultimately resulting in finding ways to facilitate the personal recovery of PMD.

Inequalities in recovery or methodological artefact? A comparison of models across physical and mental health functioning

Considerable attention has been paid to inequalities in health. More recently, focus has also turned to inequalities in ‘recovery’; with research, for example, suggesting that lower grade of employment is strongly associated with slower recovery from both poor physical and poor mental health. However, this research has tended to operationalise recovery as ‘return to baseline’, and we know less about patterns and predictors when recovery is situated as a ‘process’. This paper seeks to address this gap. Drawing on data from the UK Household Longitudinal Study, we operationalise recovery as both an ‘outcome’ and as a ‘process’ and compare patterns and predictors across the two models. Our analysis demonstrates that the determinants of recovery from poor health, measured by the SF-12, are robust, regardless of whether recovery is operationalised as an outcome or as a process. For example, being employed and having a higher degree were found to increase the odds of recovery both from poor physical and mental health functioning, when recovery was operationalised as an outcome. These variables were also important in distinguishing health functioning trajectories following a poor health episode. At one and the same time, our analysis does suggest that understandings of inequalities in recovery will depend in part on how we define it. When recovery is operationalised as a simple transition from poor health state to good, it loses sight of the fact that there may be inequalities (i) within a ‘poor health’ state, (ii) in how individuals are able to step into the path of recovery, and (iii) in whether health states are maintained over time. We therefore need to remain alert to the additional nuance in understanding which comes from situating recovery as a process; as well as possible methodological artefacts in population research which come from how recovery is operationalised.

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There is no consensus on what recovery is and how it should be operationalised.

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Understanding of inequalities in recovery across health conditions remains scarce.

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We operationalised recovery both as an outcome and as a process.

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We found robust inequalities in recovery across the two approaches.

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Considering recovery as a process revealed more nuanced patterns in inequalities.