Strategies to Promote Resilience and Community Reintegration for Patients With New Disabilities After Critical...

Millions of people who survive critical illness each year experience new disabilities that prevent them from returning to personally meaningful participation in family and community life ("community reintegration"), which is closely intertwined with resilience. We sought to describe strategies for promoting community reintegration after critical illness as a first step toward health system and care-delivery redesign.

We used modified grounded theory to analyze semistructured interviews with patients and families.

Interviews took place by phone or videoconference in a large health system in Western Pennsylvania.

Patients who had survived critical illness (n = 11) and their family members (n = 11).

Four interrelated strategies promoted an upward spiral of community reintegration: 1) develop patient and family skills to manage symptoms of underlying impairments at home; 2) re-establish competence to perform healthy habits and routines; 3) identify and support key roles and relationships so that people stay connected even amidst change; 4) problem-solve the physical and social environments so that people can participate in meaningful activities. Progress upward described a trajectory of resilience, while backsliding downward described a trajectory of demoralization.

Four strategies promoted an upward spiral of resilience and community reintegration, and counteracted a downward spiral of demoralization. They yielded novel insights about the spectrum of demoralization versus resilience in the context of disability. Future research should develop and test interventions using these strategies to promote community reintegration as a key step toward population health after critical illness.