Helle Svenningsen

Patients who survive critical illness and intensive care unit (ICU) admission often experience long-lasting physical, psychological, and cognitive impairments. Cognitive impairments are common and may persist well beyond ICU discharge. Few structured interventions address these impairments across the care continuum, from the ICU to post-discharge recovery. This gap informed the development of a stakeholder-driven cognitive rehabilitation intervention. The aim was to develop a cognitive rehabilitation intervention for critically ill patients that bridges the period from ICU admission to post-discharge recovery. The intervention was developed using a multiphase process guided by the 2021 Medical Research Council (MRC) framework for complex interventions and reported in line with the GUIDED and TIDieR checklists. Stakeholder input was gathered through: (1) a workshop (n = 11) to identify end-user needs; (2) a three-round Delphi process (n = 39) to prioritise interventions using a seven-point Likert scale; and (3) expert consultations to refine selected components. Qualitative data from the workshop and open-ended Delphi responses were analysed thematically, while quantitative analysis identified consensus, defined a priori as ≥80% agreement on importance. The process generated a range of proposed interventions, including both novel and established elements. Interventions reaching stakeholder consensus were further reviewed by experts for clinical relevance and feasibility. Two prototype interventions were selected: (1) a Mindfulness-based intervention and (2) a Brain Training intervention. This study outlines a stakeholder-informed process for developing a cognitive rehabilitation intervention tailored to ICU patients across the care continuum. The co-design approach improved contextual fit and clinical applicability. These findings support the planned feasibility evaluation of the proposed interventions. The overall research study received ethics approval, while formal ethics committee approval was not required for the workshop and Delphi activities under Danish legislation (osf.io/5a4xq).

Introduction: Survivors of critical illness commonly experience physical, cognitive, and psychological impairments. Early rehabilitation may mitigate these impairments; however, how rehabilitation practices are perceived and implemented by healthcare professionals in intensive care unit (ICU) remains insufficiently described. This study aimed to describe healthcare professionals' perceptions of rehabilitation activities in the ICU and to explore their self‐reported estimates of the time devoted to these activities in Scandinavian ICUs. Methods: A cross‐sectional survey was conducted among healthcare professionals working in ICUs in Denmark, Norway, and Sweden. Using convenience sampling, data were collected on rehabilitation activities, time allocation, timing of initiation, and availability of post‐ICU rehabilitative services. Results: In total, 518 healthcare professionals participated. Rehabilitation was described as a multidimensional practice encompassing cognitive, sensory stimulation, physical, and social rehabilitation activities, as well as patient participation in personal care. Activities were typically performed daily throughout the ICU stay. Respondents reported spending a median of 40% of their working time on rehabilitation, and most patients were considered eligible. Commonly reported activities included verbal interaction, sitting on the edge of the bed, family visits, and participation in personal care. Conclusion: Rehabilitation is an established component of ICU care in Scandinavia and is integrated into routine clinical practice. Activities span multiple domains, with physical and social rehabilitation activities being most prominent. Further research is needed to clarify optimal timing and prioritisation of rehabilitation activities. Editorial Comment: This survey study presents perceptions from ICU personnel of how rehabilitation activities tend to be implemented in their workplace. Through different means, rehabilitation efforts are described as established in ICU practice in the three Scandinavian countries which were sampled.

Background: Intensive care unit (ICU) admissions are highly stressful for both patients and their relatives. Many patients develop post‐intensive care syndrome (PICS), which includes physical, mental, cognitive and social impairments complicating recovery. Relatives involved in the critical illness trajectory may develop PICS‐family (PICS‐F). Despite healthcare support, relatives continue to experience stress. Understanding their experiences is essential to improve family‐centred care during and after ICU. Aim: The aim of this study was to explore relatives' experiences of being a relative throughout the pathway from the ICU to home. Study Design: This qualitative study employed a phenomenological‐hermeneutic approach inspired by Ricoeur. We conducted semi‐structured interviews with 15 relatives during the ICU stay and at three‐ and six‐month follow‐ups. The Consolidated Criteria for Reporting Qualitative Research checklist was applied. Results: Three themes emerged: (1) Relatives during the ICU—living in two worlds with fear of missing out: Relatives felt torn between hospital and home, overwhelmed by stress and fear of missing crucial moments; (2) Relatives in transitions—a new stage marked by uncertainty: The relatives assumed major responsibilities with limited information; and (3) Returning home—a prolonged, seemingly never‐ending journey: Caregiving continued as the relatives adapted to a changed everyday life. Across all phases, relatives described a heavy burden, vulnerability and emotional strain. Conclusions: Relatives navigate two demanding worlds—the high‐stress ICU environment and home—resulting in exhaustion, stress and isolation. Transitioning home brings uncertainty, as caregiving roles expand with little support. Structured, long‐term support and family‐centred care are essential to reduce anxiety and improve outcomes for patients and relatives. Relevance to Clinical Practice: Relatives require structured, continuous support and clear communication throughout ICU recovery. Future research should develop strategies to reduce the burden of PICS‐F and enhance family post‐ICU support. Study Registration: It was registered with the legal office of the Central Denmark Region (file no. 1‐16‐02‐286‐21).