"Never in my mind to give up!" A qualitative study of long-term intensive care patients' inner strength and willpower-Promoting and challenging aspects.

Aims and Objectives: To explore aspects that promote and challenge long-term ICU patients' inner strength and willpower.
Background: Considerable research has been devoted to ICU patients' experiences; however, research on long-term ICU patients is limited. Studies in a health-promoting perspective focusing on long-term ICU patients' inner strength and willpower are scarce.
Design: A qualitative, hermeneutic-phenomenological approach, using in-depth interviews.
Methods: Seventeen long-term Norwegian ICU patients were interviewed once, at 6-18 months after ICU discharge. The consolidated criteria for reporting qualitative research was used (Data S1).
Results: The lived experience of the phenomenon "inner strength and willpower" and what promotes and challenges this phenomenon in long-term ICU patients were represented by four main themes and nine subthemes. Promoting aspects comprised of two main themes and five subthemes: (a) "No doubt about coming back to life" with subthemes; "Strong connectedness to life; feeling alive and present," "Meaning and purpose; feeling valuable to somebody." (b) "How to ignite and maintain the spark of life," with the subthemes: "Practical solutions, coping skills from previous life experiences," "Provocative and inspiring experiences" and "Vivid dream experiences that ignite the willpower." Two main categories and four subcategories represented challenging aspects: (a) Exhaustion, weakness and discomfort; subthemes; "Physical challenges" and "Mental discomfort" and (b) "Tiring delusions," subthemes; "Living in the worst horror movie" and "Feeling trapped."
Conclusion: This study expands on previous studies by providing insights about what promotes and challenges long-term ICU patients' inner strength and willpower during their recovery trajectory.
Relevance to Clinical Practice: Insights into the variety of long-term ICU patients' experiences during the recovery trajectory are important for ICU nurses to support and facilitate ICU patients' inner strength and willpower.
(© 2019 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.)