From Threatening Chaos to Temporary Order through a Complex Process of Adaptation: A Grounded Theory Study of the Escalation of Intensive Care during the COVID-19 Pandemic

Camilla Göras, Malin Lohela-Karlsson, Markus Castegren, Emelie Condén Mellgren, Mirjam Ekstedt and Petronella Bjurling-Sjöberg ()
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Camilla Göras: Department of Caring Sciences, Faculty of Health and Occupational Sciences, University of Gävle, SE-801 76 Gävle, Sweden
Malin Lohela-Karlsson: Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, SE-752 37 Uppsala, Sweden
Markus Castegren: Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
Emelie Condén Mellgren: Centre for Clinical Research Västmanland, Uppsala University, SE-721 89 Västerås, Sweden
Mirjam Ekstedt: Department of Health and Caring Sciences, Linnaeus University Kalmar/Växjö, SE-392 31 Kalmar, Sweden
Petronella Bjurling-Sjöberg: Centre for Clinical Research Sörmland, Uppsala University, SE-631 88 Eskilstuna, Sweden

IJERPH, 2023, vol. 20, issue 21, 1-22

Abstract: To ensure high-quality care, operationalize resilience and fill the knowledge gap regarding how to improve the prerequisites for resilient performance, it is necessary to understand how adaptive capacity unfolds in practice. The main aim of this research was to explain the escalation process of intensive care during the first wave of the pandemic from a microlevel perspective, including expressions of resilient performance, intervening conditions at the micro-meso-macrolevels and short- and long-term consequences. A secondary aim was to provide recommendations regarding how to optimize the prerequisites for resilient performance in intensive care. A grounded theory methodology was used. First-person stories from different healthcare professionals (n70) in two Swedish regions were analyzed using the constant comparative method. This resulted in a novel conceptual model (including 6 main categories and 24 subcategories), and 41 recommendations. The conclusion of these findings is that the escalation of intensive care can be conceptualized as a transition from threatening chaos to temporary order through a complex process of adaptation. To prepare for the future, the components of space, stuff, staff, system and science, with associated continuity plans, must be implemented, anchored and communicated to actors at all levels of the system.

Keywords: adaptive capacity; COVID-19; grounded theory; healthcare; intensive care; resilience; resilient performance; surge response; unexpected crises (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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