From ICU Survival to Recovery: A Somalia-Adapted Nurse-Led Home Recovery Framework after Critical Illness in Low-Resource Settings

Abdishakur Mohamud Hassan HidigowDepartment of Intensive Care Unit, Dr. Sumait Hospital, SIMAD University, Mogadishu, SomaliaCorrespondence: Abdishakur Mohamud Hassan Hidigow, Email abdishakur.hidigow@simad.edu.soAbstract: Survival from critical illness is not equivalent to recovery, particularly in low-resource health systems where ICU survivors may return home with weakness, respiratory vulnerability, medication problems, poor wound care, malnutrition, psychological distress, caregiver burden, and limited follow-up. This commentary responds to the post-ICU care gap in Somalia by proposing a Somalia-adapted nurse-led home recovery framework. The framework is not presented as a fully validated intervention, but as a pragmatic implementation model for settings where ICU beds, rehabilitation services, transport, digital access, and specialist follow-up are constrained. It defines nurse-led home care as a tiered pathway coordinated by an ICU discharge nurse, supported by ward nurses, community health workers, physicians, rehabilitation providers, and referral facilities. The model includes risk stratification, discharge preparation, caregiver education, early phone follow-up, selective home visits, multidisciplinary referral, digital communication safeguards, and outcome tracking. Key implementation issues include workforce capacity, financing, supervision, quality indicators, privacy, medico-legal responsibility, transport barriers, gendered caregiver burden, and the digital divide. Strengthening post-ICU home recovery in Somalia requires local empirical evaluation, but immediate low-cost improvements can begin through structured discharge and follow-up systems.Keywords: critical care nursing, post-intensive care syndrome, home-based care, Somalia, transitional care, patient safety