Psychological effects of delirium in critically ill patients often linger after they regain awareness, according to a study published in the November issue of the American Journal of Critical Care. The researchers describe the overall experience of several critically ill patients with delirium — a medical diagnosis that includes acute alteration in mental status, inattention, disorganized thinking and altered level of consciousness.
The article, “Lived Experience of the Intensive Care Unit for Patients Who Experienced Delirium,” is based on interviews with patients who lived through the experience. Delirium begins as a serious complication for up to 90% of patients who are critically ill, according to a news release.
“Delirium puts additional emotional and physical stress on a patient whose health is already compromised, and our findings demonstrate how potentially psychologically harmful ICU delirium can be,” lead author Karen Whitehorne, MN, RN, a nurse therapist at Eastern Health in St. John’s, Newfoundland, said in a news release. “The themes and their interrelationships illustrate how the person’s everyday life experiences were distorted while delirious.”
The research team interviewed 10 adult patients who had been diagnosed with delirium while in the ICU. The interviews were held after patient transfer to a medical or surgical unit from intensive care, after the patients were no longer delirious and physically and mentally able to willingly participate.
The researchers identified four overarching themes based on the participants’ personal perspectives about their experience with delirium:
• “I can’t remember” — The lack of recall about their experience was often accompanied by feelings of guilt and shame about their behavior while delirious and a wish to apologize for what occurred during the lost time.
• “Wanting to make a connection” — Participants reported feeling disconnected while delirious and unable to communicate or move, leading to frustration and fear.
• “Trying to get it straight” — Participants discussed their struggle to make sense of their experience while delirious, both during and after being in the ICU.
• “Fear and safety concerns” — Participants recalled thinking they or their family were in danger while they were delirious. These feelings of fear were compounded by unusual experiences such as hallucinations, feeling helpless and weak and being restrained. In addition, they feared a recurrence of their delirium and avoided or planned to avoid behaviors that might trigger a further episode, including refusing sleeping pills and fearing future surgery that might send them back to the ICU.
The researchers also discuss how critical care nurses are an important element to early recognition and treatment of delirium to positively influence patient outcomes.
This research was funded by the Association of Registered Nurses of Newfoundland and Labrador Education and Research Trust.
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