Patients who experienced delirium while being treated in an intensive care unit (ICU) shared their personal stories of the distorted reality associated with delirium with researchers from Eastern Health in St. John's, Newfoundland, Canada, and the School of Nursing, Memorial University of Newfoundland, Canada.
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 – in a study published in the November issue of the American Journal of Critical Care (AJCC).
The article, "Lived Experience of the Intensive Care Unit for Patients Who Experienced Delirium," aims to improve clinicians' understanding of delirium and enable them to help their patients address ongoing concerns and emotional strain.
For the study, the research team interviewed 10 adult patients who had been diagnosed with delirium while in the ICU. The interviews were held following 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. Some patients later reviewed the thematic summary of interviews, and participated in a follow-up phone conversation, reflecting further upon their experience.
The researchers identified four overarching themes based on the participants' personal perspectives about their experience with delirium.
The themes:
> "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. Vivid hallucinations, disorganized thinking and periods of disorientation made it difficult to differentiate between reality and delirium.
> "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.
> "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," said lead author Karen Whitehorne, RN, MN, CPMHN(c), a nurse therapist at Eastern Health. "The themes and their interrelationships illustrate how the person's everyday life experiences were distorted while delirious."
The researchers also discuss how critical care nurses are an important element to early recognition and treatment of delirium to positively influence patient outcomes. In addition, they can help patients and families learn about and deal with the psychological effects of the ICU experience.
This research was funded by the Association of Registered Nurses of Newfoundland and Labrador Education and Research Trust.
The American Association of Critical-Care Nurses (AACN), which publishes AJCC, offers resources and tools to help nurses assess and manage delirium, including an evidence-based AACN Practice Alert and a recorded presentation from the AACN Critical Care Webinar Series. For more information about delirium, visit www.aacn.org.
The website www.ICUdelirium.org serves as a repository of delirium teaching materials and assessment tool implementation materials, including downloadable information and videos.
To access the article and its full-text PDF, visit the AJCC website at
www.ajcconline.org.