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Su LJ, Chen MJ, Yang R, Zou H, Chen TT, Li SL, Xin HN, Hu RF. Investigating the correlation of delirium after cardiac surgery with memories and posttraumatic stress disorder consequences of intensive care unit: A prospective cohort study. Intensive Crit Care Nurs 2024; 82:103632. [PMID: 38290221 DOI: 10.1016/j.iccn.2024.103632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/11/2024] [Accepted: 01/20/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES To explore the differences in post-intensive care unit memory and posttraumatic stress disorder symptoms between patients with and without delirium, and assess the correlations between the two. DESIGN Prospective cohort observation study. SETTING A cardiac intensive care unit of a tertiary hospital in China. We enrolled 318 consecutive patients after cardiac surgery between December 2017 and March 2019. MAIN OUTCOME MEASURES Delirium was assessed using the Confusion Assessment Method for the ICU from intensive care unit admission to discharge. Intensive care unit memory was assessed using the ICU-Memory Tool through face-to-face interviews one week after discharge. Posttraumatic stress disorder was measured telephonically using the Impact of Events Scale-revised questionnaire at three months post-discharge. RESULTS Eighty patients each in the delirium and non-delirium groups were enrolled for follow-up interviews. Patients with delirium had vaguer memories of pre-intensive care unit admission and of their stay, and recollected more memories of feelings (vs. without delirium). Posttraumatic stress disorder was diagnosed in 14 patients with and in seven without delirium, with non-significant differences between groups. Delirium did not influence post-intensive care unit factual, feeling, and delusional memories, nor posttraumatic stress disorder and hyperarousal, intrusion, and avoidance. The memories of feelings were positively correlated with the last three (r = 0.285, r = 0.390 and r = 0.373, respectively). CONCLUSION Patients with delirium had vague intensive care unit memories. Memories of feelings were positively correlated with symptoms of hyperarousal, intrusion, and avoidance. Delirium did not influence factual, feeling, or delusional memories nor posttraumatic stress disorder incidence and symptoms. IMPLICATIONS FOR CLINICAL PRACTICE Interventions are needed to reduce the impact of vague memory in patients with post-intensive care unit delirium. Memories of feelings should be focused on because of their correlation with hyperarousal, intrusion, and avoidance. Delirium prevention and early recognition measures are suggested.
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Affiliation(s)
- Li-Jing Su
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
| | - Mei-Jing Chen
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
| | - Rong Yang
- Follow-Up Center, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, China
| | - Hong Zou
- Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, China
| | - Ting-Ting Chen
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
| | - Sai-Lan Li
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, China
| | - Hui-Ning Xin
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province 350001, China.
| | - Rong-Fang Hu
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China.
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Hadler RA, Weeks S, He Y, Fraer M, Dexter F. Dignity-related distress and recall among alert, non-delirious critically ill patients. Palliat Support Care 2024:1-5. [PMID: 38736418 DOI: 10.1017/s1478951524000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
OBJECTIVES Critical illness is associated with multiple undesired impacts, including residual psychological distress, frequently associated with recollections of critical illness. Dignity-related distress is highly prevalent among the one-fifth of critically ill patients who are alert. The distress may be associated with unpleasant recollections of care. We examined whether patients at risk for dignity-related distress had recall of their reported distress approximately 1 week after assessment and whether this recall differed from another high-risk group, specifically patients undergoing dialysis for end-stage renal disease. METHODS The prospective cohort study included patients with critical illness and patients with end-stage renal disease enrolled from intensive care units (ICUs) and dialysis units at 1 academic center. Distress was assessed using the Patient Dignity Inventory (PDI). Participants received in-patient or telephonic follow-up 7-10 days after the initial interaction. Follow-up encounters focused on recollection of key aspects of the interpersonal interaction as well as the content of the PDI. RESULTS A total of 32 critically ill patients participated in initial assessment and follow-up. In total, 26 dialysis patients participated in both phases. The groups' demographics differed. Fifty percent (n = 16) of critically ill patients and 58% (n = 15) of dialysis patients reported a mean score per item of >1.6, corresponding with severe distress on the PDI. Among the ICU patients, the 95% upper 2-sided confidence interval for the median level of recall was commensurate with the participant having had no recall of the initial interview beyond remembering that there was an interview. The end-stage renal disease group did not demonstrate significantly better recall. SIGNIFICANCE OF RESULTS Dignity-related distress is high in both critically ill patients and those with end-stage renal disease; however, recollection of assessment is poor in both groups. Any intervention designed to mitigate dignity-related distress will need either to be immediately deployable or not to be reliant upon recollection for impact.
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Affiliation(s)
- Rachel A Hadler
- Department of Anesthesiology, Emory University, Atlanta, GA, USA
- Emory Critical Care Center, Emory University, Atlanta, GA, USA
- Department of Geriatrics and Extended Care, Division of Palliative Medicine, Atlanta VA Medical Center, Decatur, GA, USA
| | - Seth Weeks
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Yifan He
- Department of Anesthesiology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Mony Fraer
- Division of Nephrology, Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Franklin Dexter
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Sutton L, Bell E, Every-Palmer S, Weatherall M, Skirrow P. Survivorship outcomes for critically ill patients in Australia and New Zealand: A scoping review. Aust Crit Care 2024; 37:354-368. [PMID: 37684157 DOI: 10.1016/j.aucc.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Impairments after critical illness, termed the post-intensive care syndrome, are an increasing focus of research in Australasia. However, this research is yet to be cohesively synthesised and/or summarised. OBJECTIVE The aim of this scoping review was to explore patient outcomes of survivorship research, identify measures, methodologies, and designs, and explore the reported findings in Australasia. INCLUSION CRITERIA Studies reporting outcomes for adult survivors of critical illness from Australia and New Zealand in the following domains: physical, functional, psychosocial, cognitive, health-related quality of life (HRQoL), discharge destination, health care use, return to work, and ongoing symptoms/complications of critical illness. METHODS The Joanna Briggs Institute scoping review methodology framework was used. A protocol was published on the open science framework, and the search used Ovid MEDLINE, Scopus, ProQuest, and Google databases. Eligible studies were based on reports from Australia and New Zealand published in English between January 2000 and March 2022. RESULTS There were 68 studies identified with a wide array of study aims, methodology, and designs. The most common study type was nonexperimental cohort studies (n = 17), followed by studies using secondary analyses of other study types (n = 13). HRQoL was the most common domain of recovery reported. Overall, the identified studies reported that impairments and activity restrictions were associated with reduced HRQoL and reduced functional status was prevalent in survivors of critical illness. About 25% of 6-month survivors reported some form of disability. Usually, by 6 to12 months after critical illness, impairments had improved. CONCLUSIONS Reports of long-term outcomes for survivors of critical illness in Australia highlight that impairments and activity limitations are common and are associated with poor HRQoL. There was little New Zealand-specific research related to prevalence, impact, unmet needs, ongoing symptoms, complications from critical illness, and barriers to recovery.
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Affiliation(s)
- Lynsey Sutton
- Clinical Nurse Specialist, Wellington Intensive Care Unit, Wellington Regional Hospital, Te Whatu Ora Capital, Coast and Hutt Valley, Riddiford Street, Newtown, Wellington 6021, New Zealand; Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Elliot Bell
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand.
| | - Paul Skirrow
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
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Rashidi E, Razban F, Asadi N. The effect of nurse-initiated diary intervention on posttraumatic stress disorder and recall of memories in ICU survivors: a randomized controlled trial. BMC Psychiatry 2024; 24:158. [PMID: 38388884 PMCID: PMC10885524 DOI: 10.1186/s12888-024-05581-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 02/03/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Patients' recall of memories from the ICU plays an important role in the occurrence of post-traumatic stress disorder. This study aimed to determine the effect of nurse-initiated diary intervention on post-traumatic stress disorder and recall of memories in ICU survivors. METHODS This RCT study included all patients admitted to two trauma ICUs in Southeast of Iran. Thirty patients considered in control and intervention groups. Data collection tools included the Impact of Events Scale-Revised (IES-R), and the ICU Memory Tool (ICU-MT). The researcher wrote daily diaries of the intervention and control groups during the first 72 h of their admissions. SPSS25 was used to analyze the data. RESULTS The total mean PTSD score in the intervention group was significantly lower than that in the control group (p > 0.0001, z = -3.75). The number of those in the intervention group who clearly recalled their admission to hospital, their hospital stay before being admitted to the ICU and all memories from the ICU stay, was more than those in the control group; this difference was statistically significant (p > 0.0001). CONCLUSION The results showed that the nurse-initiated diary was effective on the PTSD and recall clear memories of patients admitted to the ICU. We suggest medical and educational centers to use this intervention in order to reduce the posttraumatic stress disorder in these patients. As nurse-initiated diary intervention had no significant difference in the recall of different types of memories from the ICU, we require further studies in this field.
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Affiliation(s)
- Elham Rashidi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Farideh Razban
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Neda Asadi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.
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Pozzi M, Ripa C, Meroni V, Ferlicca D, Annoni A, Villa M, Strepparava MG, Rezoagli E, Piva S, Lucchini A, Bellani G, Foti G. Hospital Memories and Six-Month Psychological Outcome: A Prospective Study in Critical Ill Patients with COVID-19 Respiratory Failure. J Clin Med 2023; 12:jcm12093344. [PMID: 37176785 PMCID: PMC10179721 DOI: 10.3390/jcm12093344] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
ICU survivors suffer from various long-term physical and psychological impairments. Memories from the critical illness may influence long-term psychological outcome. In particular, the role of ICU memories in COVID-19 critically ill patients is unknown. In a prospective observational study, we aimed to investigate patients' memories from the experience of critical illness and their association with a six-month psychological outcome involving quality of life evaluation. Patients' memories were investigated with ICU Memory tool, while psychological outcome and quality of life were evaluated by means of a battery of validated questionnaires during an in-person interview at the follow-up clinic. 149 adult patients were enrolled. 60% retained memories from pre-ICU days spent on a general ward, while 70% reported memories from the in-ICU period. Delusional memories (i.e., memories of facts that never happened) were reported by 69% of patients. According to a multivariable analysis, the lack of pre-ICU memories was an independent predictor of worse psychological outcomes in terms of anxiety, depression and Post-traumatic Stress Disorder (PTDS). Factors associated with long-term outcome in ICU survivors are not still fully understood and patients' experience during the day spent before ICU admission may be associated with psychological sequelae.
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Affiliation(s)
- Matteo Pozzi
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Claudio Ripa
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Valeria Meroni
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Daniela Ferlicca
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Alice Annoni
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Marta Villa
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | | | - Emanuele Rezoagli
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, 25123 Brescia, Italy
| | - Alberto Lucchini
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Giacomo Bellani
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Giuseppe Foti
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
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Muacevic A, Adler JR, Gu B. Frequency of Follow-Up Assessment for Post-Intensive Care Syndrome Among Alert and Non-Delirious Critically Ill Patients. Cureus 2022; 14:e32027. [PMID: 36600854 PMCID: PMC9800000 DOI: 10.7759/cureus.32027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Many patients surviving critical illness develop post-intensive care syndrome, a constellation of psychological, physical, and cognitive symptoms which can have long-term consequences. Physicians and nurses at our large rural teaching hospital treat many of the critically ill patients in the state. Our focus has been the subset of these critically ill patients who were alert and not delirious for multiple consecutive days. The goal of our retrospective cohort study was to estimate the percentage of the patients with multiple intensive care unit days alert and not delirious who had follow-up assessments for post-intensive care syndrome within 15 months. METHODS The inclusion criteria for the case series of randomly selected patients were: adults defined as patients aged >17 years on the date of hospital admission between October 2014 and December 2020, present in a critical care unit at noon one day and continually so for another 48 hours, and for that interval, ≥≥48 hours had every Riker sedation-agitation scale "4, calm and cooperative," as well as either all Confusion Assessment Method for the Intensive Care Unit scores negative (i.e., no delirium) or Delirium Observation Screening Scale <3 (i.e., no delirium). Each patient was then categorized as having a full one-year follow-up if there was an encounter at our hospital between 12 and 15 months after the last date meeting study inclusion criteria. All follow-up appointments completed within 15 months of the index intensive care unit stay were screened for systematic assessment for psychological and cognitive sequelae of critical illness. RESULTS From a manual chart review of 366 records, 73 patients were found with follow-up ≥≥12 months. There were 21% (15/73) of the patients assessed for post-intensive care syndrome sequelae (99% confidence interval 10%-35%). CONCLUSIONS The fact that far fewer than half the patients had documented assessments suggests that retrospective studies should not be used to judge the incidence of post-intensive care syndrome at our hospital. Prospective observational studies would be needed to judge outcomes among critically ill patients with multiple consecutive days of alert and without delirium.
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Cyr S, Guo DX, Marcil MJ, Dupont P, Jobidon L, Benrimoh D, Guertin MC, Brouillette J. Posttraumatic stress disorder prevalence in medical populations: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 69:81-93. [PMID: 33582645 DOI: 10.1016/j.genhosppsych.2021.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE PTSD is increasingly recognized following medical traumas although is highly heterogeneous. It is difficult to judge which medical contexts have the most traumatic potential and where to concentrate further research and clinical attention for prevention, early detection and treatment. The objective of this study was to compare PTSD prevalence in different medical populations. METHODS A systematic review of the literature on PTSD following medical traumas was conducted as well as a meta-analysis with final pooled result and 95% confidence intervals presented. A meta-regression was used to investigate the impact of potential effect modifiers (PTSD severity, age, sex, timeline) on study effect size between prevalence studies. RESULTS From 3278 abstracts, the authors extracted 292 studies reporting prevalence. Using clinician-administered reports, the highest 24 month or longer PTSD prevalence was found for intraoperative awareness (18.5% [95% CI=5.1%-36.6%]) and the lowest was found for epilepsy (4.5% [95% CI=0.2%-12.6%]). In the overall effect of the meta-regression, only medical events or procedures emerged as significant (p = 0.006) CONCLUSION: This review provides clinicians with greater awareness of medical contexts most associated with PTSD, which may assist them in the decision to engage in more frequent, earlier screening and referral to mental health services.
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Affiliation(s)
- Samuel Cyr
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - De Xuan Guo
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Joëlle Marcil
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Patrice Dupont
- Health Sciences Library, Université de Montréal, Montreal, Quebec, Canada
| | - Laurence Jobidon
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - David Benrimoh
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal, Montreal, Quebec, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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Maartmann-Moe CC, Solberg MT, Larsen MH, Steindal SA. Patients' memories from intensive care unit: A qualitative systematic review. Nurs Open 2021; 8:2221-2234. [PMID: 33611859 PMCID: PMC8363378 DOI: 10.1002/nop2.804] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/11/2020] [Accepted: 01/29/2021] [Indexed: 11/05/2022] Open
Abstract
AIM To identify and synthesize the evidence regarding adult patients' memories from their stay in the intensive care unit. DESIGN A qualitative systematic review and meta-synthesis. PROSPERO # CRD42020164928. The review employed the guideline of Bettany-Saltikov and McSherry and the Enhancing transparency in reporting the synthesis of qualitative research guidelines. METHODS Systematic search for qualitative studies published between January 2000 and December 2019 in Cumulative Index to Nursing and Allied Health, Medical Literature Analysis and Retrieval System Online, PsycINFO, and Excerpta Medica Database. Pairs of authors independently assessed eligibility, appraised methodological quality using Joanna Briggs's quality appraisal tool and extracted data. The analysis followed the principles of interpretative synthesis. RESULTS Sixteen papers from 15 studies were included in the review. Three themes emerged: (a) memories of surreal dreams and delusions, (b) care memories from sanctuary to alienation and (c) memories of being vulnerable and close to death.
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Affiliation(s)
- Charlotte C Maartmann-Moe
- Lovisenberg Diaconal University College, Oslo, Norway.,Emergency Department, Oslo University Hospital, Oslo, Norway
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Munro CL, Liang Z, Ji M, Elías MN, Chen X, Calero K, Ely EW. Family automated voice reorientation (FAVoR) intervention for mechanically ventilated patients in the intensive care unit: Study protocol for a randomized controlled trial. Contemp Clin Trials 2021; 102:106277. [PMID: 33482395 DOI: 10.1016/j.cct.2021.106277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 11/27/2022]
Abstract
Delirium in the intensive care unit (ICU) affects up to 80% of critically ill, mechanically ventilated (MV) adults. Delirium is associated with substantial negative outcomes, including increased hospital complications and long-term effects on cognition and health status in ICU survivors. The purpose of this randomized controlled trial is to test the effectiveness of a Family Automated Voice Reorientation (FAVoR) intervention on delirium among critically ill MV patients. The FAVoR intervention uses scripted audio messages, which are recorded by the patient's family and played at hourly intervals during daytime hours. This ongoing orientation to the ICU environment through recorded messages in a voice familiar to the patient may enable the patient to more accurately interpret the environment and thus reduce risk of delirium. The study's primary aim is to test the effect of the FAVoR intervention on delirium in critically ill MV adults in the ICU. The secondary aims are to explore: (1) if the effect of FAVoR on delirium is mediated by sleep, (2) if selected biobehavioral factors moderate the effects of FAVoR on delirium, and (3) the effects of FAVoR on short-term and long-term outcomes, including cognition and health status. Subjects (n = 178) are randomly assigned to the intervention or control group within 48 h of initial ICU admission and intubation. The intervention group receives FAVoR over a 5-day period, while the control group receives usual care. Delirium-free days, sleep and activity, cognition, patient-reported health status and sleep quality, and data regarding iatrogenic/environmental and biobehavioral factors are collected.
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Affiliation(s)
- Cindy L Munro
- University of Miami School of Nursing and Health Studies, 5030 Brunson Drive, Coral Gables, FL, United States.
| | - Zhan Liang
- University of Miami School of Nursing and Health Studies, 5030 Brunson Drive, Coral Gables, FL, United States
| | - Ming Ji
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, Tampa, FL, United States
| | - Maya N Elías
- University of Miami School of Nursing and Health Studies, 5030 Brunson Drive, Coral Gables, FL, United States
| | - Xusheng Chen
- University of Miami School of Nursing and Health Studies, 5030 Brunson Drive, Coral Gables, FL, United States
| | - Karel Calero
- Department of Pulmonary, Critical Care, and Sleep Medicine, University of South Florida College of Medicine, 12901 Bruce B. Downs Blvd, Tampa, FL, United States
| | - E Wesley Ely
- Center for Critical Illness, Brain Dysfunction, and Survivorship (CIBS), Vanderbilt University Medical Center, 2525 West End Avenue Suite 450, Nashville, TN, United States; Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, 1161 21st Ave S, Nashville, TN, United States; Veteran's Affairs TN Valley, Geriatrics Research, Education and Clinical Center (GRECC), 1310 24th Ave S, Nashville, TN, United States
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Dow B, Kenardy J, Long D, Le brocque R. Children's post‐traumatic stress and the role of memory following admission to intensive care: A review. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/j.1742-9552.2012.00040.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Belinda Dow
- Centre of National Research on Disability and Rehabilitation Medicine, School of Medicine
- School of Psychology, University of Queensland, Brisbane
| | - Justin Kenardy
- Centre of National Research on Disability and Rehabilitation Medicine, School of Medicine
- School of Psychology, University of Queensland, Brisbane
| | - Deborah Long
- Paediatric Intensive Care Unit, Royal Children's Hospital, Brisbane, Queensland, Australia
| | - Robyne Le brocque
- Centre of National Research on Disability and Rehabilitation Medicine, School of Medicine
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Meilak C, Biswell E, Willis R, Partridge J, Dhesi J. A qualitative exploration of the views of patients and their relatives regarding interventions to minimize the distress related to postoperative delirium. Int J Geriatr Psychiatry 2020; 35:230-249. [PMID: 31762082 DOI: 10.1002/gps.5241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/07/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Postoperative delirium (POD) is common in older people and can be distressing for patients and their relatives. This study aimed to describe the experience of postoperative delirium and explore the views of patients and relatives in order to inform the codesign of an intervention to minimize distress related to postoperative delirium. METHODS Qualitative study using a thematic analysis of semistructured interviews in patients (n = 11) and relatives (n = 12) who experienced and witnessed POD, respectively. RESULTS Patients and relatives find POD distressing and desire information on the cause and consequences of delirium. This information should be delivered pre-emptively where possible for patients and relatives during the episode for relatives and in post episode follow up for patients and their families. Information should be provided in person by a health care professional who has experience in managing delirium, supplemented by written materials. In addition, participants suggested training to improve staff and public awareness of delirium. CONCLUSIONS This qualitative study showed that patients and relatives find delirium distressing, report the need for an intervention to minimize this distress, and enabled codesign of a pilot intervention. Refinement and evaluation of this intervention should form the next step in this program of work.
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Affiliation(s)
- Catherine Meilak
- Perioperative Medicine for Older People Undergoing Surgery (POPS), East Kent Hospitals University Foundation Trust, Kent, UK
| | - Elizabeth Biswell
- Perioperative Medicine for Older People Undergoing Surgery (POPS), Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rosalind Willis
- Centre for Research on Ageing, University of Southampton, UK
| | - Judith Partridge
- Perioperative Medicine for Older People Undergoing Surgery (POPS), Guy's and St Thomas' NHS Foundation Trust, London, UK.,Division of Primary Care and Public Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Jugdeep Dhesi
- Perioperative Medicine for Older People Undergoing Surgery (POPS), Guy's and St Thomas' NHS Foundation Trust, London, UK.,Division of Primary Care and Public Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Abstract
Delirium is a significant medical condition that is common in hospitalized patients. Beyond the increased risk of mortality, patients who experience an episode of delirium often go on to develop long-term psychiatric disturbance, including symptoms of post-traumatic stress disorder (PTSD). While there is a growing interest in understanding the complex relationship between delirium and PTSD, the existing literature is sparse and lacking harmony. Thus, this review seeks to develop a unified and thorough description of the cognitive and psychiatric underpinnings of post-delirium PTSD with the aims of promoting awareness of this condition amongst clinicians in medical settings, improving patient care, and sparking further research on this topic. While specific underlying mechanisms are yet unclear, PTSD was found to be associated with delirium in that delirious patients may have decreased factual recall of hospital events and increased hallucinations/delusions of a traumatic nature. Several potential interventions were identified, as well as suggestions for future research and clinical practice.
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Williams ST, Dhesi JK, Partridge JSL. Distress in delirium: causes, assessment and management. Eur Geriatr Med 2019; 11:63-70. [DOI: 10.1007/s41999-019-00276-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/25/2019] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose
Delirium is a common clinical syndrome associated with increased physical and psychological morbidity, mortality, inpatient stay and healthcare costs. There is growing interest in understanding the delirium experience and its psychological impact, including distress, for patients and their relatives, carers and healthcare providers.
Methods
This narrative review focuses on distress in delirium (DID) with an emphasis on its effect on older patients. It draws on qualitative and quantitative research to describe patient and environmental risk factors and variations in DID across a number of clinical settings, including medical and surgical inpatient wards and end of life care. The article provides an overview of the available distress assessment tools, both for clinical and research practice, and outlines their use in the context of delirium. This review also outlines established and emerging management strategies, focusing primarily on prevention and limitation of distress in delirium.
Results
Both significant illness and delirium cause distress. Patients who recall the episode of delirium describe common experiential features of delirium and distress. Relatives who witness delirium also experience distress, at levels suggested to be greater than that experienced by patients themselves. DID results in long-term psychological sequelae that can last months and years. Preventative actions, such pre-episode educational information for patients and their families in those at risk may reduce distress and psychological morbidity.
Conclusions
Improving clinicians’ understanding of the experience and long term psychological harm of delirium will enable the development of targeted support and information to patients at risk of delirium, and their families or carers.
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Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 2019; 46:e825-e873. [PMID: 30113379 DOI: 10.1097/ccm.0000000000003299] [Citation(s) in RCA: 1748] [Impact Index Per Article: 349.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU. DESIGN Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups gathered face-to-face at annual Society of Critical Care Medicine congresses; virtual connections included those unable to attend. A formal conflict of interest policy was developed a priori and enforced throughout the process. Teleconferences and electronic discussions among subgroups and whole panel were part of the guidelines' development. A general content review was completed face-to-face by all panel members in January 2017. METHODS Content experts, methodologists, and ICU survivors were represented in each of the five sections of the guidelines: Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption). Each section created Population, Intervention, Comparison, and Outcome, and nonactionable, descriptive questions based on perceived clinical relevance. The guideline group then voted their ranking, and patients prioritized their importance. For each Population, Intervention, Comparison, and Outcome question, sections searched the best available evidence, determined its quality, and formulated recommendations as "strong," "conditional," or "good" practice statements based on Grading of Recommendations Assessment, Development and Evaluation principles. In addition, evidence gaps and clinical caveats were explicitly identified. RESULTS The Pain, Agitation/Sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) panel issued 37 recommendations (three strong and 34 conditional), two good practice statements, and 32 ungraded, nonactionable statements. Three questions from the patient-centered prioritized question list remained without recommendation. CONCLUSIONS We found substantial agreement among a large, interdisciplinary cohort of international experts regarding evidence supporting recommendations, and the remaining literature gaps in the assessment, prevention, and treatment of Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) in critically ill adults. Highlighting this evidence and the research needs will improve Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) management and provide the foundation for improved outcomes and science in this vulnerable population.
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Grover S, Sahoo S, Chakrabarti S, Avasthi A. Post-traumatic stress disorder (PTSD) related symptoms following an experience of delirium. J Psychosom Res 2019; 123:109725. [PMID: 31376870 DOI: 10.1016/j.jpsychores.2019.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/21/2019] [Accepted: 05/17/2019] [Indexed: 02/08/2023]
Abstract
AIM To evaluate the prevalence of symptoms of PTSD and its correlates after 2 weeks of recovery, among patients, who developed delirium. METHODOLOGY A prospective study designed was followed, in which subjects diagnosed with delirium were evaluated 2 weeks after resolution of symptoms of delirium, for PTSD symptoms by using Impact of Events Scale-Revised version (IES-R). RESULTS 59 patients were evaluated for PTSD 2 weeks after resolution of delirium and the total mean IES-R score was 27.81 (SD-11.41). Based on the IES-cut-off scores of the scale, 30.5% of the patients (n = 18) were considered to have substantial symptoms of PTSD, 22% (n = 13) had probable symptoms of PTSD and 15.3% were considered to have partial symptoms of PTSD after resolution of delirium. None of the demographic or clinical factors were associated with development of PTSD. Those with PTSD symptoms had significantly higher prevalence of fluctuation of symptoms, while experiencing delirium and had significantly higher mean scores for the items of motor agitation, attentional deficits, higher total severity score on the Delirium Rating Scale-revised-98 version (DRS-R98) and higher DRS-R-98 total score. Higher severity of delirium as indicated by the total DRS-R98 score and the total DRS-R98 severity score were associated with higher severity of PTSD symptoms. The IES-R total score did not have any significant correlation with duration of illness, duration of delirium or Charlson Co-morbidity index. CONCLUSIONS This study suggests that about one-third of patients who develop delirium go on to develop symptoms of PTSD, after recovery from delirium. Development of PTSD symptoms is associated with severity of delirium. Hence, it is important to treat the delirium adequately and provide psychological support to the patients who develop delirium, after recovery from delirium.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
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Silva SC, Silveira LM, Marchi-Alves LM, Mendes IAC, Godoy SD. Real and illusory perceptions of patients in induced coma. Rev Bras Enferm 2019; 72:818-824. [PMID: 31269151 DOI: 10.1590/0034-7167-2017-0906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/26/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify, in the scientific literature, real and illusory perceptions of adult patients in induced coma. METHODS This is an integrative review of 15 primary studies from the Medline, Web of Science, LILACS, CINAHL and SCOPUS databases. RESULTS The main memories reported after induced coma were thirst, cold, and pain. In some studies, patients reported they were unable to tell whether they were awake or dreaming, whether it was real or unreal. Satisfactory memories were reported by patients related to the care received and the use of bedside journals. CONCLUSION Evidence showed a number of studies aiming to identify delirium, but without a focus on analyzing real or illusory perceptions of patients after induced coma. Thus, this integrative review identified scientific evidence of memories related to perceptions of sedated patients in the intensive care unit.
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Affiliation(s)
- Simone Costa Silva
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. São Paulo, Brasil
| | | | | | | | - Simone de Godoy
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. São Paulo, Brasil
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Denke C, Balzer F, Menk M, Szur S, Brosinsky G, Tafelski S, Wernecke KD, Deja M. Long-term sequelae of acute respiratory distress syndrome caused by severe community-acquired pneumonia: Delirium-associated cognitive impairment and post-traumatic stress disorder. J Int Med Res 2018; 46:2265-2283. [PMID: 29609489 PMCID: PMC6023035 DOI: 10.1177/0300060518762040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective Delirium in critically ill patients is considered a risk factor for various long-term consequences. We evaluated delirium and associated long-term outcomes in patients with acute respiratory distress syndrome with non-H1N1 and H1N1- associated severe community-acquired pneumonia (sCAP) who had been recommended to take antiviral drugs associated with delirious symptoms as adverse effects. Methods Of 64 patients, 42 survivors (H1N1, 15; non-H1N1, 27) were analyzed regarding the relationship between medication and the duration of delirium in the intensive care unit. During follow-up (n = 23), we assessed cognitive abilities, post-traumatic stress disorder (PTSD), physical capacity, and health-related quality of life (HRQoL). Results The incidence of delirium was 88%. There was no difference in the incidence and duration of delirium between patients with H1N1 and non-H1N1 infection. The haloperidol and opioid doses were associated with a longer delirium duration. The delirium duration was correlated with reduced cognitive performance in motor skills, memory function, and learning efficiency. Patients with PTSD (16%) had a significantly longer delirium duration and low mental HRQoL. Conclusions H1N1 infection and corresponding antiviral medication had no impact on delirium. The duration of delirium in these patients was associated with impairments in various outcome parameters, illustrating the burden of sCAP.
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Affiliation(s)
- Claudia Denke
- 1 Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Balzer
- 1 Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mario Menk
- 1 Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Szur
- 1 Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Georg Brosinsky
- 1 Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sascha Tafelski
- 1 Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Maria Deja
- 3 Department of Anesthesiology and Operative Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,4 Department of Anesthesiology and Intensive Care, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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Liao H, Chiu C, Ko Y, Chen H. Factors associated with demoralisation syndrome in patients before and after cardiac surgery. J Clin Nurs 2017; 27:e559-e568. [DOI: 10.1111/jocn.14094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Hsiu‐Yun Liao
- School of Nursing Kaohsiung Medical University Kaohsiung Taiwan
| | - Chaw‐Chi Chiu
- Department of Surgery Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan
| | - Ying‐Ying Ko
- Department of Nursing Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan
| | - Hsing‐Mei Chen
- Department of Nursing College of Medicine National Cheng Kung University Tainan Taiwan
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Post-ICU psychological morbidity in very long ICU stay patients with ARDS and delirium. J Crit Care 2017; 43:88-94. [PMID: 28854401 DOI: 10.1016/j.jcrc.2017.08.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/19/2017] [Accepted: 08/20/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE We investigated the impact of delirium on illness severity, psychological state, and memory in acute respiratory distress syndrome patients with very long ICU stay. MATERIALS AND METHODS Prospective cohort study in the medical-surgical ICUs of 2 teaching hospitals. Very long ICU stay (>75days) and prolonged delirium (≥40days) thresholds were determined by ROC analysis. Subjects were ≥18years, full-code, and provided informed consent. Illness severity was assessed using Acute Physiology and Chronic Health Evaluation IV, Simplified Acute Physiology Score-3, and Sequential Organ Failure Assessment scores. Psychological impact was assessed using the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, and the 14-question Post-Traumatic Stress Syndrome (PTSS-14). Memory was assessed using the ICU Memory Tool survey. RESULTS 181 subjects were included. Illness severity did not correlate with delirium duration. On logistic regression, only PTSS-14<49 correlated with delirium (p=0.001; 95% CI 1.011, 1.041). 49% remembered their ICU stay clearly. 47% had delusional memories, 50% reported intrusive memories, and 44% reported unexplained feelings of panic or apprehension. CONCLUSION Delirium was associated with memory impairment and PTSS-14 scores suggestive of PTSD, but not illness severity.
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Berntzen H, Bjørk IT, Wøien H. "Pain relieved, but still struggling"-Critically ill patients experiences of pain and other discomforts during analgosedation. J Clin Nurs 2017; 27:e223-e234. [PMID: 28618123 DOI: 10.1111/jocn.13920] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2017] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To explore how critically ill patients treated according to a strategy of analgosedation experience and handle pain, other discomforts and wakefulness. BACKGROUND Patients experience both pain and discomfort while in the intensive care unit. International guidelines recommend focused pain treatment and light sedation. An analgosedation protocol favouring pain management, light sedation and early mobilisation was implemented in our university hospital medical and surgical intensive care unit in Norway in 2014. The analgosedation approach may affect patients' experiences of the intensive care unit stay. DESIGN Exploratory, descriptive design using semi-structured interviews. METHOD Eighteen adult patients treated in intensive care unit >24 hr and receiving mechanical ventilation were interviewed 1-9 days after intensive care unit discharge. Ten patients were re-interviewed after 3 months. Data were analysed using the "systematic text condensation" approach. FINDINGS Four main categories emerged from the analysis: "In discomfort, but rarely in pain," "Struggling to get a grip on reality," "Holding on" and "Handling emotionally trapped experiences." "Pain relieved, but still struggling" was the overarching theme. Analgosedation provided good pain relief, but patients still described frequent physical and psychological discomforts, in particular related to mechanical ventilation, not understanding what was going on, and experiences of delusions. To come to terms with their intensive care unit stay, patients needed to participate, trust in others and endure suffering. After hospital discharge, patients described both repression of experiences and searching for recognition of what they had gone through. RELEVANCE TO CLINICAL PRACTICE Despite good pain relief during analgosedation, other discomforts were commonly described. Critically ill patients still experience an intensive care unit stay as a traumatic part of their illness trajectory. Nurses need to attend carefully also to discomforts other than pain.
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Affiliation(s)
- Helene Berntzen
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | | | - Hilde Wøien
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Munro CL, Cairns P, Ji M, Calero K, Anderson WM, Liang Z. Delirium prevention in critically ill adults through an automated reorientation intervention - A pilot randomized controlled trial. Heart Lung 2017; 46:234-238. [PMID: 28606450 DOI: 10.1016/j.hrtlng.2017.05.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Explore the effect of an automated reorientation intervention on ICU delirium in a prospective randomized controlled trial. BACKGROUND Delirium is common in ICU patients, and negatively affects outcomes. Few prevention strategies have been tested. METHODS Thirty ICU patients were randomized to 3 groups. Ten received hourly recorded messages in a family member's voice during waking hours over 3 ICU days, 10 received the same messages in a non-family voice, and 10 (control) did not receive any automated reorientation messages. The primary outcome was delirium free days during the intervention period (evaluated by CAM-ICU). Groups were compared by Fisher's Exact Test. RESULTS The family voice group had more delirium free days than the non-family voice group, and significantly more delirium free days (p = 0.0437) than the control group. CONCLUSIONS Reorientation through automated, scripted messages reduced incidence of delirium. Using identical scripted messages, family voice was more effective than non-family voice.
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Affiliation(s)
- Cindy L Munro
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL 33612-4766, USA.
| | - Paula Cairns
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL 33612-4766, USA
| | - Ming Ji
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL 33612-4766, USA
| | - Karel Calero
- University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Blvd, MDC 19, Tampa, FL 33612-4766, USA
| | - W McDowell Anderson
- University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Blvd, MDC 19, Tampa, FL 33612-4766, USA
| | - Zhan Liang
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL 33612-4766, USA
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Abstract
OBJECTIVES To determine whether delirium during ICU stay is associated with long-term mental health problems defined as symptoms of anxiety, depression, and posttraumatic stress disorder. DESIGN Prospective cohort study. SETTING Survey study, 1 year after discharge from a medical-surgical ICU in the Netherlands. PATIENTS One-year ICU survivors of an ICU admission lasting more than 48 hours, without a neurologic disorder or other condition that would impede delirium assessment during ICU stay. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS One year after discharge, ICU survivors received a survey containing the Hospital Anxiety and Depression Scale with a subscale for symptoms of depression and a subscale for symptoms of anxiety, and the Impact of Event Scale 15 item measuring symptoms of posttraumatic stress disorder. Participants were classified as having experienced no delirium (n = 270; 48%), a single day of delirium (n = 86; 15%), or multiple days of delirium (n = 211; 37%) during ICU stay. Log-binomial regression was used to assess the association between delirium and symptoms of anxiety, depression, and posttraumatic stress disorder. The study population consisted of 567 subjects; of whom 246 subjects (43%) reported symptoms of anxiety (Hospital Anxiety and Depression Scale with a subscale for anxiety, ≥ 8), and 254 (45%) symptoms of depression (Hospital Anxiety and Depression Scale with a subscale for depression, ≥ 8). In 220 patients (39%), the Impact of Event Scale 15 item was greater than or equal to 35, indicating a high probability of posttraumatic stress disorder. There was substantial overlap between these mental health problems-63% of the subjects who scored positive for the presence of any three of the mental health problems, scored positive for all three. No association was observed between either a single day or multiple days of delirium and symptoms of anxiety, depression, or posttraumatic stress disorder. CONCLUSIONS Although symptoms of anxiety, depression, and posttraumatic stress disorder were found to be common 1 year after critical illness, the occurrence of delirium during ICU stay did not increase the risk of these long-term mental health problems.
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Foster N, Kornhaber R, McGarry S, Wood FM, Edgar DW. Heterotopic Ossification in adults following a burn: A phenomenological analysis. Burns 2017; 43:1250-1262. [PMID: 28413106 DOI: 10.1016/j.burns.2017.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/05/2017] [Accepted: 03/08/2017] [Indexed: 11/30/2022]
Abstract
Heterotopic Ossification (HO) is a rare but severely debilitating complication after a burn. Despite there being literature of varying quality explaining the postulated pathological process, risk factors and treatment for HO, the individual experiences of adults diagnosed with HO following a burn, remains unreported. This study sought to explore and describe burn survivors' experiences of HO to gain a greater understanding of the clinical needs for this unique patient population. A phenomenological inquiry of five men and one woman selected through purposeful sampling collected in-depth interviews analysed using Colaizzi's method of data analysis. Five emergent themes: (1) Early signs and symptoms, (2) Impact on the rehabilitation journey, (3) The role of the health care professionals (4) Loss of independence and an increased reliance on others and, (5) Learning to live with it: uncertainty, hope and adaptation. Eleven cluster themes were identified, highlighting the meaning of each emergent theme. These findings describe the significant impact the unique symptomology of HO had on the physical and psychosocial functioning of participants throughout the rehabilitation journey. Central to engagement in rehabilitation, is the participants' desire for autonomy particularly in the domains of living independently and community re-integration.
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Affiliation(s)
- Nichola Foster
- Sir Charles Gairdner Hospital, Physiotherapy Department, Perth, Australia; The University of Norte Dame, School of Physiotherapy, Fremantle, Australia
| | - Rachel Kornhaber
- University of Tasmania, Faculty of Health, School of Health Sciences, Sydney Campus, Australia; National Burns Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Sarah McGarry
- Total Care burn Unit, Princess Margaret Hospital, Perth, Western Australia, Australia; School of Exercise and Health Sciences, Edith Cowan University, Perth, Australia; Burns Service Western Australia, Perth, Australia; Fiona Wood Foundation, Murdoch, Australia
| | - Fiona M Wood
- Total Care burn Unit, Princess Margaret Hospital, Perth, Western Australia, Australia; Burns Service Western Australia, Perth, Australia; Burn Injury Research Unit, School of Surgery, University of Western Australia, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Perth, Murdoch, Australia; Fiona Wood Foundation, Murdoch, Australia
| | - Dale W Edgar
- Burns Service Western Australia, Perth, Australia; Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Perth, Murdoch, Australia; Fiona Wood Foundation, Murdoch, Australia.
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Smith TA, Agar M, Jenkins CR, Ingham JM, Davidson PM. Experience of acute noninvasive ventilation-insights from 'Behind the Mask': a qualitative study. BMJ Support Palliat Care 2016; 9:e11. [PMID: 27566721 DOI: 10.1136/bmjspcare-2015-000908] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/28/2016] [Accepted: 08/08/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Non-invasive ventilation (NIV) is widely used in the management of acute and acute-on-chronic respiratory failure. Understanding the experiences of patients treated with NIV is critical to person-centred care. We describe the subjective experiences of individuals treated with NIV for acute hypercapnic respiratory failure. DESIGN Qualitative face-to-face interviews analysed using thematic analysis. SETTING Australian tertiary teaching hospital. PARTICIPANTS Individuals with acute hypercapnic respiratory failure treated with NIV outside the intensive care unit. Individuals who did not speak English or were unable or unwilling to consent were excluded. RESULTS 13 participants were interviewed. Thematic saturation was achieved. Participants described NIV providing substantial relief from symptoms and causing discomfort. They described enduring NIV to facilitate another chance at life. Although participants sometimes appeared passive, others expressed a strong conviction that they knew which behaviours and treatments relieved their distress. Most participants described gaps in their recollection of acute hospitalisation and placed a great amount of trust in healthcare providers. All participants indicated that they would accept NIV in the future, if clinically indicated, and often expressed a sense of compulsion to accept NIV. Participants' description of their experience of NIV was intertwined with their experience of chronic disease. CONCLUSIONS Participants described balancing the benefits and burdens of NIV, with the goal of achieving another chance at life. Gaps in recall of their treatment with NIV were frequent, potentially suggesting underlying delirium. The findings of this study inform patient-centred care, have implications for the care of patients requiring NIV and for advance care planning discussions.
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Affiliation(s)
- Tracy A Smith
- Faculty of Medicine, UNSW Australia, St Vincent's Clinical School, Sydney, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Meera Agar
- Palliative Care Unit, Braeside Hospital, Hammond Care, Sydney, New South Wales, Australia.,Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
| | - Christine R Jenkins
- Department of Thoracic Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Jane M Ingham
- Faculty of Medicine, UNSW Australia, St Vincent's Clinical School, Sydney, New South Wales, Australia.,St Vincent's Health Network, Sydney, New South Wales, Australia
| | - Patricia M Davidson
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.,Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Finucane AM, Lugton J, Kennedy C, Spiller JA. The experiences of caregivers of patients with delirium, and their role in its management in palliative care settings: an integrative literature review. Psychooncology 2016; 26:291-300. [PMID: 27132588 PMCID: PMC5363350 DOI: 10.1002/pon.4140] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 03/07/2016] [Accepted: 03/25/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To explore the experiences of caregivers of terminally ill patients with delirium, to determine the potential role of caregivers in the management of delirium at the end of life, to identify the support required to improve caregiver experience and to help the caregiver support the patient. METHODS Four electronic databases were searched-PsychInfo, Medline, Cinahl and Scopus from January 2000 to July 2015 using the terms 'delirium', 'terminal restlessness' or 'agitated restlessness' combined with 'carer' or 'caregiver' or 'family' or 'families'. Thirty-three papers met the inclusion criteria and remained in the final review. RESULTS Papers focused on (i) caregiver experience-distress, deteriorating relationships, balancing the need to relieve suffering with desire to communicate and helplessness versus control; (ii) the caregiver role-detection and prevention of delirium, symptom monitoring and acting as a patient advocate; and (iii) caregiver support-information needs, advice on how to respond to the patient, interventions to improve caregiver outcomes and interventions delivered by caregivers to improve patient outcomes. CONCLUSION High levels of distress are experienced by caregivers of patients with delirium. Distress is heightened because of the potential irreversibility of delirium in palliative care settings and uncertainty around whether the caregiver-patient relationship can be re-established before death. Caregivers can contribute to the management of patient delirium. Additional intervention studies with informational, emotional and behavioural components are required to improve support for caregivers and to help the caregiver support the patient. Reducing caregiver distress should be a goal of any future intervention.© 2016 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd.
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Affiliation(s)
| | - Jean Lugton
- Marie Curie Hospice Edinburgh, Edinburgh, UK
| | - Catriona Kennedy
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
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26
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Affiliation(s)
- Valerie Fuller
- Department of Surgery; Maine Medical Center; Portland ME 04102
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Tramm R, Ilic D, Murphy K, Sheldrake J, Pellegrino V, Hodgson C. A qualitative exploration of acute care and psychological distress experiences of ECMO survivors. Heart Lung 2016; 45:220-6. [PMID: 26916455 DOI: 10.1016/j.hrtlng.2016.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 01/23/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To explore the acute care experience of extracorporeal membrane oxygenation (ECMO) patients. BACKGROUND ECMO is used in life-threatening scenarios of acute lung or heart failure. The patient's experience with ECMO treatment and the psychological distress are unknown. METHODS Qualitative analysis of semi-structured interviews with ECMO survivors 12 months after discharge were conducted and thematically analyzed. RESULTS Ten participants treated with ECMO for life-threatening acute heart or lung failure were interviewed. Six themes that captured the ICU experience of ECMO patients were identified including; dealing with crisis, critical care, memory, role of significant others and existence today and tomorrow. Deconditioning was the most frequently reported experience. Patchy factual memories contrasted with detailed delirious memories and paranoid ideations. CONCLUSION Patients treated with ECMO experienced deconditioning, perceived threats of serious injury or death and delusional episodes with recalls of psychological distress.
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Affiliation(s)
- Ralph Tramm
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre L6, 99 Commercial Rd, Prahran, 3004 Melbourne, Australia.
| | - Dragan Ilic
- Department of Epidemiology and Preventive Medicine (DEPM), Monash University, The Alfred Centre L6, 99 Commercial Rd, Prahran, 3004 Melbourne, Australia
| | - Kerry Murphy
- Department of Epidemiology and Preventive Medicine (DEPM), Monash University, The Alfred Centre L6, 99 Commercial Rd, Prahran, 3004 Melbourne, Australia
| | - Jayne Sheldrake
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Commercial Rd, Prahran, 3004 Melbourne, Australia
| | - Vincent Pellegrino
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Commercial Rd, Prahran, 3004 Melbourne, Australia
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre L6, 99 Commercial Rd, Prahran, 3004 Melbourne, Australia
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Riera A, Gallart E, Vicálvaro A, Lolo M, Solsona A, Mont A, Gómez J, Téllez D, Fuentelsaz-Gallego C. Health-related quality of life and nursing-sensitive outcomes in mechanically ventilated patients in an Intensive Care Unit: a study protocol. BMC Nurs 2016; 15:8. [PMID: 26855613 PMCID: PMC4743160 DOI: 10.1186/s12912-016-0127-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/26/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Mechanical ventilation (MV) is one of the most utilised techniques in the intensive care unit (ICU), but it can cause sequelae that can negatively influence the patient's health-related quality of life (HRQL). Nursing-sensitive outcomes (NSOs) can also influence the HRQL. Assessing the HRQL of mechanically ventilated patients admitted to an ICU and its relation to nurse-sensitive outcomes will give healthcare professionals with valuable information to improve patient care. METHODS Prospective longitudinal cohort study in which all patients admitted to the ICU at Hospital Universitari Vall d'Hebron who undergo MV for more than 48 h will be included. The study will last 12 consecutive months. HRQL will be assessed by the completion of the SF-36 and the Saint Georges Respiratory Questionnaire. Pre-admission HRQL assessment will be performed by the main caregiver, and after ICU discharge, the assessment will be performed by the patient him/herself. The same questionnaires will also be completed one year after ICU discharge. Other variables (sociodemographic and those related to reason for ICU admission, ICU length of stay, MV, ICU stressors and NSO) will be included in a multiple regression model to assess their relation to the patient's HRQL. DISCUSSION This study will show the relationship between the HRQL perceived by patients and their main caregiver, what the HRQL is one year after discharge from ICU, and what the impact of MV, NSO and ICU stressors and other clinical outcomes on the patient's HRQL is. Determining mechanically ventilated patients' HRQL and its relation to NSO and ICU stressors as well as other clinical variables will enable early nursing interventions to try to minimise possible sequelae and improve the patient's welfare. TRIAL REGISTRATION ClinicalTrials.gov ID:NCT02636660Registration Date: 17th December 2015.
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Affiliation(s)
- Alba Riera
- />Intensive Care Unit, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisabet Gallart
- />Intensive Care Unit, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Araceli Vicálvaro
- />Intensive Care Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Montserrat Lolo
- />Intensive Care Unit, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anabel Solsona
- />Intensive Care Unit, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Mont
- />Intensive Care Unit, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Gómez
- />Intensive Care Unit, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Téllez
- />Intensive Care Unit, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Stayt LC, Seers K, Tutton L. Making sense of it: intensive care patients' phenomenological accounts of story construction. Nurs Crit Care 2015; 21:225-32. [PMID: 26549713 DOI: 10.1111/nicc.12224] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/21/2015] [Accepted: 09/26/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients entering intensive care encounter physical and psychological stress that may lead to psychological morbidity such as depression, anxiety and post-traumatic stress. It has been suggested that constructing a story may assist psychological recovery. However, this has been minimally investigated in intensive care patients. AIM The aim of this article is to examine the process of story construction in people's phenomenological accounts of being a patient in the technological environment of intensive care. STUDY DESIGN The study design was informed by Heideggerian phenomenology. METHODS Semi-structured interviews were conducted with 19 patients who had been in intensive care for at least 4 days. Interviews were digitally recorded, transcribed and analysed utilizing Van Manen's framework for thematic analysis. FINDINGS Making sense of their experiences in an intensive care unit appeared to be fundamental to story construction. Themes that arose were 'why am I here?', 'filling in the gaps', 'sorting the real from the unreal' and 'searching for familiarity'. These themes describe how participants sought temporal and causal coherence in order to construct their integrated and understandable story. Families appeared to play a critical role in helping participants fill in the gaps, sorting the real from the unreal and their subsequent psychological recovery. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE The importance of early support from health care professionals to facilitate patients' story construction is highlighted. The study also emphasizes the role families play in supporting patients while they make sense of their experiences and the associated psychological recovery process. Further research to evaluate methods of facilitating story construction, such as nurse-led debriefing and patient diaries, is recommended. In addition, an investigation of families' perceptions of their role in assisting patients construct their story may facilitate the development of strategies by health care professionals to effectively support families in their role.
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Affiliation(s)
- Louise C Stayt
- Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straw Lane, Oxford, UK
| | - Kate Seers
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Liz Tutton
- Warwick Medical School, University of Warwick, Coventry, UK
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Henao Castaño ÁM, Amaya MCDP. CEI-UCI: instrumento para evaluar el cuidado de enfermería individualizado de adultos en la UCI. AVANCES EN ENFERMERÍA 2015. [DOI: 10.15446/av.enferm.v33n1.38310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p>El propósito de este estudio fue diseñar el instrumento Cuidado de Enfermería Individualizado en Unidad de Cuidado Intensivo (CEI-UCI) para identificar las intervenciones de cuidado de enfermería individualizado en pacientes con ventilación mecánica invasiva en la UCI.</p><p><strong>Metodología:</strong> Estudio psicométrico, exploratorio-observacional, con <em>n</em> = 156 enfermeras que laboraban en la UCI con pacientes adultos en ventilación mecánica. Se diseñaron un total de 85 ítems para iniciar las pruebas. Para la validez facial se utilizó la V. Aiken por encima de 0,70. Para la validez de contenido se realizó el cálculo de Lawshe Modificado igual o mayor a de 0,58. La validez de constructo se obtuvo por medio del análisis factorial con ocho dominios nanda. La confiabilidad se reportó con test-retest para los días 1, 2 y 3 de estadía de los pacientes en UCI.</p><p><strong>Resultados:</strong> El CEI-UCI presentó una validez facial con rangos entre 0,75-0,82, con un CVI con rangos entre 0,58-0,90. La validez de constructo se confirmó con una varianza total explicada del 73% para cuatro factores. La confiabilidad por el test-retest entre los tres primeros días de aplicado el instrumento se presentó con un rango de 0,662 a 1,00.</p><p><strong>Conclusiones:</strong> El instrumento CEI-UCI posee 53 ítems y seis dimensiones con validez facial, aparente y consistencia interna. La validez de constructo derivada del análisis factorial<br />de cuatro factores se denominaron Dimensiones, a saber: F1, <em>Protección y seguridad</em> (17 ítems); F2, <em>Interacción fisiológica y social</em> (3 ítems); F3, <em>Roles y conexiones sociales</em> (13 ítems); y F4, <em>Autopercepción y nutrición</em> (11 ítems). Además, hubo dos dimensiones permanentes y centinelas: <em>Perceptual-Cognitivo</em> y el de <em>Confort</em>.</p>
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Faria RDSB, Moreno RP. Delirium in intensive care: an under-diagnosed reality. Rev Bras Ter Intensiva 2015; 25:137-47. [PMID: 23917979 PMCID: PMC4031828 DOI: 10.5935/0103-507x.20130025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/08/2013] [Indexed: 01/25/2023] Open
Abstract
Delirium occurs in up to 80% of patients admitted to intensive care units. Although
under-diagnosed, delirium is associated with a significant increase in morbidity and
mortality in critical patients. Here, we review the main risk factors, clinical
manifestations and preventative and therapeutic approaches (pharmacological and
non-pharmacological) for this illness.
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Kornhaber R, Wilson A, Abu-Qamar M, McLean L, Vandervord J. Inpatient peer support for adult burn survivors—A valuable resource: A phenomenological analysis of the Australian experience. Burns 2015; 41:110-7. [DOI: 10.1016/j.burns.2014.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 05/03/2014] [Accepted: 05/06/2014] [Indexed: 11/29/2022]
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Coming to terms with it all: Adult burn survivors’ ‘lived experience’ of acknowledgement and acceptance during rehabilitation. Burns 2014; 40:589-97. [DOI: 10.1016/j.burns.2013.08.038] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/23/2013] [Accepted: 08/28/2013] [Indexed: 11/24/2022]
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MacLaren R, Preslaski CR, Mueller SW, Kiser TH, Fish DN, Lavelle JC, Malkoski SP. A Randomized, Double-Blind Pilot Study of Dexmedetomidine Versus Midazolam for Intensive Care Unit Sedation. J Intensive Care Med 2013; 30:167-75. [DOI: 10.1177/0885066613510874] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Sedation with dexmedetomidine may facilitate ventilator liberation and limit the occurrence of delirium. No trial has assessed patient recall or the development of psychological outcomes after dexmedetomidine sedation. This pilot study evaluated whether transitioning benzodiazepine sedation to dexmedetomidine alters patient recall and the incidence of anxiety, depression, or acute stress disorder (ASD). Methods: This investigation was a randomized, double-blind, single-center study. Existing continuous benzodiazepine sedation was converted to dexmedetomidine or midazolam when patients qualified for daily awakenings. Sedation was titrated to achieve Riker sedation agitation scores of 3 to 4. The intensive care unit (ICU) Stressful Experiences Questionnaire, hospital anxiety and depression scale, and the impact of event scale-revised were administered before hospital discharge to assess recall, anxiety, depression, and manifestations of ASD. Results: A total of 11 patients received dexmedetomidine, and 12 patients received midazolam. Median dosing was 0.61 µg/kg/h for 3.5 days for dexmedetomidine and 3.7 mg/h for 3 days for midazolam. Attainment of goal sedation and analgesia was similar; however, more dexmedetomidine patients experienced agitation and pain. The median duration of mechanical ventilation from study drug initiation to extubation was 3.4 days in dexmedetomidine patients and 2.9 days in midazolam patients. Dexmedetomidine patients remembered 18.5 experiences compared with 8.5 in midazolam patients ( P = .015). Rates of anxiety and depression were similar. In all, 5 (62.5%) dexmedetomidine patients and 1 (12.5%) midazolam patient manifested ASD ( P = .063), and 1 dexmedetomidine patient and 5 midazolam patients developed new-onset delirium ( P = .07). Hypotension occurred in 10 (90.9%) dexmedotomidine patients and 6 (50%) midazolam patients ( P = .069). Conclusions: Transitioning benzodiazepine sedation to dexmedetomidine when patients qualify for daily awakenings may reduce the development of delirium and facilitate remembrance of ICU experiences but may lead to manifestations of ASD. Monitoring hypotension is required for both the sedatives. Additional comparative studies focusing on the long-term impact of ICU recall and psychological outcomes are needed.
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Affiliation(s)
- Robert MacLaren
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | | | - Scott W. Mueller
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Tyree H. Kiser
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Douglas N. Fish
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - James C. Lavelle
- Division of Pulmonary and Critical Care Medicine, University of Colorado School of Medicine Aurora, CO, USA
| | - Stephen P. Malkoski
- Division of Pulmonary and Critical Care Medicine, University of Colorado School of Medicine Aurora, CO, USA
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Abstract
OBJECTIVE To describe and analyze the development and psychometric properties of subjective sedation scales developed for critically ill adult patients. DATA SOURCES PubMed, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, ISI Web of Science, and the International Pharmaceutical Abstracts. STUDY SELECTION English-only publications through December 2012 with at least 30 patients older than 18 years, which included the key words of adult, critically ill, subjective sedation scale, sedation scale, validity, and reliability. DATA EXTRACTION Two independent reviewers evaluated the psychometric properties using a standardized sedation scale psychometric scoring system. DATA SYNTHESIS Among the 19,000+ citations extracted for the 2013 Society of Critical Care Medicine's Clinical Practice Guidelines for the Management of Pain, Agitation and Delirium and from December 2010 to 2012, 36 articles were identified compassing 11 sedation scales. The scale development process, psychometric properties, feasibility, and implementation of sedation scales were analyzed using a 0-20 scoring system. Two scales demonstrated scores indicating "very good" published psychometric properties: Richmond Agitation-Sedation Scale (19.5) and the Sedation-Agitation Scale (19). Scores with "moderate" properties include the Vancouver Interaction and Calmness Scale (14.3), Adaptation to the Intensive Care Environment (13.7), Ramsay Sedation Scale (13.2), Minnesota Sedation Assessment Tool (13), and the Nursing Instrument for the Communication of Sedation (12.8). Scales with "low" properties included the Motor Activity Assessment Scale (11.5) and the Sedation Intensive Care Score (10.5). The New Sheffield Sedation Scale (8.5) and the Observer's Assessment of Alertness/Sedation Scale (3.7) demonstrated "very low" published properties. CONCLUSIONS Based on the current literature, and using a predetermined psychometric scoring system, the Richmond Agitation-Sedation Scale and the Sedation-Agitation Scale are the most valid and reliable subjective sedation scales for use in critically ill adult patients.
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Partridge JSL, Martin FC, Harari D, Dhesi JK. The delirium experience: what is the effect on patients, relatives and staff and what can be done to modify this? Int J Geriatr Psychiatry 2013; 28:804-12. [PMID: 23112139 DOI: 10.1002/gps.3900] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 10/10/2012] [Indexed: 12/26/2022]
Abstract
BACKGROUND Delirium is a common clinical syndrome with significant associated mortality, morbidity and financial cost. Less is understood about the experience of delirium for the patient, their family and staff involved in their care. OBJECTIVE This synthesis draws on qualitative and quantitative literature examining different populations (patients, relatives and staff) in different clinical settings (intensive care units, surgery and hospice care) to provide a clinical summary of the delirium experience from the perspective of patients, relatives and staff. DESIGN A literature search was conducted in Ovid, MEDLINE, Embase, PsychINFO, British Nursing Index and Archive and PubMed between 1980 and 2011 using the terms 'delirium' combined with 'distress', 'recall', 'anxiety', 'depression', 'PTSD', 'experience' and 'patient education'. Articles were restricted to English language only. RESULTS Evidence suggests that some patients recall delirium and that recollections are generally distressing. Distress may be greater in relatives witnessing delirium and is also reported in professional staff. This distress may result in longer-term psychological sequelae. Remedial action, such as explanatory information to patients and their families, may reduce distress and psychological morbidity. CONCLUSIONS A better understanding of the experience and psychological consequences of delirium will inform the development of appropriate methods of providing support and information to those at risk of delirium and their families or carers.
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Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41:263-306. [PMID: 23269131 DOI: 10.1097/ccm.0b013e3182783b72] [Citation(s) in RCA: 2272] [Impact Index Per Article: 206.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To revise the "Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult" published in Critical Care Medicine in 2002. METHODS The American College of Critical Care Medicine assembled a 20-person, multidisciplinary, multi-institutional task force with expertise in guideline development, pain, agitation and sedation, delirium management, and associated outcomes in adult critically ill patients. The task force, divided into four subcommittees, collaborated over 6 yr in person, via teleconferences, and via electronic communication. Subcommittees were responsible for developing relevant clinical questions, using the Grading of Recommendations Assessment, Development and Evaluation method (http://www.gradeworkinggroup.org) to review, evaluate, and summarize the literature, and to develop clinical statements (descriptive) and recommendations (actionable). With the help of a professional librarian and Refworks database software, they developed a Web-based electronic database of over 19,000 references extracted from eight clinical search engines, related to pain and analgesia, agitation and sedation, delirium, and related clinical outcomes in adult ICU patients. The group also used psychometric analyses to evaluate and compare pain, agitation/sedation, and delirium assessment tools. All task force members were allowed to review the literature supporting each statement and recommendation and provided feedback to the subcommittees. Group consensus was achieved for all statements and recommendations using the nominal group technique and the modified Delphi method, with anonymous voting by all task force members using E-Survey (http://www.esurvey.com). All voting was completed in December 2010. Relevant studies published after this date and prior to publication of these guidelines were referenced in the text. The quality of evidence for each statement and recommendation was ranked as high (A), moderate (B), or low/very low (C). The strength of recommendations was ranked as strong (1) or weak (2), and either in favor of (+) or against (-) an intervention. A strong recommendation (either for or against) indicated that the intervention's desirable effects either clearly outweighed its undesirable effects (risks, burdens, and costs) or it did not. For all strong recommendations, the phrase "We recommend …" is used throughout. A weak recommendation, either for or against an intervention, indicated that the trade-off between desirable and undesirable effects was less clear. For all weak recommendations, the phrase "We suggest …" is used throughout. In the absence of sufficient evidence, or when group consensus could not be achieved, no recommendation (0) was made. Consensus based on expert opinion was not used as a substitute for a lack of evidence. A consistent method for addressing potential conflict of interest was followed if task force members were coauthors of related research. The development of this guideline was independent of any industry funding. CONCLUSION These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation, and delirium in critically ill patients.
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Zhang Z, Pan L, Ni H. Impact of delirium on clinical outcome in critically ill patients: a meta-analysis. Gen Hosp Psychiatry 2013; 35:105-11. [PMID: 23218845 DOI: 10.1016/j.genhosppsych.2012.11.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 11/02/2012] [Accepted: 11/05/2012] [Indexed: 02/07/2023]
Abstract
CONTEXT Delirium is prevalent in the intensive care unit (ICU) and has been associated with negative clinical outcomes. However, a quantitative and systematic assessment of published studies has not been conducted. OBJECTIVE Meta-analysis of clinical observational studies was performed to investigate the association between delirium and clinical outcomes. DATA SOURCES AND STUDY SELECTION Relevant studies were identified by investigators from databases including Medline, Embase, OVID and EBSCO from inception to May 2012. Studies that reported the association of delirium with clinical outcomes in critical care setting were included. DATA EXTRACTION Data were extracted independently by reviewers and summary effects were obtained using random effects model. DATA SYNTHESIS Of the 16 studies included, 14 studies involving 5891 patients reported data on mortality, and delirious patients had higher mortality rate than non-delirious patients (odds ratio [OR]: 3.22; 95% confidence interval [CI]: 2.30-4.52). Delirious patients had higher rate of complications (OR: 6.5; 95% CI: 2.7-15.6), and were more likely to be discharged to skilled placement (OR: 2.59; 95% CI: 1.59-4.21). Furthermore, patients with delirium had longer length of stay in both ICU (weighted mean difference [WMD]: 7.32 days; 95% CI: 4.63-10.01) and hospital (WMD: 6.53 days; 95% CI: 3.03-10.03), and they spent more time on mechanical ventilation (WMD: 7.22 days; 95% CI: 5.15-9.29). CONCLUSION Delirium in critically ill patients is associated with higher mortality rate, more complications, longer duration of mechanical ventilation, and longer length of stay in ICU and hospital.
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Affiliation(s)
- Zhongheng Zhang
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, 351#, Mingyue Road, Jinhua, Zhejiang Province, 321000, PR China.
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Zetterlund P, Plos K, Bergbom I, Ringdal M. Memories from intensive care unit persist for several years--a longitudinal prospective multi-centre study. Intensive Crit Care Nurs 2012; 28:159-67. [PMID: 22579396 DOI: 10.1016/j.iccn.2011.11.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 11/23/2011] [Accepted: 11/28/2011] [Indexed: 01/22/2023]
Abstract
INTRODUCTION In connection with the care received in the intensive care unit (ICU), the patient can experience discomfort and frustration. Earlier studies have shown mechanical ventilation (MV) to be a factor that increases patients' delusional memories in the ICU. The patients who need MV after a physical trauma constitute a vulnerable group who so far has attracted little attention from a long-term perspective. AIM The aim for this study is to describe mechanically ventilated trauma patients over time regarding their memories, psychological recovery and health related quality of life (HRQoL). METHODS In a multicentre study, 41 patients who had received MV, answered a questionnaire with the SF-36, HAD and ICUM tool on two occasions about one and five years after the injury and care in the ICU. RESULTS The patients' memories were stable over time and significantly more patients remembered panic and anxiety. 37% remembered pain one year after the trauma and 46% five years thereafter. The majority of the patients remembered the family's presence from their ICU stay. Half of the patients had thoughts regarding why they had so few recollections. One fourth of the patients experienced clear symptoms of anxiety and the same amount had symptoms of depression one year after the injury. In seven of the patients the symptoms of probable anxiety persisted after five years. In six of the patients the symptoms of probable depression persisted after five years. Two of eight dimensions in HRQoL, the physical and emotional role functions, had improved significantly five years after the injury. CONCLUSIONS Five years after the trauma, the memories from the ICU were still the same and the HRQoL improved in only two out of eight dimensions. A smaller group of patients had remaining symptoms of psychological ill-health. MV in connection with trauma may result in continued reduced health in the long term.
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Affiliation(s)
- Per Zetterlund
- Operation Norr, AN/OP/IVA, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
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Nouwen MJ, Klijn FAM, van den Broek BTA, Slooter AJC. Emotional consequences of intensive care unit delirium and delusional memories after intensive care unit admission: a systematic review. J Crit Care 2011; 27:199-211. [PMID: 21958975 DOI: 10.1016/j.jcrc.2011.07.074] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 07/08/2011] [Accepted: 07/17/2011] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to review literature exploring the emotional consequences of delirium and delusional memories in intensive care unit patients. METHODS A systematic review was performed using PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsychINFO. RESULTS Fourteen articles were eligible for this review. Five of them assessed delirium during intensive care unit admission, and the remainder assessed delusional memories during or after admission. No association was found for delirium and adverse emotional outcome. Data regarding delusional memories and emotional outcome were heterogenic. Some studies presented worse scores on posttraumatic stress disorder screening tools in patients with delusional memories, whereas other studies found better scores in patients with delirium or delusional memories. CONCLUSIONS Based on current literature, no relationship could be shown for delirium and emotional outcome. Regarding delusional memories and adverse emotional outcome, results were in contradiction.
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Affiliation(s)
- Marinus J Nouwen
- Department of Intensive Care Medicine, University Medical Center, Utrecht, the Netherlands
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[Long-term consequences of postoperative delirium]. Anaesthesist 2011; 60:735-9. [PMID: 21647666 DOI: 10.1007/s00101-011-1901-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 04/15/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022]
Abstract
A patient reported anxiety and sleeping problems 9 months after reconstruction of the anterior floor of the mouth following tumor surgery. These symptoms had been initiated by a postoperative delirium with hallucinations, which had not been detected during its occurrence. One session of psychotherapy 9 months later reduced the symptoms. Patients in intensive care units should be asked and informed about delirium symptoms. This might prevent long-term psychological distress.
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Samuelson KAM. Unpleasant and pleasant memories of intensive care in adult mechanically ventilated patients--findings from 250 interviews. Intensive Crit Care Nurs 2011; 27:76-84. [PMID: 21371888 DOI: 10.1016/j.iccn.2011.01.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 01/02/2011] [Accepted: 01/07/2011] [Indexed: 01/17/2023]
Abstract
AIM In order to improve the patients' comfort and well-being during and after a stay in the intensive care unit (ICU), the patients' perspective on the intensive care experience in terms of memories is essential. The aim of this study was to describe unpleasant and pleasant memories of the ICU stay in adult mechanically ventilated patients. METHOD Mechanically ventilated adults admitted for more than 24hours from two Swedish general ICUs were included and interviewed 5 days after ICU discharge using two open-ended questions. The data were analysed exploring the manifest content. FINDINGS Of the 250 patients interviewed, 81% remembered the ICU stay, 71% described unpleasant memories and 59% pleasant. Ten categories emerged from the content analyses (five from unpleasant and five from pleasant memories), contrasting with each other: physical distress and relief of physical distress, emotional distress and emotional well-being, perceptual distress and perceptual well-being, environmental distress and environmental comfort, and stress-inducing care and caring service. CONCLUSION Most critical care patients have both unpleasant and pleasant memories of their ICU stay. Pleasant memories such as support and caring service are important to relief the stress and may balance the impact of the distressing memories of the ICU stay.
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Affiliation(s)
- Karin A M Samuelson
- Division of Nursing, Department of Health Sciences, Lund University, P.O. Box 157, SE-221 00 Lund, Sweden.
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The quality and duration of sleep in the intensive care setting: An integrative review. Int J Nurs Stud 2011; 48:384-400. [DOI: 10.1016/j.ijnurstu.2010.11.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 10/24/2010] [Accepted: 11/26/2010] [Indexed: 12/28/2022]
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Black P, Boore JRP, Parahoo K. The effect of nurse-facilitated family participation in the psychological care of the critically ill patient. J Adv Nurs 2011; 67:1091-101. [PMID: 21214624 DOI: 10.1111/j.1365-2648.2010.05558.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM This paper is a report of a Neuman systems model-guided study of the effects of nurse-facilitated family participation in psychological care on the extent of patient delirium and psychological recovery following critical illness. BACKGROUND Psychological disturbances resulting from critical illness have been well documented in international literature. Few studies have tested interventions designed to alleviate such disturbances. METHODS A comparative time series design was used. A total of 170 critically ill patients and families participated in the study - 83 in the control group and 87 in the intervention group. Data were collected during critical illness and subsequent recovery using the Therapeutic Intervention Scoring System-28, Intensive Care Delirium Screening Checklist and the Sickness Impact Profile. The study was carried out in Northern Ireland, data collection taking place from January 2004 to December 2005. RESULTS/FINDINGS Nurse-facilitated family participation in psychological care did not significantly reduce the incidence of delirium among patients in critical care, but patients receiving intervention demonstrated better psychological recovery and wellbeing than the control group at 4, 8 and 12 weeks after admission to critical care. CONCLUSION Nurse-facilitated family participation in the psychological care may strengthen the lines of defence and resistance against the stressors experienced by the patient during critical illness and improve psychological recovery.
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Affiliation(s)
- Pauline Black
- Nursing School of Nursing, University of Ulster, Coleraine, Northern Ireland.
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Abstract
AIM The aim of this study was to describe critical care nurses' experiences of follow-up visits for formerly critically ill people discharged from an intensive care unit and their close relatives. BACKGROUND The critical illness experience affects the ill person and their close relatives not only during the stay in an intensive care unit, but also for a long time afterwards. Follow-up visits were introduced to offer people the opportunity to talk about their experiences. This activity has not been studied earlier from the perspective of critical care nurses. DESIGN The design of this study was qualitative. METHOD Eight critical care nurses narrated their experiences of follow-up visits by formerly critically ill people and their close relatives to an intensive care unit. Data were collected during 2007-2008. Qualitative thematic content analysis was applied to the interview texts. RESULTS The findings show that to feel they were doing a good job it was vital for the critical care nurses to be well prepared for the follow-up visits. It was difficult, in a positive way, to recognise formerly critically ill people when they returned looking healthy. The critical care nurses were disappointed that their former patients remembered so few real events. The follow-up visits gave the critical care nurses a new picture of how the critically illness experience influenced the former patient's everyday life during and after their stay in the intensive care unit and how it affected the lives of their close relatives. CONCLUSIONS Through sharing the experiences of formerly critically ill peoples' and their close relatives' critical care nurses receive valuable feedback about their work. RELEVANCE TO CLINICAL PRACTICE Receiving feedback about one's work from follow-up visits gives critical care nurses the possibility for to evaluate given care. Follow-up visits to intensive care units can provide them with valuable knowledge that might lead to improved nursing care.
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Affiliation(s)
- Asa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technolog, Luleå, Sweden.
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Abstract
The author, a practicing psychiatrist, describes his own experience in becoming a neurosurgical patient, three times in quick succession, for a recurring subdural hematoma. In addition to a brief review of the literature, he observes his own experience, including reaction to the diagnosis and to the surgical, postsurgical, and intensive-care experience. Suggestions are made to neurosurgeons and their staff to help patients during this experience and in recovery, from the vantage point of a psychiatrist who specializes in dealing with psychological issues arising from illness.
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Affiliation(s)
- Lee Schwartz
- Psychiatry and Behavioral Science, Northwestern University Medical School, Chicago, Illinois, USA.
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Brodsky-Israeli M, DeKeyser Ganz F. Risk factors associated with transfer anxiety among patients transferring from the intensive care unit to the ward. J Adv Nurs 2010; 67:510-8. [DOI: 10.1111/j.1365-2648.2010.05497.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Terada Y, Inoue S, Tanaka Y, Kawaguchi M, Hirai K, Furuya H. The impact of postoperative intensive care on outcomes in elective neurosurgical patients in good physical condition: a single centre propensity case-matched study. Can J Anaesth 2010; 57:1089-94. [PMID: 20890691 DOI: 10.1007/s12630-010-9393-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 09/16/2010] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In the last three years, all elective neurosurgical cases were performed by a single surgeon at Nara Medical University. For the last year and a half, all patients were transferred to a newly created neurosurgical intensive care unit. The purpose of this study was to evaluate the impact of admission to an intensive care unit after elective neurosurgery. METHODS This study was conducted as a retrospective clinical chart review. Institutional ethics approval was waived, and we reviewed the charts of 296 neurosurgical patients who were American Society of Anesthesiologists' physical status I-II. To avoid channelling bias, propensity score analysis was used to generate a set of matched cases (patients transferred to the intensive care unit [ICU]) and controls (patients transferred to the neurosurgical ward). This process resulted in 104 matched pairs of elective surgical patients who did or did not have an ICU admission after surgery. Glasgow outcome scale (GOS) at discharge or at three months after the operation was compared as the primary outcome measure. As secondary outcome measures, we also compared rates of severe early complications and patient satisfaction regarding perioperative patient care. RESULTS With an unmatched population, poor GOS tended to occur more often in the non-ICU group than in the ICU group (6.5% vs 2.3%, respectively). Mortality rates and severe early complication rates also tended to be higher in the non-ICU group than in the ICU group (2.4% and 5.3%, respectively, non-ICU group vs 0.8% and 2.3%, respectively, ICU group). However, after propensity score matching, there was no difference regarding the GOS between groups. Both groups showed very high good outcome percentages (98.1% ICU vs 97.1% non-ICU). With regard to mortality rates and severe early complications, both groups showed low mortality (0.96% vs 0.96%) and complication rates (2.89% ICU vs 3.85% non-ICU). Patient care in the ICU failed to increase patient satisfaction regarding the overall hospital care. CONCLUSION The results of this analysis suggest that admission to an ICU after elective neurosurgery has little impact on outcomes.
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Affiliation(s)
- Yuki Terada
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
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Empowerment in intensive care: Patient experiences compared to next of kin and staff beliefs. Intensive Crit Care Nurs 2009; 25:332-40. [DOI: 10.1016/j.iccn.2009.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 06/08/2009] [Accepted: 06/09/2009] [Indexed: 11/18/2022]
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