Journal of Korean Academy of Nursing (대한간호학회지)

Korean Society of Nursing Science (한국간호과학회)
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Delirium Experience of the Intensive Care Unit Patients

중환자실 환자의 섬망 경험

  • Jung, Jaeyeon (Cardiac Care Unit, Seoul St. Mary's Hospital) ;
  • Jang, Sujin (Cardiac Care Unit, Seoul St. Mary's Hospital) ;
  • Jo, Seonmi (Cardiac Care Unit, Seoul St. Mary's Hospital) ;
  • Lee, Sunhee (College of Nursing, The Catholic University of Korea)
  • 정재연 (서울성모병원 심장계중환자실) ;
  • 장수진 (서울성모병원 심장계중환자실) ;
  • 조선미 (서울성모병원 심장계중환자실) ;
  • 이선희 (가톨릭대학교 간호대학)
  • Received : 2021.12.28
  • Accepted : 2022.03.30
  • Published : 2022.04.30
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Abstract

Purpose: The study aimed to understand the delirium experience of intensive care unit (ICU) patients. Methods: We performed a qualitative study using Colaizzi's phenomenological method. Eleven patients, who experienced delirium according to the Confusion Assessment Method for ICU, participated after transferring to general wards from the ICU. Individual in-depth semi-structured interviews ranging from 30 minutes to 2 hours in length were conducted between November 2018 and August 2019. Results: Nine themes and four theme clusters emerged. The four theme clusters were: 1) "Overwhelmed by fear," which describes the experience of a patient close to death and the feeling of difficulty in understanding disorganized thinking; 2) "Anxious about not understanding the situation," which means that patients' sense of time and space were disordered in the ICU; 3) "Being deserted," which indicates the feeling of being separated from others and yourself; and 4) "Resistance to protect my dignity," which indicates that the dignity and autonomy of an individual in the patient's position at the ICU, are ignored. Conclusion: Nursing interventions are needed that would enable patients to maintain orientation and self-esteem in the ICU. In addition, healthcare providers need to provide information about the unfamiliar environment in the ICU in advance.

Keywords

Acknowledgement

This study was supported by the research fund of the Catholic University of Korea, Seoul St. Mary's Hospital in 2022.

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th Engl. Ed. Kwon JS, Kim JJ, Namkoong K, Park WM, Shin MS, Yoo BH, et al., translator. Seoul: Hakjisa; c2015. p. 645-656.
  2. Choi SJ, Cho YA. Prevalence and related risk factors of delirium in intensive care units as detected by the CAMICU. Journal of Korean Clinical Nursing Research. 2014;20(3):406-416. https://doi.org/10.22650/JKCNR.2014.20.3.406
  3. Park SH, Kim HJ, Choi HY, You JE, Park JE, Kim EJ, et al. Factors related to motor subtypes of delirium patients in a surgical intensive care unit. Journal of Korean Clinical Nursing Research. 2020;26(2):207-216. https://doi.org/10.22650/JKCNR.2020.26.2.207
  4. Sharma A, Malhotra S, Grover S, Jindal SK. Incidence, prevalence, risk factor and outcome of delirium in intensive care unit: A study from India. General Hospital Psychiatry. 2012;34(6):639-646. https://doi.org/10.1016/j.genhosppsych.2012.06.009
  5. Ahn JS, Oh J, Park J, Kim JJ, Park JY. Incidence and procedure-related risk factors of delirium in patients admitted to an intensive care unit. Korean Journal of Psychosomatic Medicine. 2019;27(1):35-41. https://doi.org/10.22722/KJPM.2019.27.1.35
  6. Ko C, Kim JJ, Cho D, Oh J, Park JY. A study on clinical variables contributing to differentiation of delirium and non-delirium patients in the ICU. Korean Journal of Psychosomatic Medicine. 2019;27(2):101-110. https://doi.org/10.22722/KJPM.2019.27.2.101
  7. Evans AS, Weiner MM, Arora RC, Chung I, Deshpande R, Varghese R, et al. Current approach to diagnosis and treatment of delirium after cardiac surgery. Annals of Cardiac Anaesthesia. 2016;19(2):328-337. https://doi.org/10.4103/0971-9784.179634
  8. Sohn JH, Na SH, Shin CS, Sohn I, Oh JY, An JS, et al. Impact of delirium on clinical outcomes in intensive care unit patients: An observational study in a Korean general hospital. Journal of Korean Neuropsychiatric Association. 2014;53(6):418-425. https://doi.org/10.4306/jknpa.2014.53.6.418
  9. Shim MY, Song SH, Lee M, Park MA, Yang EJ, Kim MS, et al. The effects of delirium prevention intervention on the delirium incidence among postoperative patients in a surgical intensive care unit. Journal of Korean Clinical Nursing Research. 2015;21(1):43-52. https://doi.org/10.22650/JKCNR.2015.21.1.43
  10. Kim JY, Lee EJ. Factors affecting nursing performance of delirium for general hospital clinical nurses. Journal of Korean Clinical Nursing Research. 2016;22(2):183-193. https://doi.org/10.22650/JKCNR.2016.22.2.183
  11. Park H, Chang MY. Nurse's knowledge, confidence and performance on care for delirium. Journal of Health Informatics and Statistics. 2016;41(4):359-368. https://doi.org/10.21032/jhis.2016.41.4.359
  12. Whitehorne K, Gaudine A, Meadus R, Solberg S. Lived experience of the intensive care unit for patients who experienced delirium. American Journal of Critical Care. 2015; 24(6):474-479. https://doi.org/10.4037/ajcc2015435
  13. Svenningsen H, Egerod I, Dreyer P. Strange and scary memories of the intensive care unit: A qualitative, longitudinal study inspired by Ricoeur's interpretation theory. Journal of Clinical Nursing. 2016;25(19-20):2807-2815. https://doi.org/10.1111/jocn.13318
  14. Schmitt EM, Gallagher J, Albuquerque A, Tabloski P, Lee HJ, Gleason L, et al. Perspectives on the delirium experience and its burden: Common themes among older patients, their family caregivers, and nurses. The Gerontologist. 2019; 59(2):327-337. https://doi.org/10.1093/geront/gnx153
  15. Partridge JS, 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? International Journal of Geriatric Psychiatry. 2013;28(8):804-812. https://doi.org/10.1002/gps.3900
  16. Pollard C, Fitzgerald M, Ford K. Delirium: The lived experience of older people who are delirious post-orthopaedic surgery. International Journal of Mental Health Nursing. 2015;24(3):213-221. https://doi.org/10.1111/inm.12132
  17. Guttormson JL. "Releasing a lot of poisons from my mind": Patients' delusional memories of intensive care. Heart & Lung. 2014;43(5):427-431. https://doi.org/10.1016/j.hrtlng.2014.04.007
  18. Kim YH, Koo MJ, Kim SH, Kim YM, Lee NY, Chang KO. The experiences of patients in Intensive Care Units(ICU). Journal of Korean Academy of Nursing. 2007;37(6):924-931. https://doi.org/10.4040/jkan.2007.37.6.924
  19. Yang JH. Experiences of admission for critically ill patients in ICU. Journal of Korean Academy of Adult Nursing. 2008;20(1):149-162.
  20. Northall T, Chang E, Hatcher D, Nicholls D. The application and tailoring of Colaizzi's phenomenological approach in a hospital setting. Nurse Researcher. 2020;28(2):20-25. https://doi.org/10.7748/nr.2020.e1700
  21. Guba EG, Lincoln YS. Fourth generation evaluation. Newbury Park (CA): Sage Publications; 1989. p. 233-243.
  22. Wade DM, Brewin CR, Howell DC, White E, Mythen MG, Weinman JA. Intrusive memories of hallucinations and delusions in traumatized intensive care patients: An interview study. British Journal of Health Psychology. 2015;20(3):613-631. https://doi.org/10.1111/bjhp.12109
  23. Shin KM, Choi HR. Effects of prior information about intensive care unit environment on anxiety and environmental stress in patients undergoing open heart surgery. Journal of Korean Academic Society of Nursing Education. 2015;21(1):28-35. https://doi.org/10.5977/jkasne.2015.21.1.28
  24. Yun JY, Lee KE. Effect of nursing information on ICU patient's environmental stress, anxiety and comfort. Journal of Korean Biological Nursing Science. 2011;13(2):109-116.
  25. Min GE, Seo E, Shin SH. Effects of preoperative video education on delirium and anxiety in elderly patients with general anesthesia. Journal of East-West Nursing Research. 2020;26(1):52-62. https://doi.org/10.14370/jewnr.2020.26.1.52
  26. Gaete Ortega D, Papathanassoglou E, Norris CM. The lived experience of delirium in intensive care unit patients: A meta-ethnography. Australian Critical Care. 2020;33(2):193-202. https://doi.org/10.1016/j.aucc.2019.01.003
  27. Lee MJ, Yun SH, Choi KO, Seong SS, Lee SM, Kang JJ. Effects of delirium prevention interventions for neurocritical patients. Journal of Korean Academy of Fundamentals of Nursing. 2018;25(2):109-119. https://doi.org/10.7739/jkafn.2018.25.2.109
  28. FitzGerald JM, O'Regan N, Adamis D, Timmons S, Dunne CP, Trzepacz PT, et al. Sleep-wake cycle disturbances in elderly acute general medical inpatients: Longitudinal relationship to delirium and dementia. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring. 2017;7:61-68. https://doi.org/10.1016/j.dadm.2016.12.013
  29. Hong HJ, Kang J. A qualitative content analysis of the person-centered care experienced by critical care patients. Journal of Korean Critical Care Nursing. 2018;11(2):21-33.
  30. Lee S, Lee SM. Path analysis for delirium on patient prognosis in intensive care units. Journal of Korean Academy of Nursing. 2019;49(6):724-735. https://doi.org/10.4040/jkan.2019.49.6.724
  31. Chen CC, Li HC, Liang JT, Lai IR, Purnomo JDT, Yang YT, et al. Effect of a modified hospital elder life program on delirium and length of hospital stay in patients undergoing abdominal surgery: A cluster randomized clinical trial. JAMA Surgery. 2017;152(9):827-834. https://doi.org/10.1001/jamasurg.2017.1083
  32. Wang YY, Yue JR, Xie DM, Carter P, Li QL, Gartaganis SL, et al. Effect of the tailored, family-involved hospital elder life program on postoperative delirium and function in older adults: A randomized clinical trial. JAMA Internal Medicine. 2020;180(1):17-25. https://doi.org/10.1001/jamainternmed.2019.4446