Delirium in intensive care: violence, loss and humanity

Abstract

Delirium in intensive care is an altered state that can bring with it persecutory paranoias, and sometimes expressions of violence on the part of the patient; it can be deeply disturbing for the person experiencing it as well as for those around them. Although the impacts of delirium on patients’ recovery and long-term mental health are well documented, qualitative research in this area remains rare. This article is derived from a narrative and musical study of the experience of delirium in hospital, undertaken better to understand the perspectives of people who have experienced delirium, as well as the healthcare professionals and family members who care for them. Data were collected in South Africa between 2015 and 2017. The study took the form of interviews and focus groups with a total of 15 participants, as well as periods of observation and audio recording in a hospital intensive care unit. Thematic and narrative analysis of the data were carried out alongside the composition of new music incorporating audio recordings from the study. Analysis suggested three key themes emerging from the data. First, the violence experienced and expressed by patients, both within delirious hallucination and in observable reality. Second, the interconnected losses undergone by patients in spaces of intensive care. Third, healthcare professionals’ attempts to bring greater humanity into the potentially dehumanising space of intensive care. The results and discussion point to possible relationships between delirium and the working cultures and physical environment of intensive care, and may reinforce the need for sensitive and committed communication between healthcare professionals and patients.

Patients’ and Relatives’ Experiences of Delirium in the Intensive Care Unit—A Qualitative Study

“…Descriptions of the experiences associated with an episode of delirium are often expressed metaphorically and are always associated with emotions. Patients and their families use mild, non-clinical terms to describe the disorders associated with delirium, in contrast to medical staff for who synonyms of delirium are, e.g., disorientation, disturbance of consciousness [ 25 ]. Therefore, we considered the term “emotional disorder” to be appropriate and understandable for the study participants.…”

Family experiences and attitudes toward care of ICU patients with delirium: A scoping review

“…Our scoping review identified 209 articles, from which 13 articles reporting the experiences and attitudes of family/carers of ICU patients who developed delirium during hospitalization were included (Figure 2). Of the included studies, eight were qualitative studies (15)(16)(17)(18)(19)(20)(21)(22), three were quantitative studies (23-25), and two were reviews (one systematic review and one integrative review) (26, 27). The studies were conducted in North America (n = 5), Europe (n = 4), South Africa (n = 1), Asia (n = 1).…”

“…According to families and relatives, one of the barriers was inadequate communication between medical staff and carers (15)(16)(17)(18)(19)22). Families often feel uncertain about the interventions they are allowed to perform with their relative.…”

Humanizing the Intensive Care Unit: Perspectives of Patients and Families on the Get to Know Me Board

“… 3 Loss of identity, with or without the state of delirium, is closely tied to inability to communicate, control environment in state of critical illness, being referred to room numbers or disease entities. 4 , 5 Sequelae of critical illness of anxiety, depression, and post-traumatic stress disorder is present in upto a third of survivors. 6 – 8 Why are ICU experiences so traumatic?…”