Gaete Ortega Damaris, Papathanassoglou Elizabeth, Norris Colleen M
Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
Faculty of Nursing, University of Alberta, Edmonton, AB, Canada; Heart Health and Stroke Strategic Clinical Network-AHS, Canada; Division of Cardiac Surgery, Faculty of Medicine, Canada.
Aust Crit Care. 2020 Mar;33(2):193-202. doi: 10.1016/j.aucc.2019.01.003. Epub 2019 Mar 11.
The objectives were to interpretatively synthesise qualitative findings on patients' lived experience of delirium in the intensive care unit (ICU) and to identify meanings and potential existential issues that affect them during and after their experience. Patients may face existential challenges when they are vulnerable in their confusion, all while confronting the reality of their mortality in the critically ill state.
The study involved meta-ethnographic synthesis of published qualitative studies addressing the lived experience of delirium for patients in ICU based on a systematic literature search.
MEDLINE, PsycINFO, Embase, Scopus, CINAHL, ProQuest, and Cochrane were the sources. Studies were selected based on the predefined inclusion/exclusion criteria. The identified studies were subjected to a quality appraisal based on a Critical Appraisal Skills Programme tool.
Based on the eligibility criteria, nine qualitative studies were included, of overall medium to high quality. One core theme, "a perturbing altered reality" and four main themes were identified: "disturbed sense of time", "omnipresent feeling of fear", "impact of human connection", and "perceiving surreal events". These four themes illustrate how the three salient existential issues of uncertainty, self-perceived helplessness, and death that are present in delirium make it a highly distressing experience for patients in ICU.
Critically ill patients who experience delirium appear to face intense existential issues, which may not be identified by care providers and may remain unaddressed during their ICU stay and after discharge. Patients report that addressing the memories of these issues would be therapeutic. Future research needs to explore care approaches to meet the unique psychosocial needs of critically ill patients with delirium.
本研究旨在对重症监护病房（ICU）患者谵妄生活经历的定性研究结果进行解释性综合分析，并识别在经历期间及之后影响他们的意义和潜在的生存问题。患者在意识混乱且脆弱的状态下可能会面临生存挑战，同时还要面对重症状态下自身死亡的现实。
该研究基于系统的文献检索，对已发表的关于ICU患者谵妄生活经历的定性研究进行元民族志综合分析。
数据来源包括MEDLINE、PsycINFO、Embase、Scopus、CINAHL、ProQuest和Cochrane。研究根据预先确定的纳入/排除标准进行选择。对纳入的研究基于批判性评估技能计划工具进行质量评估。
根据纳入标准，纳入了9项定性研究，总体质量为中到高。确定了一个核心主题“令人不安的现实改变”和四个主要主题：“时间感紊乱”、“无处不在的恐惧感觉”、“人际关系的影响”以及“感知超现实事件”。这四个主题说明了谵妄中存在的不确定性、自我感知的无助感和死亡这三个突出的生存问题如何使ICU患者的经历极其痛苦。
经历谵妄的重症患者似乎面临着强烈的生存问题，护理人员可能无法识别这些问题，在他们的ICU住院期间和出院后这些问题可能仍未得到解决。患者报告称，处理这些问题的记忆将具有治疗作用。未来的研究需要探索护理方法，以满足患有谵妄的重症患者独特的心理社会需求。
