Department of Molecular Medicine and Surgery, Karolinska Institutet, L1:00, Anna Steckséns gata 53, SE-171 76 Stockholm, Sweden; Perioperative Medicine and Intensive Care Function E7:67, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, L1:00, Anna Steckséns gata 53, SE-171 76 Stockholm, Sweden; Perioperative Medicine and Intensive Care Function E7:67, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
Intensive Crit Care Nurs. 2023 Dec;79:103493. doi: 10.1016/j.iccn.2023.103493. Epub 2023 Jul 20.
Postoperative delirium affects up to 50% of patients undergoing cardiac surgery. Delirium phenotypes are commonly divided into hyperactive and hypoactive, with hypoactive symptoms (reduced motor activity and withdrawal) often being overlooked due to their discreet character. Although the consequences of hypoactive delirium are severe, studies focusing on patients' experiences of hypoactive delirium are scarce. The aim of the study was to describe cardiac surgery patients' experiences of hypoactive delirium.
RESEARCH METHODOLOGY/DESIGN: We used qualitative descriptive semi-structured interviews with an inductive, latent approach. Twelve patients with hypoactive symptoms of delirium after cardiac surgery were purposefully selected. Interview data were analysed by qualitative content analysis.
Two themes based on eight sub-themes emerged. "Dream or reality in parallel worlds" included disturbing experiences of existing in parallel realities with cognitive effects, residual nightmares, and illusions that occasionally persisted after hospital discharge. "Managing the state of hypoactive delirium" included experiences of intellectually dealing with hypoactive delirium with assumptions of causes and cures, and through interactions like communicating with others.
Participants experienced hypoactive delirium as extensive and long-lasting with perceptions of existing in parallel realities. The findings emphasize the need for healthcare professionals to have expertise in hypoactive delirium and its fluctuating course, as the delirium of many patients may be undetected and undiagnosed. Improving the use of screening tools for clinical practice is essential for the detection of hypoactive delirium, and a person-centred approach is needed to properly care for this group of patients.
The challenges in the recognition of hypoactive delirium need to be emphasized because the syndrome is still overlooked. The use of screening tools in clinical practice is essential. A person-centred approach supports relationships between delirious patients and healthcare professionals.
术后谵妄影响多达 50%的心脏手术患者。谵妄表型通常分为活动亢进型和活动低下型，由于其表现较为隐匿，活动低下型的症状（运动活动减少和退缩）常常被忽视。尽管活动低下型谵妄的后果严重，但关注患者活动低下型谵妄体验的研究却很少。本研究旨在描述心脏手术后患者活动低下型谵妄的体验。
研究方法/设计：我们采用了定性描述性半结构式访谈，采用了归纳法、潜在方法。我们有目的地选择了 12 名心脏手术后出现活动低下型谵妄症状的患者。使用定性内容分析法对访谈数据进行分析。
出现了两个主题，包含八个子主题。“在平行世界中的梦境或现实”包括存在于平行现实中的令人不安的体验，伴有认知影响、残留的噩梦和幻觉，这些体验偶尔会在出院后持续存在。“管理活动低下型谵妄状态”包括体验活动低下型谵妄的智力处理方式，通过对原因和治疗方法的假设，以及通过与他人交流等互动方式。
参与者体验到活动低下型谵妄的广泛性和长期性，以及存在于平行现实中的感知。研究结果强调了医护人员需要具备活动低下型谵妄及其波动过程的专业知识，因为许多患者的谵妄可能未被发现和诊断。改善筛查工具在临床实践中的应用对于检测活动低下型谵妄至关重要，需要采取以人为本的方法来妥善照顾这组患者。
需要强调识别活动低下型谵妄的挑战，因为该综合征仍然被忽视。在临床实践中使用筛查工具至关重要。以人为本的方法支持处于谵妄状态的患者和医护人员之间的关系。
