Laboratory of Studies & Evidence Based Nursing, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35131 Padova, Italy.
School of Nursing, Department of Medical Sciences, University of Udine, Viale Ungheria 20, 33100 Udine, Italy.
Intensive Crit Care Nurs. 2024 Apr;81:103617. doi: 10.1016/j.iccn.2023.103617. Epub 2024 Jan 4.
To critically summarise the qualitative literature to understand patients' experiences of delusional memories during their Intensive Care Unit stay.
A systematic review of qualitative studies with meta-synthesis and meta-summary. We searched MEDLINE (via PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science to July 2022. All studies that provided qualitative insights into the subjective experience of adult patients with delusional memories in the Intensive Care Unit were selected. The Critical Assessment Skills Programme checklist was used for the quality assessment.
Fourteen studies were included. The 33 codes that emerged from the inductive thematic analysis were grouped into three themes: 'The sense of danger and the terrifying aspect of death' (feeling in danger, surrounded by death, persecuted by people around, and feeling unsafe), 'The presence of someone or something nearby' (perceiving the loved ones, feeling overwhelmed by scary creatures, and being neglected by those around me), and 'The reality behind the world perceived by the senses' (travelling the world, stimulating the senses, feeling peaceful, and living in a fantasy world). The most frequent code in the studies was 'Be with a family member', with an intensity of 35.7%.
The patient's experience described as delusional is considered a real event by the person experiencing it. Further research is needed to investigate the extent to which these experiences lead to poorer early and late outcomes for patients, and to test strategies to prevent this.
A deeper understanding of the phenomenon may help healthcare professionals to recognise precursors, symptoms and consequences of delusional memories and intervene with appropriate help. One strategy would be to further humanise care and focus on family involvement and communication with patients to overcome the factual events that can potentially alter patients' quality of life.
批判性总结定性文献，以了解患者在重症监护病房期间出现妄想记忆的体验。
系统综述定性研究，采用元综合和元总结。我们检索了 MEDLINE（通过 PubMed）、护理与联合健康文献累积索引（CINAHL）、Scopus 和 Web of Science，检索时间截至 2022 年 7 月。选择了所有提供成人患者在重症监护病房出现妄想记忆的主观体验的定性见解的研究。使用关键评估技能计划清单对质量进行评估。
纳入了 14 项研究。从归纳主题分析中出现的 33 个代码被分为三个主题：“危险感和死亡的可怕方面”（感到危险，被死亡包围，被周围的人迫害，感到不安全）、“附近有人或物”（感知到亲人，被可怕的生物压得喘不过气来，被周围的人忽视）和“感官所感知的世界背后的现实”（环游世界，刺激感官，感到平静，生活在幻想世界中）。研究中最常见的代码是“与家人在一起”，强度为 35.7%。
患者体验到的被描述为妄想的经历被经历者视为真实事件。需要进一步研究，以调查这些经历在多大程度上导致患者早期和晚期结局恶化，并测试预防这些经历的策略。
对这一现象的更深入了解可能有助于医疗保健专业人员识别妄想记忆的前兆、症状和后果，并采取适当的帮助。一种策略是进一步人性化护理，关注家庭参与和与患者的沟通，以克服可能改变患者生活质量的事实事件。
