Abstract

DELIRIUM RELATED DISTRESS EXPERIENCED BY PATIENTS, CAREGIVERS AND NURSING STAFF IN A MEDICAL INTENSIVE CARE UNIT (ICU)

Author(s): Ayush Kumar Jayaswal, Harshavardhan Sampath, Geeta Shyamsunder Soohinda, Sanjiba Dutta

BACKGROUND Delirium, a common neuropsychiatric syndrome in intensive care settings is a distressing experience for the patient, caregivers and nursing staff. Research on delirium experience has been scant and unsystematic. We set out to explore the extent of recall of delirium, differential distress it had on patients, caregivers and nursing staff and the extent to which it impacted recognition across the motoric subtypes. MATERIALS AND METHODS A prospective study was carried out on all consecutively admitted patients in the medical ICU of a tertiary care teaching hospital. Patients diagnosed with delirium using Confusion Assessment Method for ICU (CAM-ICU) were administered the Richmond Agitation Sedation Scale (RASS) for differentiating the motor subtypes (hypoactive, hyperactive, mixed). Distress was assessed using the Delirium Experience Questionnaire (DEQ). RESULTS Of the 88 patients (31.43%) who developed delirium, 60.2% recalled their experience. Recall was highest in the hyperactive subtype. 76% of patients, 94.3% of caregivers and 31.8% of nursing staff reported severe levels of distress. Motoric subtypes did not impact on the distress levels experienced by the patients or their caregivers, but influenced it significantly in the nursing staff (highest in hyperactive, least in hypoactive). Identification of delirium by nursing staff (13.4%) was significantly influenced by the motor subtypes (highest in hyperactive, least in hypoactive). Linear regression analysis revealed that distress of ICU staff (F=1.36, p=0.018) and not the motoric subtypes (F=1.36, p=0.262) significantly predicted recognition of delirium. CONCLUSIONS Most patients who develop delirium and their caregivers experience high levels of distress. Under-recognition is significantly influenced by the distress it causes the ICU staff than the motor subtype of delirium.