Background

Better understanding of patient and family member experiences of delirium and related distress during critical care is required to inform the development of targeted nonpharmacologic interventions.

Objective

To examine and synthesize qualitative data on patient and family member delirium experiences and relieving factors in the Intensive Care Unit (ICU).

Design

We conducted a systematic review and qualitative meta-synthesis. Eligible studies contained adult patient or family quotes about delirium during critical care, published in English in a peer-reviewed journal since 1980. Data sources included PubMed, Embase, CINAHL, PsycINFO, Web of Science, Cochrane and Clinicaltrials.gov.

Methods

Systematic searches yielded 3238 identified articles, of which 14 reporting 13 studies were included. Two reviewers independently extracted data into a Microsoft Excel spreadsheet. Qualitative meta-synthesis was performed through line-by-line coding of relevant quotes, organization of codes into descriptive themes, and development of analytical themes. Five patients/family members with experience of ICU delirium contributed to the thematic analysis.

Results

Qualitative meta-synthesis resulted in four major themes and two sub-themes. Key new patient and family-centric insights regarding delirium-related distress in the ICU included articulation of the distinct emotions experienced during and after delirium (for patients, predominantly fear, anger and shame); its ‘whole-person’ nature; and the value that patients and family members placed on clinicians’ compassion, communication, and connectedness.

Conclusions

Distinct difficult emotions and other forms of distress are experienced by patients and families during ICU delirium, during which patients and families highly value human kindness and empathy. Future studies should further explore and address the many facets of delirium-related distress during critical care using these insights and include patient-reported measures of the predominant difficult emotions.

中文翻译：

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ICU 中谵妄相关的痛苦：患者和家庭观点和经历的定性综合综合

背景

需要更好地了解患者和家庭成员在重症监护期间谵妄和相关痛苦的经历，以便制定有针对性的非药物干预措施。

客观的

检查和综合关于重症监护病房 (ICU) 中患者和家庭成员谵妄经历和缓解因素的定性数据。

设计

我们进行了系统回顾和定性综合综合。符合条件的研究包含成人患者或家庭对重症监护期间谵妄的引用，自 1980 年以来以英文发表在同行评审期刊上。数据来源包括 PubMed、Embase、CINAHL、PsycINFO、Web of Science、Cochrane 和 Clinicaltrials.gov。

方法

系统搜索产生了 3238 篇确定的文章，其中包括 14 篇报告 13 项研究。两名审阅者独立地将数据提取到 Microsoft Excel 电子表格中。定性元综合是通过逐行编码相关引用、将代码组织成描述性主题以及开发分析主题来进行的。五名有 ICU 谵妄经历的患者/家庭成员参与了专题分析。

结果

定性元综合产生了四个主要主题和两个子主题。关于 ICU 谵妄相关痛苦的以患者和家庭为中心的关键新见解包括阐明谵妄期间和之后所经历的不同情绪（对患者而言，主要是恐惧、愤怒和羞耻）；它的“全人”性质；以及患者和家属对临床医生的同情心、沟通和联系的重视。

结论

在ICU谵妄期间，患者和家属会经历不同的困难情绪和其他形式的痛苦，在此期间患者和家属高度重视人类的善良和同理心。未来的研究应该利用这些见解进一步探索和解决重症监护期间谵妄相关痛苦的许多方面，并包括患者报告的主要困难情绪的测量。