Helle Sorensen, Communications Officer
in conversation with
Helle Svenningsen, Researcher, VIA University College, Denmark
New findings on patients’ memories after ICU stay. People remember all sorts of things. Helle Svenningsen, Researcher at the Center in Health Promotion and Rehabilitation at VIA University College in Denmark, remembers vividly the conversation that prompted her to embark on a PhD in delirium:
“It was 2004 when I worked as a critical care nurse. While trying to talk to a patient about his illness, he kept going off track. He talked about his experiences of delirium. I became aware of my own frustration and suddenly realised that perhaps there was a reason he kept returning to these memories, that perhaps I was not really asking the right questions”.
Helle decided to start asking patients about their memories after ICU discharge. To be exact, she talked to 325 people; after 2 weeks, 2 months and 6 months. We asked her what they told her.
Four themes related to ICU memories
As part of the ICU Memory Tool (Jones et al, 2010), Helle asked patients about memories of: nightmares, hallucinations, dreams and feeling that people were trying to hurt them (in the study, ICU Memory Tool was used after discharge, whereas delirium was assessed in the ICU using the Confusion Assessment Method of the ICU, ed.).
“I was surprised to discover how much patients remember, and how clear and vivid these memories are, even after six months. In general, the delirious patients remember few facts but many delusions; whereas the non-delirious remember many facts. And very interestingly I also found that 20% of patients who were not found delirious with the CAM-ICU method had intense memories of 4 types of delusions, namely both nightmares, hallucinations, dreams and the feeling that people were trying to hurt them (see table 1)”.
|Table 1 Number of memories of delusions according to timing of interview|
|No. of memories of delusions||0||1||2||3||4|
|After 2 weeks, n (% w. delirium)||143 (51)||67 (54)||59 (59)||39 (59)||17 (82)|
|After 2 mths, n (% w. delirium)||149 (47)||53 (53)||41 (61)||34 (62)||18 (78)|
|After 6 mths, n (% w. delirium)||129 (43)||39 (59)||38 (47)||25 (80)||15 (80)|
(With permission from: Svenningsen, H., Egerod, I. and Dreyer, P., 2016. Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur’s interpretation theory. Journal of Clinical Nursing, 25(19-20), pp. 2807-2815).
What did patients with delusional memories remember after discharge?
“Out of the 114 patients who described memories of delusions we consistently found four themes. Firstly, patients recalled their family being ever-present. Often the family would either be trying to save them or acting as an accomplice in some evil plan that staff members were plotting. One of the more shocking stories involved a patient who told me his family had been hanging in butcher’s hooks in the ceiling. It wasn’t frightening he said; they were just there.
“Out of the 114 patients who described memories of delusions we consistently found four themes”
Secondly, many patients described dynamic spaces and being in rooms that were not in the ICU. A patient told me that he was watching television and remembers suddenly being inside it.
Thirdly, patients experienced loss of control and trying to survive challenges. Patients took part in experiments or a game show. They were forced to overcome obstacles and eliminate other people in their way.
In addition, patients had memories of constant motion and moved around all the time in anything from a bed to a helicopter, and often in unusual ways, for example driving a truck under water.
Another two categories were recurrent. Nature played a part in many of the stories – patients remember moss in the bed and animals on the floor. One patient told me that he felt the unit should address the problem with rats.
And apparently the staff party a lot; patients went to parties, not actually joining in but merely observing; there would be music and people laughing. It makes sense, of course. We do laugh a lot, you know, we need the release.”
How would you like the professionals to use this?
“I want it to raise the awareness of the staff. With this, staff may be able to approach the subject more specifically. They can say: ‘Are you experiencing anything unusual?’ And then slowly approach the patient’s experience of delirium with these different themes.
“With this, staff may be able to approach the subject more specifically”
We can explain to patients and relatives that what they are experiencing is not unusual in ICU. It happens to many patients. And that it will pass. The patients later explained that nurses and doctors reassured them frequently that it would pass, which gave them reassurance and confidence. We can’t say that enough.
I really admire the British system where patients and relatives run support groups such as ICU Steps. We could do more in Denmark.
The people I interviewed would say ‘I really hope you will talk to all patients’. It was such a relief for them to be told that the experiences were common and that they would eventually feel better. I keep returning to that initial conversation I had with a patient back in 2004. And I keep realizing that we are not asking enough questions about delirium“.
- Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur’s interpretation theory’. Svenningsen H, Egerod I, Dreyer P. Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur’s interpretation theory. Journal of Clinical Nursing 2016 Oct, Volume 25, Issue 19-20: 2807-2815. Read it here ‘ (behind a paywall).
Did you find this interesting?
Then you might be interested in our seminar ‘Delirium in the ICU’. The fee is £100 for consultants and £50 for nurses and AHPs, and all profits are donated to intensive care research. Register now or download the programme.