Original articleUnpleasant and pleasant memories of intensive care in adult mechanically ventilated patients—Findings from 250 interviews
Introduction
In recent years intensive care has become increasingly complex, with more advanced technology and treatment options, caring for more elderly and more severely ill patients (Kompanje, 2010). In addition, light or no sedation and the practice of wake-up calls have become a common approach allowing critically ill patients to be more awake during invasive mechanical ventilation (Mehta et al., 2009, Riker and Fraser, 2009). In light of these changes, increased knowledge of intensive care memories today is essential.
For mechanically ventilated intensive care patients the stay in an intensive care unit (ICU) is likely to be unpleasant due to the life-threatening condition, the therapeutic treatments including the presence of an endotracheal tube and the environment itself. Pain, thirst, fear, anxiety, sleep disturbances, endotracheal tube-related discomforts, not being able to talk, nightmares and hallucinations have been reported as common stressful experiences in ICU patients (Fredriksen and Ringsberg, 2007, Granja et al., 2005, Samuelson et al., 2007a, Stein-Parbury and McKinley, 2000). According to several studies, these unpleasant memories and emotional imprints often persist with time (Karlsson and Forsberg, 2008, Löf et al., 2008, Roberts et al., 2006, Roberts et al., 2007, Storli et al., 2008). Besides unpleasant memories, patients may recall pleasant memories of intensive care. Studies have shown that positive recollections include appreciation of the care given, feeling safe, feeling supported by the nurse and the presence of relatives (Hofhuis et al., 2008, Rattray et al., 2010, Storli et al., 2008).
Recent research has shown that ICU patients’ recovery time and subsequent psychological well-being may be influenced by unpleasant or distressing recollections of the intensive care stay (Corrigan et al., 2007, Jones et al., 2007, Rattray and Hull, 2008, Rattray et al., 2010, Ringdal et al., 2010, Samuelson et al., 2007b). For example, Rattray et al. (2010), recruiting 103 patients from six ICUs, found a significant association between patients’ perceptions of their intensive care experience and their emotional outcome at hospital discharge, by studying anxiety, depression and post-traumatic stress related symptom scores at hospital discharge. Ringdal et al. (2010) included 153 trauma patients in their multicentre study and concluded that, amongst patients with delusional memories, more experienced poorer health-related quality of life and more developed anxiety and depression compared to those without these memories.
Notwithstanding the rather large amount of research undertaken concerning critically ill patients’ experiences of intensive care, there is a lack of qualitative studies including large patient samples. Furthermore, research focusing on the positive experiences of the ICU is sparse. Previous research carried out in our own region has investigated only the patients’ stressful experiences and has been limited by the predefined questions in the established questionnaires used (Samuelson et al., 2006, Samuelson et al., 2007a, Samuelson et al., 2007b). Thus, some dimensions of the patients’ intensive care experience in our setting were to a certain extent still unknown. In order to inform and improve the care practice within and following our ICU there was therefore a need to explore inductively both negative and positive memories. The aim of this study was to describe unpleasant and pleasant memories of intensive care in adult mechanically ventilated patients.
Section snippets
Design, setting and routines
This descriptive study using a qualitative approach was part of a prospective cohort study carried out over 18 months, from September 2003 to February 2005, in two general ICUs in Sweden; a data concerning stressful memories, sedation and psychological distress have been previously published (Samuelson et al., 2006, Samuelson et al., 2007a, Samuelson et al., 2007b). Intensive care practice was similar in the two ICUs and usually during invasive mechanical ventilation patients were lightly
Findings
Of the 250 patients included, 203 (81%) remembered being in the ICU, 178 (71%) had recall of unpleasant memories and 147 (59%) of pleasant memories (Table 1), and 25 (10%) recalled their vague and blurred memories as neither unpleasant nor pleasant. None of the patients had merely pleasant memories. From the content analysis ten categories emerged, five describing unpleasant memories and five describing pleasant memories, contrasting with each other: physical distress and relief of physical
Discussion
According to this study, most critically ill mechanically ventilated survivors had both unpleasant and pleasant recollections of their intensive care stay. The results showed that the unpleasant or distressing memories originated from a diversity of sources pertaining to physical, emotional, perceptual, environmental, and care-related stressors. The findings are to some extent comparable to the results of the previous research carried out in our region in terms of physical, emotional and
Conclusion
The results of this study showed that most mechanically ventilated survivors with an ICU length of stay of 24 hours or more had both unpleasant and pleasant memories. Ten categories emerged from the analyses, five describing unpleasant memories and five pleasant, contrasting with each other. Even if the unpleasant memories predominated, the pleasant memories seemed to play an important role in relieving the stress and promoting well-being, and may thereby balance the unpleasant memories by
Acknowledgements
I would like to thank all the participants for sharing their experiences with me. I am also most grateful to Ingrid Corrigan for her expert help during the data analyses process.
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