Identifying cues of distorted memories in intensive care by focus group interview of nurses.

AIM: To determine cues to identify intensive care unit patients with distorted memories and related practices. DESIGN: Qualitative descriptive study. METHODS: Twenty nurses were included in semi-structured focus groups. Qualitative content analysis was conducted. RESULTS: Cues and nursing practices related to distorted memories emerged under the following categories: "Get to know daily life before admission," "Facial expressions and behaviour are different from usual," "Pay close attention to the treatment outcome," "Notice it after the fact," "Sharing patients' intensive care unit experiences" and "Creates a new life." Nurses tried to detect distorted memories by observing the patients' facial expressions, medication effects and delirium presence during their normal lives and treatments, while trying to understand the patients' intensive care unit experiences and provide care that promotes autonomous living. This study emphasizes the importance of support for reconstructing ordinary life through communication and rehabilitation, in addition to support for medical care for distorted memories.

Quantitative and qualitative investigation of the stress experiences of intensive care unit patients mechanically ventilated for more than 12 hr.

AIM: The aim was to qualitatively and quantitatively clarify the stress experiences of patients who were mechanically ventilated in an intensive care unit (ICU) for more than 12 hr. METHODS: The participants were adult patients without cognitive impairment who were mechanically ventilated in a general ICU for more than 12 hr. The Japanese version of the ICU Stressful Experiences Questionnaire (ICU-SEQJ) survey was performed before subjects were discharged from the ICU to collect narratives about how they felt and what they thought during their ICU stay. The results were analyzed in a collective and complementary way by dividing ICU-SEQJ scores into quartiles and comparing the first (low stress experience group) and third quartiles (high stress experience group). RESULTS: A total of 96 subjects were enrolled in the study, with 25 scoring in the high stress experience group and 24 in the low stress experience group. The high stress experience group had significantly longer duration of intubation, higher amounts of analgesics and sedative drugs, higher C-reactive protein, lower level of deepest sedation and greater absence of medical history than the low stress experience group. Analysis of the subjects' narratives revealed "Unbearable holistic discomfort", "Pain of being unable to control myself as before" in the high stress experience group and "Responding by giving meaning" in the low stress experience group. CONCLUSIONS: Nurses must recognize that long intubation hours and invasive procedures are subjective stress experiences that may cause patients to suffer holistic discomfort and lose their sense of control.