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Delirium in intensive care: violence, loss and humanity
  1. Victoria Jane Hume1,2
  1. 1WiSER, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
  2. 2Health Communication Research Unit, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
  1. Correspondence to Victoria Jane Hume, WiSER, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; victoriahume{at}yahoo.com

Abstract

Delirium in intensive care is an altered state that can bring with it persecutory paranoias, and sometimes expressions of violence on the part of the patient; it can be deeply disturbing for the person experiencing it as well as for those around them. Although the impacts of delirium on patients’ recovery and long-term mental health are well documented, qualitative research in this area remains rare. This article is derived from a narrative and musical study of the experience of delirium in hospital, undertaken better to understand the perspectives of people who have experienced delirium, as well as the healthcare professionals and family members who care for them. Data were collected in South Africa between 2015 and 2017. The study took the form of interviews and focus groups with a total of 15 participants, as well as periods of observation and audio recording in a hospital intensive care unit. Thematic and narrative analysis of the data were carried out alongside the composition of new music incorporating audio recordings from the study. Analysis suggested three key themes emerging from the data. First, the violence experienced and expressed by patients, both within delirious hallucination and in observable reality. Second, the interconnected losses undergone by patients in spaces of intensive care. Third, healthcare professionals’ attempts to bring greater humanity into the potentially dehumanising space of intensive care. The results and discussion point to possible relationships between delirium and the working cultures and physical environment of intensive care, and may reinforce the need for sensitive and committed communication between healthcare professionals and patients.

  • critical care/intensive care
  • psychology
  • arts in health/arts and health
  • music
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Footnotes

  • Twitter @Victoria Hume

  • Contributors The study from which this article derived depended on the generous contributions of a number of former patients and their families, as well as healthcare professionals who shared their stories and helped shape the findings through discussion. The research office at Wits Donald Gordon Medical Centre, as well as Dr Tina Sideris, helped design the study. The study was supervised as part of a Master’s degree by Dr Cameron Harris and the late Professor Claire Penn. Prof Jennifer Watermeyer read draft versions of this article and offered very helpful comments.

  • Funding The study on which this article is based was supported by the Composers’ National Collegium (South Africa), the Anton Hartman Trust Bursary (South Africa) and the Division of Music, WSOA, University of the Witwatersrand (South Africa). The first draft of the original Master’s dissertation was completed thanks to a writing retreat funded by the Department of Higher Education and Training, South Africa. The musical composition was supported by the PRS Foundation’s Women Make Music scheme (UK) (grant no. WMMS2\100087).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was given separately for each phase of the study by the Human Research Ethics Committee at the University of the Witwatersrand as well as the CEO of Wits Donald Gordon Medical Centre. Specific permission for audio recording and observation in the ICU was also given by the lead consultant and senior nurse. Permission was also sought from the nurse in charge of the ICU on each day of observation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the article are included in the article.

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