ICU delirium is a common challenge in critical care, presenting as acute confusion with hallucinations, disorientation, and distress. While ICU professionals are well aware of its clinical implications, it can be particularly distressing for patients and their relatives who may not understand what is happening.
Patients experiencing delirium may perceive their environment in highly distorted ways, leading to extreme fear and confusion. One ICU survivor described their experience:
“I can only remember the many vivid dreams, some of which were seeing the grim reaper, a nurse saying to me 'do you know you are dead' and another dream that the nurses were trying to kill me.”
These hallucinations can manifest in various ways, with patients believing, for example, that they:
- Are not in a hospital
- See threatening animals
- Have been kidnapped
- Are being cared for by imposters
- Have died or lost loved ones
Such distress can lead to agitation, attempts to leave the ICU, or demands to return home. Delirium can also fluctuate rapidly, with moments of lucidity followed by confusion.
Despite its prevalence, patients and families often have limited awareness of delirium and its effects. This can make communication and reassurance challenging for ICU staff. Providing relatives with appropriate resources can help them support their loved ones more effectively.
‘You Are Safe Here’ is a leaflet designed for relatives of ICU patients experiencing delirium. Created by ICU research nurse Peter Nydahl and ICU survivor Lou Gallie, it offers guidance on how to communicate with and reassure patients. The leaflet is freely available in 11 languages and incorporates insights from individuals with lived experience.
Additionally, the ICUsteps Delirium information sheet provides further information on recognising and managing ICU delirium, including practical advice for families. ICUsteps, the UK's only intensive care patient support charity, offers extensive resources to assist patients, relatives, and ICU professionals in navigating the challenges of critical care and recovery.
Encouraging relatives to access these materials can empower them to better support patients, improving overall patient experience and recovery outcomes. If you are working with patients and families affected by critical illness, directing them to ICUsteps' resources can be a valuable step in their care journey.