title: Symptom communication during critical illness: the impact of age, delirium, and delirium presentation.
abstract: Symptom communication is integral to quality patient care. Communication between patients and nurses in the intensive care unit (ICU) is complicated by oral or endotracheal intubation and fluctuating neurocognitive status or delirium. We report the (a) prevalence of delirium and its subtypes in non-vocal, mechanically ventilated, critically ill patients; (b) impact of age on delirium; and (c) influence of delirium and age on symptom communication. Videorecorded interactions between patients (N = 89) and nurses (N = 30) were analyzed for evidence of patient symptom communication at four time points across 2 consecutive days. Delirium was measured at enrollment and following sessions. Delirium prevalence was 23.6% at enrollment and 28.7% across sessions. Participants age >60 were more likely to be delirious on enrollment and during observational sessions. Delirium was associated with self-report of pain, drowsiness, and feeling cold. Patients were significantly less likely to initiate symptom communication when delirious. Symptom identification should be carefully undertaken in older adults with or without delirium.
authors.affiliation: Department of Psychiatry, CRISMA Center, Department of Critical Care Medicine, Pittsburgh, PA 15238, USA. jta100@pitt.edu
authors.forename: Judith A
authors.initials: JA
authors.lastname: Tate
authors.forename: Susan
authors.initials: S
authors.lastname: Sereika
authors.forename: Dana
authors.initials: D
authors.lastname: Divirgilio
authors.forename: Marci
authors.initials: M
authors.lastname: Nilsen
authors.forename: Jill
authors.initials: J
authors.lastname: Demerci
authors.forename: Grace
authors.initials: G
authors.lastname: Campbell
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Happ
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D016638:Critical Illness; D003693:Delirium / Q000451:nursing / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations