My Relative seems confused – Salford Critical Care

Many patients become confused at times during their stay on the critical care unit. There are lots of different reasons for this. Sometimes a patient will not remember why they have come into the critical care unit or even that they are ill. They may need to be reminded about what’s happened and why they are there. This might need to be repeated lots of times because many patients struggle to remember things. Sometimes it’s not obvious that patients don’t know what’s going on around them so it’s worth checking that your relative understands what’s happening around them. If you think your relative is confused it’s important that you let the staff know. You know what’s normal for your relative and we can only try and work it out from the information that we have available to us!

Sometimes a patient’s confusion is due to their illness. When we are critically ill it’s like trying to run our brains on half power. If our brains were computers we would not be surprised if they didn’t work normally. The most common disease like this that makes critically ill patients confused is called ‘Delirium’.

We have a short video that you can watch as you can see below, we also have a leaflet providing information about delirium. Copies of the leaflet should be available in the waiting room and a copy of the leaflet is shown below. The contents of the leaflet are then typed out under the PDF copy of the leaflet. Lastly, there is a short section showing the advice staff are given when talking to patients that may also be useful to you.

The text of the video was produced and narrated by Sister Heather Koppens

Our leaflet setting out information for relatives about delirium is shown below. This is difficult to read on a mobile device as it’s 3 columns wide. For this reason the text is presented below the document.

Critical-Care-Unit-Delirium-May-18

What is delirium

Delirium is a name for a type of acute confusion.
A patient who is delirious is often experiencing a world that makes no sense to us but is very real to them.
Delirium is a sign that the brain is not working properly.

A patient who is experiencing delirium may…..

Not know they in a hospital
Think they can see frightening animals or are being chased or have been kidnapped.
They may believe that their close families are hurt or have passed away.
Think that the staff are plotting against them and they are only pretending to be staff.
These experiences are very real to the patient and they really think that they are happening. Trying to argue about them isn’t helpful- try to say how upsetting it must be to think this is happening.

There are two types of delirium

‘Hyperactive delirium’
This is very obvious and patients will be visibly upset and agitated or restless.
‘Hypoactive delirium‘
This is more difficult to spot. The patient is quiet and sleepy and will not communicate to others.
If you think that your relative is ‘not themselves’ and seems confused to you it’s important that you tell the staff about your concerns.

Why does it happen?

Infections that might have caused your relative to come to critical care or have developed during their stay.
Very ill patients who have to be admitted to critical care often develop delirium as part of this illness.
Patients who are older and becoming slightly more forgetful before they became ill are more likely to suffer from delirium.
Medication- Stopping prescribed medications, particularly pain killers or antidepressants may cause confusion- Please help the critical care staff to be aware of the medicines your relative normally takes.
Medications started in critical care- sometimes we start medications that may make patients confused and confusion may occur when patients are recovering from periods of sedation.
Withdrawal from alcohol or other substances If you think this may be a problem for your relative please let us know; this information is treated confidentially but is important to help us give your relative the best care that we can. There are treatments for these episodes of withdrawal.

How long will it last?

Although delirium is usually temporary it’s a serious condition and is a sign of how ill your relative is.
Delirium should improve over a few days but may last for several weeks as your relative recovers from their critical illness.
In some patients it is associated with longer term problems and it’s important that the episode of delirium is handed over to your relative’s general practitioner and to staff looking after your relative in the future.

What can I do to help?

Be calm and try not to get upset- remember it’s the delirium illness that may make your relative behave in an upsetting way that is not normal for them. Remind your relative where they are, why and the day and time. Also talk about things at home. Your presence will be very helpful to your relative even if you don’t feel that useful.
Night and day routine is important.
Make sure your relative has their glasses and hearing aid if needed.
The staff will ask you to help complete a ‘Patient Passport’ that has information about your relative to help staff look after them.
The staff try to encourage getting the patient moving as soon as they are able and to ensure pain is controlled.

Can the doctors and nurses make it go away?

There are things that we can all do to help as set out above.
An important role for the medical staff is to look for any reversible causes.
Often there are no things that we can alter to stop delirium and we have to support the patient until things begin to improve.
People have tried different drugs to cure delirium but they often do more harm than good and are only used to control extreme agitation that is a risk to the patient and others.

Summary and more information

Delirium is normally temporary but can be very distressing for patients and their relatives.
Delirium usually gets better as patients recover.
The staff are here to support you. Please do talk to the staff for support and guidance.

How to talk to someone who has delirium (information given to staff)

· Tell the person who you are each time you visit. If you leave the room for even a short time, identify yourself again when you come back. Tell the person where they are and what date and time it is. Remind the patient why they are in the critical care unit.

· Try to speak to the patient directly facing the patient- confused patients will not cope with you talking from the side or behind; try to be on the same height.

· Speak slowly and don’t shout, but make sure you are heard. Use a warm and reassuring tone of voice. Be prepared to repeat phrases several times.

· Keep sentences short and use simple words (try to avoid technical terms). Give the person enough time to absorb the information and to respond.

· Reassure the person that you understand they are having a confusing and frightening experience, but that they will get better.

· Listen carefully. Even if the content of the confused person’s conversation makes no sense to you, you may still understand the emotion being expressed. Respond to that emotion. “I’m sorry this is frightening/upsetting for you; there are lots of people here to help you”.

· Do not correct or argue with a confused person. This will not reduce confusion and will upset everyone concerned.

· Do not to speak to others about the confused patient as if he or she is not there. Try to include the confused person in all conversations. Make sure they are spoken to on ward-rounds. Humour is OK if NOT in any way possibly perceived to be at the patient’s expense.

· Sometimes a confused person may say things that are very hurtful. Although it’s hard, try not to take these comments personally. Remember it is the confusion speaking, not the person.

· Questions are a good way of communicating, but need to be simple in the first instance so that a ‘Yes’ or ‘No’ answer or a shake or nod are enough, give the patient time to process their response and ask one thing at a time

· This guidance is based on advice from the Geriatric Department in Leicester