The present description is concerned with critiquing an article entitled “Psychological distress and delusional memories after critical care: a literature review” The problem of the study is that there is a limited data with regard to the existence of a psychological distress known as delusional memories ,experienced by individuals who have been admitted in intensive care unit (ICU). The main purpose of the article was to perform to perform a literature review in order to find out and build the available empirical evidence with regard to the psychological distress linked with delusional memories in adult critically ill individuals following an ICU discharge. The purpose of the statement does not clearly express a relationship between the variables. Here, it has merely described on delusion memories in adults. It has not shed light on whether the adults are males or females and their age that might appear role playing when the conditions in ICU are presented. So, these are not testable because there is no proper information on the age factor. Secondly, psychological distresses like delusion memories could not provide any insights on cause and effect relationship in the absence of the age factor. The purpose specified the nature of the population being studied to a satisfactory extent.
The investigator had not properly identified the significance of the problem but has solely described that the article’s intention is a review to investigate and synthesize. The rationale why this study was undertaken or what gap the intended study could significantly provide a solution to the relevant problem was not described.
The concepts that are included in the review are those that are related to delusion memories, psychological distress, search strategy and types of study designs.
The dependent variables are psychological distress and delusion memories. Delusion memories are conceptually well defined as unreal experiences that represent hallucinations, paranoid delusions, nightmares and dreams. The investigator had defined this to a significant extent by highlighting its origin of cause and the effect it leaves on the susceptible patient
On the other hand, psychological distress was not vividly defined. However, it was considered to occur in the form of agitation, acute confusion, time and place disorientation, impaired capability in information processing and altered cognitive function.
The literature review has not properly related the variables. It does not emphasize much on the pathways or mechanism that transforms an ICU survivor to become a victim to psychological distress. To say, the relationship between a delusional memory and psychological distress or vice versa is not clear. It is merely stating a cause and effect relationship with no properly justified theoretical framework. The review could have considered any theoretical models that provide a support to the content.
The investigator identified that in few studies were lacking enough sample size, methodological strength and poor use of assessment tools .These appear to fail in strengthening the research and have resulted in conflict. This could make the investigator to make inconclusive remarks. In addition, the present investigator identified that some earlier researchers have considered the individuals with a good history of delusions. This indicated that the researchers are not adequate in considering the onset of psychiatric illness/delusional memories following an ICU discharge. This had contributed to the misinterpretation of the results and conflicts in knowledge.
The references cited by the author are mostly primary in nature. These are
Granberg et al. (1999), Jones et al. (2001),Roberts & Chaboyer (2004),Ringdal et al. (2006, 2009),Jones et al. (2007),Samuelson et al. (2007),Granja et al. (2008),Sackey et al. (2008),Weinert & Sprenkle (2008),Granberg et al. (1999) and Jones et al. (2001),
The operational definitions of variables appear to be delusion memories refer to a phenomenon that may be either visual or auditory when patients are in a state of wakefulness and sleep or totally wakeful. A psychological distress is defined as the altered cognition accompanied with the agitation and altered information processing. These do not totally reflect the conceptual definitions. This is because they were described in the articles as those that merely have a cause and effect relationship. For example, negative feelings and altered family relationships could also occur in other psychiatric illness and not totally confined to delusion memories.
Next, research question in the study are not clearly presented.
The investigator merely introduced the concept of ICU led delusion memories in adults and shifted to the objective by stating that it is a review and information/ evidence synthesis. No attempt was made to propose a hypothesis such that it could lead to an explorative study.
However, the articles’ objective reflected a hypothetical question. This is it is not known properly whether psychological distress is linked with delusional memories in critically ill adult patients following an ICU discharge. If this is considered as a hypothesis, then the independent variable is psychological distress and delusion memories could be dependent variable.
However, the investigator has not stated the hypothesis in any statistical form. As such, there could not be any direction of each relationship in the hypothesis and is hardly testable.
The selection of samples that is nothing but an article collection is based on the search strategy. This relied on the use of online databases like Pubmed, CINAHL and PsycINFO and refined the selection by appropriate key words like critically ill, ICU/critical care unit, psychiatric, psychological, , hallucinations, night- mares, memory, delusions, unreal experiences and
delusional memories.
The sampling method used is a review of pertinent articles on critically ill adult individuals in ICU’s, and it was found to be appropriate to study designs used for the review synthesis. The sample, the articles do not completely reflect the population recognized in the purpose .This is because some of the articles have considered the psychiatric illness of individuals before the ICU’s. Such studies appear to get deviated from the main objective of the article.
The size of the sample is inappropriate and need some more studies of further confirmation. The findings can be generalized to those adult individuals who were admitted in ICU’s and had a minimum period of stay. However, here the limitations could be that it is unknown if such ICU admitted individuals have any comorbid complication that could elevate the delusion problems. This needs to be ruled out. In addition, the specific age range that predisposes the adults to delusional memories also needs to be ruled out along with the specific number of days being spent in ICU’s.
The design is purely a literature review. It seems to flow to a moderate degree from the proposed research problem but not from any theoretical framework and hypothesis as they were not highlighted. So, the data collection method is a review of pertinent retrieved articles .
However, researchers have considered the following criteria for article selection like single or multicentre, prospective, observational or descriptive. In these studies, data was collected from patients through questionnaires. The investigator did not provide any information on the protection of patients’ rights and informed consent as it is a review study.
Further, no proper rationale was given for why a specific instrument was chosen. But, at a specific section, the article merely described about the use of a 14-item instrument known as ICU Memory Tool (ICU-MT). As per this tool, individuals who recall any negative consequences, hallucinations could have delusional memories. But, the accuracy of this instrument was not covered in detail in the review.
The observing was done by the team of authors. They were trained to minimize the bias in specifying some articles that considered critically ill adults who have psychiatric illness or delayed memory collection before ICU admission. In addition, not all studies have reported information on follow ups.
The interviewers are those investigators of the review articles. There is no clear information on how these professionals were trained to minimize the biases of any kind. The types of questionnaires highlighted by the investigator were self-administered, telephonic and home visit type. They are partially consistent with the conceptual definition. The records that were used are appropriate to some extent .Some records appear to provide a biased content that may be unfit for problem being studied. The article did not report any information on instrument reliability and validity.
The level of measurement was not detailed properly as it is a review. But the responses of patients were described. The descriptive statistics provided were that a given proportion (%) of patients were found with delusional memories. This mode of descriptive statistics could be considered moderately appropriate to the intent of hypothesis. This is because additional statistical help with correlations could have much weight to the appropriateness.
The hypothesis testing was not done properly but appear to support it indirectly with the articles’ purpose and the subsequent projection of the description. The results were interpreted partially in the context of the problem. This is because there is no clear description of the problem being highlighted.
For the relevance of nursing, the investigator identified that nurses could avoid delusional memories in individuals if they recognize the predisposing factors of delirium and by maintaining close emotional contact with the patients.
The findings could be generalized for those with anxiety, depression, sleep disorders and family conflicts .Future implications are that the article is more specific on the research that dissects the link between PTSD and delusional memories. Other studies with similar findings are rare.
The patients could benefit provided that ICU stay is minimized or regulated depending on the condition. But since not all ICU admitted patients could get delusions, researchers could put patients under panic without considering the earlier history of psychiatric illnesses. It is applicable to nursing practice on the grounds that critical nurses have a role in offering care on an evidence based approach. So, they could consider case of this kind and suggest unnecessary treatment complications. This could be applied to nursing practice. However, since this study is a review, the issue of research replicability needs to be considered carefully after much clinical trials.
References
Kiekkas, P., Theodorakopoulou, G., Spyratos, F. & Baltopoulos, G.I. (2010). Psychological
distress and delusional memories after critical care: a literature review. Int Nurs Rev,
57(3),288-96.
