Cognitive impairment in intensive care unit patients: A qualitative exploration through observations and interviews

Objectives
Many patients experience cognitive impairments while being admitted to an intensive care unit due to critical illness affecting their well-being and rehabilitation. Little is known about how patients experience cognitive impairments. This study aimed to explore patients' and relatives' experiences of patients' cognitive impairments while in the intensive care unit.

Research methodology
A multi-centre qualitative study, inspired by Ricoeur's phenomenological-hermeneutic approach, was conducted at four intensive care units at two hospitals in Denmark. Data collection encompassed participant observation and semi-structured single or dyadic interviews with 20 patients and 15 relatives, conducted in the intensive care units. The Consolidated Criteria for Reporting Qualitative Research checklist was used.

Findings
Four themes emerged during the analysis: 'Having a hazy memory and a foggy brain', 'Frustrations due to difficulties in speaking', 'An altered sense of self' and 'A feeling of disconnect between body and mind'. In the intensive care unit, patients experienced multiple cognitive impairments across several cognitive domains, significantly affecting their overall well-being.

Conclusions
The findings provided a nuanced exploration of how patients in the intensive care unit grapple with cognitive impairments, leaving them feeling exposed and vulnerable due to increased dependency and loss of dignity. Relatives' presence and help was a huge support during admission.

Implications for clinical practice
This study highlights patients' and relatives' experiences of patients' cognitive impairments in the intensive care units. There is a need for nurses and allied healthcare professionals to address and manage reduced cognition in intensive care unit patients. This is particularly important to underpin recovery and rehabilitation processes, improve quality of life and optimise patients’ return to everyday life. Future research must investigate how and when intensive care patients would benefit from preventive initiatives and initiatives to support recovery and rehabilitation of cognitive impairments.