Análisis gráfico de mercado existente de camiones de comida

The participants’ experiences of living through their delirium were described as scenes of terrifying sights which aroused intense feelings of fear and panic. Living after their experience was a period showing their resilience in the attempt to heal from the emotional wounds of hallucinating, mis-interruption and suspicion.

When a person is physically wounded, the expected outcome of healing is the formation of a mark, known as the scar. The emotional scar is a lingering sign of mental damage, for example, feeling anxious, agonising over the mental injury and the anguish of ruminating thoughts. The participants talked about the ongoing effect of their emotional scar by describing their wounded feelings, their expressed fear of recurrence, and their reluctance to seek medical advice in the future. These comments are suggestive of future morbidity and mortality implications for this group of elderly people. These findings are supported by the studies of Duppils & Wikblad (2007) and Fagerberg & Jonhagen (2002). The participants of this study ruminated about their incidents of delirium with feelings of guilt and shame. They had grave doubts that the thoughts would never leave their minds.

As if to confirm the negative effect of the episode of delirium and their hitherto impeccable characters, the participants referred to their life-long emotional stability. This need to identify their personal strengths and abilities were intensely felt and articulated by the participants. They believed when they were delirious they were portrayed as terrible people doing terrible things and they had a strong desire to emphasise that they had not always been old and delirious. This striving to protect and maintain the precious evidence of their identity and integrity is supported by the findings of Andersson et al. (2002) who identified that older adults who are delirious will draw on previous life experiences as a means to make meaning of the present. The struggle to make sense of their delirium suggests that there is a need for patients to be given the opportunity to talk about their delirious episode.

When describing their mental strength, the participants needed to question and consider the reasons why their sound minds were affected and they struggled to make sense of their delirium. Participants anguished over why they had become confused, some questioned the connection between their existing illnesses and the medications they were prescribed. Others, like, Daisy, spoke of the utter disbelief that “it” had happened. This is contrary to Schofield’s study (1997) description that there was very little curiosity for what had caused the delirium. The findings of my study were consistent with the studies of Harding, Martin and Holmes (2008) who found patients wanted validation of their experience and Fagerberg and Jonhagen (2002) subjects showed feelings of guilt and humiliation when they were looking for reasons for the experience of being delirious and the fear of recurrence of an episode of delirium.

As previously mentioned at the beginning of this chapter, participants of this study spoke of the relief of being able to talk about their experience and the reassurance that the complication of delirium in not uncommon post orthopaedic surgery. It was their feelings of shame, unworthiness and embarrassment that prevented them from being able to talk about their experiences to their families and the health care staff. Through the process of interviewing patients who have experience and who have been able to recall their experience of delirium, studies have identified the importance of empathetic communication. Studies by Duppils and Wikblad (2007); McCurren and Cronin (2003); Schofield (1997) highlighted the value to the patient in being able to talk about the delirium. This study’s finding is suggestive that there is a need for the patient to be given more than one opportunity to talk over their delirious episode at a pace that suits the patient and validates their self-worth.

Guilt is remorse and regret for what a person has done. The term ‘guilty’ is also used to describe the feeling of being ashamed or being embarrassed or it may also be used when someone feels guilty about something that happened for which they are not responsible. Shame can be either defined as the discomfort that is felt when a person does not live up to the expectations of others or the powerful and destructive self-disapproval which makes a person feel ridiculous, disgraced or dishonourable(Anxiety Care UK 2014).The disgust the people felt about their sound minds becoming delirious was not of the same depth as the shame and guilt they felt for their behaviour towards their families, friends and staff when they were delirious (Duppils & Wikblad 2007; Fagerberg & Jonhagen 2002; McCurren & Cronin 2003). It was a

feeling of disgust of themselves that was tied to their personal beliefs, their moral codes of what is right and what is wrong for them as a person living within a society. Their personal integrity had been assaulted. The study by Andersson et al. (2002) showed that the behaviour displayed while delirious was not consistent with the subject’s moral behaviours. The participants had been emotionally wounded by the experience of being delirious, possibly leaving them a psychological scar.

The participants of this study had difficulty in understanding their experiences in the context of who they were prior to their hospital admission. In the process of trying to understand this traumatic experience it may cause psychological distress such as fear and anxiety. The difficulties described by the participants in understanding their experience of delirium in the context of who they normally are may suggest they are at risk of developing psychological symptoms of trauma. Bowker (1995) noted the published literature evidence for significant psychological trauma arising from delirium experiences with later psychiatric morbidity. Breitbart, Gibson and Tremblay (2002) identified that delirium is like pain, it is a distressing experience and equally distressing for hyperactive and hypoactive types of delirium. In recent years the literature provides evidence of the increasing recognition being given to post-traumatic stress disorder (PTSD) as a result of life-threatening medical experiences. Details of the studies starting to inquire into psychological morbidity will be discussed under ‘Implications for Clinical Practice’.

Psychological trauma occurs after surviving an extraordinary frightening experience, that is, any situation that results in a person feeling emotionally overwhelmed or devastated. The importance of researching the lived experience of delirium allows delirium to be seen as being more than a complicated and multifactorial system of pathological disease processes but being a wound of terrifying emotions that may heal leaving a long-term psychological scar.

4.2 Implications and Recommendations for Clinical Practice