Hospital Delirium: Underlying Causes and Treatment

This article in today's Denver Post describes a condition described as "hospital delirium," which is apparently only being recognized recently. Hospital delirium typically occurs in ICU patients (80% of those on ventilators experience this) and it seems to take on characteristics of panic attacks, for the patient reacts not as if he understands that his hospital stay is intended to cure him, but as if he is imprisoned or doomed. Relying on a standard belief that sleep is best to help the patient recover, the traditional and typical reaction of doctors and hospital staff to this is to sedate the patient. However, in a ICU research study of hospital delirium in patients at Littleton Adventist Hospital in Colorado, Dr. Kelly Greene suggests the opposite is more effective. As a result, Dr. Greene is spearheading hospital reforms to help assuage patient anxiety and reduce the incidence of unnecessary psychological trauma.

From this article, I make several connections, which are perhaps abstract and may or may not be meaningful. Here they are in no particular order.

1. This taste of the Dr. Greene's research and movement forward in hospital reform reminds me of the work of Dr. Temple Grandin and her research and influence of reforming the cattle industry. It's interesting how as a society, we have made so much progress toward slaughterhouse reform geared to the psychological well-being of livestock, while doctors and nurses continue to be trained in old-fashioned presuppositions that fail to get to the root cause of why the ICU environmental experience might be so traumatic.

2. As with my comments about medication in my previous post on Positive Disintegration, this is an example of how traditional American medical practices, while perhaps not intentionally nefarious, are more focused on medicating outward symptomatic behaviors as dysfunction as opposed to giving thoughtful consideration to underlying psychological needs of the patient. Understandably, an individual who is undergoing the trauma of being trapped in a hell of medical gadgets to keep him alive is going to panic at some point. It seems that medication focuses more on diminishing the flight or fight impulse (reaction) as opposed to reducing the external environment which might be rife with sensory cues that make such reactions perfectly logical which you sit down to think about it . . .

3. That is not to say that doctors and nurses are incompetent or evil. They are simply not adequately trained to effectively differentiate treatment to meet the emotional needs of patients.

4. How goes the reform? Who is implementing Dr. Greene's suggestions? What other hospital and patient care facilities are moving along a similar trajectory.

5. How will this improve society? How would it compare to other areas which do not follow suit?

6. In what ways has the pharmaceutical industry influenced the dependence on use of sedatives in traditional medical practices to treat psychological disorders that may be more effectively cured without reliance on pills?

7. And how are hospital delirium and positive disintegration possibly connected?

8. Reading about hospital delirium reminds me of my former mother-in-law's nursing home experiences. In the first nursing home we put her in, she was clearly over-sedated for the convenience of the nursing staff. I described the experience back in 2007, and here is another.