INTRODUCTION: A stay in the intensive care unit (ICU), although potentially life-saving, may cause considerable discomfort to patients. However, retrospective assessment of discomfort is difficult because recollection of stressful events may be impaired by sedation and severe illness during the ICU stay. This study addresses the following questions. What is the incidence of discomfort reported by patients recently discharged from an ICU? What were the sources of discomfort reported? What was the degree of factual recollection during patients' stay in the ICU? Finally, was discomfort reported more often in patients with good factual recollection?METHODS: All ICU patients older than 18 years who had needed prolonged (>24 hour) admission with tracheal intubation and mechanical ventilation were consecutively included. Within three days after discharge from the ICU, a structured, in-person interview was conducted with each individual patient. All patients were asked to complete a questionnaire consisting of 14 questions specifically concerning the environment of the ICU they had stayed in. Furthermore, they were asked whether they remembered any discomfort during their stay; if they did then they were asked to specify which sources of discomfort they could recall. A reference group of surgical ward patients, matched by sex and age to the ICU group, was studied to validate the questionnaire.RESULTS: A total of 125 patients discharged from the ICU were included in this study. Data for 123 ICU patients and 48 surgical ward patients were analyzed. The prevalence of recollection of any type of discomfort in the ICU patients was 54% (n = 66). These 66 patients were asked to identify the sources of discomfort, and presence of an endotracheal tube, hallucinations and medical activities were identified as such sources. The median (min-max) score for factual recollection in the ICU patients was 15 (0-28). The median (min-max) score for factual recollection in the reference group was 25 (19-28). Analysis revealed that discomfort was positively related to factual recollection (odds ratio 1.1; P < 0.001), especially discomfort caused by the presence of an endotracheal tube, medical activities and noise. Hallucinations were reported more often with increasing age. Pain as a source of discomfort was predominantly reported by younger patients.CONCLUSION: Among postdischarge ICU patients, 54% recalled discomfort. However, memory was often impaired: the median factual recollection score of ICU patients was significantly lower than that of matched control patients. The presence of an endotracheal tube, hallucinations and medical activities were most frequently reported as sources of discomfort. Patients with a higher factual recollection score were at greater risk for remembering the stressful presence of an endotracheal tube, medical activities and noise. Younger patients were more likely to report pain as a source of discomfort.
Het sectoraal adviescollege Hogere Sociale Studies (SAC-HSS) van de Vereniging Hogescholen (VH) heeft in het voorjaar van 2015 een project geïnitieerd met als doel de gemeenschappelijke kennisbasis van de bachelor opleidingen voor het sociaal werk vast te stellen. De kennisbasis zal voor een substantieel deel de inhoud van deze opleidingen gaan bepalen, waarbij opleidingen en studenten ruimte houden voor profilerende invullingen en aanvullingen. Het SAC-HSS beoogt met het project een bijdrage te leveren aan het versterken van de kwaliteit van de opleidingen. Aanleiding voor het project zijn de rapporten ‘Meer van Waarde’ van de Commissie Boutellier en ‘Sociaal werk op solide basis’ van de Gezondheidsraad waarin geconstateerd is dat de kwaliteit van de beroepsuitoefening van sociaal werkers in het kader van de Wet Maatschappelijke Ondersteuning achterblijft bij de verwachtingen. Voor een duurzame kwaliteitsverbetering is een goed functionerend kennissysteem nodig. Kennis afkomstig uit wetenschappelijk onderzoek en uit de beroepspraktijk, van professionals en van ervaringsdeskundige burgers. Kennis die samen met beroepsvaardigheden en houdingen het curriculum van sociaal werk opleidingen uitmaken en studenten helpen zich te ontwikkelen tot start bekwame sociale professionals. Het onderhavige rapport heeft als doel een overzicht te bieden van het wetenschappelijk deel van de kennisbasis.
