Table 1.

Definitional Terms for Common Symptoms in Chronic Critical Illness.

Symptom and references	Literature-Derived Definition	Nurse-Patient Terminology
Lack of Energy21-23	Fatigue Ranges from tiredness to exhaustion that interferes with ability to function Decreased capacity to perform physical and mental work Physical, emotional, or cognitive tiredness	Lethargic (rarely used by patients but often by nurses) Tired Weak ‘Worn out’ Sleepy Drowsy
Thirst 24	Desire for fluid, especially water The urge to drink Often the result of dry mouth	Asking for water Asking for mouth care Pantomiming drinking or mouth care (often used by nonverbal, intubated patients) Nurse statements that patients must be thirsty because their mouths appear dry
Dry Mouth25, 26	Subjective complaints of dryness, burning of oral mucosa Difficulty chewing or swallowing Objective observations of dry, cracked lips, furrowed tongue Presence of oral candidiasis	Same terminology as for thirst, used by both nurses and patients
Dyspnea27	Three key dimensions: (1) Physiologic : measurable parameters (respiratory rate; oxygenation) (2) Functional : effect of dyspnea on ability to perform activities of daily living Psychologic : emotional states related to difficulty breathing (fear, anxiety)	Can't catch breath Having ‘trouble’ breathing ‘Numbers’ or ‘Oxygen’ look good/bad (remarks made by nurses when patients note breathing difficulty) Tired from breathing(usually associated with a weaning trial) Fear, anxiety related to dyspnea less commonly discussed
Anxiety28, 29	Vague uneasiness or increasing sense of tension Nonspecific state of uneasiness A somatic, rather than cognitive, symptom	Anxious Nervous Worried Jumpy Restless
Worry30-32	Negative affect associated with perceived inability to control or obtain desired results in a future situation A negative emotion about a specific event or object (not a vague, generalized feeling, as with anxiety) A cognitive, rather than somatic, symptom May be the cognitive counterpart to generalized anxiety	Same terminology used for anxiety, by both nurses and patients
Communication Difficulty30, 33, 34	Distressing communication impairment, primarily the inability to speak, understand messages, and/or be understood Inability to represent thoughts, feelings, desires and needs fully to others Distressing problem with speech, word recall, writing and/or gesture	Often expressed as frustration (by patients and nurses) or anger (by patients) related to communication problems