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Johansson M, Wåhlin I, Magnusson L, Hanson E. The use and application of intensive care unit diaries: An instrumental multiple case study. PLoS One 2024; 19:e0298538. [PMID: 38422059 PMCID: PMC10903823 DOI: 10.1371/journal.pone.0298538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
AIMS AND OBJECTIVES The study aim was to explore the use of an Intensive Care Unit (ICU) diary within four different ICUs units in Sweden and thereby contribute to practice guidelines regarding the structure, content and use of an ICU diary. BACKGROUND ICU diaries are used to aid psychological recovery among critical care patients, but differences remain in diary writing both within and across countries. Few studies have focused on the combined views and experiences of ICU patients, family members and nursing staff about the use of ICU diaries. DESIGN An instrumental multiple case study design was employed. METHODS Three focus groups interviews were carried out with 8 former patients and their family members (n = 5) from the research settings. Individual interviews were carried out with 2 patients, a family member and a nurse respectively. Observations, field notes, documentary analysis and conversations with nursing staff were also conducted. Consolidated criteria for reporting qualitative research (COREQ) was followed. RESULTS The qualitative findings firstly consisted of a matrix and descriptive text of the four ICU contexts and current practices. This highlighted that there were similarities regarding the aims and objectives of the diaries. However, differences existed across the case study sites about how the ICU diary was developed and implemented. Namely, the use of photographs and when to commence a diary. Second, a thematic analysis of the qualitative data regarding patients' and family members' use of the ICU diary, resulted in four themes: i) the diary was used to take in and fully understand the situation; ii) the diary was an opportunity to assimilate warm, personalised and human care; iii) the diary was used to manage existential issues; and iv) the diary was a tool in daily activities. CONCLUSIONS Analysis of the instrumental case study data led to the identification of core areas for inclusion in ICU diary practice guidelines.
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Affiliation(s)
- Maria Johansson
- Intensive Care Department, County Hospital, Region Kalmar County, Kalmar, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Ingrid Wåhlin
- Intensive Care Department, County Hospital, Region Kalmar County, Kalmar, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Research Section, Region Kalmar County, Kalmar, Sweden
| | - Lennart Magnusson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Swedish Family Care Competence Centre, Kalmar, Sweden
| | - Elizabeth Hanson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Swedish Family Care Competence Centre, Kalmar, Sweden
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Johnson KR, Temeyer JP, Schulte PJ, Nydahl P, Philbrick KL, Karnatovskaia LV. Aloud real- time reading of intensive care unit diaries: A feasibility study. Intensive Crit Care Nurs 2023; 76:103400. [PMID: 36706496 DOI: 10.1016/j.iccn.2023.103400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Memories of frightening/delusional intensive care unit experiences are a major risk factor for subsequent psychiatric morbidity of critical illness survivors; factual memories are protective. Systematically providing factual information during initial memory consolidation could mitigate the emotional character of the formed memories. We explored feasibility and obtained stakeholder feedback of a novel approach to intensive care unit diaries whereby entries were read aloud to the patients right after they were written to facilitate systematic real time orientation and formation of factual memories. RESEARCH METHODOLOGY Prospective interventional pilot study involving reading diary entries aloud. We have also interviewed involved stakeholders for feedback and collected exploratory data on psychiatric symptoms from patients right after the intensive care stay. SETTING Various intensive care units in a single academic center. MAIN OUTCOME MEASURES Feasibility was defined as intervention delivery on ≥80% of days following patient recruitment. Content analysis was performed on stakeholder interview responses. Questionnaire data were compared for patients who received real-time reading to the historical cohort who did not. RESULTS Overall, 57% (17 of 30) of patients achieved the set feasibility threshold. Following protocol adjustment, we achieved 86% feasibility in the last subset of patients. Patients reported the intervention as comforting and appreciated the reorientation aspect. Nurses overwhelmingly liked the idea; most common concern was not knowing what to write. Some therapists were unsure whether reading entries aloud might overwhelm the patients. There were no significant differences in psychiatric symptoms when compared to the historic cohort. CONCLUSION We encountered several implementation obstacles; once these were addressed, we achieved set feasibility target for the last group of patients. Reading diary entries aloud was welcomed by stakeholders. Designing a trial to assess efficacy of the intervention on psychiatric outcomes appears warranted. IMPLICATIONS FOR CLINICAL PRACTICE There is no recommendation to change current practice as benefits of the intervention are unproven.
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Affiliation(s)
- Kimberly R Johnson
- Department of Pulmonary and Critical Care, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Joseph P Temeyer
- Department of Nursing, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Phillip J Schulte
- Department of Biostatistics, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Peter Nydahl
- Department of Anesthesia and Critical Care, Arnold-Heller-Str. 3, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Kemuel L Philbrick
- Department of Psychiatry and Psychology, 200 First St SW, Mayo Clinic, Rochester, MN 55905, USA
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Eklind S, Olby K, Åkerman E. The Intensive Care Unit diary - A significant complement in the recovery after intensive care. A focus group study. Intensive Crit Care Nurs 2023; 74:103337. [PMID: 36333188 DOI: 10.1016/j.iccn.2022.103337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to gain an increased understanding of the intensive care unit diary and how it affects patients' recovery after intensive care. METHODOLOGY/DESIGN The study had a qualitative design and was conducted by two focus group interviews in October 2021 and was analysed with thematic analysis. SETTING Ventilator treated intensive care patients with a length of stay ≥ 72 hours who had received a written diary were included. The study was conducted at two university hospitals in the south of Sweden. FINDINGS The intensive care unit diary can be an important complement to the medical record and notes taken by family members by enhancing understanding of critical illness. The patients experience several prominent feelings from reading the diary such as guilt, fear, and anxiety as well as feelings of being cared for. The design and content of the diary can be important used as a tool in patients' recovery after intensive care. CONCLUSION Understanding their critical illness and the time in intensive care seems important to former intensive care patients. In this respect, the intensive care unit diary on its own does not provide significant information and thus need to be complemented by information from the medical record and notes taken by family members. Therefore, the diary can be used as a complement that might increase patients' sense of coherence and facilitate recovery after intensive care.
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Affiliation(s)
- Sara Eklind
- Division of Nursing Research, Department of Health and Society, Malmö University, Malmö, Sweden; Department of Intensive Care and Perioperative Medicine, Skane University Hospital, Malmö, Sweden.
| | - Karin Olby
- Division of Nursing Research, Department of Health and Society, Malmö University, Malmö, Sweden; Department of Intensive Care and Perioperative Medicine, Skane University Hospital, Malmö, Sweden
| | - Eva Åkerman
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Maagaard CA, Laerkner E. Writing a diary for ”you” —Intensive care nurses' narrative practices in diaries for patients: A qualitative study. Int J Nurs Stud 2022; 136:104363. [DOI: 10.1016/j.ijnurstu.2022.104363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/08/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022]
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[Ways of supporting relatives in intensive care units : Overview and update]. Med Klin Intensivmed Notfmed 2022; 117:349-357. [PMID: 35394164 PMCID: PMC8992398 DOI: 10.1007/s00063-022-00915-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/02/2022] [Indexed: 11/11/2022]
Abstract
Hintergrund Angehörige von kritisch Kranken auf der Intensivstation („intensive care unit“, ICU) sind in einer herausfordernden Situation: Sie befinden sich häufig in einer existenziellen Krise mit einer großen emotionalen Belastung, gleichzeitig sind sie oftmals aktiv in therapeutische Entscheidungen mit eingebunden. Die Besuchsrestriktionen während der Pandemie aufgrund der Coronaviruserkrankung 2019 (COVID-19) haben viele Rahmenbedingungen für die Angehörigenbegleitung geändert und so die Betreuung von Angehörigen schwieriger gemacht. Ziel Ziel der Publikation ist die Darstellung der aktuellen und neuen Entwicklungen in der Angehörigenbegleitung von kritisch Kranken auf Intensivstationen im Rahmen einer narrativen Übersichtsarbeit. Ergebnisse In den letzten Jahren wurden zahlreiche Maßnahmen und Projekte zur Angehörigenbegleitung entwickelt, die sich den folgenden 6 Bereichen zuordnen lassen: 1) Anwesenheit der Angehörigen, 2) proaktive Einbindung in die Betreuung, 3) strukturierte Kommunikation und Information sowie Onlineangebote, 4) multidisziplinäre Zusammenarbeit, 5) Aufgaben der Organisationsleitung und 6) Follow-up-Angebote. Die Evidenz und der derzeitige Implementierungsstand der Maßnahmen sind international und national sehr heterogen. Schlussfolgerungen Maßnahmen zur Angehörigenbetreuung sind vielfältig und können zum Teil auch unter Besuchsrestriktionen umgesetzt werden. Neuere Entwicklungen im digitalen Bereich ermöglichen zunehmend auch virtuelle Besuche und einen ergänzenden Informationsaustausch zwischen dem Team der ICU und den Angehörigen.
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Roikjaer SG, Gärtner HS, Timm H. Use of narrative methods in rehabilitation and palliative care in Scandinavian countries: A scoping review. Scand J Caring Sci 2021; 36:346-381. [PMID: 34882807 DOI: 10.1111/scs.13050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 10/21/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although narratives-including an ill person's life story, life situation and future perspectives-seem to lie at the core of rehabilitation and palliative care in Scandinavian countries, we lack a scope of how, when and where narrative methods are used. Such a scope could provide knowledge and inspiration on a practical as well as a policy level. The objective of this study is to explore the literature on the use of systematic, narrative methods in rehabilitative and palliative care for people with life-threatening illness in Scandinavian countries. METHOD We conducted a scoping review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) where applicable. We performed a systematic search in CINAHL, Medline, PsychInfo, SOCIndex and SveMed+using the search terms 'life threatening illness', 'narratives', 'rehabilitation', 'palliative care' and 'Scandinavia', followed by a search for grey literature. We found 42 records to be eligible for this scope and extracted the data via piloted extraction tables. RESULTS We identified 17 narrative methods and present findings concerning four themes: (1) a record of the narrative methods used; (2) an objective and theoretical framework for the narrative methods; (3) the content and form of the narrative methods; and (4) the significance of the narrative methods used. CONCLUSION Narrative methods are used in systematic ways in rehabilitation and palliative care in Scandinavian countries and cover a wide variety of objectives, theoretical frames, forms and outcomes. Further development may benefit from more elaboration on definitions and the relationships between objectives, theoretical frameworks and outcomes.
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Affiliation(s)
- Stine Gundtoft Roikjaer
- REHPA, The Danish Knowledge Center for Rehabilitation and Palliative Care, Nyborg, Denmark.,Naestved, Slagelse, Ringsted Hospitals Department of Neurology, and Department of Physiotherapy and occupational therapy, Region Zealand, Slagelse, Denmark
| | - Henriette Søby Gärtner
- REHPA, The Danish Knowledge Center for Rehabilitation and Palliative Care, Nyborg, Denmark.,SIF, The National Institute of Public Health, University of Southern Denmark, Nyborg, Denmark
| | - Helle Timm
- REHPA, The Danish Knowledge Center for Rehabilitation and Palliative Care, Nyborg, Denmark.,SIF, The National Institute of Public Health, University of Southern Denmark, Nyborg, Denmark
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Haruna J, Tatsumi H, Kazuma S, Kuroda H, Goto Y, Aisaka W, Terada H, Masuda Y. Using an ICU Diary to Communicate With Family Members of COVID-19 Patients in ICU: A Case Report. J Patient Exp 2021; 8:23743735211034094. [PMID: 34377772 PMCID: PMC8323441 DOI: 10.1177/23743735211034094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Visitation restrictions for family members are problematic in intensive care management
due to the COVID-19 pandemic. We analyzed the usefulness of an intensive care unit (ICU)
diary about the experiences of family members of critical COVID-19 patients. Four family
members of 2 COVID-19 patients participated in this report. Both patients were transferred
to our ICU after 2 weeks of treatment at another ICU. An ICU diary was given to their
family members post-transfer. The family members were interviewed before and after the
patients’ discharge; the recorded interviews were analyzed and categorized into several
clusters using a text mining method. Five categories regarding their anxious feelings were
classified before the use of the ICU diary, and 3 categories were based on their positive
feelings after the use of the ICU diary. Intensive care unit diaries may be beneficial for
disclosing patients’ information when visitation restrictions are exercised due to the
COVID-19 pandemic.
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Affiliation(s)
- Junpei Haruna
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Hiroomi Tatsumi
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Satoshi Kazuma
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Hiromitsu Kuroda
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Yuya Goto
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Wakiko Aisaka
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Hirofumi Terada
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
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Negro A, Villa G, Zangrillo A, Rosa D, Manara DF. Diaries in intensive care units: An Italian qualitative study. Nurs Crit Care 2021; 27:36-44. [PMID: 34053148 DOI: 10.1111/nicc.12668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The literature emphasizes the importance of the intensive care unit (ICU) diary to fill the gaps and recover the delusional memories of patients admitted to ICU in order to build the history of their illness. The ICU diary is a measure originally intended to support the severely ill patient, but it would also seem to be useful for family members and carers. According to our analysis of the literature, this study is the first description of the contents of ICU diaries in the Italian context. AIM The aim of the study was to describe the contents of ICU patients' diaries filled in by their caregivers, in order to explore the experience and significance attributed to the diaries. DESIGN A qualitative longitudinal narrative investigation was conducted at an ICU during the period from April 2016 to April 2017 with a sample composed of 32 families. METHODS The participants were caregivers selected through purposive sampling. An ICU nurse explained the study to caregivers and offered the opportunity to participate. RESULTS The sample included 32 diaries. Through the analysis we identified seven themes: future plans and memories; the people who care for the patient and the context; the love surrounding the patient; the clinical progression of the patient and the passage of time; what happens outside the patient's life; references to the usefulness/non-usefulness of the diary; communication/reflection on the likely death of the patient. CONCLUSIONS Some themes emerged that have never explored in the literature, and it would be necessary to understand whether the themes that emerged depend on cultural issues. RELEVANCE TO CLINICAL PRACTICE The diaries could be adapted to the Italian context and this could make the diary a common practice in Italy as well.
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Affiliation(s)
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- IRCCS San Raffaele Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Debora Rosa
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Duilio F Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
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Abstract
Supplemental Digital Content is available in the text. OBJECTIVES: To investigate patients’ experience of ICU diaries 6 months after ICU discharge among survivors. This study was designed to add insight into a large randomized study, which found no benefit of the ICU diary to post-traumatic stress disorder among critically ill patients having received mechanical ventilation. DESIGN: A preplanned qualitative substudy of patients receiving an ICU diary written by ICU caregivers and families. Six months after ICU discharge, survivors were contacted by a psychologist for a telephone interview using a semi-directive guide. SETTING: Thirty-five French ICUs. PATIENTS: All ICU survivors having received an ICU diary. INTERVENTION: An ICU diary written by both ICU staff and families. MEASUREMENTS AND MAIN RESULTS: Among the 332 patients randomized in the intervention group (having had an ICU diary filled by both ICU staff and families), 191 (57.7%) were alive at 6 months and 101 of 191 (52.9%) participated in a telephone interview. They were (median [interquartile range]) 64 years old (53–70 yr old); 65 (64.4%) were men, and 79 (78.2%) were medical patients. Duration of ICU stay was 13 days (8–21 d). Three themes were derived from the thematic analysis: 1) reading the diary: between emotion and pain, 2) how the diary helped, and 3) the bittersweet representation of the diary. For half of the patients, the diary is a good memory of difficult times (55/101, 54.5%), others seem to be more ambivalent about it (28/101, 27.8%), and 37 of 101, 36.6% see it as a painful representation of a time to be forgotten. CONCLUSIONS: When reading their ICU diaries, ICU survivors experienced mixed emotions, related to family messages, medical caregiving, and to the severity of their illness. Patients described diaries as a help or a hindrance to recovery, depending on their wish to remember the period or move on from it.
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Exploring Patients' Perceptions on ICU Diaries: A Systematic Review and Qualitative Data Synthesis. Crit Care Med 2021; 49:e707-e718. [PMID: 33861546 DOI: 10.1097/ccm.0000000000005019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aims to summarize the current qualitative evidence on patients' experiences of reading the ICU diaries. DATA SOURCES We searched the online databases PubMed, Ovid, EMBASE, and EBSCO host from inception to July 2020. STUDY SELECTION All studies that presented any qualitative findings regarding patients' experiences of reading an ICU diary were included. DATA EXTRACTION Study design, location, publication year, data collection method, and mode, all qualitative themes identified and reported, and participant quotations, when appropriate. We also extracted data regarding the diary structure, when available. A thematic synthesis approach was used to analyze and synthesize qualitative data. DATA SYNTHESIS Seventeen studies were analyzed. Most patients reported positive experiences with the ICU diary, such as understanding what they survived during critical illness, better understanding the process of recovery, gaining coherence of nightmares and delusional memories, realizing the importance of the presence of family and loved ones during ICU stay, and humanizing healthcare professionals that helped them survive critical illness. Patients also reported which components of the diary were important for their recovery, such as the presence of photographs and reading the diary with a healthcare professional, allowing the improvement of the concept of the ICU diary. CONCLUSION This qualitative synthesis shows that patients recommend having an ICU diary, enlightening benefits such as better coping with the slow recovery from critical illness, strengthening family ties, and humanizing the ICU staff. It also identifies characteristics of the diary valued by the patients, in order to standardize the ICU diary according to their perspectives, and allowing future comparability between randomized controlled trials.
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Affiliation(s)
- Christina Jones
- Research Manager ICU steps and Visiting Research Fellow, University of Plymouth, United Kingdom
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12
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Nydahl P, Kuzma J. [Diaries for critically ill patients]. Med Klin Intensivmed Notfmed 2021; 116:210-215. [PMID: 33687486 DOI: 10.1007/s00063-021-00801-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/07/2021] [Indexed: 12/19/2022]
Abstract
After a stay on an intensive care unit (ICU), patients and relatives may be affected by psychological consequences such as anxiety, depression or posttraumatic stress disorder. ICU diaries written for patients during the stay by clinicians and relatives can alleviate the consequences. Diaries can contribute to the humanization of intensive care through the person-centered approach. A case report illustrates the perspective and benefits from a patient's perspective.
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Affiliation(s)
- P Nydahl
- Pflegeforschung, Klinik für Anästhesie und operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Haus V40, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
| | - J Kuzma
- , Mönchengladbach, Deutschland
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Nydahl P, Deffner T. Use of Diaries in Intensive Care Unit Delirium Patients: German Nursing Perspectives. Crit Care Nurs Clin North Am 2020; 33:37-46. [PMID: 33526197 DOI: 10.1016/j.cnc.2020.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Diaries are written for patients in intensive care units by staff and relatives, especially when patients experience a disorder of their consciousness, such as delirium. Diary entries are written in common language, describing the situation of the patient. The diary can be read by the patient and the family and support the coping and understanding of what happened. It can function as a tool for supporting communication about different experiences and views of critical illness.
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Affiliation(s)
- Peter Nydahl
- Nursing Research, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus V40, Kiel 24105, Germany.
| | - Teresa Deffner
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07743 Jena, Germany
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Wang S, Xin HN, Chung Lim Vico C, Liao JH, Li SL, Xie NM, Hu RF. Effect of an ICU diary on psychiatric disorders, quality of life, and sleep quality among adult cardiac surgical ICU survivors: a randomized controlled trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:81. [PMID: 32143655 PMCID: PMC7060606 DOI: 10.1186/s13054-020-2797-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/18/2020] [Indexed: 01/30/2023]
Abstract
Background Although studies on the effectiveness of the use of ICU diaries on psychiatric disorders and quality of life have been published, the results still seem to be controversial. The study aimed to determine the effects of using an ICU diary on psychiatric disorders, sleep quality, and quality of life (QoL) in adult ICU survivors in China. Methods One hundred and twenty-six patients who underwent a scheduled cardiac surgery and were expected to stay ≥ 24 h in ICU were randomized to two groups (63 in each group). The patients in the intervention group received the use of ICU diaries during the period of post-ICU follow-up, while the patients in the control group received usual care without ICU diaries. The primary outcome was significant PTSD symptoms (Chinese version of Impact of Event Scale-Revised, IES-R; total score ≥ 35 was defined as significant PTSD symptoms) and its severity in patients 3 months post-ICU. The secondary outcomes included memories of the ICU at 1 month, QoL (Medical Outcomes Study 36-item Short-Form, SF-36), sleep quality (Pittsburgh Sleep Quality Index Questionnaire, PSQI), anxiety, and depression symptoms (Hospital Anxiety and Depression Scale, HADS) at 3 months. Results Eighty-five and 83 patients completed the follow-up interviews at 1 month and 3 months post-ICU, respectively. Significant PTSD symptoms were reported by 6 of 41 (14.63%) in the intervention group vs 9 of 42 (21.43%) in the control group (risk difference, − 9% [95% CI, − 2% to 21%], P = 0.10). There was no significant differences between groups in IES-R score, symptoms of intrusion, symptoms of avoidance, numbers of memories of feeling and delusional memories, SF-36 score and anxiety score (P > 0.05), while significant differences were found in symptom of hyperarousal score, numbers of factual memories and PSQI score (P < 0.05). No adverse effect was reported. Conclusions Using an ICU diary is not useful for preventing PTSD symptoms and anxiety symptoms and preserving the quality of life of the patients at 3 months post-ICU, while it significantly improves the survivor’s factual memory of ICU and sleep quality, and prevents the hyperarousal symptom. Trial registration Chinese Clinical Trial Registry, ChiCTR-IOR-16009109, registered on 28 August 2016
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Affiliation(s)
- Shuo Wang
- School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fuzhou, 350122, China
| | | | | | - Jin-Hua Liao
- School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fuzhou, 350122, China
| | - Sai-Lan Li
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Na-Mei Xie
- School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fuzhou, 350122, China
| | - Rong-Fang Hu
- School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fuzhou, 350122, China.
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Castillo MI, Mitchell M, Davis C, Powell M, Le Brocque R, Ullman A, Wetzig K, Rattray J, Hull AM, Kenardy J, Aitken LM. Feasibility and acceptability of conducting a partially randomised controlled trial examining interventions to improve psychological health after discharge from the intensive care unit. Aust Crit Care 2020; 33:488-496. [PMID: 32113735 DOI: 10.1016/j.aucc.2020.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/19/2019] [Accepted: 01/06/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Interventions to support psychological recovery after critical illness, including information provision via an intensive care unit (ICU) diary or discharge summary, have been widely adopted in some regions, albeit without strong empirical evidence. OBJECTIVE The objective of this study was to examine the feasibility and acceptability, for patients, family members, and clinicians, of information provision via an ICU diary or discharge summary to support psychological recovery for critical illness survivors. METHODS This was a pilot, partially randomised patient preference study in a mixed ICU in a tertiary hospital in Australia. Eligible patients were those in the ICU for >24 h and who were able to converse in English. Interventions were ICU diary or discharge summary compared with usual care. Feasibility was assessed throughout the study process, and acceptability assessed 3 and 6 months after hospital discharge, with data analysed descriptively and thematically. RESULTS Sixty-one patients were recruited; 45 completed 3-month follow-up (74%), and 37 (61%), 6-month follow-up. Participants were medical (39%), surgical (30%), and trauma (31%) patients; aged 55 [interquartile range (IQR): 36-67] years; and stayed in the ICU for 7 [IQR: 3-13] days and hospital for 23 [IQR: 14-32] days. Within the partially randomised framework, 34 patients chose their intervention - four chose usual care, 10 ICU diary, and 20 discharge summary. The remaining 27 patients were randomised - nine usual care, 10 ICU diary, and seven discharge summary. The majority (>90%) considered each intervention helpful during recovery; however, a significant proportion of patients reported distress associated with reading the ICU diary (42%) or discharge summary (15%). Clinicians reported they were hesitant to make diary entries. CONCLUSIONS When given a choice, more patients chose a discharge summary over the ICU diary or usual care. Participants considered both interventions acceptable. Given the reports of distress associated with information provision, clear empirical evidence is required to determine effectiveness, optimal timing, support needed, and for whom they should be used. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12615001079538.
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Affiliation(s)
- Maria I Castillo
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Nathan Campus N48 2.14, 170 Kessels Road, Nathan, Brisbane, 4111, QLD, Australia.
| | - Marion Mitchell
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Nathan Campus N48 2.14, 170 Kessels Road, Nathan, Brisbane, 4111, QLD, Australia.
| | - Chelsea Davis
- Intensive Care Unit, Princess Alexandra Hospital, Building 53 Level 4, 199 Ipswich Road, Woolloongabba, Brisbane, 4102, QLD, Australia.
| | - Madeleine Powell
- Intensive Care Unit, Princess Alexandra Hospital, Building 53 Level 4, 199 Ipswich Road, Woolloongabba, Brisbane, 4102, QLD, Australia.
| | - Robyne Le Brocque
- School of Nursing, Midwifery, and Social Work, University of Queensland, Chamberlain Building (35) Level 3, St Lucia, Brisbane, 4072, QLD, Australia.
| | - Amanda Ullman
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Nathan Campus N48 2.14, 170 Kessels Road, Nathan, Brisbane, 4111, QLD, Australia.
| | - Krista Wetzig
- Intensive Care Unit, Princess Alexandra Hospital, Building 53 Level 4, 199 Ipswich Road, Woolloongabba, Brisbane, 4102, QLD, Australia.
| | - Janice Rattray
- School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, United Kingdom.
| | - Alastair M Hull
- Institute of Medical Sciences, University of Dundee, Dundee, DD1 9SY, United Kingdom.
| | - Justin Kenardy
- School of Psychology, University of Queensland, McElwain Building (24A) Level 4, Room 408, St Lucia, Brisbane, 4072, QLD, Australia.
| | - Leanne M Aitken
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Nathan Campus N48 2.14, 170 Kessels Road, Nathan, Brisbane, 4111, QLD, Australia; School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, United Kingdom.
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16
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Nielsen AH, Angel S, Egerod I. An ICU diary written by relatives: Who is it really written for? Intensive Crit Care Nurs 2020; 57:102813. [PMID: 32067821 DOI: 10.1016/j.iccn.2020.102813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anne Højager Nielsen
- Department of Anesthesiology, Gødstrup Hospital, Lægårdvej 12, 7500 Holstebro, Denmark.
| | - Sanne Angel
- Section for Nursing, Department of Public Health, Aarhus University, Building 1260, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Ingrid Egerod
- University of Copenhagen, Health and Medical Sciences, Blegdamsvej 3B, 2200 Copenhagen N, Denmark; Intensive Care Unit 4131, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
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17
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Barreto BB, Luz M, Rios MNDO, Lopes AA, Gusmao-Flores D. The impact of intensive care unit diaries on patients' and relatives' outcomes: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:411. [PMID: 31842929 PMCID: PMC6916011 DOI: 10.1186/s13054-019-2678-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023]
Abstract
Background Memory gaps in intensive care unit (ICU) survivors are associated with psychiatric disorders. The ICU diaries improve the patient’s factual memory of the ICU, but it is not clear if they reduce the incidence of psychiatric disorders in patients and relatives after hospital discharge. The aim of this study is to evaluate the literature on the effect of ICU diaries for patients admitted in ICU and their relatives. Methods Two authors independently searched the online databases PubMed, OVID, Embase, EBSCO host, and PsycINFO from inception to July 2019. Studies were included if the intervention group (ICU diary) was compared with a group with no diaries and the sample was comprised patients ≥ 18 years old admitted in the ICU for more than 24 h and their relatives. Randomized clinical trials, observational studies, letter with original data, and abstracts were included, irrespective of the language. The search was not limited by any specific outcome. Review articles, commentaries, editorials, and studies without a control group were excluded. Structured tools were used to assess the methodological quality (“Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I)” for cohort studies and the “Cochrane Risk of Bias tool” for included RCTs and before/after studies). A random-effects model was employed considering the anticipated variability between the studies. Results Seven hundred eighty-five titles were identified for screening. Two additional studies were selected after a reference search, and after a full-text review, a total of 12 studies were included. When pooling the results, ICU diary was associated with lower risk of depression (RR 0.41, 95% CI 0.23–0.75) and better quality of life (10.3 points higher in SF-36 general health score, 95% CI 0.79–19.8), without a decrease in anxiety or post-traumatic stress disorder (PTSD). For the relatives receiving an ICU diary, there was no difference in the incidence of PTSD, anxiety, or depression. Conclusion and relevance This systematic review and meta-analysis supports the use of ICU diaries to reduce the risk of depression and preserve the quality of life of patients after ICU admission. ICU diaries do not seem to have any beneficial effect on the relatives of the patients. Trial registration PROSPERO, CRD42019136639
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Affiliation(s)
- Bruna Brandao Barreto
- Intensive Care Unit, Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, Bahia, 40411-900, Brazil.
| | - Mariana Luz
- Intensive Care Unit, Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, Bahia, 40411-900, Brazil
| | | | - Antonio Alberto Lopes
- Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.,Departamento de Medicina Interna e Apoio Diagnóstico, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil.,Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Dimitri Gusmao-Flores
- Intensive Care Unit, Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, Bahia, 40411-900, Brazil.,Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.,Departamento de Medicina Interna e Apoio Diagnóstico, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil.,Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Intensive Care Unit, Hospital da Cidade, Salvador, Bahia, Brazil
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18
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Garrouste-Orgeas M, Flahault C, Vinatier I, Rigaud JP, Thieulot-Rolin N, Mercier E, Rouget A, Grand H, Lesieur O, Tamion F, Hamidfar R, Renault A, Parmentier-Decrucq E, Monseau Y, Argaud L, Bretonnière C, Lautrette A, Badié J, Boulet E, Floccard B, Forceville X, Kipnis E, Soufir L, Valade S, Bige N, Gaffinel A, Hamzaoui O, Simon G, Thirion M, Bouadma L, Large A, Mira JP, Amdjar-Badidi N, Jourdain M, Jost PH, Maxime V, Santoli F, Ruckly S, Vioulac C, Leborgne MA, Bellalou L, Fasse L, Misset B, Bailly S, Timsit JF. Effect of an ICU Diary on Posttraumatic Stress Disorder Symptoms Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. JAMA 2019; 322:229-239. [PMID: 31310299 PMCID: PMC6635906 DOI: 10.1001/jama.2019.9058] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Keeping a diary for patients while they are in the intensive care unit (ICU) might reduce their posttraumatic stress disorder (PTSD) symptoms. OBJECTIVES To assess the effect of an ICU diary on the psychological consequences of an ICU hospitalization. DESIGN, SETTING, AND PARTICIPANTS Assessor-blinded, multicenter, randomized clinical trial in 35 French ICUs from October 2015 to January 2017, with follow-up until July 2017. Among 2631 approached patients, 709 adult patients (with 1 family member each) who received mechanical ventilation within 48 hours after ICU admission for at least 2 days were eligible, 657 were randomized, and 339 were assessed 3 months after ICU discharge. INTERVENTIONS Patients in the intervention group (n = 355) had an ICU diary filled in by clinicians and family members. Patients in the control group (n = 354) had usual ICU care without an ICU diary. MAIN OUTCOMES AND MEASURES The primary outcome was significant PTSD symptoms, defined as an Impact Event Scale-Revised (IES-R) score greater than 22 (range, 0-88; a higher score indicates more severe symptoms), measured in patients 3 months after ICU discharge. Secondary outcomes, also measured at 3 months and compared between groups, included significant PTSD symptoms in family members; significant anxiety and depression symptoms in patients and family members, based on a Hospital Anxiety and Depression Scale score greater than 8 for each subscale (range, 0-42; higher scores indicate more severe symptoms; minimal clinically important difference, 2.5); and patient memories of the ICU stay, reported with the ICU memory tool. RESULTS Among 657 patients who were randomized (median [interquartile range] age, 62 [51-70] years; 126 women [37.2%]), 339 (51.6%) completed the trial. At 3 months, significant PTSD symptoms were reported by 49 of 164 patients (29.9%) in the intervention group vs 60 of 175 (34.3%) in the control group (risk difference, -4% [95% CI, -15% to 6%]; P = .39). The median (interquartile range) IES-R score was 12 (5-25) in the intervention group vs 13 (6-27) in the control group (difference, -1.47 [95% CI, -1.93 to 4.87]; P = .38). There were no significant differences in any of the 6 prespecified comparative secondary outcomes. CONCLUSIONS AND RELEVANCE Among patients who received mechanical ventilation in the ICU, the use of an ICU diary filled in by clinicians and family members did not significantly reduce the number of patients who reported significant PTSD symptoms at 3 months. These findings do not support the use of ICU diaries for preventing PTSD symptoms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02519725.
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Affiliation(s)
- Maité Garrouste-Orgeas
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Department of Biostatistics, Outcomerea, Paris, France
- Medical unit, French British Hospital, Levallois-Perret, France
| | - Cécile Flahault
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Isabelle Vinatier
- Medical ICU, Les Oudaries Hospital, La Roche-sur-Yon, Vendée, France
| | | | | | - Emmanuelle Mercier
- CRICS-TRIGGERSEP group, Medical-Surgical ICU, Tours University Hospital, Tours, France
| | - Antoine Rouget
- Medical-Surgical ICU, Rangueil University Hospital, Toulouse, France
| | - Hubert Grand
- Medical-Surgical ICU, Hospital Robert Boulin, Libourne, France
| | | | - Fabienne Tamion
- Medical ICU, University Medical Center, Rouen, France
- INSERM U-1096, University of Rouen, Rouen, France
| | - Rebecca Hamidfar
- Medical ICU, Albert Michallon University Hospital, Grenoble, France
| | - Anne Renault
- Medical ICU, La Cavale Blanche University Hospital, Brest, France
| | | | | | - Laurent Argaud
- Medical ICU, Edouard Herriot University Hospital, Lyon, France
| | - Cédric Bretonnière
- Medical ICU, Nantes University Hospital, Nantes, France
- EA3826, Laboratory of Clinical and Experimental Therapeutics of Infections, University of Nantes, Nantes, France
| | - Alexandre Lautrette
- Medical ICU, Gabriel-Montpied University Hospital, Clermont Ferrand, France
- LMGE UMR CNRS 6023, University of Clermont-Ferrand, Clermont Ferrand, France
| | - Julio Badié
- Medical-Surgical ICU, General Hospital Belfort-Montbéliard, Belfort, France
| | - Eric Boulet
- Medical ICU, Beaumont General Hospital, Beaumont, France
| | - Bernard Floccard
- Medical ICU, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France
| | - Xavier Forceville
- Medical-Surgical ICU, Great Hospital of East Francilien, Meaux, France
| | - Eric Kipnis
- Surgical ICU, Lille University Hospital, Lille, France
| | - Lilia Soufir
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | | | - Naike Bige
- Medical ICU, Saint Antoine University Hospital, Paris, France
| | - Alain Gaffinel
- Medical-Surgical ICU, Gustave Roussy Cancer Campus, Villejuif, France
| | - Olfa Hamzaoui
- Medical Surgical ICU, University Hospital Paris -Sud, Beclère University Hospital, Clamart, France
| | - Georges Simon
- Medical-Surgical ICU, General Hospital, Troyes, France
| | - Marina Thirion
- Medical-Surgical ICU, General Hospital Victor Dupouy, Argenteuil, France
| | - Lila Bouadma
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Medical ICU, Bichat University Hospital, Paris, France
| | - Audrey Large
- Medical ICU, François Mitterrand University Hospital, Dijon, France
| | - Jean-Paul Mira
- Medical ICU, Cochin University Hospital, Paris Centre Hospital Group, AP-HP, Paris, France
| | | | - Mercé Jourdain
- Group of medical ICUs, Lille University Hospital, Lille, France
- Lille University, Inserm U1190, Lille, France
| | - Paul-Henri Jost
- Surgical ICU, Henri Mondor University Hospital, Créteil, France
| | - Virginie Maxime
- Medical ICU, Raymond Poincaré University Hospital, Garches, France
| | - François Santoli
- Medical ICU, General Hospital Robert Ballanger, Aulnay-Sous-Bois, France
| | | | - Christel Vioulac
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Marie Annick Leborgne
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Lucie Bellalou
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Léonor Fasse
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Benoit Misset
- Medical ICU, University Medical Center, Rouen, France
| | - Sébastien Bailly
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Grenoble Alpes University, INSERM, University hospital Grenoble Alpes, HP2, Grenoble, France
| | - Jean-François Timsit
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Department of Biostatistics, Outcomerea, Paris, France
- Medical ICU, Bichat University Hospital, Paris, France
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19
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Tavares T, Camões J, Carvalho DR, Jacinto R, Vales CM, Gomes E. Assessment of patient satisfaction and preferences with an intensive care diary. Rev Bras Ter Intensiva 2019; 31:164-170. [PMID: 31141084 PMCID: PMC6649223 DOI: 10.5935/0103-507x.20190028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/07/2019] [Indexed: 11/20/2022] Open
Abstract
Objectives To evaluate the satisfaction of patients admitted to the intensive care unit
using a diary and analyze possible points for improving this instrument. Methods This was an observational, retrospective study, conducted between March 2014
and July 2017, in a multidisciplinary intensive care unit of a district
hospital. The diary was implemented in patients sedated for 3 or more days.
Three months after discharge, their satisfaction was assessed using a
questionnaire. A patient who agreed with the 5 statements assessing the
diary's help in clarifying the intensive care unit stay, in filling memory
gaps, in recovery, in reassurance, and in the recommendation of this
intervention was defined as satisfied. Results A total of 110 patients were included, of whom 55 answered the questionnaire.
Of these, 36 (65.5%) were classified as satisfied. Each item had a positive
response in more than 74% of cases. A total of 60% of the participants
suggested increasing the number of photographs. No significant differences
were found in the subgroup analysis (age, sex, duration of sedation and
ventilation, length of diary keeping, severity on admission, or delirium,
depression, or anxiety in the intensive care unit). Conclusions Most patients were satisfied with the diary but suggested an increase in the
number of photographs.
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Affiliation(s)
- Teresa Tavares
- Serviço de Medicina Interna, Hospital Pedro Hispano - Matosinhos, Portugal
| | - João Camões
- Serviço de Medicina Intensiva, Hospital Pedro Hispano - Matosinhos, Portugal
| | | | - Rosa Jacinto
- Serviço de Medicina Intensiva, Hospital Pedro Hispano - Matosinhos, Portugal
| | | | - Ernestina Gomes
- Serviço de Medicina Intensiva, Hospital Pedro Hispano - Matosinhos, Portugal
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Abstract
OBJECTIVES To determine the feasibility of implementing an ICU diary in the pediatric critical care setting and to understand the perceptions held by family members who receive the diaries after PICU discharge. DESIGN Observational pilot study. SETTING PICU in a tertiary academic hospital in the United States. PARTICIPANTS Critically ill pediatric patients admitted to the PICU and their families. INTERVENTIONS The addition of a PICU diary to a patient's routine care. MEASUREMENTS AND MAIN RESULTS Twenty families of critically ill children admitted to the PICU were enrolled in the PICU diary pilot study between May 2017 and March 2018. Patients who had an anticipated length of stay of at least 3 days and whose families were English-speaking were included. The median age of patients was 6 years, ranging from newborns to 18 years old, and the median length of stay was 11.5 days (interquartile range, 8.5-41 d). A total of 453 diary entries were written in 19 diaries over 433 PICU days, the majority of which were composed by bedsides nurses (63%). Follow-up surveys sent to parents 2 weeks after PICU discharge revealed that of the parents who had contributed to the diary, most enjoyed doing so (7/8). Nine of 12 parents had reviewed the diary at least once since discharge, and all parent respondents found the diary to be a beneficial aspect of their experience after PICU discharge. CONCLUSIONS The use of ICU diaries in the PICU setting is feasible and perceived as beneficial by families of critically ill children. Future studies are needed to better understand if PICU diaries may objectively improve psychologic outcomes of patients and family members after PICU admission.
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21
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Johansson M, Wåhlin I, Magnusson L, Hanson E. Nursing staff's experiences of intensive care unit diaries: a qualitative study. Nurs Crit Care 2019; 24:407-413. [PMID: 30680873 DOI: 10.1111/nicc.12416] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/11/2018] [Accepted: 12/21/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Diaries as an intervention to aid psychological recovery among intensive care patients have been used for about 20 years, and findings tend to be positive. The provision of a diary directed at the patient may clarify the story of the intensive care unit (ICU) even for the family members and the family members of non-survivors. Members of nursing staff are the primary authors, but how they themselves experience the use of ICU diaries has been minimally explored. AIMS AND OBJECTIVES This study aimed to explore how nursing staff experienced the use of ICU patient diaries. DESIGN Qualitative design using focus group interviews. METHODS A qualitative methodology was used. Six focus group interviews were conducted with 27 nursing staff recruited from one university and two county hospitals. The data were analysed via thematic content analysis. FINDINGS One overarching theme, 'An effort to do good in words and actions', and four interconnected themes were derived from the analysis. By creating the diary, nursing staff had to deal with a variety of ethical and practical dilemmas, but feedback from patients, family members and ICU follow-up services reinforced the feeling of doing good. This overarching feeling of beneficence encouraged diary authoring and increased motivation and commitment to strive towards excellent patient care. To sustain the use of ICU diaries, collegiate and organizational support was deemed essential. CONCLUSIONS Nursing staff strived to do good in words and actions for patients and their families when writing the diaries. Positive feedback from patients, family members and ICU follow-up services reinforced feelings of doing good, which served to enhance work satisfaction and a commitment to good-quality nursing care. Experiential-based education was recommended to help sustain ICU diary writing. RELEVANCE TO CLINICAL PRACTICE Nursing staff requested mentoring and group discussions concerning the format, content and communication channels of the diary.
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Affiliation(s)
- Maria Johansson
- Intensive Care Department, County Hospital, Kalmar, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Ingrid Wåhlin
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.,Kalmar Countym, Intensive Care Department, County Hospital, Kalmar, Sweden.,Research Section, Kalmar County Council, Kalmar, Sweden
| | - Lennart Magnusson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.,Swedish Family Care Competence Centre, Linnaeus University, Kalmar, Sweden
| | - Elizabeth Hanson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.,Swedish Family Care Competence Centre, Linnaeus University, Kalmar, Sweden
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Bäckman CG, Ahlberg M, Jones C, Frisman GH. Group meetings after critical illness-Giving and receiving strength. Intensive Crit Care Nurs 2018; 46:86-91. [PMID: 29605238 DOI: 10.1016/j.iccn.2017.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/03/2017] [Accepted: 11/26/2017] [Indexed: 10/17/2022]
Abstract
INTRODUCTION An increasing number of intensive care patients are surviving critical illness, but many develop mental, cognitive and physical impairments after discharge. Adapting to a new life situation, often with major challenges, implies the need of support. Therefore, it is important to develop interventions aimed at promoting recovery. OBJECTIVE The aim was to describe former intensive care patients' feelings of sharing their experience of critical illness with other former patients. METHOD Former intensive care patients (n = 17) participated in group meetings and wrote about their thoughts in a notebook after each group meeting. To deepen the understanding of the former patients' experience 11 of the former patients were interviewed. The notes in the notebooks and the interviews were analysed using qualitative content analysis. FINDINGS Meeting others revealed to the former patients new dimensions of being critically ill, and they both gave and received strength from each other. The meetings were meaningful as they gained insight into other patients' lives, and realised what it meant to survive intensive care. CONCLUSIONS The group meetings meant sharing experiences and understanding the process of survival after critical illness. Giving and receiving strength from others helped the participants to go further.
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Affiliation(s)
- Carl G Bäckman
- Department of Anesthesiology and Intensive Care, Vrinnevi Hospital Norrköping, Sweden.
| | - Mona Ahlberg
- Department of Anesthesiology and Intensive Care, Vrinnevi Hospital Norrköping, Sweden
| | - Christina Jones
- Musculoskeletal Biology, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK
| | - Gunilla Hollman Frisman
- Department and Anesthetics, Operations and Speciality Surgery Center and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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23
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Teece A, Baker J. Thematic Analysis: How do patient diaries affect survivors' psychological recovery? Intensive Crit Care Nurs 2017; 41:50-56. [DOI: 10.1016/j.iccn.2017.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/04/2017] [Indexed: 10/19/2022]
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24
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Affiliation(s)
- Judy E Davidson
- Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, Mail Code 8929, 200 W Arbor Drive, San Diego CA 92103 Maurene A. Harvey is an Educational Consultant, Lake Tahoe, Nevada
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25
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Ednell AK, Siljegren S, Engström Å. The ICU patient diary-A nursing intervention that is complicated in its simplicity: A qualitative study. Intensive Crit Care Nurs 2017; 40:70-76. [PMID: 28233651 DOI: 10.1016/j.iccn.2016.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 11/19/2016] [Accepted: 12/03/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Writing a diary for intensive care patients has been shown to facilitate patientrecovery and prevent post-traumatic stress following hospitalisation. AIM This study aimed to describe the experiences of critical care nurses' (CCNs') in writing personal diaries for ICU patients. METHOD The study was conducted with a qualitative design. Ten CCNs from two hospitals participated. Data were collected with semi-structured interviews and analysed using a qualitative thematic content analysis. FINDINGS The result consists of a theme: Patient diary: a complex nursing intervention in all its simplicity, as well as four categories: Writing informatively and with awareness shows respect and consideration; The diary is important for both patient and CCN; To jointly create an organisation that facilitates and develops the writing; Relatives' involvement in the diary is a matter of course. CONCLUSION CCNs are aware of the diary's importance for the patient and relatives, but experience difficulties in deciding which patients should get this intervention and how to prioritize it. Writing a personal diary for an ICU patient is a nursing intervention that is complicated in its simplicity.
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Affiliation(s)
| | | | - Åsa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
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Blair KTA, Eccleston SD, Binder HM, McCarthy MS. Improving the Patient Experience by Implementing an ICU Diary for Those at Risk of Post-intensive Care Syndrome. J Patient Exp 2017; 4:4-9. [PMID: 28725854 PMCID: PMC5513660 DOI: 10.1177/2374373517692927] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The critical care literature in the US has recently brought attention to the impact an ICU experience can have long after the patient survives critical illness, particularly if delirium was present. Current recommendations to mitigate post-intensive care syndrome (PICS) are embedded in patient and family-centered care and aim to promote family presence in the ICU, provide support for decision-making, and enhance communication with the health-care team. Evidence-based interventions are few in number but include use of an ICU diary to minimize the psychological and emotional sequelae affecting patients and family members in the months following the ICU stay. In this paper we describe our efforts to implement an ICU diary and solicit feedback on its role in fostering teamwork and communication between patients, family members, and ICU staff. Next steps will involve a PICS follow-up clinic where trained staff will coordinate specialty referrals and perform long-term monitoring of mental health and other quality of life outcomes.
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Affiliation(s)
- K Taylor A Blair
- Critical Care Nursing Section, Department of Inpatient Services, Madigan Army Medical Center, Tacoma, WA, USA
| | - Sarah D Eccleston
- Center for Nursing Science & Clinical Inquiry, Department of Inpatient Services, Madigan Army Medical Center, Tacoma, WA, USA
| | - Hannah M Binder
- Critical Care Nursing Section, Department of Inpatient Services, Madigan Army Medical Center, Tacoma, WA, USA
| | - Mary S McCarthy
- Center for Nursing Science & Clinical Inquiry, Department of Inpatient Services, Madigan Army Medical Center, Tacoma, WA, USA
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Aitken LM, Rattray J, Kenardy J, Hull AM, Ullman AJ, Le Brocque R, Mitchell M, Davis C, Castillo MI, Macfarlane B. Perspectives of patients and family members regarding psychological support using intensive care diaries: An exploratory mixed methods study. J Crit Care 2016; 38:263-268. [PMID: 28011420 DOI: 10.1016/j.jcrc.2016.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/03/2016] [Accepted: 12/07/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Diaries summarizing intensive care are routine practice in some countries, although evidence to support diary use is limited. The purpose of this study was to identify whether distress post-intensive care influences patients' and relatives' choice as to whether they would like to receive a diary and what information delivery method is preferred. MATERIALS AND METHODS Intensive care patients admitted for at least 3 days and their relatives participated in an exploratory mixed methods study. Interviews were conducted 3 to 5 months after discharge. Psychological distress was assessed using Kessler-10 and Posttraumatic Stress Disorder Symptom Checklist - 5. Perceptions of benefit of diaries were assessed using a 4-point Likert scale. Differences were examined using Fisher exact test (P<.05). RESULTS Fifty-seven patients and 22 relatives consented to participation, with 22 patients and 22 relatives interviewed before data saturation. Psychological distress was evident in 25 (47%) patients and 5 (23%) relatives. Participants' psychological health was similar for those who perceived diaries as beneficial, and those who did not. Themes included memory, process, and impact, although opinions were diverse. CONCLUSIONS Patient and relative preferences of receiving a diary are not related to psychological distress. Diverse opinions around common themes suggest the need for a range of interventions to aid psychological recovery.
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Affiliation(s)
- Leanne M Aitken
- School of Health Sciences, City, University of London, United Kingdom; National Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia.
| | - Janice Rattray
- School of Nursing and Health Sciences, University of Dundee, Dundee, DD1 4HJ, United Kingdom
| | - Justin Kenardy
- School of Psychology, University of Queensland, St Lucia 4072, Queensland, Australia; Recover Injury Research Centre, Level 7, Oral Health Building, The University of Queensland, Herston, Queensland 4029, Australia
| | - Alastair M Hull
- Department of Psychiatry, University of Dundee, NHS Tayside, Perth, United Kingdom; Multidisciplinary Adult Psychotherapy Service, Perth Royal Infirmary, Perth PH1 1NX, United Kingdom
| | - Amanda J Ullman
- National Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Robyne Le Brocque
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Marion Mitchell
- Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia; School of Nursing and Midwifery, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland 4111, Australia
| | - Chelsea Davis
- Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia
| | - Maria I Castillo
- Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Nathan, Queensland 4111, Australia
| | - Bonnie Macfarlane
- National Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia
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Svenningsen H, Egerod I, Dreyer P. Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur's interpretation theory. J Clin Nurs 2016; 25:2807-15. [DOI: 10.1111/jocn.13318] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Helle Svenningsen
- Department of Nursing; Faculty of Health Sciences; VIA University College; Aarhus N Denmark
| | - Ingrid Egerod
- University of Copenhagen Health & Medical Sciences Rigshospitalet; Trauma Center HOC 3193; Copenhagen Denmark
| | - Pia Dreyer
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus C Denmark
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A qualitative exploration into the long-term perspectives of patients receiving critical care diaries across the United Kingdom. Intensive Crit Care Nurs 2016; 36:1-7. [PMID: 27287736 DOI: 10.1016/j.iccn.2016.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/26/2016] [Accepted: 04/30/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Increasing evidence suggests the use of a diary with entries by nurses, doctors, AHPs and the patient's family can potentially help by "filling in the gaps" and help the patient make sense of a time that they have forgotten or feel confused and have fears about. AIMS A qualitative exploration of the impact of diaries on critical care patients around the United Kingdom in order to describe the long-term effects of patient diaries. METHODS In-depth qualitative interviews, using principles of grounded theory, via telephone and email were undertaken. The sample included former patients who responded via adverts on critical care charity/support websites. People who had diaries in the previous 1-3 years were asked about their experiences. FINDINGS Eight people who had been patients in various critical care units across the United Kingdom and who had a critical care diary were interviewed. All reported value in having diaries, however, participants reported needing support when first receiving the diary to understand events that took place in critical care. CONCLUSION Diaries can offer a means of filing the gaps for patients who struggle with coming to terms with their critical care recovery, but should be given to patients with forethought and subsequent support.
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Developing a framework for implementing intensive care unit diaries: a focused review of the literature. Aust Crit Care 2016; 29:224-234. [PMID: 27240937 DOI: 10.1016/j.aucc.2016.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/01/2016] [Accepted: 05/15/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Intensive care unit diaries have been shown to improve post-critical illness recovery, however, prior reports of diary implementation are heterogeneous. We sought to construct a common framework for designing and implementing Intensive Care Unit diaries based on prior studies. REVIEW METHOD USED/DATA SOURCES We conducted a focused review of the literature regarding intensive care diaries based on a systematic search of several databases. Two reviewers assessed 56 studies and data were abstracted from a total of 25 eligible studies conducted between 1990 and 2014. We identified key information regarding the development, design, and implementation of the journals. We then grouped elements that appeared consistently across these studies within three main categories: (1) diary target populations; (2) diary format and content; and (3) the manner of diary return and follow-up. RESULTS Most studies were conducted in European countries in adult intensive care units and targeted patients in both medical and surgical units. The timing of diary initiation was based on the elapsed length of stay or duration of mechanical ventilation. We categorised diary format and content as: entry content, authors, use of standardised headings, type of language, initiation, frequency of entries, and physical location of diaries. Diaries were hand written and many studies found that photographs were an essential element in ICU diaries. We categorised the manner of diary return and follow-up. The context in which intensive care unit diaries were returned were felt to be important factors in improving the use of diaries in recovery. CONCLUSIONS In conclusion, we describe a common framework for the future development of intensive care unit diaries that revolves around the target population for the diaries, their format and content, and the timing of their use. Future studies should address how these elements impact the mechanisms by which intensive are diaries exert beneficial effects.
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Glimelius Petersson C, Ringdal M, Apelqvist G, Bergbom I. Diaries and memories following an ICU stay: a 2-month follow-up study. Nurs Crit Care 2015; 23:299-307. [PMID: 26010232 DOI: 10.1111/nicc.12162] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 11/03/2014] [Accepted: 01/05/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many patients lack a clear recollection from their stay in the intensive care unit (ICU). Diaries have been introduced as a tool to complete memories and reduce the risk of posttraumatic stress disorder (PTSD). AIMS To describe and compare patients' memories and PTSD in relation to having received and read or not received a diary and patients' experiences of having received and read their diary, without having discussed the contents with ICU staff. DESIGN Descriptive and comparative. METHODS Patients received their diaries at ICU discharge. After 2 months patients answered the ICU Memory Tool, a screening instrument for PTSD (PTSS-14) and a questionnaire including space for own comments about the diaries. RESULTS Of 96 patients, 52(54%) received a diary, 44 did not. Patients with diaries had significantly longer stay and more mechanical ventilation. Of these, 40 patients responded to PTSS-14 and had evaluated and read the diary and 34 patients served as controls. No significant differences were found in presence/absence of memories between these groups. In the diary-group patients with emotional memories had lower APACHE. Feelings of being anxious or frightened were more common in the diary-group. At 2 months, 12% scored above cut-off on the PTSS14 with no difference between groups. The diaries were helpful for understanding the ICU-stay. CONCLUSIONS Diaries seem valuable in understanding what happened, as an act of caring and as a tool for discussion with relatives and friends. Patients valued reading their diaries. None expressed the wish to have read the diary together with a member of staff. The diary and non-diary groups however reported similar memories. RELEVANCE TO CLINICAL PRACTICE Diaries seem to be valuable in understanding what happened, giving a feeling of trust and for talking about their ICU-stay. As many patients described stressful memories, sessions should be offered with ICU staff.
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Affiliation(s)
| | - Mona Ringdal
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Gustav Apelqvist
- Department of Anaesthesia, ICU, Centralsjukhuset, Kristianstad, Sweden
| | - Ingegerd Bergbom
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Engström Å, Rogmalm K, Marklund L, Wälivaara BM. Follow-up visit in an ICU: receiving a sense of coherence. Nurs Crit Care 2015; 23:308-315. [PMID: 25690677 DOI: 10.1111/nicc.12168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 11/25/2014] [Accepted: 01/22/2015] [Indexed: 01/03/2023]
Abstract
AIM To describe patients' experiences of a follow-up visit to an intensive care unit (ICU) after being critically ill and nursed there. BACKGROUND Knowledge about the follow-up visit needs to be developed, with the previously critically ill patient in focus. DESIGN Qualitative descriptive. METHOD Semi-structured interviews were conducted with nine patients and analysed using qualitative content analysis. The data collection occurred during spring 2014. FINDINGS During the follow-up visits in ICU, the relatives, the patient diary, and those who took part in the care contribute to fill memory gaps to create a picture and an explanation of the care period. CONCLUSION The follow-up visit is an important tool in the patients' struggle to create a context and coherence from a missing or unreal time. The patient diary is essential to subsequently be able to relate to the period of care. RELEVANCE TO CLINICAL PRACTICE The follow-up visit, together with a personal diary, after an ICU stay could be seen as significant for strengthening the patients' feeling of coherence and better health.
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Affiliation(s)
- Åsa Engström
- Associate Professor, Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | | | | | - Britt-Marie Wälivaara
- Senior Lecturer, Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
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Svenningsen H, Langhorn L, Ågård AS, Dreyer P. Post-ICU symptoms, consequences, and follow-up: an integrative review. Nurs Crit Care 2015; 22:212-220. [DOI: 10.1111/nicc.12165] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/09/2014] [Accepted: 01/15/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Helle Svenningsen
- Lecturer, Department of Nursing, Faculty of Health Sciences, VIA University College; DK-8200 Aarhus N Denmark
| | - Leanne Langhorn
- Clinical Nurse Specialist, Aarhus University Hospital, Department of Neurosurgery NK; Dk-8000 Aarhus C Denmark
| | - Anne Sophie Ågård
- Clinical Nurse Specialist, Aarhus University Hospital, Department of Anaesthesiology and Intensive Care; DK-8200 Aarhus N Denmark
| | - Pia Dreyer
- Clinical Nurse Specialist, Associated Professor, Aarhus University, Department of Public Health, Section of Nursing Science, Aarhus University Hospital, Department of Anaesthesia and Intensive Care Medicine; Dk-8000 Aarhus C Denmark
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Clancy O, Edginton T, Casarin A, Vizcaychipi MP. The psychological and neurocognitive consequences of critical illness. A pragmatic review of current evidence. J Intensive Care Soc 2015; 16:226-233. [PMID: 28979415 DOI: 10.1177/1751143715569637] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Mortality rates alone are no longer a sufficient guide to quality of care. Due to medical advances, patients are surviving for longer following critical illness and major surgery; therefore, functional outcomes and long-term quality of life are of increasing consequence. Post-operative cognitive dysfunction has been acknowledged as a complication following anaesthesia for many years, and interest in persistent cognitive dysfunction following a critical illness is growing. Psychological and neurocognitive sequelae following discharge from intensive care are acknowledged to occur with sufficient significance to have recently coined the term 'the post-intensive care syndrome'. Rehabilitation following critical illness has been highlighted as an important goal in recently published national UK guidelines, including the need to focus on both physical and non-physical recovery. Neuropsychological and cognitive consequences following anaesthesia and critical illness are significant. The exact pathophysiological mechanisms linking delirium, cognitive dysfunction and neuropsychological symptoms following critical illness are not fully elucidated but have been studied elsewhere and are outside the scope of this article. There is limited evidence as yet for specific peri-operative preventative strategies, but early management and rehabilitation strategies following intensive care discharge are now emerging. This article aims to summarise the issues and appraise current options for management, including both neuroprotective and neurorehabilitative strategies in intensive care.
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Affiliation(s)
- Olivia Clancy
- Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.,Imperial College Faculty of Medicine, London, UK
| | - Trudi Edginton
- Department of Psychology, The University of Westminster, London, UK
| | - Annalisa Casarin
- Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.,Department of Anaesthesia, Watford General Hospital, London, UK
| | - Marcela P Vizcaychipi
- Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.,Imperial College Faculty of Medicine, London, UK
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Fukuda T, Inoue T, Kinoshita Y, Yukawa T. Effectiveness of ICU Diaries: Improving “Distorted Memories” Encountered during ICU Admission. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojn.2015.54034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ullman AJ, Aitken LM, Rattray J, Kenardy J, Le Brocque R, MacGillivray S, Hull AM. Diaries for recovery from critical illness. Cochrane Database Syst Rev 2014; 2014:CD010468. [PMID: 25488158 PMCID: PMC6353055 DOI: 10.1002/14651858.cd010468.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND During intensive care unit (ICU) admission, patients experience extreme physical and psychological stressors, including the abnormal ICU environment. These experiences impact on a patient's recovery from critical illness and may result in both physical and psychological disorders. One strategy that has been developed and implemented by clinical staff to treat the psychological distress prevalent in ICU survivors is the use of patient diaries. These provide a background to the cause of the patient's ICU admission and an ongoing narrative outlining day-to-day activities. OBJECTIVES To assess the effect of a diary versus no diary on patients, and their caregivers or families, during the patient's recovery from admission to an ICU. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 1), Ovid MEDLINE (1950 to January 2014), EBSCOhost CINAHL (1982 to January 2014), Ovid EMBASE (1980 to January 2014), PsycINFO (1950 to January 2014), Published International Literature on Traumatic Stress (PILOTS) database (1971 to January 2014); Web of Science Conference Proceedings Citation Index - Science and Social Science and Humanities (1990 to January 2014); seven clinical trial registries and reference lists of identified trials. We applied no language restriction. SELECTION CRITERIA We included randomized controlled trials (RCTs) or clinical controlled trials (CCTs) that evaluated the effectiveness of patient diaries, when compared to no ICU diary, for patients or family members to promote recovery after admission to ICU. Outcome measures for describing recovery from ICU included the risk of post-traumatic stress disorder (PTSD), anxiety, depression and post-traumatic stress symptomatology, health-related quality of life and costs. DATA COLLECTION AND ANALYSIS We used standard methodological approaches as expected by The Cochrane Collaboration. Two review authors independently reviewed titles for inclusion, extracted data and undertook risk of bias according to prespecified criteria. MAIN RESULTS We identified three eligible studies; two describing ICU patients (N = 358), and one describing relatives of ICU patients (N = 30). The study involving relatives of ICU patients was a substudy of family members from one of the ICU patient studies. There was a mixed risk of bias within the included studies. Blinding of participants to allocation was not possible and blinding of the outcome assessment was not adequately achieved or reported. Overall the quality of the evidence was low to very low. The patient diary intervention was not identical between studies. However, each provided a prospectively prepared, day-to-day description of the participants' ICU admission.No study adequately reported on risk of PTSD as described using a clinical interview, family or caregiver anxiety or depression, health-related quality of life or costs. Within a single study there was no clear evidence of a difference in risk for developing anxiety (risk ratio (RR) 0.29, 95% confidence interval (CI) 0.07 to 1.19) or depression (RR 0.38, 95% CI 0.12 to 1.19) in participants who received ICU diaries, in comparison to those that did not receive a patient diary. However, the results were imprecise and consistent with benefit in either group, or no difference. Within a single study there was no evidence of difference in median post-traumatic stress symptomatology scores (diaries 24, SD 11.6; no diary 24, SD 11.6) and delusional ICU memory recall (RR 1.04, 95% CI 0.84 to 1.28) between the patients recovering from ICU admission who received patient diaries, and those who did not. One study reported reduced post-traumatic stress symptomatology in family members of patients recovering from admission to ICU who received patient diaries (median 19; range 14 to 28), in comparison to no diary (median 28; range 14 to 38). AUTHORS' CONCLUSIONS Currently there is minimal evidence from RCTs of the benefits or harms of patient diaries for patients and their caregivers or family members. A small study has described their potential to reduce post-traumatic stress symptomatology in family members. However, there is currently inadequate evidence to support their effectiveness in improving psychological recovery after critical illness for patients and their family members.
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Affiliation(s)
- Amanda J Ullman
- NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, 170 Kessels Road, Brisbane, Queensland, 4111, Australia.
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Ewens BA, Hendricks JM, Sundin D. The use, prevalence and potential benefits of a diary as a therapeutic intervention/tool to aid recovery following critical illness in intensive care: a literature review. J Clin Nurs 2014; 24:1406-25. [PMID: 25488139 DOI: 10.1111/jocn.12736] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 12/20/2022]
Abstract
AIMS AND OBJECTIVES To critically appraise the available literature and summarise the evidence related to the use, prevalence, purpose and potential therapeutic benefits of intensive care unit diaries following survivors' discharge from hospital and identify areas for future exploration. BACKGROUND Intensive care unit survivorship is increasing as are associated physical and psychological complications. These complications can impact on the quality of life of survivors and their families. Rehabilitation services for survivors have been sporadically implemented and lack an evidence base. Patient diaries in intensive care have been implemented in Scandinavia and Europe with the intention of filling memory gaps, enable survivors to set realistic recovery goals and cement their experiences in reality. DESIGN A review of original research articles. METHODS The review used key terms and Boolean operators across a 34-year time frame in: CIHAHL, Medline, Scopus, Proquest, Informit and Google Scholar for research reports pertaining to the area of enquiry. Twenty-two original research articles met the inclusion criteria for this review. RESULTS The review concluded that diaries are prevalent in Scandinavia and parts of Europe but not elsewhere. The implementation and ongoing use of diaries is disparate and international guidelines to clarify this have been proposed. Evidence which demonstrates the potential of diaries in the reduction of the psychological complications following intensive care has recently emerged. Results from this review will inform future research in this area. CONCLUSIONS Further investigation is warranted to explore the potential benefits of diaries for survivors and improve the evidence base which is currently insufficient to inform practice. The exploration of prospective diarising in the recovery period for survivors is also justified. RELEVANCE TO CLINICAL PRACTICE Intensive care diaries are a cost effective intervention which may yield significant benefits to survivors.
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Garrouste-Orgeas M, Périer A, Mouricou P, Grégoire C, Bruel C, Brochon S, Philippart F, Max A, Misset B. Writing in and reading ICU diaries: qualitative study of families' experience in the ICU. PLoS One 2014; 9:e110146. [PMID: 25329581 PMCID: PMC4199718 DOI: 10.1371/journal.pone.0110146] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/16/2014] [Indexed: 12/03/2022] Open
Abstract
Purpose Keeping an ICU patient diary has been reported to benefit the patient's recovery. Here, we investigated the families' experience with reading and writing in patient ICU diaries kept by both the family and the staff. Methods We conducted a qualitative study involving 32 semi-structured in-depth interviews of relatives of 26 patients (34% of all family members who visited patients) who met our ICU-diary criterion, i.e., ventilation for longer than 48 hours. Grounded theory was used to conceptualise the interview data via a three-step coding process (open coding, axial coding, and selective coding). Results Communicative, emotional, and humanising experiences emerged from our data. First, family members used the diaries to access, understand, and assimilate the medical information written in the diaries by staff members, and then to share this information with other family members. Second, the diaries enabled family members to maintain a connection with the patient by documenting their presence and expressing their love and affection. Additionally, families confided in the diaries to maintain hope. Finally, family members felt the diaries humanized the medical staff and patient. Conclusions Our findings indicate positive effects of diaries on family members. The diaries served as a powerful tool to deliver holistic patient- and family-centered care despite the potentially dehumanising ICU environment. The diaries made the family members aware of their valuable role in caring for the patient and enhanced their access to and comprehension of medical information. Diaries may play a major role in improving the well-being of ICU-patient families.
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Affiliation(s)
- Maité Garrouste-Orgeas
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
- IAME, UMR 1137, Paris Diderot University, Sorbonne Paris Cité, Paris, France
- * E-mail:
| | - Antoine Périer
- Maison des Adolescents, University Hospital Cochin, Paris, France
- INSERM U-669, University Paris Sud and University Paris Descartes, UMR-S0669, Paris, France
| | - Philippe Mouricou
- Management department, ESSCA School of Management PRES UNAM, Boulogne- Billancourt, France
| | - Charles Grégoire
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | - Cédric Bruel
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | - Sandie Brochon
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | | | - Adeline Max
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | - Benoit Misset
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
- University Paris Descartes, Paris, France
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ICU survivors’ utilisation of diaries post discharge: A qualitative descriptive study. Aust Crit Care 2014; 27:28-35. [DOI: 10.1016/j.aucc.2013.07.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 04/29/2013] [Accepted: 07/02/2013] [Indexed: 12/26/2022] Open
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Aitken LM, Rattray J, Hull A, Kenardy JA, Le Brocque R, Ullman AJ. The use of diaries in psychological recovery from intensive care. Crit Care 2013; 17:253. [PMID: 24351578 PMCID: PMC4056894 DOI: 10.1186/cc13164] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Intensive care patients frequently experience memory loss, nightmares, and delusional memories and some may develop symptoms of anxiety, depression, and post-traumatic stress. The use of diaries is emerging as a putative tool to 'fill the memory gaps' and promote psychological recovery. In this review, we critically analyze the available literature regarding the use and impact of diaries for intensive care patients specifically to examine the impact of diaries on intensive care patients' recovery. Diversity of practice in regard to the structure, content, and process elements of diaries for intensive care patients exists and emphasizes the lack of an underpinning psychological conceptualization. The use of diaries as an intervention to aid psychological recovery in intensive care patients has been examined in 11 studies, including two randomized controlled trials. Inconsistencies exist in sample characteristics, study outcomes, study methods, and the diary intervention itself, limiting the amount of comparison that is possible between studies. Measurement of the impact of the diary intervention on patient outcomes has been limited in both scope and time frame. Furthermore, an underpinning conceptualization or rationale for diaries as an intervention has not been articulated or tested. Given these significant limitations, although findings tend to be positive, implementation as routine clinical practice should not occur until a body of evidence is developed to inform methodological considerations and confirm proposed benefits.
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Affiliation(s)
- Leanne M Aitken
- NHMRC Centre of Research Excellence in Nursing, Health Practice Innovation – Griffith Health Institute, Griffith University, Kessels Road, Nathan, QLD 4111, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD 4102, Australia
| | - Janice Rattray
- School of Nursing and Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, UK
| | - Alastair Hull
- Multidisciplinary Adult Psychotherapy Service, Perth Royal Infirmary, Perth PH1 1NX, UK
| | - Justin A Kenardy
- School of Medicine, University of Queensland, Brisbane, QLD, 4029, Australia
- School of Psychology, University of Queensland, Brisbane, QLD, 4029, Australia
| | - Robyne Le Brocque
- School of Medicine, University of Queensland, Brisbane, QLD, 4029, Australia
| | - Amanda J Ullman
- NHMRC Centre of Research Excellence in Nursing, Health Practice Innovation – Griffith Health Institute, Griffith University, Kessels Road, Nathan, QLD 4111, Australia
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Impact of an intensive care unit diary on psychological distress in patients and relatives*. Crit Care Med 2012; 40:2033-40. [PMID: 22584757 DOI: 10.1097/ccm.0b013e31824e1b43] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To assess the impact of an intensive care unit diary on the psychological well-being of patients and relatives 3 and 12 months after intensive care unit discharge. DESIGN Prospective single-center study with an intervention period between two control periods. SETTING Medical-surgical intensive care unit in a 460-bed tertiary hospital. PATIENTS Consecutive patients from May 2008 to November 2009 and their relatives. Study inclusion occurred after the fourth day in the intensive care unit. INTERVENTIONS A diary written by both the patient's relatives and the intensive care unit staff. MEASUREMENTS AND MAIN RESULTS Patients and relatives completed the Hospital Anxiety and Depression Scale and Peritraumatic Dissociative Experiences Questionnaire 3 months after intensive care unit discharge, and completed the Impact of Events Scale assessing posttraumatic stress-related symptoms 12 months after intensive care unit discharge. Of the 378 patients admitted during the study period, 143 were included (48 in the prediary period, 49 in the diary period, and 46 in the postdiary period). In relatives, severe posttraumatic stress-related symptoms after 12 months varied significantly across periods (prediary 80%, diary 31.7%, postdiary 67.6%; p<.0001). Similar results were obtained in the posttraumatic stress-related symptom score after 12 months in the surviving patients (prediary 34.6 ± 15.9, diary 21 ± 12.2, and postdiary 29.8 ± 15.9; p = .02). CONCLUSIONS The intensive care unit diary significantly affected posttraumatic stress-related symptoms in relatives and surviving patients 12 months after intensive care unit discharge.
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Engström Å, Nyström N, Sundelin G, Rattray J. People's experiences of being mechanically ventilated in an ICU: a qualitative study. Intensive Crit Care Nurs 2012; 29:88-95. [PMID: 22917591 DOI: 10.1016/j.iccn.2012.07.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 07/17/2012] [Accepted: 07/18/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES In previous studies people receiving mechanical ventilation treatment have described experiencing distress over their inability to speak and feelings such as anxiety. More research is needed to improve their experience in the intensive care unit and promote recovery. The aim of this study was to describe the intensive care unit experiences of people undergoing mechanical ventilation. METHOD Qualitative, personal interviews were conducted during 2011 with eight people who were mechanically ventilated in an intensive care unit in the northern part of Sweden. Interview transcripts were analysed using qualitative content analysis. FINDINGS Two themes emerged, with four and three categories, respectively. Being dependent for survival on other people and technical medical equipment created a sense of being vulnerable in an anxious situation and a feeling of uncertainty about one's own capacity to breathe. Having lines and tubes in one's body was stressful. Being given a diary and follow-up visit to the intensive care unit after the stay were important tools for filling in the missing time, but there was also one participant who did not want to remember his stay in the intensive care unit. CONCLUSION To be dependent on other people and technical medical equipment for survival creates a sense of being delivered into the hands of others, as the people being mechanically ventilated could not trust their body to function.
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Affiliation(s)
- Åsa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
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Thygesen MK, Pedersen BD, Kragstrup J, Wagner L, Mogensen O. Gynecological cancer patients' differentiated use of help from a nurse navigator: a qualitative study. BMC Health Serv Res 2012; 12:168. [PMID: 22721253 PMCID: PMC3442985 DOI: 10.1186/1472-6963-12-168] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 05/28/2012] [Indexed: 11/10/2022] Open
Abstract
Background Fragmentation in healthcare can present challenges for patients with suspected cancer. It can add to existing anxiety, fear, despair and confusion during disease trajectory. In some circumstances patients are offered help from an extra contact person, a Nurse Navigator (NN). Scientific studies showing who will benefit from the extra help offered are missing. This study aims to explore who could benefit from the help on offer from a nurse appointed as NN in the early part of a cancer trajectory, and what would be meaningful experiences in this context. Methods A longitudinal study with a basis in phenomenology and hermeneutics was performed among Danish women with gynecological cancer. Semi-structured interviews provided data for the analysis, and comprehensive understanding was arrived at by first adopting an open-minded approach to the transcripts and by working at three analytical levels. Results Prior experience of trust, guarded trust or distrust of physicians in advance of encountering the NN was of importance in determining whether or not to accept help from the NN. For those lacking trust in physicians and without a close relationship to a healthcare professional, the NN offered a new trusting relationship and they felt reassured by her help. Conclusions Not everyone could use the help offered by the NN. This knowledge is vital both to healthcare practitioners and to administrators, who want to do their best for cancer patients but who are obliged to consider financial consequences. Moreover patients’ guarded trust or distrust in physicians established prior to meeting the NN showed possible importance for choosing extra help from the NN. These findings suggest increased focus on patients’ trust in healthcare professionals. How to find the most reliable method to identify those who can use the help is still a question for further debate and research.
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Affiliation(s)
- Marianne K Thygesen
- Department of Gynecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Sdr, Boulevard, Odense, Denmark.
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Åkerman E, Ersson A, Fridlund B, Samuelson K. Preferred content and usefulness of a photodiary as described by ICU-patients--a mixed method analysis. Aust Crit Care 2012; 26:29-35. [PMID: 22633052 DOI: 10.1016/j.aucc.2012.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 03/19/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022] Open
Abstract
UNLABELLED Many ICU-patients have memory-gaps which may affect their recovery. A tool in the recovery can be an ICU-diary to explain and clarify thoughts and events from the ICU-period. There are different standards for the content in the ICU-diary. The aim of this study was to identify the preferred content and usefulness of an ICU-diary as described by ICU-patients. METHOD A descriptive, exploratory cohort design with a mixed method approach. The patients answered a questionnaire (n=115) and participated in an interview (n=15) six months after the ICU-stay. Data analysis was carried out in three stages; the questionnaire was analysed by descriptive statistics and categorised by content (four open-ended questions) and the interviews were analysed by manifest content analysis. RESULTS The patients were explained that detailed information about daily activities and medical facts had to be included to understand and give a sense of coherence of what had happened. The content in the ICU-diary had to be chronological in order to follow the process in which photos were an important part. The patients re-read the ICU-diary during the recovery which helped them to fill in the memory gaps and used it as a tool for communication. CONCLUSION To construct a coherent story, it was essential that the ICU-diary was complete and were amplified by photos, all appearing in a chronological order. The results of this study could form a basis for further developments of standards and guidelines for ICU-diaries.
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Affiliation(s)
- Eva Åkerman
- School of Health Sciences, Jönköping University, 551 11 Jönköping, Sweden.
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Smith CA, Hetzel S, Dalrymple P, Keselman A. Beyond readability: investigating coherence of clinical text for consumers. J Med Internet Res 2011; 13:e104. [PMID: 22138127 PMCID: PMC3278090 DOI: 10.2196/jmir.1842] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 07/08/2011] [Accepted: 08/10/2011] [Indexed: 11/23/2022] Open
Abstract
Background A basic tenet of consumer health informatics is that understandable health resources empower the public. Text comprehension holds great promise for helping to characterize consumer problems in understanding health texts. The need for efficient ways to assess consumer-oriented health texts and the availability of computationally supported tools led us to explore the effect of various text characteristics on readers’ understanding of health texts, as well as to develop novel approaches to assessing these characteristics. Objective The goal of this study was to compare the impact of two different approaches to enhancing readability, and three interventions, on individuals’ comprehension of short, complex passages of health text. Methods Participants were 80 university staff, faculty, or students. Each participant was asked to “retell” the content of two health texts: one a clinical trial in the domain of diabetes mellitus, and the other typical Visit Notes. These texts were transformed for the intervention arms of the study. Two interventions provided terminology support via (1) standard dictionary or (2) contextualized vocabulary definitions. The third intervention provided coherence improvement. We assessed participants’ comprehension of the clinical texts through propositional analysis, an open-ended questionnaire, and analysis of the number of errors made. Results For the clinical trial text, the effect of text condition was not significant in any of the comparisons, suggesting no differences in recall, despite the varying levels of support (P = .84). For the Visit Note, however, the difference in the median total propositions recalled between the Coherent and the (Original + Dictionary) conditions was significant (P = .04). This suggests that participants in the Coherent condition recalled more of the original Visit Notes content than did participants in the Original and the Dictionary conditions combined. However, no difference was seen between (Original + Dictionary) and Vocabulary (P = .36) nor Coherent and Vocabulary (P = .62). No statistically significant effect of any document transformation was found either in the open-ended questionnaire (clinical trial: P = .86, Visit Note: P = .20) or in the error rate (clinical trial: P = .47, Visit Note: P = .25). However, post hoc power analysis suggested that increasing the sample size by approximately 6 participants per condition would result in a significant difference for the Visit Note, but not for the clinical trial text. Conclusions Statistically, the results of this study attest that improving coherence has a small effect on consumer comprehension of clinical text, but the task is extremely labor intensive and not scalable. Further research is needed using texts from more diverse clinical domains and more heterogeneous participants, including actual patients. Since comprehensibility of clinical text appears difficult to automate, informatics support tools may most productively support the health care professionals tasked with making clinical information understandable to patients.
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Affiliation(s)
- Catherine Arnott Smith
- School of Library and Information Studies, University of Wisconsin-Madison, Madison, WI 53706, United States.
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Benefits and challenges perceived by patients with cancer when offered a nurse navigator. Int J Integr Care 2011; 11:e130. [PMID: 22128278 PMCID: PMC3225241 DOI: 10.5334/ijic.629] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 08/09/2011] [Accepted: 08/09/2011] [Indexed: 11/28/2022] Open
Abstract
Introduction Lack of communication, care and respect from healthcare professionals can be challenges for patients in trajectories of cancer, possibly accompanied by experienced fragmentation of the care, anxiety and worries. One way to try to improve delivery of care is additional help from nurse navigators (NN) offered in a predefined shorter or longer period, but patients’ experiences with this have seldom been investigated. Aims To explore experiences of nurse navigation offered in a short period of a longer subsequent part of cancer trajectories by patients who can use the help on offer. Methods The NNs worked from one hospital department with patients in the transition between primary care and a university hospital before admission. A phenomenological-hermeneutical longitudinal study was performed from referral and until two months after discharge from the hospital. Semi-structured interviews with five patients who could use the help from an NN provided data for the analysis, which started open-minded. Results Affectional bonds were made to the NN and patients felt that they benefited from her presence and her help, which they requested until one month after discharge. They were disappointed and felt rejected when the contact to the NN stopped. Conclusion In efforts to increase quality of care for patients with cancer we recommend an increased awareness of cultural areas within the healthcare system, which may be an impediment to good communication. Moreover, we recommend paying special attention to critical periods in cancer patients’ trajectories, as well as to the theory of attachment to supplement thoughts of continuity of care and coordination in the care for women. In short, it is fine to offer additional help to those who can use it, but in practice as well as in research we recommend awareness of how and when to stop the help, to prevent patients from feeling hurt.
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Constructing the illness narrative: A grounded theory exploring patientsʼ and relativesʼ use of intensive care diaries. Crit Care Med 2011; 39:1922-8. [DOI: 10.1097/ccm.0b013e31821e89c8] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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