Patients' perceptions of an intensive care unit diary written by relatives: A hermeneutic phenomenological study

Photographs in burn patient diaries: A qualitative study of patients' and nurses' experiences

OBJECTIVE

To explore burn patients' and burn intensive care nurses' experiences of the photos in patient diaries.

DESIGN

A qualitative inductive study using thematic analysis was performed. We conducted individual interviews with six former burn patients (age range 20-77 years; four women), and two focus groups with 11 burn intensive care nurses (age range 38-61 years; all women). Data from patients and nurses were analysed together, and the findings reported according to the consolidated criteria for reporting qualitative research (COREQ).

SETTING

A Norwegian burn centre where the writing of diaries including text and photos has been practiced for approximately two decades.

FINDINGS

Three main themes were derived from the combined analysis of the two data sets: hesitating when facing photos; visualising others care; and visualising the trajectory from burn trauma to recovery. Although the patients worried beforehand about what they would see in the photos and the nurses feared to select frightening photos, the photos were welcome, and several patients said they would have liked even more. The photos filled in gaps of memory, told more than words, and did not lie. Photos of family, friends or staff demonstrated shared actions that supported memories and recovery.

CONCLUSION

Both the burn patients and the burn intensive care nurses considered photos to be an essential part of the diary that gave context and provided a factual presentation of the patients' pathway of treatment, care and recovery.

IMPLICATION FOR CLINICAL PRACTICE

Tailored information about photo content should be offered to patients before a diary is handed over to them. Nurses should attempt to include photos covering the patients' entire stay at the burn centre, as well as photos of family, friends and staff. Individual nurses should be supported in their practical selection of photos for the diary.

Aloud real- time reading of intensive care unit diaries: A feasibility study

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.

Use of Intensive Care Unit Diary as an Integrated Tool in an Italian General Intensive Care Unit: A Mixed-Methods Pilot Study

PURPOSE

The aim of this study was to investigate the implementation of an intensive care unit (ICU) diary in an Italian general ICU.

METHODS

A mixed-methods pilot study was performed, enrolling all patients who received an ICU diary in an Italian ICU during the study period.

RESULTS

Study results are presented in 2 sections: (1) diary evaluation and content themes and (2) follow-up program results. Sixty-six patients were assessed for eligibility. Diary administration was possible in 31 patients (47%). The overall diary entries, in 31 analyzed diaries, were 1331, with a median of 25 entries (interquartile range, 16-57 entries) for each diary. Participants' relatives and friends wrote a median of 1.2 (0.3-1.6), and nurses wrote 1.1 (0.8-1.2). Other ICU staff wrote a total of 24 entries (2%). Follow-up results revealed low incidence of delirium detected in only 1 patient at the 7-day visit (3%). The median value of PTSS-10 (Post Traumatic Stress Symptoms) score was 12 (3.5-12) at the 7-day visit, 6 (1.5-12) at 3 months' telephone interview, and 12 (1.5-17) at 6 months' visit.

CONCLUSIONS

To our knowledge, this is the first Italian report about the introduction of an ICU diary. The diaries were easily implemented in our clinical practice as a "low-cost" initiative. In our study, nurses and participants' relatives and friends wrote a similar number of entries in each analyzed diary. This project could be effective in reducing survivors' delirium and post-traumatic stress disorder and in implementing mutual understanding between clinical staff and relatives during ICU stay.

Exploring Patients' Perceptions on ICU Diaries: A Systematic Review and Qualitative Data Synthesis

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.

A comparison of standard occupational therapy versus early enhanced occupation-based therapy in a medical/surgical intensive care unit: study protocol for a single site feasibility trial (EFFORT-ICU)

BACKGROUND

Admissions to intensive care units (ICUs) are increasing due to an ageing population, and rising incidence of cardiac and respiratory disease. With advances in medical care, more patients are surviving an initial stay in critical care; however, they can experience ongoing health and cognitive limitations that may influence return to baseline function up to a year post-admission. Recent research has focused on the introduction of early rehabilitation within the ICU to reduce long-term physical and cognitive complications. The aim of this study is to explore the feasibility and impact of providing early enhanced occupation-based therapy, including cognitive stimulation and activities of daily living, to patients in intensive care.

METHODS

This study involves a single site randomised-controlled feasibility trial comparing standard occupational therapy care to an early enhanced occupation-based therapy. Thirty mechanically ventilated ICU patients will be recruited and randomly allocated to the intervention or control group. The primary outcome measure is the Functional Independence Measure (FIM), and secondary measures include the Modified Barthel Index (MBI), Montreal Cognitive Assessment (MoCA), grip strength, Hospital Anxiety and Depression Scale (HADS) and Short-Form 36 Health survey (SF-36). Measures will be collected by a blind assessor at discharge from intensive care, hospital discharge and a 90-day follow-up. Daily outcome measures including the Glasgow Coma Scale (GCS), Richmond Agitation and Sedation Scale (RASS) and Confusion Assessment Measure for intensive care units (CAM-ICU) will be taken prior to treatment. Participants in the intervention group will receive daily a maximum of up to 60-min sessions with an occupational therapist involving cognitive and functional activities such as self-care and grooming. At the follow-up, intervention group participants will be interviewed to gain user perspectives of the intervention. Feasibility data including recruitment and retention rates will be summarised descriptively. Parametric tests will compare outcomes between groups. Interview data will be thematically analysed.

DISCUSSION

This trial will provide information about the feasibility of investigating how occupational therapy interventions in ICU influence longer term outcomes. It seeks to inform the design of a phase III multicentre trial of occupational therapy in critical care general medical intensive care units.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618000374268 ; prospectively registered on 13 March 2018/ https://www.anzctr.org.au Trial funding: Metro South Health Research Support Scheme Postgraduate Scholarship.

In sechs Wochen hat sich die Welt verändert: COVID-19

In six weeks the world has changed: COVID-19 - Family-centered care in the intensive care unit Abstract. Background and problem definition: The admission of patients to an intensive care unit is extremely stressful for relatives during the COVID-19 pandemic, as they are not allowed to visit their family members due to a visitation restriction.

OBJECTIVES

To describe the experience of relatives during the COVID-19 pandemic and to derive support information for health professionals.

METHODS

Qualitative analysis of three written testimonies of relatives whose family members were hospitalized with COVID-19 or other disease at intensive care unit.

RESULTS

Relatives report the sudden, unexpected occurrence of the disease. "It was there, out of nowhere, hits the heart of life, doesn't just go away, does what it wants. It is an unknown virus that we have to get to know very closely." The ban on visiting was harsh, it made her faint. The first visit was an indescribable joy. Knowing how the family member was and that the health care professionals were taking professional and empathetic care of the sick person were the only things the relatives could hold on to.

DISCUSSION

Relatives were reassured when they experienced a high level of commitment on the part of health professionals and received repeated comprehensible information by phone. Limitations and transfer: Restrictions on visits depend on national legislation. Measures such as video calls can also be useful outside of a pandemic to build relationships with relatives.

Effect of intensive care unit diary on incidence of posttraumatic stress disorder, anxiety, and depression of adult intensive care unit survivors: A systematic review and meta-analysis

AIM

To systematically evaluate the effect of intensive care unit diary psychotherapy on the incidence of posttraumatic stress disorder, anxiety, and depression after discharge from intensive care unit.

BACKGROUND

Many studies have reported the potential advantages and risks of intensive care unit diary psychotherapy in adult patients discharged from intensive care unit, but the results are divergent.

DESIGN

Systematic review and meta-analysis of prospective randomized controlled or case-controlled studies.

DATA SOURCE

Databases such as Cochran Library, Pubmed, Embase, CINAHL, and ProQuest databases, China national knowledge infrastructure (CNKI) were searched for literatures published from January 2000-March 2020.

REVIEW METHODS

We use the Cochrane Risk of Bias Tool for quality assessment and audit manager 5.3 software for meta-analysis. The main result is the incidence of posttraumatic stress disorder, anxiety, and depression.

RESULTS

Ten studies meeting the inclusion criteria were identified, including eight randomized controlled studies and two case-controlled studies, with a total of 1,210 patients. The pooled results of this meta-analysis indicated that the intensive care unit diary could reduce the incidence of posttraumatic stress disorder, anxiety, and depression.

CONCLUSION

This study showed that an intensive care unit diary could improve the psychological symptoms of adult intensive care unit patients after discharge. However, due to limitations such as publication bias and case sample size, the results should be carefully considered. Researchers need to further clarify the multidisciplinary collaborative process of intensive care unit diary therapy, the real beneficiaries, and its impact on family members' psychological status by conducting large, robust studies in the future.

IMPACT

This study's findings suggest that medical staff need to re-examine the role of intensive care unit diary therapy, its standardized implementation and provide effective intervention for reducing psychological stress-related symptoms of intensive care unit patients after discharge.