Timing of Exposure to ICU Diaries and Its Impact on Mental Health, Memories, and Quality of Life: A Double-Blind Randomized Control Trial

Post-ICU Care: Why, What, When and How? ISCCM Position Statement

How to cite this article: Ramakrishnan N, Abraham BK, Barokar R, Chanchalani G, Jagathkar G, Shetty RM, et al. Post-ICU Care: Why, What, When and How? ISCCM Position Statement. Indian J Crit Care Med 2024;28(S2):S279-S287.

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.

The effect of nurse-initiated diary intervention on posttraumatic stress disorder and recall of memories in ICU survivors: a randomized controlled trial

BACKGROUND

Patients' recall of memories from the ICU plays an important role in the occurrence of post-traumatic stress disorder. This study aimed to determine the effect of nurse-initiated diary intervention on post-traumatic stress disorder and recall of memories in ICU survivors.

METHODS

This RCT study included all patients admitted to two trauma ICUs in Southeast of Iran. Thirty patients considered in control and intervention groups. Data collection tools included the Impact of Events Scale-Revised (IES-R), and the ICU Memory Tool (ICU-MT). The researcher wrote daily diaries of the intervention and control groups during the first 72 h of their admissions. SPSS25 was used to analyze the data.

RESULTS

The total mean PTSD score in the intervention group was significantly lower than that in the control group (p > 0.0001, z = -3.75). The number of those in the intervention group who clearly recalled their admission to hospital, their hospital stay before being admitted to the ICU and all memories from the ICU stay, was more than those in the control group; this difference was statistically significant (p > 0.0001).

CONCLUSION

The results showed that the nurse-initiated diary was effective on the PTSD and recall clear memories of patients admitted to the ICU. We suggest medical and educational centers to use this intervention in order to reduce the posttraumatic stress disorder in these patients. As nurse-initiated diary intervention had no significant difference in the recall of different types of memories from the ICU, we require further studies in this field.

[The intensive care diary-a communication tool]

Diaries in intensive care units (ICU) are mostly written by families and nurses for patients with impaired consciousness. In the diary, the development of the patients is described in plain language by daily reports. Patients can read the diary later and process their experiences and, if necessary, reframe them differently. ICU diaries reduce the risks of psychosocial sequelae of patients and families and are now used worldwide. Diaries have different purposes and also serve as a communication tool: words are written to a person who will hopefully read them later. This can help families to stay connected and cope better with the situation. However, writing a diary can also be perceived as a burden by some relatives and nurses due to lack of time or because it seems to be too close. ICU diaries can serve as a tool for patientand family-centered care.

[The intensive care diary-a communication tool]

Tagebücher auf Intensivstationen werden meist von Familien und Pflegenden für Patient:innen mit Bewusstseinsstörungen geschrieben. In dem Tagebuch wird in laienverständlicher Sprache die Geschichte der Patient:innen anhand täglicher Berichte beschrieben. Patient:innen können später das Tagebuchbuch lesen und ihre Erfahrungen und Erlebnisse verarbeiten und ggf. anders bewerten. Intensivtagebücher senken die Risiken für psychosoziale Folgeschäden bei Patient:innen und Familien und sind mittlerweile weltweit verbreitet. Tagebücher haben unterschiedliche Zwecke und dienen auch der Kommunikation: Es werden Worte an eine Person geschrieben, die sie später hoffentlich lesen wird. Dies kann Familien darin unterstützen, verbunden zu bleiben und die Situation besser zu bewältigen. Gleichzeitig kann das Schreiben eines Tagebuchs auch von einigen Angehörigen und Pflegenden als Belastung empfunden werden, weil keine Zeit verfügbar ist oder es zu nahe scheint. Intensivtagebücher können als ein Mittel zur patienten- und familienzentrierten Versorgung genutzt werden.