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Peschel E, Krotsetis S, Seidlein AH, Nydahl P. Opening Pandora's box by generating ICU diaries through artificial intelligence: A hypothetical study protocol. Intensive Crit Care Nurs 2024; 82:103661. [PMID: 38394982 DOI: 10.1016/j.iccn.2024.103661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Patients and families on Intensive Care Units (ICU) benefit from ICU diaries, enhancing their coping and understanding of their experiences. Staff shortages and a limited amount of time severely restrict the application of ICU diaries. To counteract this limitation, generating diary entries from medical and nursing records using an artificial intelligence (AI) might be a solution. DESIGN AND PURPOSE Protocol for a hypothetical multi-center, mixed method study to identify the usability and impact of AI-generated ICU diaries, compared with hand-written diaries. METHOD A hand-written ICU diary will be written for patients with expected length of stay ≥ 72 h by trained nursing staff and families. Additionally at discharge, the medical and nursing records are analyzed by an AI software, transformed into understandable, empathic diary entries, and printed as diary. Based on an appointment with patients within 3 months, diaries are read in randomized order by trained clinicians with the patients and families. Patients and families will be interviewed about their experiences of reading both diaries. In addition, usability of diaries will be evaluated by a questionnaire. EXPECTED FINDINGS AND RESULTS Patients and families describe the similarities and differences of language and the content of the different diaries. In addition, concerns can be expressed about the generation and data processing by AI. IMPLICATIONS FOR PRACTICE Professional nursing involves empathic communication, patient-centered care, and evidence-based interventions. Diaries, beneficial for ICU patients and families, could potentially be generated by Artificial Intelligence, raising ethical and professional considerations about AI's role in complementing or substituting nurses in diary writing. CONCLUSIONS Generating AI-based entries for ICU diaries is feasible, but raises serious questions about nursing ethics, empathy, data protection, and values of professional nurses. Researchers and developers shall discuss these questions in detail, before starting such projects and opening Pandora's box, that can never be closed afterwards.
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Affiliation(s)
- Ella Peschel
- University Hospital of Schleswig-Holstein, Kiel, Germany
| | | | | | - Peter Nydahl
- University Hospital of Schleswig-Holstein, Nursing Research and Development, Kiel, Germany; Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria.
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2
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Tcharmtchi J, Coss-Bu JA, Tcharmtchi MH. Enhancing family experience in the paediatric intensive care unit through the adoption of the family care journal: A single-center study. Nurs Crit Care 2024. [PMID: 38191827 DOI: 10.1111/nicc.13029] [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: 07/27/2023] [Revised: 12/20/2023] [Accepted: 12/24/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Multidisciplinary patient care rounds are increasingly seen as a vital complement to patient care management. Family engagement in these rounds, especially in the paediatric population, is important to treatment and outcomes, but there is little information about family experience in the Paediatric Intensive Care Unit (PICU). AIMS To develop a process using family care journals (FCJ) to systematically evaluate family experience in the PICU and identify needed supportive resources that will enhance their critical care stay. METHODS This is a single-centre quasi-experimental design conducted at a large urban quaternary level freestanding children's hospital. A family care journal (FCJ) was distributed to families upon admission to PICU to serve as a resource tool during their stay. An electronic point of care (POC) questionnaire was used to assess families' experiences in the PICU. RESULTS Three hundred sixty-six questionnaires were completed (100% response rate) and analysed. Overall, there was an improvement in all phases post FCJ implementation compared with the baseline. Seventy five percent of families found it a useful tool for communication with the PICU team. Open-ended comments revealed improvement opportunities related to communication, environment, and delay in care. Almost all commented on excellent nursing care. CONCLUSIONS Introducing FCJ in a paediatric ICU is a practical approach, providing a cost-effective method to assess family experiences and gain insights for ongoing quality improvement efforts. Collaboration among all care team members, including nursing, medical, and administrative leaders, is crucial for empathetically addressing parental needs during hospitalization. RELEVANCE TO CLINICAL PRACTICE Combining the use of journals and questionnaires provides the clinical team with an efficient means of collecting valuable feedback from parents regarding their experience in the PICU and the factors that foster ongoing commitment from families. Nurses play a crucial role in encouraging the adoption of these journals, as they promote greater parent involvement in their children's care.
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Affiliation(s)
| | - Jorge A Coss-Bu
- Division of Critical Care Medicine at Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - M Hossein Tcharmtchi
- Division of Critical Care Medicine at Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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3
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Dimou K, Batiridou AL, Tatsis F, Georgakis S, Konstanti Z, Papathanakos G, Mantzoukas S, Dragioti E, Gouva M, Koulouras V. Patients' Dreams and Unreal Experiences During Intensive Care Unit (ICU) Hospitalization. Cureus 2024; 16:e51588. [PMID: 38313939 PMCID: PMC10835202 DOI: 10.7759/cureus.51588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
In the intensive care unit (ICU), patients often experience fragmented memories, primarily comprising dreams and illusions. These experiences can impact psychosocial well-being, correlating with post-traumatic stress symptoms and heightened anxiety. Understanding these phenomena is crucial for holistic care. To systematically explore patients' perspectives concerning the recollection of dreams and unreal encounters during their stay in the ICU, considering pertinent clinical conditions and potential influencing factors, we conducted a comprehensive search in the PubMed/MEDLINE, Web of Science, and Scopus databases until November 20, 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From an initial pool of 288 records, a thorough screening for eligibility resulted in the inclusion of nine studies for this systematic review. These selected studies underwent evaluation using either the Critical Appraisal Skills Programme (CASP) Qualitative Checklist or the Newcastle-Ottawa Scale (NOS). All studies categorized dreams into three main types: positive, distressing (including nightmares), and neutral experiences. These were further detailed based on aspects such as time, space, senses, emotions, and distinguishing between reality and unreality. Two studies found associations between dreams and conditions like Guillain-Barré syndrome (GBS), mental abnormalities, and delirium. In one study, GBS patients had more vivid dreams, hallucinations, and delusions compared to ICU control group patients; delirious patients tend to report more frequent frightening dreams. Patients in the ICU who recalled dreams often had more severe illness, longer stays, and higher ventilation frequency. Notably, a prolonged ICU stay significantly predicted the likelihood of dream recall, as consistently observed in three other studies. This suggests that patients with prolonged ICU stays, experiencing higher dream recall, underwent extended treatments. This systematic exploration of patients' perspectives on fragmented memories underscores the connections between these experiences, clinical conditions such as GBS and delirium, and extended ICU stays. Recognizing and attending to these psychological aspects in post-ICU care is critical for alleviating the enduring emotional consequences for patients.
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Affiliation(s)
- Konstantina Dimou
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Agapi L Batiridou
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Fotios Tatsis
- Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Spiros Georgakis
- Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Zoe Konstanti
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | | | - Stefanos Mantzoukas
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Elena Dragioti
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Mary Gouva
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Vasilios Koulouras
- Department of Intensive Care Unit, University Hospital of Ioannina, Ioannina, GRC
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4
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Bosco V, Froio A, Mercuri C, Sansone V, Garofalo E, Bruni A, Guillari A, Bruno D, Talarico M, Mastrangelo H, Longhini F, Doldo P, Simeone S. The Impact of an Intensive Care Diary on the Psychological Well-Being of Patients and Their Family Members: Longitudinal Study Protocol. Healthcare (Basel) 2023; 11:2583. [PMID: 37761780 PMCID: PMC10531207 DOI: 10.3390/healthcare11182583] [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: 08/09/2023] [Revised: 09/16/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Thanks to medical and technological advancements, an increasing number of individuals survive admission to intensive care units. However, survivors often experience negative outcomes, including physical impairments and alterations in mental health. Anxiety, depression, cognitive impairments, post-traumatic stress disorders, and functional disorders are known collectively as post-intensive care syndrome (PICS). Among the key triggering factors of this syndrome, memory impairment appears to play a significant role. AIMS This study aims to evaluate the impact of an intensive care diary on the psychological well-being of patients and their relatives after discharge from the ICU. DESIGN Prospective observational study. EXPECTED RESULTS The results of this study evaluate the impact of an ICU diary on the quality of life of ICU survivors and their family members.
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Affiliation(s)
- Vincenzo Bosco
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Annamaria Froio
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Caterina Mercuri
- School of Medicine and Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (C.M.); (M.T.)
| | - Vincenza Sansone
- Department of Experimental Medicine, Luigi Vanvitelli University, 80131 Naples, Italy;
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Andrea Bruni
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Assunta Guillari
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy
| | - Daniela Bruno
- School of Medicine and Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (C.M.); (M.T.)
| | - Michaela Talarico
- School of Medicine and Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (C.M.); (M.T.)
| | | | - Federico Longhini
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Patrizia Doldo
- Clinical and Experimental Medicine Department, Magna Graecia University, 88100 Catanzaro, Italy; (P.D.); (S.S.)
| | - Silvio Simeone
- Clinical and Experimental Medicine Department, Magna Graecia University, 88100 Catanzaro, Italy; (P.D.); (S.S.)
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5
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Galazzi A, Bruno M, Binda F, Caddeo G, Chierichetti M, Roselli P, Grasselli G, Laquintana D. Thematic analysis of intensive care unit diaries kept by staff: insights for caring. Intensive Crit Care Nurs 2023; 76:103392. [PMID: 36731262 PMCID: PMC9870754 DOI: 10.1016/j.iccn.2023.103392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/07/2023] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To explore recurrent themes in diaries kept by intensive care unit (ICU) staff during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN Qualitative study. SETTING Two ICUs in a tertiary level hospital (Milan, Italy) from January to December 2021. METHODS ICU staff members wrote a digital diary while caring for adult patients hospitalized in the intensive care unit for >48 hours. A thematic analysis was performed. FINDINGS Diary entries described what happened and expressed emotions. Thematic analysis of 518 entries gleaned from 48 diaries identified four themes (plus ten subthemes): Presenting (Places and people; Diary project), Intensive Care Unit Stay (Clinical events; What the patient does; Patient support), Outside the Hospital (Family and topical events; The weather), Feelings and Thoughts (Encouragement and wishes; Farewell; Considerations). CONCLUSION The themes were similar to published findings. They offer insight into care in an intensive care unit during a pandemic, with scarce resources and no family visitors permitted, reflecting on the patient as a person and on daily care. The staff wrote farewell entries to dying patients even though no one would read them. IMPLICATIONS FOR CLINICAL PRACTICE The implementation of digital diaries kept by intensive care unit staff is feasible even during the COVID-19 pandemic. Diaries kept by staff can provide a tool to humanize critical care. Staff can improve their work by reflecting on diary records.
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Affiliation(s)
- Alessandro Galazzi
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Bruno
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Filippo Binda
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Corresponding author at: Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35 – 20122 Milan, Italy
| | - Giorgia Caddeo
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Chierichetti
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Roselli
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Grasselli
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Dario Laquintana
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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6
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Secunda KE, Kruser JM. Patient-Centered and Family-Centered Care in the Intensive Care Unit. Clin Chest Med 2022; 43:539-550. [PMID: 36116821 PMCID: PMC9885766 DOI: 10.1016/j.ccm.2022.05.008] [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] [Indexed: 02/01/2023]
Abstract
Patient-centered and family-centered care (PFCC) is widely recognized as integral to high-quality health-care delivery. The highly technical nature of critical care puts patients and families at risk of dehumanization and renders the delivery of PFCC in the intensive care unit (ICU) challenging. In this article, we discuss the history and terminology of PFCC, describe interventions to promote PFCC, highlight limitations to the current model, and offer future directions to optimize PFCC in the ICU.
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Affiliation(s)
- Katharine E Secunda
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pennsylvania
| | - Jacqueline M Kruser
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA.
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7
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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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8
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Kovaleva MA, Jones A, Kimpel CC, Lauderdale J, Sevin C, Boehm L. Patients' and Caregivers' Perceptions of Intensive Care Unit Hospitalization and Recovery. Am J Crit Care 2022; 31:319-323. [PMID: 35773198 PMCID: PMC9275380 DOI: 10.4037/ajcc2022945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Telehealth-based intensive care unit recovery clinics (ICU-RCs) can increase access to post-ICU recovery care for patients and their families. It is crucial to understand patients' and caregivers' experience of illness and recovery to build patient- and family-centered ICU-RCs. OBJECTIVE To explore patients' and caregivers' perceptions of ICU hospitalization and recovery. METHODS Individual semistructured telephone interviews were conducted with 14 patients and 12 caregivers who participated in a telehealth ICU-RC. This study was guided by qualitative description methodology. Conventional content analysis was used to analyze the data. RESULTS Patients described their ICU hospitalization as scary, traumatic, and lonely. Participants' feedback on hospitalization ranged from praise to criticism. Patients wanted more realistic and detailed prognostication about post-ICU recovery and more physical therapy after discharge. Patients strongly valued the mental health component of ICU-RC visits, which contrasted with the scant attention paid to mental health in other postdischarge health care settings. Their knowledge about post-ICU recovery and connectedness to a primary care provider varied. CONCLUSIONS Examining patients' and caregivers' perceptions of ICU hospitalization and recovery highlights ICU-RC components that can be strengthened to support patient- and family-centered recovery. The ICU-RC staff should invite patients to share feedback about their ICU stay; give a timely, realistic prognosis for recovery; offer mental health consultations; provide physical therapy; and partner with patients and their caregivers to develop and deliver post-ICU care.
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Affiliation(s)
| | - Abigail Jones
- Vanderbilt University School of Nursing, Nashville, TN
| | | | | | - Carla Sevin
- Vanderbilt University Medical Center, Nashville, TN
| | - Leanne Boehm
- Vanderbilt University School of Nursing, Nashville, TN
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9
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Demographic, psychosocial, and medical correlates of psychological morbidity after intensive care unit stay. HEALTH PSYCHOLOGY REPORT 2022. [DOI: 10.5114/hpr.2022.113515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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10
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Zisopoulos G, Triliva S, Roussi P. Processing Intensive Care Unit Treatment Experiences: A Thematic Analysis of a Diary Intervention. QUALITATIVE HEALTH RESEARCH 2022; 32:371-384. [PMID: 34855527 DOI: 10.1177/10497323211055459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Survivors of the intensive care unit (ICU) report an aggregate of burdensome memories. ICU diaries have been proposed to address the psychological impact of ICU treatment. Twenty-six participants wrote about their ICU experiences in three successive sessions, while in the second session, they were presented with a dairy derived from their medical records. Using inductive thematic analysis in the first and third narratives, we explore how participants initially describe their ICU experience and how they process it after the intervention. Participants described a martyrdom experience, including being emotionally distressed, disorientated, and physically trapped that provoked a quest for any available interpersonal support. A vacuum-like state permeated their existence, impacted their sense-making ability, and the proximity to death uniquely characterized this experience. After intervention, participants made small but significant changes in their written narratives. They appeared to reorganize their recollections, reestablish self-continuity by integrating their ICU experiences, and authored restitution narratives.
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Affiliation(s)
| | | | - Pagona Roussi
- 204209Aristotle University of Thessaloniki, Thessaloniki, Greece
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11
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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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12
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Galazzi A, Adamini I, Bazzano G, Cancelli L, Fridh I, Laquintana D, Lusignani M, Rasero L. Intensive care unit diaries to help bereaved family members in their grieving process: a systematic review. Intensive Crit Care Nurs 2021; 68:103121. [PMID: 34373147 DOI: 10.1016/j.iccn.2021.103121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 06/30/2021] [Accepted: 07/17/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intensive care unit diaries are often used to support patients during their psychological recovery. The intensive care unit stay can be upsetting, disturbing and traumatic for both patients and their families especially when the patient does not survive. AIM To investigate the connection between intensive care unit diaries and the grieving process experienced by family members of adult patients deceased in the intensive care unit. METHODS Systematic literature review according to PRISMA guidelines: PubMed, CINAHL and Cochrane Library were consulted. The Caldwell's framework was used for the quality appraisal. RESULTS Only six studies examine this topic. The potential benefits of intensive care unit diaries in family members' bereavement process may be an aid to realise how extremely ill their loved one was, may provide comfort and may help relatives to cope with their loss. CONCLUSION The use of intensive care unit diaries to help family members' bereavement process may be a useful tool but further research is necessary to better understand their role and benefits.
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Affiliation(s)
- Alessandro Galazzi
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Health Sciences, University of Florence, Florence, Italy.
| | - Ileana Adamini
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giacomo Bazzano
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Livia Cancelli
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden; Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Dario Laquintana
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Laura Rasero
- Department of Health Sciences, University of Florence, Florence, Italy.
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13
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Brandao Barreto B, Luz M, do Amaral Lopes SAV, Rosa RG, Gusmao-Flores D. Exploring family members' and health care professionals' perceptions on ICU diaries: a systematic review and qualitative data synthesis. Intensive Care Med 2021; 47:737-749. [PMID: 34117901 DOI: 10.1007/s00134-021-06443-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/22/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Although the intensive care unit (ICU) diary has been proposed as a tool for preventing psychiatric symptoms in survivors of critical illness, relatives and health care providers may benefit from it too. This study aims to summarize the current qualitative evidence on families' and health care professionals' experiences of writing in and reading the ICU diaries. METHODS We searched MEDLINE, OVID, Embase, and EBSCOhost from inception to February 2021, and included all the studies that presented any qualitative finding regarding relatives' and health care providers' experiences of writing in and reading an ICU diary. We used modified Critical Appraisal Skills Programme (CASP) and Confidence in the Evidence from Reviews of Qualitative Research (CERQual) for quality assessment. A thematic synthesis approach was used to analyze and synthesize the qualitative data. RESULTS Twenty-eight studies were analyzed (15 including family members and 13 including health care professionals). For family members, the ICU diary is an important source of medical information, provides a way for them to register their presence at patient's bedside and express their feelings, and contributes to humanizing the ICU staff. This impression is shared by relatives of patients who did not survive critical illness. Health care providers believe the diary is beneficial for themselves and others; however, they are concerned with possible negative impressions from patients and family that could lead to judicial problems. They also remark on several obstacles they face when constructing the diaries (workload, creativity, and environment for writing), which can make it a distressful process. CONCLUSION This qualitative synthesis shows that family members and health care professionals consider the ICU diary a valuable intervention. It also brings evidence to challenges faced during diary writing, which should be carefully approached in order to reduce the stress associated with this process.
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Affiliation(s)
- Bruna Brandao Barreto
- Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, 40411-900, Brazil. .,Programa de Pós Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Mariana Luz
- Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, 40411-900, Brazil.,Programa de Pós Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Selma Alves Valente do Amaral Lopes
- Department of Paediatrics, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Neonatal Intensive Care Unit, Hospital Martagão Gesteira, Salvador, Bahia, Brazil
| | - Regis Goulart Rosa
- Intensive Care Unit, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Dimitri Gusmao-Flores
- Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, 40411-900, Brazil.,Departamento de Medicina Interna E Apoio Diagnóstico, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, 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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Effect of Nurse-Led Consultations on Post-Traumatic Stress and Sense of Coherence in Discharged ICU Patients With Clinically Relevant Post-Traumatic Stress Symptoms-A Randomized Controlled Trial. Crit Care Med 2021; 48:e1218-e1225. [PMID: 33048906 DOI: 10.1097/ccm.0000000000004628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate the effect of nurse-led consultations on reducing post-traumatic stress symptoms and increasing sense of coherence in discharged ICU patients with clinically relevant post-traumatic stress symptoms and to identify variables associated with symptoms 12 months later. DESIGN A pragmatic nonblinded randomized controlled trial. SETTINGS Five surgical and medical ICUs at Oslo University Hospital. PATIENTS Adult patients treated in the ICU greater than or equal to 24 hours were screened with Post-Traumatic Stress Scale 10 intensive part B after ICU discharge. Those scoring greater than or equal to 25 were included in the study. INTERVENTION Patients randomized to intervention group were offered three nurse-led consultations within 2 months, and patients in the control group received standard care. MEASUREMENTS AND MAIN RESULTS Sense of Coherence Scale 13 and Post-Traumatic Stress Scale 10 intensive part B were completed after inclusion, and reevaluated after 3, 6, and 12 months. Linear mixed model for repeated measures and linear regression analyses were performed. Among 523 screened patients, 111 and 113 were randomized to intervention group and control group, respectively. Mean Post-Traumatic Stress Scale 10 intensive part B score was 37 (±10) before randomization. No differences in post-traumatic stress symptoms or sense of coherence were found between intervention group versus control group, with a mean Post-Traumatic Stress Scale 10 intensive part B score 39 (95% CI, 37-41) versus 37 (95% CI, 35-39), 32 (95% CI, 28-35) versus 32 (95% CI, 29-35), 31 (95% CI, 28-34) versus 30 (95% CI, 27-33), and 31 (95% CI, 28-34) versus 29 (95% CI, 26-33) at baseline, 3, 6, and 12 months, respectively. There was a significantly reduced Post-Traumatic Stress Scale 10 intensive part B score for both groups during the year (p = 0.001). Low sense of coherence, pain, and previous psychiatric problems were associated with increased level of post-traumatic stress symptoms at 12 months. CONCLUSIONS Nurse-led consultations did not reveal any significant effect on post-traumatic stress symptoms or sense of coherence after ICU discharge in patients with clinically relevant symptoms.
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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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Kean S, Donaghy E, Bancroft A, Clegg G, Rodgers S. Theorising survivorship after intensive care: A systematic review of patient and family experiences. J Clin Nurs 2021; 30:2584-2610. [PMID: 33829568 DOI: 10.1111/jocn.15766] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVE This systematic literature review explores and maps what we know about survivorship to understand how survivorship can be theoretically defined. BACKGROUND Survivorship of critical illness has been identified as a challenge for the 21st Century. Whilst the use of the term 'survivorship' is now common in critical care, it has been borrowed from the cancer literature where the discourse on what survivorship means in a cancer context is ongoing and remains largely descriptive. In the absence of a theoretical understanding, the term 'survivorship' is often used in critical illness in a generic way, limiting our understanding of what survivorship is. The current COVID-19 pandemic adds to an urgency of understanding what intensive care unit (ICU) survivorship might mean, given the emerging long-term consequences of this patient cohort. We set out to explore how survivorship after critical illness is being conceptualised and what the implications might be for clinical practice and research. DESIGN Integrated systematic literature review. The review protocol was registered with PROSPERO International Prospective Register of Systematic Reviews. PRISMA guidelines were followed and a PRISMA checklist for reporting systematic reviews completed. RESULTS The three main themes around which the reviewed studies were organised are: (a) healthcare system; (b) ICU survivors' families; and (c) ICU survivor's identity. These three themes feed into an overarching core theme of 'ICU Survivorship Experiences'. These themes map our current knowledge of what happens when a patient survives a critical illness and where we are in understanding ICU survivorship. CONCLUSION We mapped in this systematic review the different pieces of the jigsaw that emerge following critical illness to understand and see the bigger picture of what happens after patients survive critical illness. It is evident that existing research has mapped these connections, but what we have not managed to do yet is defining what survivorship is theoretically. We offer a preliminary definition of survivorship as a process but are aware that this definition needs to be developed further with patients and families.
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Affiliation(s)
- Susanne Kean
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Eddie Donaghy
- Usher Institute of Population Health Sciences and Informatics & Edinburgh Critical Care Research Group, The University of Edinburgh, Edinburgh, UK
| | - Angus Bancroft
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Gareth Clegg
- Deanery of Clinical Sciences, Centre for Inflammation Research, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Sheila Rodgers
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
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Chang PY, Chang TH, Yu JM. Perceived stress and social support needs among primary family caregivers of ICU Patients in Taiwan. Heart Lung 2021; 50:491-498. [PMID: 33831701 DOI: 10.1016/j.hrtlng.2021.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Family caregivers of intensive care unit (ICU) patients may experience distress due to their care recipients' unexpected ICU hospitalization. Social support in coping with stress has been discussed from different cultural perspectives, but social support does not seem to buffer stress for Chinese people. OBJECTIVES The purpose of this study was to explore stress perception and social support needs and their associations among Taiwanese primary family caregivers of patients admitted to the ICU for the first time. METHODS This descriptive correlational study used the Perceived Stress Scale (PSS), the Impact of Events Scale-Revised (IES-R), the Norbeck Social Support Questionnaire (NSSQ), and structured interviews to explore stress perception and social support needs among Taiwanese primary family caregivers of patients admitted to the ICU. RESULTS The Taiwanese primary family caregivers (N = 71) perceived considerable social support, but they still experienced high stress, either daily life stress or ICU-related event stress. Most of them required extra support, such as discussion of medical conditions, disease treatment information and psychological support, even though they had social resources to assist them. CONCLUSION ICU health professionals should actively inquire about family caregivers' actual needs, even when family caregivers perceive considerable social support. Tailor-made interventions should be provided to assist family members in coping with stress. Further research should also explore the role of social support in stress and coping processes in Asian contexts due to cultural variance.
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Affiliation(s)
- Pei-Yu Chang
- Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | | | - Jung-Min Yu
- Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
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18
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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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19
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Schofield R, Dibb B, Coles-Gale R, Jones CJ. The experience of relatives using intensive care diaries: A systematic review and qualitative synthesis. Int J Nurs Stud 2021; 119:103927. [PMID: 33905992 DOI: 10.1016/j.ijnurstu.2021.103927] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/04/2021] [Accepted: 03/10/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Intensive care patient diaries written by staff and/or relatives are widely used in intensive care units (ICUs) across the world. Although the original aim of the diaries was to support patients in their recovery from ICU, a more recent focus of the literature has been the potential benefit of the diaries to the relatives of patients. Meta-analyzes of quantitative studies looking at the impact on the psychological wellbeing of relatives have not consistently found an effect of the diaries, even though qualitative studies suggest that relatives find the diaries to be a useful coping strategy. OBJECTIVES To evaluate and synthesise qualitative studies looking at the experience of relatives writing in ICU diaries. DESIGN A systematic review and qualitative synthesis. DATA SOURCES A structured search using CINAHL, MEDLINE, PsycInfo, Cochrane Central Register of Controlled Trials (CENTRAL), PTSDHubs and Published International Literature Web of Science Conference Proceedings Citation Index - Science and Social Science and Humanities was conducted. REVIEW METHODS All studies published at any time that included qualitative data (including mixed methods studies) about the perceptions of relatives using ICU patient diaries were included. Themes and narrative statements were extracted from included articles and synthesised. Articles were quality assessed using the Critical Appraisal Skills Programme (CASP) qualitative checklist and Mixed Methods Appraisal Tool (MMAT). RESULTS Sixteen studies were included in the review, thirteen qualitative and three mixed methods articles. The themes identified were: 1. Coping (subthemes: 1.1. Emotion-Focused Coping and 1.2. Problem-Focused Coping) 2. Connection (subthemes: 2.1 Method of Communication and 2.2 Developing and maintaining relationships) 3. Developing a Narrative (subthemes 3.1 Understanding 3.2 Shaping the story 3.3 Remembering). CONCLUSIONS Relatives use the diaries in a variety of ways including as a means of coping, a way of staying connected, as a tool to understand and develop a narrative about the experience. These findings link the use of ICU diaries with literature on written emotional exposure, post-traumatic growth and meaning making. The relationship between a relative's use of the ICU diary, coping strategies and/or post-traumatic growth could be a focus for future quantitative trials. PROSPERO protocol number CRD42020165869.
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Affiliation(s)
- Rachel Schofield
- University of Surrey, Stag Hill, University Campus, Guildford GU2 7XH, UK.
| | - Bridget Dibb
- University of Surrey, Stag Hill, University Campus, Guildford GU2 7XH, UK
| | - Rebecca Coles-Gale
- East Sussex Healthcare NHS Trust, St. Anne's House, 729 The Ridge, St. Leonards-on-Sea, East Sussex TN37 7PT, UK
| | - Christina J Jones
- University of Surrey, Stag Hill, University Campus, Guildford GU2 7XH, UK
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20
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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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21
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Yoo HJ, Shim J. The Effect of a Multifaceted Family Participation Program in an Adult Cardiovascular Surgery ICU. Crit Care Med 2021; 49:38-48. [PMID: 33177359 DOI: 10.1097/ccm.0000000000004694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop and implement a patient- and family-centered care program for patients in a cardiovascular surgery ICU. DESIGN Prospective, pre- and postintervention evaluations were conducted. SETTING The cardiovascular surgery ICU was located in a tertiary hospital. PARTICIPANTS Participants included 56 family members of patients in cardiovascular surgery ICU between May and July 2019. INTERVENTIONS Providing personalized treatment plans for patients by: 1) providing an ICU diary, 2) communicating with the medical staff, 3) providing personal care using ICU visitation kit, and 4) guiding bedside range of motion exercises. The experimental group received a guided ICU diary and education program from a nurse, including the application of a family participation visitation program. Family members were provided with customized information from the ICU diary and communicated with the medical staff for approximately 10 minutes. Family members were instructed on how to perform personal care using an "ICU visitation kit" during visitation hours when permitted to participate in bedside activities for approximately 10-minute intervals. MEASUREMENTS AND MAIN RESULTS Scores for satisfaction with the provided care and information increased significantly for the experimental group compared with the control group (t = 8.62; p < 0.001). Anxiety levels decreased significantly after intervention in both groups (t = -7.05; p < 0.001 and t = -12.94; p < 0.001) with a significant association observed between group and time point (F = 20.50; p < 0.001). However, no significant change was observed in satisfaction with decision-making following intervention in either group, and no significant association was noted between groups and time points for this variable (F = 0.24; p = 0.626). CONCLUSIONS This set of implemented family participation processes significantly improved satisfaction and reduced anxiety in family members of critically ill patients.
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Affiliation(s)
- Hye Jin Yoo
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - JaeLan Shim
- Department of Nursing Gyeongju, Dongguk University, College of Medicine, Seoul, South Korea
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Nielsen AH, Angel S, Egerod I. Effect of relatives' intensive care unit diaries on post traumatic stress in patients and relatives (DRIP-study): A mixed methods study. Intensive Crit Care Nurs 2020; 62:102951. [PMID: 33139163 DOI: 10.1016/j.iccn.2020.102951] [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: 01/31/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022]
Abstract
AIM To explore the relationship between psychological distress and diary sharing in patients and relatives, by investigating: 1) diary usage, 2) diary perception and 3) symptoms of psychological stress. DESIGN Convergent mixed methods study. SETTING Two intensive care units using patient diaries written by relatives with nurse guidance and shared with the patient after discharge. DATA Self-reported scores of symptoms of posttraumatic stress, anxiety, depression and diary usage were crossed with qualitative description of diary usage and diary perception in 10 patients and 11 relatives. RESULTS Most relatives expressed positive perceptions of diary usage; sharing the diary with the patient was related to fewer symptoms of posttraumatic stress. Patients had a positive perception of diary sharing, but symptoms of posttraumatic stress were unchanged. CONCLUSION Reflecting on the tribulations of critical illness and later sharing reflections with the patient were related to lower rates of posttraumatic stress in relatives, suggesting that the act of writing and sharing a diary could have a protective effect. Delayed diary sharing did not have the same effect on patients but might enhance support between relatives and patients.
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Affiliation(s)
- Anne Højager Nielsen
- Department of Anaesthesiology, Gødstrup Hospital, Lægårdvej 12, 7500 Holstebro, Denmark.
| | - Sanne Angel
- Section for Nursing and healthcare, Department of Public Health, Aarhus University, Building 1260, Bartholins Allé 2, 8000 Aarhus C, Denmark. https://twitter.com/@Angel123_Sanne
| | - 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. https://twitter.com/@IngridEgerod
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Approaches to Addressing Post-Intensive Care Syndrome among Intensive Care Unit Survivors. A Narrative Review. Ann Am Thorac Soc 2020; 16:947-956. [PMID: 31162935 DOI: 10.1513/annalsats.201812-913fr] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Critical illness can be lethal and devastating to survivors. Improvements in acute care have increased the number of intensive care unit (ICU) survivors. These survivors confront a range of new or worsened health states that collectively are commonly denominated post-intensive care syndrome (PICS). These problems include physical, cognitive, psychological, and existential aspects, among others. Burgeoning interest in improving long-term outcomes for ICU survivors has driven an array of potential interventions to improve outcomes associated with PICS. To date, the most promising interventions appear to relate to very early physical rehabilitation. Late interventions within aftercare and recovery clinics have yielded mixed results, although experience in heart failure programs suggests the possibility that very early case management interventions may help improve intermediate-term outcomes, including mortality and hospital readmission. Predictive models have tended to underperform, complicating study design and clinical referral. The complexity of the health states associated with PICS suggests that careful and rigorous evaluation of multidisciplinary, multimodality interventions-tied to the specific conditions of interest-will be required to address these important problems.
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Exploring the Relational Intervention of Storytelling: A Qualitative Study of the Patient Stories Project in a Single ICU. Crit Care Explor 2020; 2:e0224. [PMID: 33063029 PMCID: PMC7523772 DOI: 10.1097/cce.0000000000000224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objectives: Our study objective was to explore nurses’ experiences of how the Patient Stories Project, an intervention consisting of garnering and sharing ICU survivor stories with the ICU team, influenced their perceptions of the value of their work and their nurse-patient relationships. Design: This was a qualitative descriptive case study that used thematic analysis. Setting: This study was conducted in a single, 34-bed adult ICU in a Canadian tertiary care teaching hospital, serving a mixed medical and surgical patient population and employing over 200 nurses. Subjects: Semistructured focus groups with 12 ICU nurses were conducted between June 2019 and July 2019. Intervention: The Patient Stories Project is a systematic process for collecting and sharing former patients’ stories. On a regular basis, former ICU patients return to the ICU to say, “thank you,” share their experiences, and tell their stories to staff. Measurements and Main Results: Storytelling through the Patient Stories Project gives meaning to nurses’ work and provides avenues for nurses to think about their work more positively. Key themes were as follows: 1) perspective taking, 2) emphasizing the value in caring, 3) providing positive closure, 4) engendering team belonging, and 5) building a sense of hope. Conclusions: This study addresses the Critical Care Societies Collaboratives “call to action” to create a healthy work environment. Nurse focus group participants articulated how an initiative such as the Patient Stories Project may augment the relational aspects of work that are important to nurses, as well as their patients and families. Our study results have implications for the importance of using storytelling as a relational strategy to protect against depersonalization and cynicism, elements of burnout.
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Narrative critical care: A literary analysis of first-person critical illness pathographies. J Crit Care 2020; 59:194-200. [PMID: 32688167 DOI: 10.1016/j.jcrc.2020.06.018] [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: 05/14/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Life-threatening illness can be devastating for patients as they experience shifting levels of consciousness, recurrent delirium, and repeated setbacks. Narrative Medicine and its sub-discipline Narrative Critical Care increase healthcare professionals' understanding of the patient perspective, and interpretation of their stories is a means to improving practice. PURPOSE We aimed to investigate book length first-person accounts of critical illness to gain a deeper understanding of universal and individual patient responses and to provide an example of Narrative Critical Care. METHOD We performed a comparative literary analysis of five books supported by the Biographical Narrative Interpretive Method (BNIM) that moves through stages of structural analysis, thematic analysis, and cross-case theoretisation. FINDINGS Universal patient responses evolved through five existential dichotomies of life/death, sanity/madness, before/after, gain/loss and inner strength/external support. Individual patient responses were expressed as turning points along the illness trajectory, and biographical continuity was restored by integration of new self and old self. CONCLUSION We uncovered commonalities and differences in storied accounts of critical illness and survival. New insights might enable healthcare professionals to personalize patient care. More consistency is needed during transitions and rehabilitation of intensive care survivors.
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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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27
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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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Abstract
Delirium is a significant medical condition that is common in hospitalized patients. Beyond the increased risk of mortality, patients who experience an episode of delirium often go on to develop long-term psychiatric disturbance, including symptoms of post-traumatic stress disorder (PTSD). While there is a growing interest in understanding the complex relationship between delirium and PTSD, the existing literature is sparse and lacking harmony. Thus, this review seeks to develop a unified and thorough description of the cognitive and psychiatric underpinnings of post-delirium PTSD with the aims of promoting awareness of this condition amongst clinicians in medical settings, improving patient care, and sparking further research on this topic. While specific underlying mechanisms are yet unclear, PTSD was found to be associated with delirium in that delirious patients may have decreased factual recall of hospital events and increased hallucinations/delusions of a traumatic nature. Several potential interventions were identified, as well as suggestions for future research and clinical practice.
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Lynch F, Endacott R, Latour JM. Patient diaries: Survey of paediatric intensive care units in the United Kingdom and Ireland. Nurs Crit Care 2019; 25:31-36. [PMID: 31583802 DOI: 10.1111/nicc.12472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 11/27/2022]
Abstract
AIM The aim of the study was to explore the incidence, use, and scope of patient diaries in paediatric intensive care units (PICUs) in the United Kingdom and Ireland. DESIGN This was an electronic survey sent to 30 PICUs in the United Kingdom and Ireland. RESULTS All PICUs (n = 30) responded, and 43% (n = 13) offered diaries. For those units that did not supply diaries, the reasons given were concerns around the legal and professional implication of using diaries. Parental/carer consent to use a diary was obtained informally (79%, n = 11), and once there was agreement to provide a diary to parents, diaries were usually started immediately (72%, n = 12). Parents were the main contributors to the diaries (94%, n = 17), and the diaries were populated with photographs (94%, n = 15), drawings (100%, n = 16), and stickers (94%, n = 15). The reasons for offering diaries were to fill gaps in memories, to engage with families, and to explain what has happened in lay language. The owner of the diary was reported to be the family (82%, n = 14) and the child (12%, n = 2). CONCLUSIONS The use of patient diaries is an evolving intervention in paediatric intensive care settings in the United Kingdom and Ireland. This national survey has provided a clearer picture of how this intervention is used in the United Kingdom and Ireland. PICU patient diaries are used in a significant number of units, and how these are used is relatively standardized, although in some different ways from general ICUs. RELEVANCE TO CLINICAL PRACTICE This survey provides a baseline for future exploration, understanding, and promotion of patient diaries, as a well evaluated tool for the critically ill child and his or her family.
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Affiliation(s)
- Fiona Lynch
- Women & Children's Division, Western Sussex NHS Trust, Worthing Hospital, Worthing, UK.,School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - Ruth Endacott
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK.,School of Nursing and Midwifery, Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
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30
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Aitken LM, Rattray J, Hull AM. The creation of patient diaries as a therapeutic intervention - for whom? Nurs Crit Care 2019; 22:67-69. [PMID: 28191748 DOI: 10.1111/nicc.12286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/05/2017] [Accepted: 01/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Leanne M Aitken
- School of Health Sciences, City University of London, London, UK.,National Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Intensive Care Unit, Princess Alexandra Hospital, Nathan, Australia
| | - Janice Rattray
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Alastair M Hull
- Department of Psychiatry, University of Dundee, Dundee DD1 9SY, UK.,Multidisciplinary Adult Psychotherapy Service, NHS Tayside, Perth Royal Infirmary, Perth PH1 1NX, UK
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31
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Nielsen AH, Angel S, Egerod I, Lund TH, Renberg M, Hansen TB. The effect of family-authored diaries on posttraumatic stress disorder in intensive care unit patients and their relatives: A randomised controlled trial (DRIP-study). Aust Crit Care 2019; 33:123-129. [PMID: 30795978 DOI: 10.1016/j.aucc.2019.01.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/11/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Critical illness and mechanical ventilation may cause patients and their relatives to experience symptoms of posttraumatic stress, anxiety, and depression due to fragmentation of memories of their intensive care unit (ICU) stay. Intensive care diaries authored by nurses may help patients and relatives process the experience and reduce psychological problems after hospital discharge; however, as patients particularly appreciate diary entries made by their relatives, involving relatives in authoring the diary could prove beneficial. OBJECTIVES The objective of this study was to explore the effect of a diary authored by a close relative for a critically ill patient. METHODS The study was a multicenter, block-randomised, single-blinded, controlled trial conducted at four medical-surgical ICUs at two university hospitals and two regional hospitals. Eligible for the study were patients ≥18 years of age, undergoing mechanical ventilation for ≥24 h, staying in the ICU ≥48 h, with a close relative ≥18 years of age. A total of 116 relatives and 75 patients consented to participate. Outcome measures were scores of posttraumatic stress symptoms, anxiety, depression, and health-related quality of life three months after ICU discharge. RESULTS Relatives had 26.3% lower scores of posttraumatic stress in the diary group than in the control group (95% confidence interval: 4.8-% to 52.2%). Patients had 11.2% lower scores of posttraumatic stress symptoms in the diary group (95% confidence interval: -15.7% to 46.8%). There were no differences between groups in depression, anxiety, or health-related quality of life. CONCLUSION A diary written by relatives for the ICU patient reduced the risk of posttraumatic stress symptoms in relatives. The diary had no effect on depression, anxiety, or health-related life quality. However, as the diary was well received by relatives and proved safe, the diary may be offered to relatives of critically ill patients during their stay in the ICU.
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Affiliation(s)
- Anne Højager Nielsen
- Department of Anesthesiology, Regional Hospital Holstebro, Lægårdvej 12, 7500, Holstebro, Denmark; Department of Clinical Medicine, Aarhus University, Incuba/Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, 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, Denmark.
| | - Trine Højfeldt Lund
- Intensive Care Unit, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
| | - Marianne Renberg
- Recovery and Intensive Care Unit, Aarhus University Hospital, Tage Hansens Gade 2, 8000 Århus C, Denmark.
| | - Torben Bæk Hansen
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital Holstebro, Aarhus University, Lægårdvej 12, 7500 Holstebro, Denmark.
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32
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Nielsen AH, Angel S, Hansen TB, Egerod I. Structure and content of diaries written by close relatives for intensive care unit patients: A narrative approach (DRIP study). J Adv Nurs 2019; 75:1296-1305. [PMID: 30666697 DOI: 10.1111/jan.13956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/06/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Abstract
AIM To investigate structure and content of a nurse prompted diary written by relatives for intensive care unit (ICU) patients. DESIGN A narrative analysis of ICU diaries. METHODS From September 2015-August 2016, 12 diaries authored by 12 relatives for 12 ICU patients were sampled at 3-4 months post-ICU discharge. We used Ricoeur's hermeneutical phenomenology as a framework for a narrative analysis of the diaries. The first step was naïve reading, followed by structural analysis exploring the internal relations of the text. The structural analysis was broadened by exploring narrative structures. The last step was critical interpretation of the findings. FINDINGS The diaries had a clear narrative structure; the diary-timeline consisted of: Pre-ICU phase, Early ICU phase, Culmination, Recovery and Post-ICU reflection. Three themes described the content of the diary: Struggling to get the story right for the patient; striving to understand what was happening and longing to re-establish a connection with the patient. Keeping a diary was perceived by the relatives as a challenging but rewarding task. CONCLUSION The diary had the potential for reflection and a deeper understanding of the ICU stay. The diary served as a locus for patient and relatives to connect or re-connect, but some diaries might be too personal and emotional to share with the patient. Future research needs to explore advantages and disadvantages of ICU diaries authored by relatives.
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Affiliation(s)
- Anne Højager Nielsen
- Department of Anesthesiology, Regional Hospital Holstebro, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sanne Angel
- Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Torben Baek Hansen
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital Holstebro, Aarhus University, Aarhus, Denmark
| | - Ingrid Egerod
- Health and Medical Sciences, University of Copenhagen, Aarhus, Denmark.,Intensive Care Unit 4131, Rigshospitalet, Copenhagen, Denmark
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33
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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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Intensive care unit diaries: Developing a shared story strengthens relationships between critically ill patients and their relatives: A hermeneutic-phenomenological study. Int J Nurs Stud 2019; 92:90-96. [PMID: 30753929 DOI: 10.1016/j.ijnurstu.2019.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/18/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND After discharge from the intensive care unit, patients and relatives struggle to rebuild their lives while suffering from fatigue and distress. Intensive care unit diaries written by relatives are a novel approach that may help relatives and patients process the critical illness experience together. OBJECTIVES To explore patients' and relatives' perceptions and use of a diary written by relatives for the critically ill patient. DESIGN Hermeneutical-phenomenological interview study. SETTING Two regional mixed surgical/medical intensive care units in a regional hospital. PARTICIPANTS 10 critically ill patients and 13 relatives. All participants were 18 years or older, all patients had undergone mechanical ventilation. METHODS Dyadic, in-depth interviews conducted at 3-6 months and 8-16 months after discharge from the intensive care unit in 2015-2017. Interviews were analyzed using Ricoeur's theory of interpretation; a three-step process initiated by a naïve reading; followed by a structural analysis exploring the internal relations of the text, and finally, a critical interpretation to identify the most probable interpretation. RESULTS Before sharing the intensive care unit diary, relatives had to feel able to give the diary to the patient, which meant separating themselves from the diary and being available for discussions with the patient. Likewise, the patients had to be prepared to receive the diary and to acknowledge relatives' efforts. Sharing the diary included interpreting the content of the diary, and developing a re-configured story based on the diary. CONCLUSION The diary written by relatives for the critically ill patient was fulfilled when the diary was shared between the authoring relative and patient and a re-configured story was developed. This enabled a strengthened relationship between patient and relative. Not sharing could be disappointing to the relative, but did not preclude discussion of the experience of critical illness. This study provides professionals with knowledge about supporting patients and relatives through intensive care unit diaries written by relatives. Relatives need guidance on when to share the diary with the patient and how to accept patient rejection.
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35
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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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36
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Egerod I, Kaldan G, Shaker SB, Guldin MB, Browatski A, Marsaa K, Overgaard D. Spousal bereavement after fibrotic interstitial lung disease: A qualitative study. Respir Med 2018; 146:129-136. [PMID: 30665511 DOI: 10.1016/j.rmed.2018.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 11/11/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Fibrotic interstitial lung disease (f-ILD) comprises a group of diseases with lung scarring and reduced life expectancy. The short time from diagnosis to death affects the patients' bereaved spouses, who risk developing prolonged grief. In Denmark palliative care is most often offered to cancer patients. AIM We aimed to investigate the experience of spouses of f-ILD patients during the final stages of illness and up to the first year after the patient's death to investigate if palliative care could ease the transition and prevent PGD. METHODS Our study had a qualitative design triangulating in-depth interviews, field notes, participant diaries and the prolonged grief questionnaire PG-13. We included 20 spouses and applied thematic analysis. Initial coding was performed deductively according to the chronological stages of before, during and after the death of the patient. We subsequently coded inductively within the stages. RESULTS During the final days the spouses experienced emotional ambivalence shifting between hope, acceptance and despair. Factors affecting the spouses during the final hours were the timing, location, and process of death. After the patient's death the spouses experienced feelings of grief and optimism as they moved toward a new life on their own. CONCLUSIONS Some of the factors affecting the spouses and potentially causing prolonged grief might be alleviated by offering palliative/supportive care and advance care planning to f-ILD patients and their family.
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Affiliation(s)
- Ingrid Egerod
- University of Copenhagen, Rigshospitalet, Intensive Care Unit, Copenhagen, Denmark.
| | - Gudrun Kaldan
- Copenhagen University Hospital, Rigshospitalet, Abdominal Centre, Copenhagen, Denmark
| | - Saher Burhan Shaker
- Department of Respiratory Medicine, Gentofte Hospital, University of Copenhagen, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, University of Aarhus, Aarhus, Denmark
| | - Andrea Browatski
- Department of Pulmonary and Infectious Diseases, North Zealand University Hospital, Denmark
| | - Kristoffer Marsaa
- Palliative Unit, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Dorthe Overgaard
- Faculty of Health and Technology, Institute of Nursing and Nutrition, Copenhagen University College, Denmark
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Levine SA, Reilly KM, Nedder MM, Avery KR. The Patient's Perspective of the Intensive Care Unit Diary in the Cardiac Intensive Care Unit. Crit Care Nurse 2018; 38:28-36. [PMID: 30068718 DOI: 10.4037/ccn2018970] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Many patients who survive an intensive care unit admission develop post-intensive care syndrome and face significant long-term physical, cognitive, and mental health impairments. The intensive care unit diary is a reality-sorting tool that is effective in aiding patients to connect their flashbacks and delusional memories to actual events. OBJECTIVES To describe implementation of an intensive care unit diary in the cardiac intensive care unit and to describe the patient's perspective of the diary. METHODS Consent for participation in the study was given by the patient health care proxy or a family member. The study consisted of 3 phases: writing in the diary about the patient's events in the cardiac intensive care unit, a follow-up visit with the patient within 1 week of cardiac intensive care unit transfer, and a follow-up telephone call 2 months after hospital discharge. RESULTS Of 26 patients, 13 completed all phases of the study. Four themes were identified from the transcripts of the patients' responses: (1) The diary allowed patients to correlate memories to actual events, (2) it enabled patients to read about their families' experiences during their critical illness, (3) recovery was an emotional process that affected the patient's readiness to read the diary, and (4) patients expressed a desire for more entries by caregivers. CONCLUSIONS The intensive care unit diary can help patients gain clarity of their time in the cardiac intensive care unit. Additional research on the use of the diary and long-term patient follow-up is warranted.
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Affiliation(s)
- Sharon A Levine
- Sharon A. Levine is a research nurse in Advanced Heart Disease at Brigham & Women's Hospital, Boston, Massachusetts. .,Karen M. Reilly is associate chief nurse, Cardiovascular, Thoracic, and Surgical Services, Brigham & Women's Hospital. .,Melanie M. Nedder is a staff nurse in the cardiac intensive care unit, Shapiro Cardiovascular Center, Brigham & Women's Hospital. .,Kathleen Ryan Avery is program director, Center for Nursing Excellence, Brigham & Women's Hospital. At the time of this study, she was the clinical educator for the cardiac intensive care unit, Brigham & Women's Hospital.
| | - Karen M Reilly
- Sharon A. Levine is a research nurse in Advanced Heart Disease at Brigham & Women's Hospital, Boston, Massachusetts.,Karen M. Reilly is associate chief nurse, Cardiovascular, Thoracic, and Surgical Services, Brigham & Women's Hospital.,Melanie M. Nedder is a staff nurse in the cardiac intensive care unit, Shapiro Cardiovascular Center, Brigham & Women's Hospital.,Kathleen Ryan Avery is program director, Center for Nursing Excellence, Brigham & Women's Hospital. At the time of this study, she was the clinical educator for the cardiac intensive care unit, Brigham & Women's Hospital
| | - Melanie M Nedder
- Sharon A. Levine is a research nurse in Advanced Heart Disease at Brigham & Women's Hospital, Boston, Massachusetts.,Karen M. Reilly is associate chief nurse, Cardiovascular, Thoracic, and Surgical Services, Brigham & Women's Hospital.,Melanie M. Nedder is a staff nurse in the cardiac intensive care unit, Shapiro Cardiovascular Center, Brigham & Women's Hospital.,Kathleen Ryan Avery is program director, Center for Nursing Excellence, Brigham & Women's Hospital. At the time of this study, she was the clinical educator for the cardiac intensive care unit, Brigham & Women's Hospital
| | - Kathleen Ryan Avery
- Sharon A. Levine is a research nurse in Advanced Heart Disease at Brigham & Women's Hospital, Boston, Massachusetts.,Karen M. Reilly is associate chief nurse, Cardiovascular, Thoracic, and Surgical Services, Brigham & Women's Hospital.,Melanie M. Nedder is a staff nurse in the cardiac intensive care unit, Shapiro Cardiovascular Center, Brigham & Women's Hospital.,Kathleen Ryan Avery is program director, Center for Nursing Excellence, Brigham & Women's Hospital. At the time of this study, she was the clinical educator for the cardiac intensive care unit, Brigham & Women's Hospital
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38
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Nielsen AH, Angel S, Egerod I, Hansen TB. The effect of diaries written by relatives for intensive care patients on posttraumatic stress (DRIP study): protocol for a randomized controlled trial and mixed methods study. BMC Nurs 2018; 17:37. [PMID: 30127664 PMCID: PMC6097222 DOI: 10.1186/s12912-018-0306-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 07/26/2018] [Indexed: 02/08/2023] Open
Abstract
Background Critically ill patients and their relatives have complex needs for support during their stay in the intensive care unit (ICU) and the post-ICU rehabilitation period. Diaries written by nurses have proven beneficial for patients and relatives, preventing post-traumatic stress, anxiety and depression and helping patients and families find meaning. Actively involving relatives in writing a diary for critically ill patients is a new approach to helping relatives and patients cope; however, research is limited.The aim of this study is to test the hypothesis that a diary written by a close relative of a critically ill patient will reduce the risk of developing symptoms of post-traumatic stress disorder (PTSD) in the patient and relatives at 3 months post-ICU. Furthermore, the aim is to explore the perceptions and use of the diary and describe the diary content and structure. Method The intervention consists of a hard-cover notebook that will be given to a close relative to write a diary for the critically ill patient while in the ICU. Guidance will be offered by ICU nurses on how to author the diary. The effect of the intervention will be tested in a two-arm, single-blind, randomized controlled trial, which aims to include 100 patient/relative pairs in each group. The primary outcome studied is symptoms of post-traumatic stress (PTSS-14). Secondary outcomes are scores on anxiety and depression (HADS) and the Medical Outcomes Study Questionnaire Short Form 36 (SF-36). The narrative structure and content of the diary as well as its use will be explored in two qualitative studies. Discussion The results of this study will inform ICU nurses about the effects, strengths and limitations of prompting relatives to author a diary for the patient. This will allow the diary intervention to be tailored to the individual needs of patients and relatives. Trial registration NCT02357680. Registered September 3, 2015.
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Affiliation(s)
- Anne Højager Nielsen
- 1Department of Anesthesiology, Regional Hospital Holstebro, Lægårdvej 12, 7500 Holstebro, Denmark.,2Department of Clinical Medicine, Aarhus University, Incuba/Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Sanne Angel
- 3Section for Nursing, Department of Public Health, Aarhus University, Building 1260, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Ingrid Egerod
- 4Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.,Intensive Care Unit 4131, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Torben Bæk Hansen
- 6Regional Hospital Holstebro, University Clinic for Hand, Hip and Knee Surgery, Aarhus University, Lægårdvej 12, 7500 Holstebro, Denmark
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Nydahl P, Fischill M, Deffner T, Neudeck V, Heindl P. [Diaries for intensive care unit patients reduce the risk for psychological sequelae : Systematic literature review and meta-analysis]. Med Klin Intensivmed Notfmed 2018; 114:68-76. [PMID: 29995235 DOI: 10.1007/s00063-018-0456-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diaries are written for patients on intensive care units (ICU) by clinicians and relatives to reduce the risk of psychological complications such as posttraumatic stress disorder (PTSD), anxiety, and depression. The authors of a Cochrane Review on this topic published in 2015, included studies with PTSD diagnoses based on interviews carried out by qualified personnel, and concluded that there is inadequate evidence to support the thesis that ICU diaries reduce the risk of psychological complications. METHODS The present study replicated the design of the Cochrane Review with identical search algorithms, but included additional outcomes data from validated methods of diagnosing psychological complications that were not considered in the original Cochrane Review. The primary outcome was PTSD in patients or relatives with ICU diaries. Secondary outcomes were anxiety and/or depression symptoms. Study quality was evaluated using the Cochrane risk of bias assessment. RESULTS The replicated search produced 3179 citations, of which there were 6 eligible studies from which 605 patients and 145 relatives could be included in the meta-analysis. Studies ratings ranged from low to good. The meta-analyses of the PTSD outcome demonstrated the following: (a) for ICU patients (4 studies, n = 569 patients) a non-significant reduction (odds ratio [OR] 0.58, 95% confidence interval [CI]: 0.24-1.42, p = 0.23), and (b) for relatives' PTSD (2 studies, n = 145 relatives) a significant reduction (OR 0.17, 95%CI: 0.08-0.38, p < 0.0001). The symptoms anxiety and depression in ICU patients (2 studies each, n = 88 patients) were significantly reduced (OR 0.23, 95%CI: 0.07-0.77, p = 0.02; OR 0.27, 95%CI: 0.09-0.77, p = 0.01, respectively). Heterogeneity was between 0 and 54%. CONCLUSION ICU diaries may reduce the risk of psychological complications in patients and relatives after ICU stays.
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Affiliation(s)
- P Nydahl
- Pflegeforschung, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland. .,Klinik für Anästhesie und operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Brunswiker Str. 10, 24105, Kiel, Deutschland.
| | | | - T Deffner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | | | - P Heindl
- Internistischer Intensivbehandlungsbereich, Notfallmedizin und Intensivbehandlung für Brandverletzte, Allgemeines Krankenhaus der Stadt Wien, Medizinischer Universitätscampus, Wien, Österreich
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Coombs M, Puntillo KA, Franck LS, Scruth EA, Harvey MA, Swoboda SM, Davidson JE. Implementing the SCCM Family-Centered Care Guidelines in Critical Care Nursing Practice. AACN Adv Crit Care 2018; 28:138-147. [PMID: 28592473 DOI: 10.4037/aacnacc2017766] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Family-centered care is an important component of holistic nursing practice, particularly in critical care, where the impact on families of admitted patients can be physiologically and psychologically burdensome. Family-centered care guidelines, developed by an international group of nursing, medical, and academic experts for the American College of Critical Care Medicine/Society of Critical Care Medicine, explore the evidence base in 5 key areas of family-centered care. Evidence in each of the guideline areas is outlined and recommendations are made about how critical care nurses can use this information in family-centered care practice.
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Affiliation(s)
- Maureen Coombs
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Kathleen A Puntillo
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Linda S Franck
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Elizabeth A Scruth
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Maurene A Harvey
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Sandra M Swoboda
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Judy E Davidson
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
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Davidson JE, Zisook S. Implementing Family-Centered Care Through Facilitated Sensemaking. AACN Adv Crit Care 2018; 28:200-209. [PMID: 28592480 DOI: 10.4037/aacnacc2017102] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The Society of Critical Care Medicine has released updated recommendations for care of the family in neonatal, pediatric, and adult intensive care units. Translation of the recommendations into practice may benefit from a supporting theoretical framework. Facilitated sensemaking is a mid-range theory built from the same literature that formed the basis for recommendations within the guidelines. The process of facilitated sensemaking may be used to help nurses adopt the SCCM recommendations into practice through the development of caring relationships, promoting family presence, teaching family engagement strategies, and supporting families with communication, information gathering, and participation in decision-making.
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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, 200 W Arbor Drive 8929, San Diego, CA 92103 . Sidney Zisook is Distinguished Professor, Department of Psychiatry, University of California, San Diego, and San Diego Veteran's Administration Health Care System, San Diego, California
| | - Sidney Zisook
- Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California, San Diego Health, 200 W Arbor Drive 8929, San Diego, CA 92103 . Sidney Zisook is Distinguished Professor, Department of Psychiatry, University of California, San Diego, and San Diego Veteran's Administration Health Care System, San Diego, California
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Schoeman T, Sundararajan K, Micik S, Sarada P, Edwards S, Poole A, Chapman M. The impact on new-onset stress and PTSD in relatives of critically ill patients explored by diaries study (The "INSPIRED" study). Aust Crit Care 2017; 31:382-389. [PMID: 29254812 DOI: 10.1016/j.aucc.2017.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/03/2017] [Accepted: 11/04/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND There is rising prevalence of post-traumatic-stress-disorder (PTSD) in patients and their relatives after ICU discharge. The impact of ICU diaries on PTSD in relatives of critically ill patients in Australia has not been fully evaluated. OBJECTIVES To determine if relatives of an Australian critically ill population were interested in using ICU diaries. To determine the prevalence and impact of ICU diaries upon symptoms of PTSD, depression and anxiety in relatives of an Australian critically ill population. METHODS DESIGN Prospective, observational, exploratory study. SETTING Royal Adelaide Hospital (RAH), Adelaide, Australia. PARTICIPANTS One hundred and eight consecutive patients, staying >48h in a level 3 ICU were identified. A survey using DASS-21, IES-R questionnaires was performed on admission followed by a repeat survey 90days post discharge from ICU. An IES-R score >33 was used to define severe PTSD symptoms. A comparison between subjects who did and did not complete their diaries was performed. RESULTS Forty subjects refused to participate, eight were excluded, and sixty family members were included for analysis, thirty-six of whom completed diaries. There was no statistically significant difference between PTSD symptom scores at follow-up controlling for useful diary completion (complete - see methods) and PTSD at baseline. There was a statistically significant association between PTSD and unemployment, controlling for PTSD at baseline (P value=0.0045). Family members had significantly higher odds of PTSD at baseline compared to 3 month follow up (P value=0.0092, Odds Ratio=3.3, 95% CI: 1.3, 8.2). This was independent of the completeness of the diaries and adjusted for clustering on subject. Family members with incomplete diaries were less likely to report depressive symptoms at baseline (P value=0.0218, estimate=-4.6, 95% CI: -8.5, -0.7). Diary completion was not indicative of the likelihood of family members to report PTSD symptoms (P value=0.5468, estimate=-1.6, 95% CI: -6.8, 3.6). CONCLUSION ICU diaries were often not completed and completion did not appear to be related to the incidence of stress, anxiety, depression and PTSD symptoms in the families of patients in the ICU. This may be because Australian families are generally not interested in maintaining a diary.
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Affiliation(s)
- Tom Schoeman
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.
| | - Krishnaswamy Sundararajan
- Intensive Care Unit, Royal Adelaide Hospital and the Discipline of Acute Care Medicine, University of Adelaide, Australia
| | - Svatka Micik
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Pooja Sarada
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Suzanne Edwards
- Data, Design and Statistics Service, Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Australia
| | - Alexis Poole
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Marianne Chapman
- Intensive Care Unit, Royal Adelaide Hospital and the Discipline of Acute Care Medicine, University of Adelaide, Australia
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Olsen KD, Nester M, Hansen BS. Evaluating the past to improve the future – A qualitative study of ICU patients’ experiences. Intensive Crit Care Nurs 2017; 43:61-67. [DOI: 10.1016/j.iccn.2017.06.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/12/2017] [Accepted: 06/24/2017] [Indexed: 11/29/2022]
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Garrouste-Orgeas M, Flahault C, Fasse L, Ruckly S, Amdjar-Badidi N, Argaud L, Badie J, Bazire A, Bige N, Boulet E, Bouadma L, Bretonnière C, Floccard B, Gaffinel A, de Forceville X, Grand H, Halidfar R, Hamzaoui O, Jourdain M, Jost PH, Kipnis E, Large A, Lautrette A, Lesieur O, Maxime V, Mercier E, Mira JP, Monseau Y, Parmentier-Decrucq E, Rigaud JP, Rouget A, Santoli F, Simon G, Tamion F, Thieulot-Rolin N, Thirion M, Valade S, Vinatier I, Vioulac C, Bailly S, Timsit JF. The ICU-Diary study: prospective, multicenter comparative study of the impact of an ICU diary on the wellbeing of patients and families in French ICUs. Trials 2017; 18:542. [PMID: 29141694 PMCID: PMC5688734 DOI: 10.1186/s13063-017-2283-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 10/24/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Post-intensive care syndrome includes the multiple consequences of an intensive care unit (ICU) stay for patients and families. It has become a new challenge for intensivists. Prevention programs have been disappointing, except for ICU diaries, which report the patient's story in the ICU. However, the effectiveness of ICU diaries for patients and families is still controversial, as the interpretation of the results of previous studies was open to criticism hampering an expanded use of the diary. The primary objective of the study is to evaluate the post-traumatic stress syndrome in patients. The secondary objectives are to evaluate the post-traumatic stress syndrome in families, anxiety and depression symptoms in patients and families, and the recollected memories of patients. Endpoints will be evaluated 3 months after ICU discharge or death. METHODS A prospective, multicenter, randomized, assessor-blind comparative study of the effect of an ICU diary on patients and families. We will compare two groups: one group with an ICU diary written by staff and family and given to the patient at ICU discharge or to the family in case of death, and a control group without any ICU diary. Each of the 35 participating centers will include 20 patients having at least one family member who will likely visit the patient during their ICU stay. Patients must be ventilated within 48 h after ICU admission and not have any previous chronic neurologic or acute condition responsible for cognitive impairments that would hamper their participation in a phone interview. Three months after ICU discharge or death of the patient, a psychologist will contact the patient and family by phone. Post-traumatic stress syndrome will be evaluated using the Impact of Events Scale-Revised questionnaire, anxiety and depression symptoms using the Hospital Anxiety and Depression Scale questionnaire, both in patients and families, and memory recollection using the ICU Memory Tool Questionnaire in patients. The content of a randomized sample of diaries of each center will be analyzed using a grid. An interview of the patients in the intervention arm will be conducted 6 months after ICU discharge to analyze in depth how they use the diary. DISCUSSION This study will provide new insights on the impact of ICU diaries on post-traumatic stress disorders in patients and families after an ICU stay. TRIAL REGISTRATION ClinicalTrial.gov, ID: NCT02519725 . Registered on 13 July 2015.
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Affiliation(s)
- Maïté Garrouste-Orgeas
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and 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 Institute, Levallois-Perret, France.
| | - Cécile Flahault
- Psychology laboratory and work process, Paris Descartes University, Paris, France
| | - Léonor Fasse
- Laboratoire Psy-DREPI EA-7458, Bourgogne Franche Comté University, Dijon, France
| | - Stéphane Ruckly
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France.,Department of Biostatistics, Outcomerea, Paris, France
| | | | - Laurent Argaud
- Medical ICU, Edouard Herriot University Hospital, Lyon, France
| | - Julio Badie
- Medical-Surgical ICU, General Hospital Belfort-Montbeliard, Belfort, France
| | - Amélie Bazire
- Medical ICU, La Cavale Blanche University Hospital, Brest, France
| | - Naike Bige
- Medical ICU, Saint Antoine University Hospital, Paris, France
| | - Eric Boulet
- Medical ICU, Beaumont General Hospital, Beaumont, France
| | - Lila Bouadma
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France.,Medical ICU, Bichat University Hospital, Paris, France
| | - Cédric Bretonnière
- Medical ICU, Nantes University Hospital, Nantes, France.,EA3826, Laboratory of clinical and experimental therapeutics of infections, University of Nantes, Nantes, France
| | - Bernard Floccard
- Medical ICU, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France
| | - Alain Gaffinel
- Medical-Surgical ICU, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Hubert Grand
- Medical-Surgical ICU, Hospital Robert Boulin, Libourne, France
| | - Rebecca Halidfar
- Medical ICU, Albert Michallon University Hospital, Grenoble, France
| | - Olfa Hamzaoui
- Medical ICU, University Hospital Paris-Sud, Beclère University Hospital, Clamart, France
| | - Mercé Jourdain
- Lille University, Inserm U1190, Lille, France.,Group of medical ICUs, Lille University Hospital, Lille, France
| | - Paul-Henri Jost
- Surgical ICU, Henri Mondor University Hospital, Créteil, France
| | - Eric Kipnis
- Surgical ICU, Lille University Hospital, Lille, France
| | - Audrey Large
- Medical ICU, François Mitterrand University Hospital, Dijon, France
| | - Alexandre Lautrette
- Medical ICU, Gabriel-Montpied University Hospital, Clermont Ferrand, France.,LMGE UMR CNRS 6023, University of Clermont-Ferrand, Clermont Ferrand, France
| | - Olivier Lesieur
- Medical-Surgical ICU, General Hospital, La Rochelle, France.,EA 4569, University Paris Descartes, Paris, France
| | - Virginie Maxime
- Medical ICU, Raymond Poincaré University Hospital, Garches, France
| | - Emmanuelle Mercier
- CRICS group, Medical-Surgical ICU, Tours University Hospital, Tours, France
| | | | | | | | | | - Antoine Rouget
- Medical-Surgical ICU, Rangueil University Hospital, Toulouse, France
| | - François Santoli
- Medical ICU, General Hospital Robert Ballanger, Aulnay-Sous-Bois, France
| | - Georges Simon
- Medical-Surgical ICU, General Hospital, Troyes, France
| | - Fabienne Tamion
- Medical ICU, University medical center, Rouen, France.,INSERM U-1096, University of Rouen, Rouen, France
| | | | - Marina Thirion
- Medical-Surgical ICU, General Hospital Victor Dupouy, Argenteuil, France
| | | | | | - Christel Vioulac
- Psychology laboratory and work process, Paris Descartes University, Paris, France
| | - Sebastien Bailly
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
| | - Jean-François Timsit
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and 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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Falkenberg L, Zeckey C, Mommsen P, Winkelmann M, Zelle BA, Panzica M, Pape HC, Krettek C, Probst C. Long-term outcome in 324 polytrauma patients: what factors are associated with posttraumatic stress disorder and depressive disorder symptoms? Eur J Med Res 2017; 22:44. [PMID: 29084612 PMCID: PMC5663112 DOI: 10.1186/s40001-017-0282-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/28/2017] [Indexed: 12/14/2022] Open
Abstract
Background Physical impairment is well-known to last for many years after a severe injury, and there is a high impact on the quality of the survivor’s life. The purpose of this study was to examine if this is also true for psychological impairment with symptoms of posttraumatic stress disorder or depression after polytrauma. Design Retrospective cohort outcome study. Setting Level I trauma centre. Population 637 polytrauma trauma patients who were treated at our Level I trauma centre between 1973 and 1990. Minimum follow-up was 10 years after the injury. Methods Patients were asked to fill in a questionnaire, including parts of the Posttraumatic Stress Diagnostic Scale, the Impact of Event Scale-Revised and the German Hospital Anxiety and Depression Scale, to evaluate mental health. Clinical outcome was assessed before by standardised scores. Results Three hundred and twenty-four questionnaires were evaluated. One hundred and forty-nine (45.9%) patients presented with symptoms of mental impairment. Quality of life was significantly higher in the mentally healthy group, while the impaired group achieved a lower rehabilitation status. Conclusions Mental impairment can be found in multiple trauma victims, even after 10 years or more. Treating physicians should not only focus on early physical rehabilitation but also focus on early mental rehabilitation to prevent long-term problems in both physical and mental disability.
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Affiliation(s)
- Lisa Falkenberg
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Christian Zeckey
- Trauma Department, Hannover Medical School, Hannover, Germany. .,Department of General, Trauma and Reconstructive Surgery, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Philipp Mommsen
- Trauma Department, Hannover Medical School, Hannover, Germany
| | | | - Boris A Zelle
- Division of Orthopaedic Traumatology, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Martin Panzica
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Christian Probst
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
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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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Johansson M, Wåhlin I, Magnusson L, Runeson I, Hanson E. Family members' experiences with intensive care unit diaries when the patient does not survive. Scand J Caring Sci 2017; 32:233-240. [DOI: 10.1111/scs.12454] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/06/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Maria Johansson
- Intensive Care Department; County Hospital; Kalmar Sweden
- Department of Health and Caring Sciences; Linnaeus University; Kalmar Sweden
- Research Section; Kalmar County Council; Kalmar Sweden
| | - Ingrid Wåhlin
- 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
| | - Ingrid Runeson
- Department of Health and Caring Sciences; Linnaeus University; Kalmar Sweden
| | - Elizabeth Hanson
- Department of Health and Caring Sciences; Linnaeus University; Kalmar Sweden
- School of Nursing & Midwifery; University of Sheffield; Sheffield UK
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Locke M, Eccleston S, Ryan CN, Byrnes TJ, Mount C, McCarthy MS. Developing a Diary Program to Minimize Patient and Family Post-Intensive Care Syndrome. AACN Adv Crit Care 2017; 27:212-20. [PMID: 27153310 DOI: 10.4037/aacnacc2016467] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
A series of evidence-based interventions beginning with an intensive care unit diary and a patient/family educational pamphlet were implemented to address the long-term consequences of critical illness after discharge from the intensive care unit, bundled as post-intensive care syndrome and post-intensive care syndrome-family. An extensive literature review and nursing observations of the phenomenon highlighted the potential for this project to have a favorable impact on patients, their families, and the health care team. The goal of this article is to explain the education of all stakeholders; the introduction of the diary, video, and educational pamphlet; and the evaluation of the acceptance of these interventions. This process began with an informal evaluation of the educational products and overall perception of the usefulness of the diary by patients, family members, and staff. The efforts described contribute to the evidence base supporting diaries as an adjunct to intensive care.
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Affiliation(s)
- Meaghan Locke
- Meaghan Locke is a Consultant, Critical Care Nursing Section, Madigan Army Medical Center. Sarah Eccleston is Critical Care Clinical Nurse Specialist, Center for Nursing Science & Clinical Inquiry, Madigan Army Medical Center. Claire N. Ryan is Intensive Care Unit (ICU) Staff Nurse, Critical Care Nursing Section, Madigan Army Medical Center. Tiffany J. Byrnes is ICU Staff Nurse, Critical Care Nursing Section, Madigan Army Medical Center. Cristin Mount is Chief, Department of Medicine, Madigan Army Medical Center. Mary S. McCarthy is Senior Nurse Scientist, Center for Nursing Science & Clinical Inquiry, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431
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Egerod I, Andersson AE, Fagerdahl AM, Knudsen VE. Images of suffering depicted in diaries of family caregivers in the acute stage of necrotising soft tissue infection: A content analysis. Intensive Crit Care Nurs 2017; 41:57-62. [PMID: 28292567 DOI: 10.1016/j.iccn.2017.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/08/2017] [Accepted: 02/11/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Severe necrotising soft tissue infections (NSTI) are rare life threatening rapidly progressing bacterial infections requiring immediate diagnosis and treatment. The aim of the study was to explore the experience of family caregivers of patients with necrotising soft tissue infection during the acute stage of disease. METHODS Our study had a qualitative descriptive binational design using qualitative content analysis to explore diaries written by close family members (n=15). Participants were recruited from university hospitals in Denmark and Sweden. FINDINGS Three main categories emerged: Trajectory, Treatment, and Patient & Family. The first helped us construct an overview of the NSTI trajectory showing issues of importance to patient and family caregivers. The following categories were analysed further to describe four themes central to the family caregiver experience: craving information, needing to be near, suffering separation and network taking over. CONCLUSIONS Necrotising soft tissue infections are uncommon causing shock and concern. Centralised treatment might involve physical separation of patient and family during the acute stage of illness. Family accommodations near the patient and accessibility to adequate communication devices at the bedside are recommended. Health professionals need to keep in mind the importance of information and reassurance on the wellbeing of the family and ultimately of the patient.
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Affiliation(s)
- Ingrid Egerod
- University of Copenhagen, Rigshospitalet, Intensive Care Unit 4131, Blegdamsvej 9, Copenhagen, Denmark,.
| | - Annette E Andersson
- Institute of Health and care science, University of Gothenburg, Sweden; Department of Orthopedic Surgery, Sahlgrenska University Hospital, Mölndal, Sweden.
| | - Ann-Mari Fagerdahl
- Ann-Mari Fagerdahl: Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden.
| | - Vibeke E Knudsen
- University of Copenhagen, Rigshospitalet, Intensive Care Unit 4131, Blegdamsvej 9, Copenhagen, Denmark,.
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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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