Intensive Care Unit Diaries Research Articles

Application of ICU electronic diary platform based on co-design concept in Chinese critically ill patients: a mixed methods study protocol.

Critically ill patients are at a heightened risk for post-traumatic stress disorder (PTSD). While the intensive care unit (ICU) diary has been shown to improve the mental health and quality of life of ICU patients, the handwritten version still has some limitations such as a lack of support for multimedia content and writing by remote family members, as well as being time-consuming and labour-intensive. We hypothesise that constructing an ICU electronic diary platform based on a co-design approach and verifying its applicability could alleviate these limitations, making the ICU diary more convenient for users. This sequential exploratory mixed-methods study will consist of four consecutive phases: understanding the ICU diary research content and implementation, developing an ICU electronic diary platform after conducting qualitative interviews with stakeholders, verifying the applicability of the platform and verifying its effectiveness. Ethics approval was obtained from the Biomedical Research Ethics Committee of the Affiliated Hospital of Zunyi Medical University (approval number: KLL-2023-602). The results of this study will be distributed through peer-reviewed journals. Chinese Clinical Trial Register (ChiCTR2400079903).

Enhancing ICU care with nurse-written diaries.

Patient diaries are a supportive intervention aiding intensive care unit (ICU) survivors and their families post-critical illness. Despite their growing acceptance, ICU diary usage varies across settings. This study explored themes in nurse-written ICU diaries and their impact on nursing work and communication. This qualitative study employed an interpretative narrative methodology to explore the experiences of ICU nurses. The narrative approach enabled the synthesis of diverse events and impressions into coherent stories, facilitating a deeper understanding of participants' perspectives. Data collection involved thematic analysis of diaries following Braun and Clarke's methodology. The analysis included familiarization, coding, theme identification and validation by the research team. The findings were reviewed by participants and translated into English using the WHO's cultural adaptation guidelines, ensuring reliability and credibility in the study's outcomes. The sample consisted of 28 ICU nurses, each with professional experience ranging from 1 to 23 years. The hospitalized subjects for whom our sample wrote the diary consist of 13 participants aged 23-79 years. Two main themes emerged from the analysis: (1) simplifying the intensive care situation with specific minimization strategies and (2) attention to nonverbal communication. This study highlights the role of nurse-written ICU diaries in making the ICU environment more understandable and less intimidating for patients. Nurse-written ICU diaries contribute to improved communication and emotional support within the ICU environment. Further research is needed to explore these effects more fully and to assess the broader implications of ICU diaries on patient outcomes. Nurse-written intensive care unit (ICU) diaries have a significant impact on both patient care and nursing practice in ICUs. ICU diaries serve as a crucial tool for enhancing communication, emotional support and empathetic care within these high-stress environments. By simplifying complex medical information and focusing on nonverbal communication, nurses can make the ICU experience more comprehensible and less intimidating for patients. This approach reduces patient anxiety and psychological stress while fostering a stronger nurse-patient relationship, ultimately improving care quality.

"The Psychiatric Domain of Post-Intensive Care Syndrome: A Review for the Intensivist".

Post-intensive care syndrome (PICS) is a clinical syndrome characterized by new or worsening changes in mental health, cognition, or physical function that persist following critical illness. The psychiatric domain of PICS encompasses new or worsened psychiatric burdens following critical illness, including post-traumatic stress disorder (PTSD), depression, and anxiety. Many of the established predisposing and precipitating factors for the psychiatric domain of PICS are commonly found in the setting of critical illness, including mechanical ventilation (MV), exposure to sedating medications, and physical restraint. Importantly, previous psychiatric history is a strong risk factor for the development of the psychiatric domain of PICS and should be considered when screening patients to diagnose psychiatric impairment and interventions. Delirium has been associated with psychiatric symptoms following ICU admission, therefore prevention warrants careful consideration. Dexmedetomidine has been shown to have the lowest risk for development of delirium when compared to other sedatives and has been the only sedative studied in relation to the psychiatric domain of PICS. Nocturnal dexmedetomidine and intensive care unit (ICU) diaries have been associated with decreased psychiatric burden after ICU discharge. Studies evaluating the impact of other intra-ICU practices on the development of the psychiatric domain of PICS, including the ABCDEF bundle, depth of sedation, and daily spontaneous awakening trials, have been limited and inconclusive. The psychiatric domain of PICS is difficult to treat and may be less responsive to multidisciplinary post-discharge programs and targeted interventions than the cognitive and physical domains of PICS. Given the high morbidity associated with the psychiatric domain of PICS, intensivists should familiarize themselves with the risk factors and intra-ICU interventions that can mitigate this important and under-recognized condition.

A Qualitative Study to Explore the Nurses’ Experience of Writing Caring Notes in Diaries for Extracorporeal Oxygenation Membrane (ECMO) Patients: Explore the nurse’s experience

The use of diaries is known to reduce post-intensive care syndrome in the intensive care unit (ICU) for survivors and families. Studies are needed to explore nurses’ experience with diaries. Although the diaries are written for the patient, the diary entries may be helpful for the nurse as well. Research has shown that ICU diaries fill in significant memory gaps and aid in the resolution of delusional memories. However, there is a shortage of knowledge about the nurses’ experience of writing caring notes in diaries. The purpose of this research was to explore the extracorporeal membrane oxygenation (ECMO) nurses’ experience of writing caring notes in diaries during the patients’ ICU stay. This is a descriptive phenomenological qualitative research study using semi-structured interviews. A one-on-one interview was performed, audiotaped, and transcribed. Three investigators analyzed the data for themes, subcategories, and indicators. A purposive sample of 15 specialty-trained ECMO nurses participated in the study. Three themes emerged from the study relating to the nurse, family, and patient, including positive and negative aspects of writing in the diary and barriers. The vast majority (88%) of 340 comments answered during the interviews were positive. Overall, nurses found the diaries to be beneficial to the nurse, family, and patient. Diary writing may help nurses get back to the core of why we do what they do. Understanding the nurses’ experience may help to improve communication and family satisfaction while optimizing dairy programs.

Effects of web neonatal intensive care unit diaries on the mental health, quality of life, sleep quality, care ability, and hormone levels of parents of preterm infants in the neonatal intensive care unit: A randomized controlled trial

ObjectiveTo examine the effects of web neonatal intensive care unit diaries on the mental health, quality of life, sleep quality, care ability, and hormone levels of parents of preterm infants in the neonatal intensive care unit. DesignProspective randomized controlled parallel-group clinical trial. SettingMaternal and Child Health Hospital, Fujian, China. MethodsThe control group received routine neonatal intensive care unit care, while the intervention group received a web neonatal intensive care unit diary based on routine care. Outcomes, including anxiety, depression, and post-traumatic stress disorder symptoms, quality of life, sleep quality, care ability, and cortisol and melatonin levels, were evaluated at T1 (Time 1, before the intervention), T2 (Time 2, immediately after the intervention), and T3 (Time 3, 1 month after the intervention). ResultsSeventy pairs of parents of preterm infants in the neonatal intensive care unit were randomly allocated to two groups: intervention (n = 35) and control (n = 35). The anxiety scores in the intervention group were significantly lower at T2 and T3 than those in the control group (P < 0.001). The care ability scores in the intervention group were significantly higher at T2 and T3 (P < 0.001). The prevalence of post-traumatic stress disorder at T3 was significantly different between the groups (P = 0.040). No significant differences were observed in the quality of life or sleep quality between the groups at T2 and T3 (P > 0.05). No significant differences were observed in cortisol and melatonin levels between the groups (P > 0.05). ConclusionsWeb neonatal intensive care unit diaries effectively relieved anxiety symptoms, reduced the prevalence of post-traumatic stress disorder, and enhanced the care abilities of parents of preterm infants in the neonatal intensive care unit. Implications for clinical practiceWeb neonatal intensive care unit diary can be considered in clinical practice as a convenient psychological intervention method, especially among parents of preterm infants in the neonatal intensive care unit.

The use and application of intensive care unit diaries: An instrumental multiple case study.

The study aim was to explore the use of an Intensive Care Unit (ICU) diary within four different ICUs units in Sweden and thereby contribute to practice guidelines regarding the structure, content and use of an ICU diary. ICU diaries are used to aid psychological recovery among critical care patients, but differences remain in diary writing both within and across countries. Few studies have focused on the combined views and experiences of ICU patients, family members and nursing staff about the use of ICU diaries. An instrumental multiple case study design was employed. Three focus groups interviews were carried out with 8 former patients and their family members (n = 5) from the research settings. Individual interviews were carried out with 2 patients, a family member and a nurse respectively. Observations, field notes, documentary analysis and conversations with nursing staff were also conducted. Consolidated criteria for reporting qualitative research (COREQ) was followed. The qualitative findings firstly consisted of a matrix and descriptive text of the four ICU contexts and current practices. This highlighted that there were similarities regarding the aims and objectives of the diaries. However, differences existed across the case study sites about how the ICU diary was developed and implemented. Namely, the use of photographs and when to commence a diary. Second, a thematic analysis of the qualitative data regarding patients' and family members' use of the ICU diary, resulted in four themes: i) the diary was used to take in and fully understand the situation; ii) the diary was an opportunity to assimilate warm, personalised and human care; iii) the diary was used to manage existential issues; and iv) the diary was a tool in daily activities. Analysis of the instrumental case study data led to the identification of core areas for inclusion in ICU diary practice guidelines.

The diary in the intensive care unit: Concept analysis

IntroductionAdmission to an intensive care unit can cause sequelae to both patients and family members. In some countries, the use of diaries is a preventive action. AimThis research proposes to critically examine the concept of ‘Intensive Care Unit Diary’ by analysing the current state of the scientific literature to develop a precise conception of this phenomenon in nursing practice, since there are multiple unknowns regarding its use and content. MethodA bibliographic search was carried out in the PubMed, Cochrane Library, Scopus and CINAHL databases in January 2023. The terms used to search for their use and definitions in the databases included Nurse, Concept analysis, Family, Uci Diary, Patient Critical, Intensive Care Unit. We use Wilson’s concept analysis, later developed by Walker and Avant. ResultsThe concept analysis shows that the ‘ICU Diary’ is a record made in colloquial language by health workers and relatives of the patient admitted to the intensive care unit. Aimed at the patient, with an empathic and reflective style, which offers a narrative of the process, daily life and the conduct or behaviour of the patient during his stay.It is a therapeutic tool led by nurses accepted by patients, families and professionals. Its use benefits the recovery process, reducing post-traumatic stress in family members and patients. It favours communication and the bond between nurses, family members and patients, helping to express feelings and emotions. ConclusionsThe concept of ‘UCI Diary’ is complex. Through Wilson’s model, a clarification of the concept has been achieved, creating a starting point for more precise research on this phenomenon and its effects on patients, family members, professionals and the health system.

Postintensive care syndrome family: A comprehensive review.

Families of critically ill patients are predisposed to tremendous burdens when their relatives are admitted to the intensive care unit (ICU). Postintensive care syndrome family (PICS-F) can be described as a devastated life, encompassing psychological, physical, and socioeconomical burdens that begin with the emotional impact experienced by the family when the patient is admitted to the ICU. PICS-F was primarily proposed as a clinically significant psychological impairment, but it needs to be extended beyond the psychological impairment of the family to include physical and socioeconomical impairments in the future. The prevalence of physiological problems including depression, anxiety and post-traumatic syndrome is 20-40%, and that of non-physiological problems including fatigue is 15% at 6 months after the ICU stay. Assessment of PICS-F was frequently conducted at 3- or 6-month points, although the beginning of the evaluation was based on different assessment points among each of the studies. Families of ICU patients need to be given and understand accurate information, such as the patient's diagnosis, planned care, and prognosis. Prevention of PICS-F requires a continuous bundle of multifaceted and/or multidisciplinary interventions including providing a family information leaflet, ICU diary, communication facilitators, supportive grief care, and follow-up, for the patient and families from during the ICU stay to after discharge from the ICU. This is the first comprehensive review of PICS-F to address the concept, risk factors, assessment tools, prevalence, and management to prevent PICS-F to facilitate acute care physicians' understanding of PICS-F.

Care intervention on psychological outcomes among patients admitted to intensive care unit: an umbrella review of systematic reviews and meta-analyses

BackgroundNumerous studies have explored care interventions to improve the psychological outcome of intensive care unit (ICU) patients, but inconclusive evidence makes it difficult for decision-makers, managers, and clinicians to get familiar with all available literature and find appropriate interventions. This umbrella review aimed to analyze the relationship between care intervention and psychological outcomes of ICU patients based on existing systematic reviews.MethodsAn umbrella review of evidence across systematic reviews and meta-analyses published between 1987 and 2023 was undertaken. We systematically searched reviews that examined the association between care intervention and the improvement of adverse psychological outcomes in ICU patients using PubMed, EMBASE, Web of Science, Cochrane Library, and manual reference screening. The measurement tool (AMSTAR 2) was applied to evaluate the methodological quality of included studies. The excess significance bias, between-study heterogeneity expressed by I2, small-study effect, and evidence class were estimated.ResultsA total of 5110 articles were initially identified from the search databases and nine of them were included in the analysis. By applying standardized criteria, only weak evidence was observed in 13 associations, even though most included reviews were of moderate to high methodological quality. These associations pertained to eight interventions (music therapy, early rehabilitation, post-ICU follow-up, ICU diary, information intervention, preoperative education, communication and psychological support, surrogate decision-making) and five psychological outcomes (post-intensive care syndrome, transfer anxiety, post-traumatic stress disorder, anxiety, and depression). Weak or null association was shown among the rest of the associations (e.g., weak association between music therapy and maternal anxiety or stress level).ConclusionsThe evidence of these eight supporting interventions to improve the adverse psychological outcomes of ICU patients and caregivers was weak. Data from more and better-designed studies with larger sample sizes are needed to establish robust evidence.

The role of intensive care unit diaries in the grieving process: A monocentric qualitative study.

The growing importance of psychological recovery for patients and their families following intensive care unit (ICU) experiences in recent years cannot be overemphasized. The ICU diary is used to aid patients in reducing the prevalence of post-traumatic stress disorder, anxiety, and depression. The usefulness of maintaining a diary during the grieving process has not yet been thoroughly investigated. To investigate the role of ICU diaries in the grief process experienced by family members of a person who died in the intensive care unit. Nine family members of seven deceased ICU patients with an ICU diary were contacted and interviewed by phone using a semi-structured interview. A qualitative data analysis was performed using thematic synthesis. Italian general intensive care unit. Interviewed family members felt that the diary helped them during the grieving process. The return of diaries was desired by family members for support and to remember one's loved one. The diary helped them process their losses in various ways, including signs of evidence of care, emotional involvement, consideration, and coping with grief. Four main themes emerged from the analysis: writing the diary, reading the diary, talking about the diary, and the diary during the grieving process. The overall perception of the ICU diary was positive. The diary mostly helped relatives to "give back something of what we lost". This study also affirms the positive link between ICU diaries and bereavement in Italian ICU. Further studies are required to confirm the usefulness of this tool in the grieving process. The ICU diary can help patients' family members understand what happened to their loved one and play an important role in the grieving process. The diary served as a valuable source of information that aided in providing bereavement support to the family by helping them to gain a rational and emotional understanding of the patient's death.

The intensive care unit diary as a valuable care tool: A qualitative study of patients’ experiences

ObjectivesThe aim is to learn about patients' experience of reading the diary, assess attributed meaning and explore patients’ experience and memories during their stay in the intensive care unit. SettingEleven patients who received the diary after a stay in a nine-bed cardiac intensive care unit in Southern Switzerland, from November 2019 to October 2021. Main Outcome MeasuresDescriptive qualitative research was performed using semi-structured interviews, followed by thematic analysis. Three research nurses conducted individual telephone or face-to-face interviews. FindingsFifteen sub-themes emerged from the data interviews and were grouped into five main categories: a) the experience in the intensive care unit; b) Post Intensive Care Syndrome symptoms; c) the patient diary; d) new meaning of life; and e) sharing. Patients showed difficulties in remembering and understanding what happened during the hospitalization period. Reading the diary enabled them to understand the impact that the illness had on their daily experience. For some of them, reading the diary was helpful in reacting positively during moments of discouragement. ConclusionQualitative approach allowed us to assess how patients perceive the diary in the intensive care unit in a cultural context of Central and Southern Europe, which is still poorly investigated. The diary responded to the person's need to know what happened during a period that they had no memory of. Its use demonstrated important benefits, allowing people to understand the impact that the illness had on everyday life. It allowed them to relate to the difficulties encountered during the healing process. Thus, the diary played an important role during the healing process. Implications for clinical practiceThe diary was appreciated by patients during all stages of recovery from severe and acute illness. Gaps within the narration were avoided, in order to provide patients with a better timeline of the events occurred during the time they were unconscious.

Effect of intensive care unit diary on quality of life of intensive care unit survivors and their relatives: A systematic review and meta-analysis.

To evaluate the current literature on the effect of ICU diaries on the quality of life of ICU survivors and their relatives. Systematic review and meta-analysis. We searched the online databases Web of Science, PubMed, Embase, The Cochrane Library, CNKI and WanFang from inception to April 2021. Cochrane Risk of Bias Assessment Tool and Newcastle-Ottawa Scale (NOS) were used to assess the methodological quality. Seven studies were identified. ICU diaries improved the QoL of ICU survivors (SMD 0.79, 95% CI 0.24-1.34), and a small study described no benefit of diaries in improving the QoL of relatives. This meta-analysis revealed the use of ICU diaries to improve the QoL in survivors, but the ICU diaries do not have a beneficial effect on the QoL in relatives. The evidence summarized in our study is limited and biased, and more research should be carried out to verify it.

Nurses' and Parents' View on Neonatal Intensive Care Unit Diaries: A Qualitative Study and Framework Conceptualization.

The birth of a premature or critically ill newborn can be a traumatic event for the entire family. In these situations, the neonatal intensive care unit (NICU) diary is a relevant coping intervention to support family members. However, a profound theoretical concept is lacking, and there is little evidence about how it is applied by nurses in clinical practice. Therefore, this study aims to investigate how NICU diaries are used by nurses to support family members cope with their experiences and to develop an evidence-guided and theory-based framework for conceptualizing diary usage in the NICU. A qualitative study design containing 12 narrative interviews with nurses from six different hospitals and two focus group interviews with nine parents from two different hospitals was chosen. The qualitative data were analyzed via content analysis inductively and separately and brought together via graphical coding in a second step. Four main categories emerged from the analyzed data to describe the NICU diary in nursing practice. Regarding diary (1) "usage," three different types of NICU diaries were identified, which seem to be established largely intuitive. The (2) "content" is constituted by the diary's title, introduction, textual, and nontextual components. Taking into account the diary (3) "function" for the parental coping process, three subcategories emerge: (a) strengthening the parental role, (b) supporting understanding of events, and (c) bringing joy and normality to the situation. (4) "Challenges" address an appropriate writing style, the reading of parental entries by nurses and limited resources. Based on these results and taking into account relevant literature, a framework for conceptualizing NICU diaries was developed. NICU diaries show great potential to support the parental coping process. Nevertheless, diary conceptualization should be based on a theoretical framework to clarify its usage for nurses and parents. · NICU diaries are an established intervention used by nurses to support parental coping.. · In nursing practice, different types of NICU diaries emerge.. · Writing styles, content, and reading of entries are reported heterogeneously.. · A conceptualizing framework for NICU diaries is needed..

Expert consensus on late stage of critical care management

We wished to establish an expert consensus on late stage of critical care (CC) management. The panel comprised 13 experts in CC medicine. Each statement was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principle. Then, the Delphi method was adopted by 17 experts to reassess the following 28 statements. (1) ESCAPE has evolved from a strategy of delirium management to a strategy of late stage of CC management. (2) The new version of ESCAPE is a strategy for optimizing treatment and comprehensive care of critically ill patients (CIPs) after the rescue period, including early mobilization, early rehabilitation, nutritional support, sleep management, mental assessment, cognitive-function training, emotional support, and optimizing sedation and analgesia. (3) Disease assessment to determine the starting point of early mobilization, early rehabilitation, and early enteral nutrition. (4) Early mobilization has synergistic effects upon the recovery of organ function. (5) Early functional exercise and rehabilitation are important means to promote CIP recovery, and gives them a sense of future prospects. (6) Timely start of enteral nutrition is conducive to early mobilization and early rehabilitation. (7) The spontaneous breathing test should be started as soon as possible, and a weaning plan should be selected step-by-step. (8) The waking process of CIPs should be realized in a planned and purposeful way. (9) Establishment of a sleep-wake rhythm is the key to sleep management in post-CC management. (10) The spontaneous awakening trial, spontaneous breathing trial, and sleep management should be carried out together. (11) The depth of sedation should be adjusted dynamically in the late stage of CC period. (12) Standardized sedation assessment is the premise of rational sedation. (13) Appropriate sedative drugs should be selected according to the objectives of sedation and drug characteristics. (14) A goal-directed minimization strategy for sedation should be implemented. (15) The principle of analgesia must be mastered first. (16) Subjective assessment is preferred for analgesia assessment. (17) Opioid-based analgesic strategies should be selected step-by-step according to the characteristics of different drugs. (18) There must be rational use of non-opioid analgesics and non-drug-based analgesic measures. (19) Pay attention to evaluation of the psychological status of CIPs. (20) Cognitive function in CIPs cannot be ignored. (21) Delirium management should be based on non-drug-based measures and rational use of drugs. (22) Reset treatment can be considered for severe delirium. (23) Psychological assessment should be conducted as early as possible to screen-out high-risk groups with post-traumatic stress disorder. (24) Emotional support, flexible visiting, and environment management are important components of humanistic management in the intensive care unit (ICU). (25) Emotional support from medical teams and families should be promoted through"ICU diaries"and other forms. (26) Environmental management should be carried out by enriching environmental content, limiting environmental interference, and optimizing the environmental atmosphere. (27) Reasonable promotion of flexible visitation should be done on the basis of prevention of nosocomial infection. (28) ESCAPE is an excellent project for late stage of CC management.

The Lived Experiences of Patient’s Families with the Intensive Care Unit Diary

Purpose : Intensive care unit (ICU) diaries have been implemented across the international ICU community. This study aimed to comprehend the meaning and nature of the lived experience of patients’ families using the ICU diary in Korea.Methods : This qualitative study adopted van Manen’s hermeneutic phenomenology. The participants comprised eight women and two men who were the family members of patients in the ICU for more than three days. Data were collected using in-depth interviews and observation from July 2018 to January 2019.Results : Patients’ families who experienced the ICU diary recognized it with six beings according to time: a good idea, forgotten stuff, burdensome work, touching service, my stuff, and a thing in the memory. The ICU diary had three essential meanings for the families: communication, solace and hope, and a record of life. These findings were rearranged according to van Manen’s fundamental existential, and the lived things and lived others were remarkably confirmed.Conclusion : Patients’ families experienced various ICU diary forms over time and recognized an ICU diary as a means of communication. Therefore, the ICU diary is expected to be used as an intervention between families and healthcare providers in the ICU to support mutual communication.

Intensive Care Unit Diaries: A Nurse-Led Program.

Following intensive care unit stays, patients with post-intensive care syndrome can experience mental health symptoms that impact quality of life. Intensive care unit diaries have been shown to improve outcomes for patients and their families. Identification of limited support for high volumes of intensive care unit patients and families led to implementation of an intensive care unit diary program in a 24-bed adult medical-surgical intensive care unit. Patients requiring mechanical ventilation with an expected intensive care unit stay of more than 24 hours were provided intensive care unit diaries. Nursing staff and patients' families entered daily descriptive narratives of patients' progress during the stay. After intensive care unit discharge, patients and families reviewed the diaries to improve acceptance of their intensive care unit experience. Project evaluation included review of patient and family follow-up calls, a staff nurse feedback survey, and project champion debriefing sessions to gauge implementation success and feasibility. Twenty diaries were completed and distributed to patients or families at intensive care unit discharge. Follow-up calls illustrated support and gratitude for diaries regardless of patient outcomes. Patients reported that diaries helped fill memory gaps between intensive care unit admission and discharge. Nurse surveys and project champion debriefings confirmed that completion of intensive care unit diary entries had minimal impact on workload, eased communication, and improved staff members' coping skills. Successful intensive care unit diary program implementation has the potential to benefit patients, families, and nursing staff for little organizational cost.

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

ObjectivesMemories of frightening/delusional intensive care unit experiences are a major risk factor for subsequent psychiatric morbidity of critical illness survivors; factual memories are protective. Systematically providing factual information during initial memory consolidation could mitigate the emotional character of the formed memories. We explored feasibility and obtained stakeholder feedback of a novel approach to intensive care unit diaries whereby entries were read aloud to the patients right after they were written to facilitate systematic real time orientation and formation of factual memories. Research methodologyProspective interventional pilot study involving reading diary entries aloud. We have also interviewed involved stakeholders for feedback and collected exploratory data on psychiatric symptoms from patients right after the intensive care stay. SettingVarious intensive care units in a single academic center. Main outcome measuresFeasibility was defined as intervention delivery on ≥80% of days following patient recruitment. Content analysis was performed on stakeholder interview responses. Questionnaire data were compared for patients who received real-time reading to the historical cohort who did not. ResultsOverall, 57% (17 of 30) of patients achieved the set feasibility threshold. Following protocol adjustment, we achieved 86% feasibility in the last subset of patients. Patients reported the intervention as comforting and appreciated the reorientation aspect. Nurses overwhelmingly liked the idea; most common concern was not knowing what to write. Some therapists were unsure whether reading entries aloud might overwhelm the patients. There were no significant differences in psychiatric symptoms when compared to the historic cohort. ConclusionWe encountered several implementation obstacles; once these were addressed, we achieved set feasibility target for the last group of patients. Reading diary entries aloud was welcomed by stakeholders. Designing a trial to assess efficacy of the intervention on psychiatric outcomes appears warranted. Implications for Clinical PracticeThere is no recommendation to change current practice as benefits of the intervention are unproven.

Thematic analysis of intensive care unit diaries kept by staff: insights for caring

ObjectiveTo explore recurrent themes in diaries kept by intensive care unit (ICU) staff during the coronavirus disease 2019 (COVID-19) pandemic. DesignQualitative study. SettingTwo ICUs in a tertiary level hospital (Milan, Italy) from January to December 2021. MethodsICU 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. FindingsDiary 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). ConclusionThe 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 practiceThe 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.

Clinical impact of rehabilitation and ICU diary on critically ill patients: A systematic review and meta‐analysis

AbstractBackgroundVarious physical and mental sequelae reduce the quality of life (QOL) of intensive care unit (ICU) patients. Current guidelines recommend multi‐angular approaches to prevent these sequelae. Some studies have demonstrated the clinical effectiveness of rehabilitation or the ICU diary against these sequelae, whereas others have not.AimThe aims of the present study were to establish whether rehabilitation or the ICU diary was useful for reducing the severity of anxiety, depression, and post‐traumatic stress disorder (PTSD) in ICU patients. We also investigated whether these interventions improved the QOL of these patients.Study designWe conducted a systematic review and meta‐analysis of relevant randomized controlled trials published between January 1, 1985, and October 19, 2022, with the following search engines: PubMed, CHINAHL, all Ovid journals, and CENTRAL. The hospital anxiety and depression scale (HADS), the short‐form health survey (SF‐36), the EuroQol 5‐dimensions, 5‐levels (EQ‐5D‐5L), and the Impact of Event Scale‐Revised (IES‐R) were used as outcome measures. The quality of evidence across all studies was independently assessed using Review Manager software (v.5.4).ResultsWe included 12 rehabilitation studies and five ICU diary studies. Rehabilitation had no significant effects on HADS‐anxiety, HADS‐depression, or EQ‐5D‐5L, but significantly improved the physical component summary (PCS) [MD = 3.31, 95%CI (1.33 to 5.28), p = .001] and mental component summary (MCS) [MD = 4.31, 95%CI: (1.48 to 7.14), p = .003] of the SF‐36. The ICU diary significantly ameliorated HADS‐anxiety [MD = 0.96, 95%CI: (0.21 to 1.71), p = .01], but did not affect HADS‐depression, the IES‐R, or the PCS or MCS of the SF‐36.ConclusionsThe present study showed that rehabilitation initiated after discharge from the ICU effectively improved SF‐36 scores. The ICU diary ameliorated HADS‐anxiety. Neither rehabilitation nor the ICU diary attenuated HADS‐depression or IES‐R in this setting. Rehabilitation and the ICU diary partially improved the long‐term prognosis of ICU patients.Relevance to clinical practiceThe present study provides evidence for the beneficial effects of rehabilitation and the ICU diary for ICU patients. Rehabilitation alone does not ameliorate anxiety, depression, or PTSD symptoms, but may improve QOL. The ICU diary only appeared to ameliorate anxiety.

Should intensive care unit patients get psychotherapy after discharge for Post-Traumatic Stress Disorder (PTSD)?

Intensive Care Unit (ICU) patients should get psychotherapy consultations because most of the patients suffer from Post- Traumatic Stress Disorder (PTSD) after discharge, which leads to life-threatening conditions like flashbacks of the events which ultimately results in mood swings and depression. An ICU diary can be used as a form of psychotherapy that can be written by family members and staff everyday. This diary can help the patient during recovery and is useful in their rehabilitation. However, according to a survey on neurotic patients, psychotherapy may not always be effective and can sometimes lead to other problems. People who survive Intensive Care Units have the chance to develop Post-Intensive Care Syndrome (PICS), of which PTSD is also a component.