Newsletter June 2026
08/06/26 08:06 Filed in: News-Ticker
Dear Friends of the ICU Diary,
We hope you are all doing well!
The working group on family- and child-friendly intensive care units of the German Society of Intensive Care Medicine (DIVI), Section on Critical Care Rehabilitation is sending you this newsletter on ICU diaries and psychosocial aspects of intensive care medicine and nursing.
We are delighted to welcome two new members to our core team: Ella Peschel and Dominik Stark, both intensive care nurses who are highly committed to the promotion of ICU diaries. They will contribute to our newsletters, research activities, webinars, and dissemination efforts. Ella and Dominik, a very warm welcome to the team!
As always, we have summarized several studies on ICU diaries and family-centered care for you and also report on some other interesting articles!
Enjoy reading!
Chu-Won, Dominik, Ella, Kristin, Maria, and Peter
CONFERENCES
15th Johns Hopkins Critical Care Rehabilitation Conference
Date: November 5-6, 2026
Register now: ICURehabNetwork.org
Description: The 2026 JH Critical Care Rehabilitation Conference builds on last year’s conference, welcoming attendees from across the US and around the world. This year’s conference features the latest evidence and updates to advance early mobility and rehabilitation in adult ICUs.
Over two days, 16 multi-disciplinary experts will share new, evidence-based content. Attendees will have access to five interactive workshops and two “Meet the Expert” lunch-and-learn sessions, designed to foster collaboration and improve ICU and hospital-wide patient care. There will also be dedicated time to network with fellow PT, OT, SLP, and nursing registrants.
This conference offers a truly unique learning experience and models the multidisciplinary collaboration needed for successful early mobility/rehabilitation programs in adult ICUs!
ICU DIARIES
Diaries on the NICU
In this study conducted in Turkey, the diary entries of 27 mothers were analyzed using a hermeneutic-phenomenological approach to gain an understanding of their experiences in the neonatal unit. The participating mothers were asked to write a one-page diary entry on five consecutive days, documenting their perceptions of emotional closeness and the time spent with their infants. The results showed that, due to the physical separation from their infants, the mothers initially felt emotional distance and uncertainty. Over time, especially as they had skin-to-skin contact, participated in caregiving, and became accustomed to the daily routine in the neonatal unit, their sense of emotional closeness increased. Keeping the diary provided the mothers with a structured way to reflect on their emotions, track their bonding experiences, and process the challenges of the neonatal unit. Furthermore, factors such as support from the nursing staff, opportunities for parental involvement in infant care, and interactions with other mothers played a significant role in shaping emotional closeness.
Kasımoğlu, N., Gürol, A., Metin, A., & Polat, Ş. (2026). Mothers’ experiences of journaling during their infants’ stay in a baby-friendly NICU: a hermeneutic phenomenological study. BMC Pregnancy and Childbirth.
Pilotstudy for implementing Diaries in NICU
The use of narrative diaries in neonatal intensive care units (NICUs) has been proposed as a strategy to support parents during the stressful experience of a newborn’s critical illness. The research question was whether the implementation of a narrative NICU diary is feasible and acceptable for parents and healthcare professionals and how both groups perceive its use. Thekkan et al. (2026) conducted a prospective mixed-methods feasibility study in a tertiary NICU in Italy. Twenty-three parents of critically ill newborns participated, and data were collected through diary usage metrics, questionnaires, and follow-up interviews. A total of 581 diary entries were recorded across 21 diaries, with parents contributing far more frequently than healthcare professionals. Parents reported very high satisfaction and perceived usefulness, with most rereading the diary after discharge and recommending it to other families. Qualitative findings showed that diaries helped parents express emotions, cope with stress, create memories, and strengthen communication with their child and the care team. Healthcare professionals also recognised benefits but reported lower personal usefulness and limited participation. Limitations included the single-centre design, small sample size, potential selection bias, exclusion of non-Italian-speaking families, and low healthcare professional engagement. The authors concluded that narrative NICU diaries are feasible, well accepted, and beneficial, although additional strategies are needed to increase staff involvement in diary writing
Thekkan KR, Genna C, Sorrentino G, Aite L, Ragni A, Bevilacqua F, Dall'Oglio I, Tiozzo E, Dotta A, Gawronski O. Parents' and Healthcare Providers' Perceptions About the Use of Narrative Diaries in the Neonatal Intensive Care Unit: A Prospective Feasibility Study. Nurs Crit Care. 2026 May;31(3):e70472
Diaries for Delirium
Delirium is a frequent and serious complication among patients in intensive care units (ICUs), often leading to prolonged recovery and long-term cognitive impairment. The research question was whether the implementation of ICU diaries, combined with targeted nurse education, could improve delirium recognition and reduce delirium incidence in critically ill older adults. Abdulkhasanova et al. (2026) conducted a nurse-led quality improvement project in a surgical ICU at an academic medical centre using a Plan–Do–Study–Act (PDSA) framework. Nurses received education on delirium recognition and the Confusion Assessment Method for the ICU (CAM-ICU), after which personalised ICU diaries were introduced for older patients identified as being at risk of delirium. Outcomes were assessed through pre- and post-intervention surveys and four weeks of chart audits. The intervention improved nurses’ knowledge of delirium, confidence in using the CAM-ICU, and confidence in implementing ICU diaries. Documentation of delirium screening became more consistent, and documented delirium cases decreased from 12 to 9 over the four-week period, representing a 25% reduction. Families and nurses also reported positive experiences with the diaries, describing them as valuable tools for preserving memories and supporting person-centred care. Limitations included the single-centre design, short observation period, reliance on self-reported outcomes, and the quality improvement nature of the project, which limits causal inference and generalisability. The authors concluded that ICU diaries are a feasible, low-cost intervention that can enhance delirium prevention efforts and support cognitive recovery. Unfortunately, the publication is a very short report and details are not presented. We hope for a larger publication.
Abdulkhasanova I. Use of ICU diaries to prevent delirium in older adults: A nurse-led quality improvement in an academic medical center. Geriatr Nurs. 2026 Apr 4:104011
Diaries for improving quality of life and reducing PTSD
Major trauma survivors frequently experience long-term impairments in health-related quality of life (HRQoL) and are at increased risk of post-traumatic stress disorder (PTSD). The research question was whether the early implementation of a nurse-led intensive care unit (ICU) diary within 48 hours of trauma could improve HRQoL and reduce PTSD symptoms one year after major trauma. Benazzouz et al. (2026) conducted a multicentre randomized controlled trial (QUALITRAU) in three ICUs of a French tertiary hospital. Adult patients with major trauma (Injury Severity Score >15) were randomly assigned to receive either an ICU diary in addition to usual care or usual care alone. The primary outcome was HRQoL at 12 months, measured using the WHOQOL-BREF questionnaire, while PTSD symptoms were assessed using the Impact of Event Scale (IES). A total of 208 patients were randomized, although only 121 completed the primary outcome assessment. At 12 months, no significant differences were observed between the intervention and control groups across any HRQoL domains, including physical, psychological, social, and environmental well-being. Similarly, PTSD symptom severity did not differ between groups. Secondary analyses suggested that successful social reintegration, particularly return to work and stable housing, was more strongly associated with improved quality of life than diary use. The main limitations were the substantial loss to follow-up, the absence of detailed data on diary engagement and diary delivery, the single-centre setting, and the possibility that unmeasured post-discharge rehabilitation and psychosocial support influenced outcomes. The authors concluded that early nurse-led ICU diaries alone did not improve long-term HRQoL or reduce PTSD symptoms after major trauma and may need to be integrated into broader rehabilitation strategies.
Benazzouz M, James A, Rousseau A, Paries M, Cachanado M, Fromentin H, Raux M, Leblanc J, Nicolas-Robin A. Impact of early nurse-led implementation of an intensive care unit diary following major trauma on quality of life: The QUALITRAU randomized controlled trial. Intensive Crit Care Nurs. 2026 May 8;96:104437
From trauma to marriage
Intensive care unit (ICU) diaries are increasingly recognised as valuable tools for supporting psychological recovery after critical illness. The article explored how ICU diaries helped a young trauma patient and his family cope with the aftermath of a severe traumatic brain injury. Kuzma et al. (2026) presented a reflective case-based commentary describing the experiences of a former ICU patient, his family, and healthcare professionals. The patient reported that the diaries enabled him to reconstruct the four weeks he spent in an induced coma, process traumatic memories, and gain perspective on his recovery journey. Family members found the diaries equally valuable as a safe space to express emotions and maintain connection during a highly stressful period. Although based on a single case and not designed to evaluate effectiveness systematically, the article highlights the profound personal value of ICU diaries. The authors conclude that this simple, low-cost intervention can provide meaningful emotional support for patients and families and may contribute positively to recovery from critical illness and the long-term challenges associated with post-intensive care syndrome (PICS). The commentary includes impressive photos, and last one is “just married”. It is a touching story.
Kuzma L, Kuzma J. Our Intensive Care Diary. Nurs Crit Care. 2026 May;31(3):e70452.
Diaries for Patients after Liver Transplantation
This research tested whether a nurse-led ICU diary intervention could reduce emotional distress in patients undergoing liver transplantation during their postoperative ICU stay. Wu et al. (2026) conducted a single-centre randomized controlled trial in a transplant ICU in Taiwan. Fifty-two adult liver transplant recipients were randomly assigned to either a nurse-led ICU diary intervention in addition to usual care or usual care alone. Participants in the intervention group completed structured ICU diaries for 14 days after surgery, supported by nurses and family members. Emotional distress, including anxiety, depression, and stress, was assessed using the Depression Anxiety and Stress Scales-21 at baseline and on postoperative days 7 and 14.The study demonstrated significant reductions in overall emotional distress among patients receiving the ICU diary intervention compared with controls. Improvements were evident by postoperative day 7 and became more pronounced by day 14. Significant benefits were also observed across all three psychological domains, with lower anxiety, depression, and stress scores in the intervention group. The authors suggested that diary writing facilitated emotional expression, enhanced communication with family members and healthcare professionals, and helped patients better understand their recovery journey. Limitations included the single-centre design, relatively small sample size, short follow-up period, and reliance on a single self-report measure of emotional distress. The authors concluded that nurse-led ICU diaries represent a feasible and effective supportive intervention that can improve short-term psychological outcomes in liver transplant recipients during postoperative ICU care.
Wu JS, Wang CY, Wang BY, Wang BC, Tsai PC. Effects of nurse-led intensive care unit diaries on emotional distress in patients undergoing liver transplantation: A randomized controlled trial. Intensive Crit Care Nurs. 2026 May 30;95:104461. doi: 10.1016/j.iccn.2026.104461
Diaries after Brain Injury
Severe traumatic brain injury requiring intensive care treatment can have profound consequences for both survivors and their family members. This study explored the significance of nurse-written ICU diaries for individuals with severe traumatic brain injury and their relatives following an intensive care unit stay. The research question was how a nurse-written ICU diary influences patients’ and family members’ processing of the illness experience and their shared coping with the situation. Högvall et al. (2026) conducted an exploratory qualitative single-centre study. Nine survivors of severe traumatic brain injury and ten family caregivers participated in dyadic interviews. The data were analysed using the interpretive description methodology. The findings showed that the ICU diary played an important role in filling memory gaps and helping participants make sense of a period that was often only partially remembered. For many patients, the diary served as a trustworthy source of information that helped them understand the severity of their illness and the actual course of treatment. Family members reported that the diary facilitated conversations about the illness, promoted a shared understanding of the situation, and helped align expectations regarding recovery. In addition, the diary conveyed a sense of personalised and compassionate care and contributed to making the intensive care experience appear more human and understandable. Although reading the diary sometimes evoked distressing emotions and reminded participants of a difficult period, the overall experience was perceived positively. The authors concluded that nurse-written ICU diaries can support the reconstruction of the illness narrative, facilitate communication within families, and contribute to the development of a shared understanding of the illness trajectory.
Högvall LM, Herling SF, Egerod I, Rustøen T, Berntzen H. Creating a shared narrative: A qualitative study on the impact of nurse-written ICU diaries for TBI-survivors and their family caregivers. Neuropsychol Rehabil. 2026 Jun 4:1-21.
Implementation of Digital Diaries
Digital intensive care unit (ICU) diaries are increasingly used to support psychological recovery and family engagement following critical illness. The research question was how a digital ICU diary can be successfully implemented in routine clinical practice and which contextual factors influence its uptake and sustainability. Schol et al. (2026) conducted a multicentre mixed-methods implementation study across four adult ICUs in the Netherlands. Data were collected through usage metrics, questionnaires, and semi-structured interviews with ICU nurses and implementation champions to evaluate adoption, engagement, normalisation, fidelity of use, and implementation processes. The study included 159 ICU professionals and demonstrated considerable variation in implementation success between hospitals. The median e-diary activation rate among eligible patients was 22.6%, while adoption and normalisation scores were generally positive. Successful implementation was associated with engaged champions, effective training, regular reminders, leadership support, and prior experience with paper diaries. Barriers included workload, staff resistance, limited follow-up, and competing clinical priorities. Hospitals with strong champion involvement and supportive team cultures achieved higher uptake and more consistent use. The authors concluded that successful implementation of digital ICU diaries depends not only on the technology itself but also on organisational, cultural, and leadership factors.
Schol CMA, Ista E, van Son-Kemmeren W, Rinket M, Berger E, Gommers DAMPJ, van Mol MMC. More Than a Tool: How Context Shapes the Implementation of Digital Diaries in the Intensive Care Unit. Nurs Crit Care. 2026 May;31(3):e70517.
RELATED STUDIES
Some titles were taken from the newsletters of @ICURehab Newsletter by Dale M. Needham and Critical Care Reviews by Rob Mac Sweeney, and of course our own searches.
Well-being: Bodet-Contentin et al. (2026) developed and validated a brief four-item scale to assess well-being and feelings of safety among intensive care patients. The instrument represents a practical tool for measuring patient-centred outcomes and may contribute to the humanisation of intensive care. Bodet-Contentin et al. (2026), France. Link
Rehabilitation: Johnson et al. (2026) describe an AI-supported, person-centred follow-up care concept that uses individually tailored summaries of the ICU stay to facilitate the processing of critical illness experiences, improve understanding of the intensive care journey, and support long-term recovery. The framework is guided by principles such as transparency, co-design, equity, cultural sensitivity, and the ethical use of artificial intelligence. Johnson et al. (2026). Link
Waiting: In a study involving 17 family members, supplemented by observations of 39 relatives, waiting in the intensive care environment was described as an emotionally demanding and active process characterised by uncertainty, individual coping strategies, and the importance of both physical surroundings and social contexts. Qualitative study by Rennet et al. (2026), France. Link
Bereavement: Among 22 relatives of patients who died in intensive care, end-of-life experiences were characterised by anxiety, uncertainty, and difficulties in understanding the situation. Clear communication and the opportunity for a meaningful farewell were identified as central factors supporting emotional processing and coping. Qualitative study by Palmryd et al. (2026), Sweden. Link
Weaning: In a qualitative study involving eight family members of intensive care patients, participation in the weaning process—particularly through presence, touch, and communication—was found to promote meaning, hope, and inner strength. The findings highlight the importance of person-centred involvement of family members as active partners in care. Qualitative study by Tinksvik et al. (2026), Sweden. Link
Coping Strategies: In this qualitative study, 11 former ICU patients who had spent more than seven days in intensive care described their experiences and coping strategies following critical illness. Six key themes emerged: (1) no longer being the same person, (2) the social environment as both a source of support and burden, (3) coping with memory gaps, (4) recognising personal progress, (5) managing setbacks and finding motivation, and (6) accepting what cannot be understood or changed. Qualitative study by Ruch et al. (2026), Switzerland. Link
PICS: Physical impairments associated with Post-Intensive Care Syndrome (PICS) frequently persist long after discharge and are associated with increased mortality and reduced quality of life, while early mobilisation and individualised risk stratification represent key preventive strategies. Herman et al. (2026). Link
Burn Injury and PICS: This review highlights the transition from acute burn injury to persistent metabolic, immunological, physical, and psychological impairments, emphasising the overlap between persistent critical illness and Post-Intensive Care Syndrome in survivors of severe burns. Berger et al. (2026). Link
Social Frailty: In a multicentre qualitative study involving 44 participants, including 27 sepsis survivors, 6 family members, and 11 healthcare professionals from the United Kingdom, social frailty emerged as an important consequence of critical illness, characterised by financial insecurity, restricted social interactions, treatment-related burdens, and family and social challenges. Social frailty was negatively associated with both physical and psychological outcomes, raising the question of whether it represents an additional dimension of Post-Intensive Care Syndrome. Qualitative multicentre study by McPeake et al. (2026), United Kingdom. Link
Cognitive Rehabilitation: In a systematic review of 27 studies, the following interventions were identified as promising approaches to cognitive rehabilitation after critical illness: orientation and multisensory stimulation, activities of daily living (ADL)-focused occupational therapy, early mobilisation and physical training, as well as music-based and virtual reality interventions. Systematic review by Lassen et al. (2026). Link
Cognitive Rehabilitation II: In a five-arm randomised feasibility trial involving 83 of 1,679 screened ICU patients, the ICU CogHab cognitive rehabilitation programme demonstrated limited feasibility, characterised by low recruitment rates, a 40% follow-up rate at six months, and variable data completeness. The study highlights the challenges of conducting complex rehabilitation research in critically ill populations. Randomised feasibility study by Astrup et al. (2026), Denmark. Link
Visiting Hours: In a retrospective study of 264 critically ill ICU patients, an open visiting policy (24-hour access) was associated with significantly lower delirium rates (11.4% vs. 25.8%), shorter durations of mechanical ventilation and ICU stay, reduced anxiety levels, and improved treatment adherence compared with restricted visiting hours (0.5–1 hour per day). Although the findings are encouraging, the retrospective design introduces important methodological limitations. Retrospective study by Xu et al. (2026), China. Link
Voices for Reorientation: In a systematic review and meta-analysis of seven randomised studies involving 582 ICU patients, family voice interventions significantly reduced the incidence of delirium compared with usual care (OR 0.39, 95% CI 0.26–0.58) and shortened delirium duration by approximately one day. These findings support the use of recorded family voices as a simple and effective non-pharmacological intervention to promote orientation and prevent delirium in critically ill patients. Systematic review and meta-analysis by Peschel et al. (2026). Link
The Prayer Tree: Ashcraft et al. (2026) describe a “Prayer Tree” located in a garden adjacent to the intensive care unit, which provides family members and healthcare professionals with a meaningful opportunity to express emotional, spiritual, and personal hopes and wishes, thereby supporting holistic and compassionate care. Descriptive report from the United States. Link
Communication: Ahsana et al. (2026) emphasise that communication remains a cornerstone of intensive care practice for patients, families, and healthcare teams, while simultaneously evolving in response to ongoing technological, societal, and healthcare-related changes. Expert statement. Link
Digital Communication: In a systematic review of 54 studies from 19 countries, digital communication interventions in intensive care, particularly virtual visits, significantly improved family satisfaction (SMD 0.76, 95% CI 0.45–1.06). Although quantitative effects on patient anxiety and depression were not significant, qualitative findings suggested reduced emotional burden and enhanced family involvement in care. Systematic review by Oh et al. (2026). Link
PAEDIATRIC STUDIES
Paediatric Visiting Policies: In a survey of 59 paediatric intensive care units in Türkiye, 78% of units allowed one parent to remain with a non-intubated child for 24 hours a day; however, 91.5% maintained other restrictive visiting policies, 67.8% prohibited sibling visits, and no unit permitted family presence during invasive procedures or cardiopulmonary resuscitation. Survey study by Emeksiz et al. (2026). Link
Family-Centered Care in the PICU: This systematic review summarized parents’ perceptions of family-centered care (FCC) in the pediatric intensive care unit. 25 qualitative studies were included and synthesized into 6 key findings, supporting a successful implementation of FCC: (1) Emotional support, assistance, and care provided by the team, (2) Changes in the parental role, presence, and care of the child, (3) Reliability of the team, (4) Stay in the pediatric intensive care unit, influence of the physical environment, and lack of privacy, (5) Information received and involvement in decision-making, and (6) The team’s approach to making parents feel welcome and respected regarding their needs, beliefs, and culture. Lessa et al (2026) Link
End-of-Life Care: The Society of Critical Care’s multidisciplinary panel developed questions relevant to end-of-life care in the intensive care unit and addressed them through a systematic review. From this, five recommendations were derived for the care of dying children in neonatal and pediatric intensive care units: The implementation of advance care planning, (2) Integration of palliative care, (3) a systematic approach to symptom assessment and management, (4) palliative care training for the treating team, (5) implementation of a grieving support during and after death, and (6) active engagement with the unequal care received by marginalized groups. Derrington et al (2026) Link
Parental Presence During Invasive Procedures: In this study, 22 parents were interviewed in semi-structured interviews about their experiences with being present during their children’s invasive procedures in the intensive care unit. The parents viewed their presence as essential to fulfilling their role as caregivers, providing comfort to their children, and strengthening emotional bonds. They expressed a desire to be present, despite the emotional stress. They identified the following key needs: receiving clear information, receiving emotional support, having the freedom to decide for themselves whether they wanted to be present, and having a private and safe environment. Expósito et al (2026) Link
Did We Miss a Study?
We cannot review and summarize every study. If we have overlooked an important one, please send us a short summary and a reference via email, and we will gladly include it in the newsletter!
Stay healthy!
Chu-Won, Dominik, Kristin, Maria & Peter
Dr. Chu-Won Sim, M.Sc. – Psychologist, Department of Pediatric Cardiology, German Heart Center of Charité (DHZC), Berlin, Germany
Dominik Stark, CCRN, University Hospital OWL, Bethel, Bielefeld
Ella Peschel, RN BSc., Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
Kristin Gabriel, Media Scientist, Art Historian, and Yoga Instructor, Berlin
Maria Brauchle, CCRN, Nursing School Vorarlberg, Feldkirch, Austria
PD Dr. Peter Nydahl, RN BScN MScN – Nursing Research, University Hospital Schleswig-Holstein, Kiel, Germany
We hope you are all doing well!
The working group on family- and child-friendly intensive care units of the German Society of Intensive Care Medicine (DIVI), Section on Critical Care Rehabilitation is sending you this newsletter on ICU diaries and psychosocial aspects of intensive care medicine and nursing.
We are delighted to welcome two new members to our core team: Ella Peschel and Dominik Stark, both intensive care nurses who are highly committed to the promotion of ICU diaries. They will contribute to our newsletters, research activities, webinars, and dissemination efforts. Ella and Dominik, a very warm welcome to the team!
As always, we have summarized several studies on ICU diaries and family-centered care for you and also report on some other interesting articles!
Enjoy reading!
Chu-Won, Dominik, Ella, Kristin, Maria, and Peter
CONFERENCES
15th Johns Hopkins Critical Care Rehabilitation Conference
Date: November 5-6, 2026
Register now: ICURehabNetwork.org
Description: The 2026 JH Critical Care Rehabilitation Conference builds on last year’s conference, welcoming attendees from across the US and around the world. This year’s conference features the latest evidence and updates to advance early mobility and rehabilitation in adult ICUs.
Over two days, 16 multi-disciplinary experts will share new, evidence-based content. Attendees will have access to five interactive workshops and two “Meet the Expert” lunch-and-learn sessions, designed to foster collaboration and improve ICU and hospital-wide patient care. There will also be dedicated time to network with fellow PT, OT, SLP, and nursing registrants.
This conference offers a truly unique learning experience and models the multidisciplinary collaboration needed for successful early mobility/rehabilitation programs in adult ICUs!
ICU DIARIES
Diaries on the NICU
In this study conducted in Turkey, the diary entries of 27 mothers were analyzed using a hermeneutic-phenomenological approach to gain an understanding of their experiences in the neonatal unit. The participating mothers were asked to write a one-page diary entry on five consecutive days, documenting their perceptions of emotional closeness and the time spent with their infants. The results showed that, due to the physical separation from their infants, the mothers initially felt emotional distance and uncertainty. Over time, especially as they had skin-to-skin contact, participated in caregiving, and became accustomed to the daily routine in the neonatal unit, their sense of emotional closeness increased. Keeping the diary provided the mothers with a structured way to reflect on their emotions, track their bonding experiences, and process the challenges of the neonatal unit. Furthermore, factors such as support from the nursing staff, opportunities for parental involvement in infant care, and interactions with other mothers played a significant role in shaping emotional closeness.
Kasımoğlu, N., Gürol, A., Metin, A., & Polat, Ş. (2026). Mothers’ experiences of journaling during their infants’ stay in a baby-friendly NICU: a hermeneutic phenomenological study. BMC Pregnancy and Childbirth.
Pilotstudy for implementing Diaries in NICU
The use of narrative diaries in neonatal intensive care units (NICUs) has been proposed as a strategy to support parents during the stressful experience of a newborn’s critical illness. The research question was whether the implementation of a narrative NICU diary is feasible and acceptable for parents and healthcare professionals and how both groups perceive its use. Thekkan et al. (2026) conducted a prospective mixed-methods feasibility study in a tertiary NICU in Italy. Twenty-three parents of critically ill newborns participated, and data were collected through diary usage metrics, questionnaires, and follow-up interviews. A total of 581 diary entries were recorded across 21 diaries, with parents contributing far more frequently than healthcare professionals. Parents reported very high satisfaction and perceived usefulness, with most rereading the diary after discharge and recommending it to other families. Qualitative findings showed that diaries helped parents express emotions, cope with stress, create memories, and strengthen communication with their child and the care team. Healthcare professionals also recognised benefits but reported lower personal usefulness and limited participation. Limitations included the single-centre design, small sample size, potential selection bias, exclusion of non-Italian-speaking families, and low healthcare professional engagement. The authors concluded that narrative NICU diaries are feasible, well accepted, and beneficial, although additional strategies are needed to increase staff involvement in diary writing
Thekkan KR, Genna C, Sorrentino G, Aite L, Ragni A, Bevilacqua F, Dall'Oglio I, Tiozzo E, Dotta A, Gawronski O. Parents' and Healthcare Providers' Perceptions About the Use of Narrative Diaries in the Neonatal Intensive Care Unit: A Prospective Feasibility Study. Nurs Crit Care. 2026 May;31(3):e70472
Diaries for Delirium
Delirium is a frequent and serious complication among patients in intensive care units (ICUs), often leading to prolonged recovery and long-term cognitive impairment. The research question was whether the implementation of ICU diaries, combined with targeted nurse education, could improve delirium recognition and reduce delirium incidence in critically ill older adults. Abdulkhasanova et al. (2026) conducted a nurse-led quality improvement project in a surgical ICU at an academic medical centre using a Plan–Do–Study–Act (PDSA) framework. Nurses received education on delirium recognition and the Confusion Assessment Method for the ICU (CAM-ICU), after which personalised ICU diaries were introduced for older patients identified as being at risk of delirium. Outcomes were assessed through pre- and post-intervention surveys and four weeks of chart audits. The intervention improved nurses’ knowledge of delirium, confidence in using the CAM-ICU, and confidence in implementing ICU diaries. Documentation of delirium screening became more consistent, and documented delirium cases decreased from 12 to 9 over the four-week period, representing a 25% reduction. Families and nurses also reported positive experiences with the diaries, describing them as valuable tools for preserving memories and supporting person-centred care. Limitations included the single-centre design, short observation period, reliance on self-reported outcomes, and the quality improvement nature of the project, which limits causal inference and generalisability. The authors concluded that ICU diaries are a feasible, low-cost intervention that can enhance delirium prevention efforts and support cognitive recovery. Unfortunately, the publication is a very short report and details are not presented. We hope for a larger publication.
Abdulkhasanova I. Use of ICU diaries to prevent delirium in older adults: A nurse-led quality improvement in an academic medical center. Geriatr Nurs. 2026 Apr 4:104011
Diaries for improving quality of life and reducing PTSD
Major trauma survivors frequently experience long-term impairments in health-related quality of life (HRQoL) and are at increased risk of post-traumatic stress disorder (PTSD). The research question was whether the early implementation of a nurse-led intensive care unit (ICU) diary within 48 hours of trauma could improve HRQoL and reduce PTSD symptoms one year after major trauma. Benazzouz et al. (2026) conducted a multicentre randomized controlled trial (QUALITRAU) in three ICUs of a French tertiary hospital. Adult patients with major trauma (Injury Severity Score >15) were randomly assigned to receive either an ICU diary in addition to usual care or usual care alone. The primary outcome was HRQoL at 12 months, measured using the WHOQOL-BREF questionnaire, while PTSD symptoms were assessed using the Impact of Event Scale (IES). A total of 208 patients were randomized, although only 121 completed the primary outcome assessment. At 12 months, no significant differences were observed between the intervention and control groups across any HRQoL domains, including physical, psychological, social, and environmental well-being. Similarly, PTSD symptom severity did not differ between groups. Secondary analyses suggested that successful social reintegration, particularly return to work and stable housing, was more strongly associated with improved quality of life than diary use. The main limitations were the substantial loss to follow-up, the absence of detailed data on diary engagement and diary delivery, the single-centre setting, and the possibility that unmeasured post-discharge rehabilitation and psychosocial support influenced outcomes. The authors concluded that early nurse-led ICU diaries alone did not improve long-term HRQoL or reduce PTSD symptoms after major trauma and may need to be integrated into broader rehabilitation strategies.
Benazzouz M, James A, Rousseau A, Paries M, Cachanado M, Fromentin H, Raux M, Leblanc J, Nicolas-Robin A. Impact of early nurse-led implementation of an intensive care unit diary following major trauma on quality of life: The QUALITRAU randomized controlled trial. Intensive Crit Care Nurs. 2026 May 8;96:104437
From trauma to marriage
Intensive care unit (ICU) diaries are increasingly recognised as valuable tools for supporting psychological recovery after critical illness. The article explored how ICU diaries helped a young trauma patient and his family cope with the aftermath of a severe traumatic brain injury. Kuzma et al. (2026) presented a reflective case-based commentary describing the experiences of a former ICU patient, his family, and healthcare professionals. The patient reported that the diaries enabled him to reconstruct the four weeks he spent in an induced coma, process traumatic memories, and gain perspective on his recovery journey. Family members found the diaries equally valuable as a safe space to express emotions and maintain connection during a highly stressful period. Although based on a single case and not designed to evaluate effectiveness systematically, the article highlights the profound personal value of ICU diaries. The authors conclude that this simple, low-cost intervention can provide meaningful emotional support for patients and families and may contribute positively to recovery from critical illness and the long-term challenges associated with post-intensive care syndrome (PICS). The commentary includes impressive photos, and last one is “just married”. It is a touching story.
Kuzma L, Kuzma J. Our Intensive Care Diary. Nurs Crit Care. 2026 May;31(3):e70452.
Diaries for Patients after Liver Transplantation
This research tested whether a nurse-led ICU diary intervention could reduce emotional distress in patients undergoing liver transplantation during their postoperative ICU stay. Wu et al. (2026) conducted a single-centre randomized controlled trial in a transplant ICU in Taiwan. Fifty-two adult liver transplant recipients were randomly assigned to either a nurse-led ICU diary intervention in addition to usual care or usual care alone. Participants in the intervention group completed structured ICU diaries for 14 days after surgery, supported by nurses and family members. Emotional distress, including anxiety, depression, and stress, was assessed using the Depression Anxiety and Stress Scales-21 at baseline and on postoperative days 7 and 14.The study demonstrated significant reductions in overall emotional distress among patients receiving the ICU diary intervention compared with controls. Improvements were evident by postoperative day 7 and became more pronounced by day 14. Significant benefits were also observed across all three psychological domains, with lower anxiety, depression, and stress scores in the intervention group. The authors suggested that diary writing facilitated emotional expression, enhanced communication with family members and healthcare professionals, and helped patients better understand their recovery journey. Limitations included the single-centre design, relatively small sample size, short follow-up period, and reliance on a single self-report measure of emotional distress. The authors concluded that nurse-led ICU diaries represent a feasible and effective supportive intervention that can improve short-term psychological outcomes in liver transplant recipients during postoperative ICU care.
Wu JS, Wang CY, Wang BY, Wang BC, Tsai PC. Effects of nurse-led intensive care unit diaries on emotional distress in patients undergoing liver transplantation: A randomized controlled trial. Intensive Crit Care Nurs. 2026 May 30;95:104461. doi: 10.1016/j.iccn.2026.104461
Diaries after Brain Injury
Severe traumatic brain injury requiring intensive care treatment can have profound consequences for both survivors and their family members. This study explored the significance of nurse-written ICU diaries for individuals with severe traumatic brain injury and their relatives following an intensive care unit stay. The research question was how a nurse-written ICU diary influences patients’ and family members’ processing of the illness experience and their shared coping with the situation. Högvall et al. (2026) conducted an exploratory qualitative single-centre study. Nine survivors of severe traumatic brain injury and ten family caregivers participated in dyadic interviews. The data were analysed using the interpretive description methodology. The findings showed that the ICU diary played an important role in filling memory gaps and helping participants make sense of a period that was often only partially remembered. For many patients, the diary served as a trustworthy source of information that helped them understand the severity of their illness and the actual course of treatment. Family members reported that the diary facilitated conversations about the illness, promoted a shared understanding of the situation, and helped align expectations regarding recovery. In addition, the diary conveyed a sense of personalised and compassionate care and contributed to making the intensive care experience appear more human and understandable. Although reading the diary sometimes evoked distressing emotions and reminded participants of a difficult period, the overall experience was perceived positively. The authors concluded that nurse-written ICU diaries can support the reconstruction of the illness narrative, facilitate communication within families, and contribute to the development of a shared understanding of the illness trajectory.
Högvall LM, Herling SF, Egerod I, Rustøen T, Berntzen H. Creating a shared narrative: A qualitative study on the impact of nurse-written ICU diaries for TBI-survivors and their family caregivers. Neuropsychol Rehabil. 2026 Jun 4:1-21.
Implementation of Digital Diaries
Digital intensive care unit (ICU) diaries are increasingly used to support psychological recovery and family engagement following critical illness. The research question was how a digital ICU diary can be successfully implemented in routine clinical practice and which contextual factors influence its uptake and sustainability. Schol et al. (2026) conducted a multicentre mixed-methods implementation study across four adult ICUs in the Netherlands. Data were collected through usage metrics, questionnaires, and semi-structured interviews with ICU nurses and implementation champions to evaluate adoption, engagement, normalisation, fidelity of use, and implementation processes. The study included 159 ICU professionals and demonstrated considerable variation in implementation success between hospitals. The median e-diary activation rate among eligible patients was 22.6%, while adoption and normalisation scores were generally positive. Successful implementation was associated with engaged champions, effective training, regular reminders, leadership support, and prior experience with paper diaries. Barriers included workload, staff resistance, limited follow-up, and competing clinical priorities. Hospitals with strong champion involvement and supportive team cultures achieved higher uptake and more consistent use. The authors concluded that successful implementation of digital ICU diaries depends not only on the technology itself but also on organisational, cultural, and leadership factors.
Schol CMA, Ista E, van Son-Kemmeren W, Rinket M, Berger E, Gommers DAMPJ, van Mol MMC. More Than a Tool: How Context Shapes the Implementation of Digital Diaries in the Intensive Care Unit. Nurs Crit Care. 2026 May;31(3):e70517.
RELATED STUDIES
Some titles were taken from the newsletters of @ICURehab Newsletter by Dale M. Needham and Critical Care Reviews by Rob Mac Sweeney, and of course our own searches.
Well-being: Bodet-Contentin et al. (2026) developed and validated a brief four-item scale to assess well-being and feelings of safety among intensive care patients. The instrument represents a practical tool for measuring patient-centred outcomes and may contribute to the humanisation of intensive care. Bodet-Contentin et al. (2026), France. Link
Rehabilitation: Johnson et al. (2026) describe an AI-supported, person-centred follow-up care concept that uses individually tailored summaries of the ICU stay to facilitate the processing of critical illness experiences, improve understanding of the intensive care journey, and support long-term recovery. The framework is guided by principles such as transparency, co-design, equity, cultural sensitivity, and the ethical use of artificial intelligence. Johnson et al. (2026). Link
Waiting: In a study involving 17 family members, supplemented by observations of 39 relatives, waiting in the intensive care environment was described as an emotionally demanding and active process characterised by uncertainty, individual coping strategies, and the importance of both physical surroundings and social contexts. Qualitative study by Rennet et al. (2026), France. Link
Bereavement: Among 22 relatives of patients who died in intensive care, end-of-life experiences were characterised by anxiety, uncertainty, and difficulties in understanding the situation. Clear communication and the opportunity for a meaningful farewell were identified as central factors supporting emotional processing and coping. Qualitative study by Palmryd et al. (2026), Sweden. Link
Weaning: In a qualitative study involving eight family members of intensive care patients, participation in the weaning process—particularly through presence, touch, and communication—was found to promote meaning, hope, and inner strength. The findings highlight the importance of person-centred involvement of family members as active partners in care. Qualitative study by Tinksvik et al. (2026), Sweden. Link
Coping Strategies: In this qualitative study, 11 former ICU patients who had spent more than seven days in intensive care described their experiences and coping strategies following critical illness. Six key themes emerged: (1) no longer being the same person, (2) the social environment as both a source of support and burden, (3) coping with memory gaps, (4) recognising personal progress, (5) managing setbacks and finding motivation, and (6) accepting what cannot be understood or changed. Qualitative study by Ruch et al. (2026), Switzerland. Link
PICS: Physical impairments associated with Post-Intensive Care Syndrome (PICS) frequently persist long after discharge and are associated with increased mortality and reduced quality of life, while early mobilisation and individualised risk stratification represent key preventive strategies. Herman et al. (2026). Link
Burn Injury and PICS: This review highlights the transition from acute burn injury to persistent metabolic, immunological, physical, and psychological impairments, emphasising the overlap between persistent critical illness and Post-Intensive Care Syndrome in survivors of severe burns. Berger et al. (2026). Link
Social Frailty: In a multicentre qualitative study involving 44 participants, including 27 sepsis survivors, 6 family members, and 11 healthcare professionals from the United Kingdom, social frailty emerged as an important consequence of critical illness, characterised by financial insecurity, restricted social interactions, treatment-related burdens, and family and social challenges. Social frailty was negatively associated with both physical and psychological outcomes, raising the question of whether it represents an additional dimension of Post-Intensive Care Syndrome. Qualitative multicentre study by McPeake et al. (2026), United Kingdom. Link
Cognitive Rehabilitation: In a systematic review of 27 studies, the following interventions were identified as promising approaches to cognitive rehabilitation after critical illness: orientation and multisensory stimulation, activities of daily living (ADL)-focused occupational therapy, early mobilisation and physical training, as well as music-based and virtual reality interventions. Systematic review by Lassen et al. (2026). Link
Cognitive Rehabilitation II: In a five-arm randomised feasibility trial involving 83 of 1,679 screened ICU patients, the ICU CogHab cognitive rehabilitation programme demonstrated limited feasibility, characterised by low recruitment rates, a 40% follow-up rate at six months, and variable data completeness. The study highlights the challenges of conducting complex rehabilitation research in critically ill populations. Randomised feasibility study by Astrup et al. (2026), Denmark. Link
Visiting Hours: In a retrospective study of 264 critically ill ICU patients, an open visiting policy (24-hour access) was associated with significantly lower delirium rates (11.4% vs. 25.8%), shorter durations of mechanical ventilation and ICU stay, reduced anxiety levels, and improved treatment adherence compared with restricted visiting hours (0.5–1 hour per day). Although the findings are encouraging, the retrospective design introduces important methodological limitations. Retrospective study by Xu et al. (2026), China. Link
Voices for Reorientation: In a systematic review and meta-analysis of seven randomised studies involving 582 ICU patients, family voice interventions significantly reduced the incidence of delirium compared with usual care (OR 0.39, 95% CI 0.26–0.58) and shortened delirium duration by approximately one day. These findings support the use of recorded family voices as a simple and effective non-pharmacological intervention to promote orientation and prevent delirium in critically ill patients. Systematic review and meta-analysis by Peschel et al. (2026). Link
The Prayer Tree: Ashcraft et al. (2026) describe a “Prayer Tree” located in a garden adjacent to the intensive care unit, which provides family members and healthcare professionals with a meaningful opportunity to express emotional, spiritual, and personal hopes and wishes, thereby supporting holistic and compassionate care. Descriptive report from the United States. Link
Communication: Ahsana et al. (2026) emphasise that communication remains a cornerstone of intensive care practice for patients, families, and healthcare teams, while simultaneously evolving in response to ongoing technological, societal, and healthcare-related changes. Expert statement. Link
Digital Communication: In a systematic review of 54 studies from 19 countries, digital communication interventions in intensive care, particularly virtual visits, significantly improved family satisfaction (SMD 0.76, 95% CI 0.45–1.06). Although quantitative effects on patient anxiety and depression were not significant, qualitative findings suggested reduced emotional burden and enhanced family involvement in care. Systematic review by Oh et al. (2026). Link
PAEDIATRIC STUDIES
Paediatric Visiting Policies: In a survey of 59 paediatric intensive care units in Türkiye, 78% of units allowed one parent to remain with a non-intubated child for 24 hours a day; however, 91.5% maintained other restrictive visiting policies, 67.8% prohibited sibling visits, and no unit permitted family presence during invasive procedures or cardiopulmonary resuscitation. Survey study by Emeksiz et al. (2026). Link
Family-Centered Care in the PICU: This systematic review summarized parents’ perceptions of family-centered care (FCC) in the pediatric intensive care unit. 25 qualitative studies were included and synthesized into 6 key findings, supporting a successful implementation of FCC: (1) Emotional support, assistance, and care provided by the team, (2) Changes in the parental role, presence, and care of the child, (3) Reliability of the team, (4) Stay in the pediatric intensive care unit, influence of the physical environment, and lack of privacy, (5) Information received and involvement in decision-making, and (6) The team’s approach to making parents feel welcome and respected regarding their needs, beliefs, and culture. Lessa et al (2026) Link
End-of-Life Care: The Society of Critical Care’s multidisciplinary panel developed questions relevant to end-of-life care in the intensive care unit and addressed them through a systematic review. From this, five recommendations were derived for the care of dying children in neonatal and pediatric intensive care units: The implementation of advance care planning, (2) Integration of palliative care, (3) a systematic approach to symptom assessment and management, (4) palliative care training for the treating team, (5) implementation of a grieving support during and after death, and (6) active engagement with the unequal care received by marginalized groups. Derrington et al (2026) Link
Parental Presence During Invasive Procedures: In this study, 22 parents were interviewed in semi-structured interviews about their experiences with being present during their children’s invasive procedures in the intensive care unit. The parents viewed their presence as essential to fulfilling their role as caregivers, providing comfort to their children, and strengthening emotional bonds. They expressed a desire to be present, despite the emotional stress. They identified the following key needs: receiving clear information, receiving emotional support, having the freedom to decide for themselves whether they wanted to be present, and having a private and safe environment. Expósito et al (2026) Link
Did We Miss a Study?
We cannot review and summarize every study. If we have overlooked an important one, please send us a short summary and a reference via email, and we will gladly include it in the newsletter!
Stay healthy!
Chu-Won, Dominik, Kristin, Maria & Peter
Dr. Chu-Won Sim, M.Sc. – Psychologist, Department of Pediatric Cardiology, German Heart Center of Charité (DHZC), Berlin, Germany
Dominik Stark, CCRN, University Hospital OWL, Bethel, Bielefeld
Ella Peschel, RN BSc., Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
Kristin Gabriel, Media Scientist, Art Historian, and Yoga Instructor, Berlin
Maria Brauchle, CCRN, Nursing School Vorarlberg, Feldkirch, Austria
PD Dr. Peter Nydahl, RN BScN MScN – Nursing Research, University Hospital Schleswig-Holstein, Kiel, Germany