Newsletter December 2025
01/12/25 09:08 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.
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, Kristin, Manuel, Maria, and Peter
ICU DIARIES
Nurse-written Diaries
This study addresses the role of nurse-written intensive care unit (ICU) diaries in supporting communication and emotional understanding during critical illness. It asks how nurses use these diaries and which thematic elements characterise their entries. Bosco et al. (2024) conducted a qualitative study using interpretative narrative methodology to analyse 13 ICU diaries written by 28 nurses. The authors identified two central themes: simplifying the ICU experience and focusing on nonverbal communication. Nurses used non-technical, reassuring language and second-person narration to make procedures more understandable and to reduce fear. They also documented patients’ nonverbal cues—such as facial expressions and body tension—to interpret needs and emotions when speech was impaired. Both strategies aimed to humanise care and strengthen the nurse–patient relationship. Limitations include the single-country setting and the exclusive focus on nurse-authored diaries, which may restrict transferability and omit perspectives from families or other professionals. The authors conclude that nurse-written diaries can clarify complex clinical experiences and enhance emotional support, although effects on patient outcomes were not directly measured. Its significance lies in highlighting how structured, compassionate communication tools may aid recovery and mitigate elements of post-intensive care syndrome.
Bosco V, Mercuri C, Giordano V, Froio AM, Commisso D, Nocerino R, Guillari A, Rea T, Mastrangelo H, Uchmanowicz I, Simeone S. Enhancing ICU care with nurse-written diaries. Nurs Crit Care. 2024 Nov;29(6):1355-1362 https://pubmed.ncbi.nlm.nih.gov/39308054/
There is a short communication about this publication
Letter by Deng et al. https://pubmed.ncbi.nlm.nih.gov/40485131/
Response by Bosco et al https://pubmed.ncbi.nlm.nih.gov/40631507/
Thematic analysis of diaries
There might be some heterogeneity in the content of written ICU diaries. Kredentser et al. (2025) conducted a secondary qualitative analysis of 30 diaries from a Canadian pilot randomized controlled trial explored how intensive care unit (ICU) diaries are written and which thematic elements characterise their content. It addresses the research question of what patients, families and staff document in ICU diaries and how these entries function during critical illness. Using reflexive thematic analysis, the authors identified three overarching themes: connection, information provision and coping. Connection was evident in staff entries emphasising personhood, empathy and personal investment, while family members used the diaries to maintain closeness with the patient and communicate with relatives. Information provision included timelines, explanations of procedures and recovery updates, communicated clearly and in accessible language. Coping emerged as a major theme, with families expressing hope, fear and gratitude, using humour, or turning to spirituality. There are some limitations including the small sample, single-centre North American setting, variation in diary length, and the historical context (2014–2016), which limits generalisability. Staff–patient ratios and pre-pandemic conditions may also have influenced diary use. After all, ICU diaries foster human connection, support communication and may help families manage emotional burden. Its significance lies in offering a structured understanding of diary content and supporting future implementation.
Kredentser MS, Reynolds K, Marten N, Blouw M, Sareen J, Olafson K. A Thematic Analysis of Intensive Care Unit Diaries Content. Nurs Crit Care. 2025 Jul;30(4):e70107. doi: 10.1111/nicc.70107 https://pubmed.ncbi.nlm.nih.gov/40671371/
Implementing e-Diaries
Electronical ICU diaries are an emerging topic, but implementation remain challenging. Rose et al. (2025) investigated whether implementing an electronic intensive care unit (ICU) diary is feasible, acceptable, and sustainable in routine clinical practice. The authors conducted a multi-method service evaluation in four ICUs across two UK hospitals, examining diary uptake, staff perceptions, and sustained use over two years. During implementation, commencement rates increased from a 20% baseline (paper diaries) to a mean of 65%, with 380 patients receiving e-diaries and 1,242 entries recorded. Nurses wrote most entries, while families contributed nearly a quarter - enabled by remote access. Staff rated the e-diary as easy to access and generally feasible, highlighting facilitators such as legibility, reduced risk of diary loss, environmental benefits, and enhanced family participation. Barriers included login requirements, need for training, digital literacy challenges, and the inability to include drawings or images. Sustained use stabilised at moderate levels (mean 45.6%). The authors conclude that e-diaries are a viable alternative to paper diaries, provided implementation challenges are addressed.
Rose L, Welch A, Okelana K, Hassan F, Apps C, Brooks K, Law E, Slack A, Susser K, Meyer J. Implementation and sustainability of an innovative ICU e-diary. Intensive Crit Care Nurs. 2025 Nov 8;93:104266. doi: 10.1016/j.iccn.2025.104266 https://pubmed.ncbi.nlm.nih.gov/41206985/
Implementing Diaries
This study examines how digital intensive care unit (ICU) diaries can be effectively implemented in routine care and identifies the strategies needed to achieve sustainable adoption. Schol et al. (2025) developed a comprehensive implementation guide using Implementation Mapping, translating evidence, behavioural theory and stakeholder insights into practical recommendations for ICU teams. Major recommendations include prioritising knowledge-building through structured education, using kickoff training, interactive workshops, short instructional videos, demonstrations and accessible written materials. The guide emphasises guided practice with hands-on sessions, role-play and repeated demonstrations. It recommends strong involvement of trained champions, who model diary use, address resistance, promote the diary daily and deliver ongoing support. The authors advise creating a supportive culture by involving team leaders, sharing positive testimonials and integrating diary use into start- and end-of-shift routines. The guide also recommends technical facilitation, including single sign-on access, integration into existing workflows and automated reminders, and advises providing monthly feedback on diary activations and staff contributions. These recommendations form a structured, locally adaptable blueprint to help ICUs introduce digital diaries systematically. The guide might improve staff engagement and establish a reliable diary use, supporting communication and reducing the psychological burden associated with post-intensive care syndrome.
Schol CMA, van Mol MMC, Ista E. Developing implementation strategies for digital ICU diaries targeting ICU professionals: an implementation mapping approach. Implement Sci Commun. 2025 Aug 7;6(1):85. doi: 10.1186/s43058-025-00767-0 https://pubmed.ncbi.nlm.nih.gov/40775358/
Umbrella Review
Zuo et al. (2025) conducted an overview of 15 SRs/MAs assessing patient and relative outcomes using AMSTAR 2, PRISMA 2020 and GRADE. Findings across reviews indicate that ICU diaries consistently reduce PTSD, anxiety and depressive symptoms in patients and improve quality of life. Effects on relatives are less certain: some reviews suggest benefits for PTSD, while anxiety and depression outcomes remain unchanged. Evidence quality, however, is weak. All 15 SRs/MAs were rated “critically low” by AMSTAR 2, with common problems including absent protocol registration, incomplete search strategies, missing lists of excluded studies, inadequate analysis of heterogeneity and limited assessment of publication bias. GRADE ratings confirmed the fragility of the evidence base: none of the outcomes were supported by high-quality evidence, only two by moderate-quality evidence, and the majority by low levels. The authors recommend stricter methodological standards, standardised outcome measures and improved reporting structures to strengthen future diary research. The findings highlight the potential value of ICU diaries for patient recovery while underlining the need for robust evidence to guide post-intensive care syndrome interventions.
Zuo J, Li J, Cai L, Zhen H, Xu Y, Sun T, Ye X. The Effect of ICU Diaries on Psychological Outcomes and Quality of Life of Patients and Relatives: Overview of Systematic Reviews. J Clin Nurs. 2025 Nov;34(11):4899-4914. doi: 10.1111/jocn.17832. https://pubmed.ncbi.nlm.nih.gov/40464287/
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.
PICS: Assessment time points in PICS research, analysed across 657 studies, showed substantial discrepancies between current practice (most common reference point: hospital discharge, 40%) and expert recommendations (preferred: ICU discharge, 47%). Experts propose standardisation using three assessments between 6 and 12 months. Scoping review and online survey by Tanaka et al. (2025). Link https://doi.org/10.1186/s40560-025-00817-8
Aftercare: Reunions between intensive care survivors and staff promote staff well-being and enhance care through humanisation, improved decision-making, and quality improvements. Qualitative study by Malyon et al. (2025) from Australia. Link https://www.sciencedirect.com/science/article/pii/S0964339725002745?via%3Dihub
Quality of Life: In a systematic review and meta-analysis including 65 studies and 17,298 intensive care survivors, key factors influencing quality of life were identified, most notably higher age, female sex, and longer ICU length of stay and duration of mechanical ventilation. Overall, survivors’ quality of life was found to be at a moderate level, with the physical domain more impaired than the psychological domain. Jiang et al. (2025). Link https://pubmed.ncbi.nlm.nih.gov/40662879/
Outcomes by Clusters: In a prospective cohort study (MONITOR-IC) involving 2,361 intensive care survivors, with external validation in an additional 866 patients, four clusters were identified that differed clearly in their physical, psychological, cognitive, and quality-of-life outcomes one year after ICU treatment, based on a combination of clinical and non-clinical characteristics. Cluster A (n = 204): patients with good pre-ICU health status, high illness severity, low Glasgow Coma Scale scores, and long ICU length of stay, who demonstrated functional decline but still reported relatively high quality of life at one year. Cluster B (n = 877): patients with good pre-ICU health status and lower illness severity at admission, who showed the best physical, mental, and cognitive outcomes. Cluster C (n = 632): younger, predominantly female patients with moderate pre- and post-ICU limitations, who experienced persistent impairments after one year. Cluster D (n = 648): patients with lower educational levels and poor pre-ICU health status, who remained highly impaired at one year, although they showed improvement compared with baseline. The findings indicate that multidimensional clustering beyond diagnostic categories more accurately reflects patient-centred long-term outcomes than disease-based classifications alone. Porter et al. (2025) from the Netherlands. Link. https://link.springer.com/article/10.1007/s00134-025-08052-3
Symptom Burden: A multicentre cohort study demonstrated that among 175 intensive care patients with a high symptom burden during their stay, there was a markedly increased risk of physical, cognitive, and psychological impairments three months after admission. The findings highlight the importance of early interventions to reduce long-term PICS-related burdens. Saltnes-Lillegard et al. (2025) from Norway. Link https://link.springer.com/article/10.1007/s00134-025-07995-x
Psychological Distress in Family Members After Intensive Care (PICS-F): In a cross-sectional study involving 487 family members of intensive care patients in China, post-traumatic stress disorder (PTSD), anxiety, and depression were examined as core symptoms of Post-Intensive-Care Syndrome – Family (PICS-F). Using network analysis, the study demonstrated how closely these symptoms are interconnected. Approximately one quarter of participants showed symptoms of PTSD, and nearly half experienced anxiety or depression. Particularly central were symptoms such as negative thoughts, hyperarousal, restlessness, and difficulty relaxing. These factors acted as “bridges” linking PTSD, anxiety, and depression, thereby increasing the risk of comorbidities. Men more often reported physical tension and fatigue, whereas women more commonly experienced sadness and guilt. The findings emphasise the need for early screening and support for psychological distress among family members of intensive care patients. Targeted interventions focusing on inner restlessness and hyperarousal may help prevent subsequent mental health disorders. Peng et al. (2025). Link. https://www.sciencedirect.com/science/article/abs/pii/S0022395625005333?via%3Dihub
Caregiver Pathway: A structured follow-up guide (Caregiver Pathway) reduced PTSD and anxiety among 101 family members compared with usual care, with the strongest effects observed among relatives of surviving patients. Watland et al. (2025) from Norway. Link https://doi.org/10.1007/s00134-025-08139-x
Family-Centred Care: A group of patients, family members, and intensive care staff developed the key interventions for family- and patient-centred care through a consensus process. The top five were: regular conversations with patients and families about care and goals; ICU diaries; psychological support; a coordinated daily routine; and regular communication with the patient’s primary contact person. Tilburgs et al. (2025). Link https://doi.org/10.1016/j.iccn.2025.104253
PEDIATRIC STUDIES
Diaries for reducing PICS
This study examines how paediatric intensive care unit (PICU) diaries may influence psychological outcomes for children and their parents after critical illness. It addresses the research question of whether a PICU diary intervention is feasible and whether it affects post-intensive care syndrome in children and families (PICS-p/PICS-f). Genna et al. (2025) conducted a non-blinded, single-centre pilot randomized controlled trial in two Italian PICUs. The authors enrolled 119 children, randomising 60 to receive a diary and 59 to usual care. Feasibility benchmarks—such as eligibility, adherence, retention and missing data - were largely met. At one and three months after discharge, parents and children completed validated scales assessing PTSD, anxiety, depression, and behavioural difficulties. No statistically significant differences were found between groups, although at one month parents in the diary group showed a trend towards fewer PTSD symptoms. Parent satisfaction with the diary was high, and qualitative feedback highlighted perceived emotional support and improved communication. Study limitations include its single-centre design, lack of blinding, small sample size and imbalance in baseline characteristics. These factors restrict generalisability and preclude firm conclusions on effectiveness. The authors concludes that a PICU diary trial is feasible and acceptable, supporting the need for larger multicentre trials. Its significance lies in advancing diary-based, family-centred interventions that may help mitigate PICS in paediatric intensive care.
Genna C, Thekkan KR, Cancani F, Di Nardo M, Rossi A, Franci M, Satta T, Chiusolo F, De Ranieri C, Piga S, Tiozzo E, Dall'Oglio I, Cecchetti C, Gawronski O; PICU Diaries Study Group. The impact of the PICU diary on post-intensive care syndrome in children and their parents: A pilot randomized controlled trial. Intensive Crit Care Nurs. 2025 Aug 13;92:104190. doi: 10.1016/j.iccn.2025.104190 https://pubmed.ncbi.nlm.nih.gov/40812125/
OTHER PEDIATRIC STUDIES
PICU Humanisation I: This three-stage Delphi study adapted and validated the first humanisation handbook specifically for paediatric intensive care units, providing a structured and measurable framework that can promote child- and family-centred care and support continuous quality improvement. García-Fernandez et al. from Spain (2024). Link: https://www.sciencedirect.com/science/article/pii/S0964339724001101
PICU Humanisation II: this scoping review examined definitions of child- and family-centred care and identified 40 heterogeneous definitions and 28 models of care, which were developed over time and across different contexts, reflecting the diversity and ongoing evolution of the field. Togo et al. (2025). Link. https://pubmed.ncbi.nlm.nih.gov/40999926/
End-of-Life Care on PICU: This review examines the experiences of end-of-life care for relatives and caregivers in pediatric intensive care units, which take place simultaneously and in parallel. A narrative synthesis of 55 included studies identified seven themes: communication; end-of-life decisions; suffering; preparation for death; at the end of life; after death; and nurse impacts. While the experiences of nursing staff and parents largely coincided, there were some discrepancies between the communication needs of parents and the understanding of nursing staff regarding their role in communication. The authors conclude that improving end-of-life care for children in intensive care units is only possible if it is recognized that relationships and respect for personality are just as important as the correct implementation of clinical procedures. Bloomer et al (2025) Link https://www.sciencedirect.com/science/article/pii/S1036731425002851
PICSp: Psychosocial functioning of children after intensive care stay
With increasing survival rates after a PICU stay, assessing the long-term effects for children is crucial. In a prospective cohort study, 100 children (aged 2–11 years) were compared with a control group six weeks and six months after discharge from the PICU in order to assess psychosocial and adaptive functioning. Parents completed a parent report scale and a questionnaire on the stress they experienced in raising their children. The results showed that children who had been in intensive care had greater psychosocial problems and poorer adaptability up to six months after discharge than children in the control group. Factors such as the number of procedures and parental stress were frequently associated with these impairments. Younger age and length of stay were associated with psychosocial problems six months after discharge. These findings emphasize the need for comprehensive psychological follow-up and the integration of adaptive behavior assessments into the long-term care of children after a PICU stay.
Abdelmageed et al (2025) Link https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-025-06156-9
Palliative Care on NICU
The Belgian study examines the perceptions, experiences, and needs of professionals working in neonatal intensive care units (NICUs) with regard to pediatric palliative care (PPC). Twenty-six complete responses from NICU staff were analyzed from a survey that revealed emotional distress, communication problems, and a need for ethical support and further training. Many found collaboration with a pediatric palliative care center helpful, but some made little use of it. The study recommends greater integration of PPC teams and better training to improve the quality of care and staff well-being.
Brichard et al. (2025) Link https://pubmed.ncbi.nlm.nih.gov/41094695/
Separation of parents and newborns
The ethnographic study examined the effects of separation between parents and newborns after birth, focusing on the psychological, social, and physical implications of these separations. It was conducted in a Danish NICU and included observations and informal interviews with 19 parents whose children required intensive care. The results showed that the first hours in the NICU were often characterized by disjointed rather than consistent care, as nurses focused their attention on the family in a task-oriented manner while parents struggled with the emotional stress of separation. Organizational and structural barriers further complicated reunification and highlighted the need for care models that prioritize closeness, family bonding, and minimal separation. Bjerregaard et al (2025) Link https://bmjopen.bmj.com/content/15/11/e105199.long
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, Kristin, Manuel, Maria & Peter
Dr. Chu-Won Sim, M.Sc. – Psychologist, Department of Pediatric Cardiology, German Heart Center of Charité (DHZC), Berlin, Germany
Kristin Gabriel – Media Scientist, Art Historian, and Yoga Instructor, Berlin
Manuel Köpper, M.Sc. – Psychologist, Pediatric Intensive Care Unit, University Hospital Tübingen, Germany
Maria Brauchle, GKP – 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.
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, Kristin, Manuel, Maria, and Peter
ICU DIARIES
Nurse-written Diaries
This study addresses the role of nurse-written intensive care unit (ICU) diaries in supporting communication and emotional understanding during critical illness. It asks how nurses use these diaries and which thematic elements characterise their entries. Bosco et al. (2024) conducted a qualitative study using interpretative narrative methodology to analyse 13 ICU diaries written by 28 nurses. The authors identified two central themes: simplifying the ICU experience and focusing on nonverbal communication. Nurses used non-technical, reassuring language and second-person narration to make procedures more understandable and to reduce fear. They also documented patients’ nonverbal cues—such as facial expressions and body tension—to interpret needs and emotions when speech was impaired. Both strategies aimed to humanise care and strengthen the nurse–patient relationship. Limitations include the single-country setting and the exclusive focus on nurse-authored diaries, which may restrict transferability and omit perspectives from families or other professionals. The authors conclude that nurse-written diaries can clarify complex clinical experiences and enhance emotional support, although effects on patient outcomes were not directly measured. Its significance lies in highlighting how structured, compassionate communication tools may aid recovery and mitigate elements of post-intensive care syndrome.
Bosco V, Mercuri C, Giordano V, Froio AM, Commisso D, Nocerino R, Guillari A, Rea T, Mastrangelo H, Uchmanowicz I, Simeone S. Enhancing ICU care with nurse-written diaries. Nurs Crit Care. 2024 Nov;29(6):1355-1362 https://pubmed.ncbi.nlm.nih.gov/39308054/
There is a short communication about this publication
Letter by Deng et al. https://pubmed.ncbi.nlm.nih.gov/40485131/
Response by Bosco et al https://pubmed.ncbi.nlm.nih.gov/40631507/
Thematic analysis of diaries
There might be some heterogeneity in the content of written ICU diaries. Kredentser et al. (2025) conducted a secondary qualitative analysis of 30 diaries from a Canadian pilot randomized controlled trial explored how intensive care unit (ICU) diaries are written and which thematic elements characterise their content. It addresses the research question of what patients, families and staff document in ICU diaries and how these entries function during critical illness. Using reflexive thematic analysis, the authors identified three overarching themes: connection, information provision and coping. Connection was evident in staff entries emphasising personhood, empathy and personal investment, while family members used the diaries to maintain closeness with the patient and communicate with relatives. Information provision included timelines, explanations of procedures and recovery updates, communicated clearly and in accessible language. Coping emerged as a major theme, with families expressing hope, fear and gratitude, using humour, or turning to spirituality. There are some limitations including the small sample, single-centre North American setting, variation in diary length, and the historical context (2014–2016), which limits generalisability. Staff–patient ratios and pre-pandemic conditions may also have influenced diary use. After all, ICU diaries foster human connection, support communication and may help families manage emotional burden. Its significance lies in offering a structured understanding of diary content and supporting future implementation.
Kredentser MS, Reynolds K, Marten N, Blouw M, Sareen J, Olafson K. A Thematic Analysis of Intensive Care Unit Diaries Content. Nurs Crit Care. 2025 Jul;30(4):e70107. doi: 10.1111/nicc.70107 https://pubmed.ncbi.nlm.nih.gov/40671371/
Implementing e-Diaries
Electronical ICU diaries are an emerging topic, but implementation remain challenging. Rose et al. (2025) investigated whether implementing an electronic intensive care unit (ICU) diary is feasible, acceptable, and sustainable in routine clinical practice. The authors conducted a multi-method service evaluation in four ICUs across two UK hospitals, examining diary uptake, staff perceptions, and sustained use over two years. During implementation, commencement rates increased from a 20% baseline (paper diaries) to a mean of 65%, with 380 patients receiving e-diaries and 1,242 entries recorded. Nurses wrote most entries, while families contributed nearly a quarter - enabled by remote access. Staff rated the e-diary as easy to access and generally feasible, highlighting facilitators such as legibility, reduced risk of diary loss, environmental benefits, and enhanced family participation. Barriers included login requirements, need for training, digital literacy challenges, and the inability to include drawings or images. Sustained use stabilised at moderate levels (mean 45.6%). The authors conclude that e-diaries are a viable alternative to paper diaries, provided implementation challenges are addressed.
Rose L, Welch A, Okelana K, Hassan F, Apps C, Brooks K, Law E, Slack A, Susser K, Meyer J. Implementation and sustainability of an innovative ICU e-diary. Intensive Crit Care Nurs. 2025 Nov 8;93:104266. doi: 10.1016/j.iccn.2025.104266 https://pubmed.ncbi.nlm.nih.gov/41206985/
Implementing Diaries
This study examines how digital intensive care unit (ICU) diaries can be effectively implemented in routine care and identifies the strategies needed to achieve sustainable adoption. Schol et al. (2025) developed a comprehensive implementation guide using Implementation Mapping, translating evidence, behavioural theory and stakeholder insights into practical recommendations for ICU teams. Major recommendations include prioritising knowledge-building through structured education, using kickoff training, interactive workshops, short instructional videos, demonstrations and accessible written materials. The guide emphasises guided practice with hands-on sessions, role-play and repeated demonstrations. It recommends strong involvement of trained champions, who model diary use, address resistance, promote the diary daily and deliver ongoing support. The authors advise creating a supportive culture by involving team leaders, sharing positive testimonials and integrating diary use into start- and end-of-shift routines. The guide also recommends technical facilitation, including single sign-on access, integration into existing workflows and automated reminders, and advises providing monthly feedback on diary activations and staff contributions. These recommendations form a structured, locally adaptable blueprint to help ICUs introduce digital diaries systematically. The guide might improve staff engagement and establish a reliable diary use, supporting communication and reducing the psychological burden associated with post-intensive care syndrome.
Schol CMA, van Mol MMC, Ista E. Developing implementation strategies for digital ICU diaries targeting ICU professionals: an implementation mapping approach. Implement Sci Commun. 2025 Aug 7;6(1):85. doi: 10.1186/s43058-025-00767-0 https://pubmed.ncbi.nlm.nih.gov/40775358/
Umbrella Review
Zuo et al. (2025) conducted an overview of 15 SRs/MAs assessing patient and relative outcomes using AMSTAR 2, PRISMA 2020 and GRADE. Findings across reviews indicate that ICU diaries consistently reduce PTSD, anxiety and depressive symptoms in patients and improve quality of life. Effects on relatives are less certain: some reviews suggest benefits for PTSD, while anxiety and depression outcomes remain unchanged. Evidence quality, however, is weak. All 15 SRs/MAs were rated “critically low” by AMSTAR 2, with common problems including absent protocol registration, incomplete search strategies, missing lists of excluded studies, inadequate analysis of heterogeneity and limited assessment of publication bias. GRADE ratings confirmed the fragility of the evidence base: none of the outcomes were supported by high-quality evidence, only two by moderate-quality evidence, and the majority by low levels. The authors recommend stricter methodological standards, standardised outcome measures and improved reporting structures to strengthen future diary research. The findings highlight the potential value of ICU diaries for patient recovery while underlining the need for robust evidence to guide post-intensive care syndrome interventions.
Zuo J, Li J, Cai L, Zhen H, Xu Y, Sun T, Ye X. The Effect of ICU Diaries on Psychological Outcomes and Quality of Life of Patients and Relatives: Overview of Systematic Reviews. J Clin Nurs. 2025 Nov;34(11):4899-4914. doi: 10.1111/jocn.17832. https://pubmed.ncbi.nlm.nih.gov/40464287/
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.
PICS: Assessment time points in PICS research, analysed across 657 studies, showed substantial discrepancies between current practice (most common reference point: hospital discharge, 40%) and expert recommendations (preferred: ICU discharge, 47%). Experts propose standardisation using three assessments between 6 and 12 months. Scoping review and online survey by Tanaka et al. (2025). Link https://doi.org/10.1186/s40560-025-00817-8
Aftercare: Reunions between intensive care survivors and staff promote staff well-being and enhance care through humanisation, improved decision-making, and quality improvements. Qualitative study by Malyon et al. (2025) from Australia. Link https://www.sciencedirect.com/science/article/pii/S0964339725002745?via%3Dihub
Quality of Life: In a systematic review and meta-analysis including 65 studies and 17,298 intensive care survivors, key factors influencing quality of life were identified, most notably higher age, female sex, and longer ICU length of stay and duration of mechanical ventilation. Overall, survivors’ quality of life was found to be at a moderate level, with the physical domain more impaired than the psychological domain. Jiang et al. (2025). Link https://pubmed.ncbi.nlm.nih.gov/40662879/
Outcomes by Clusters: In a prospective cohort study (MONITOR-IC) involving 2,361 intensive care survivors, with external validation in an additional 866 patients, four clusters were identified that differed clearly in their physical, psychological, cognitive, and quality-of-life outcomes one year after ICU treatment, based on a combination of clinical and non-clinical characteristics. Cluster A (n = 204): patients with good pre-ICU health status, high illness severity, low Glasgow Coma Scale scores, and long ICU length of stay, who demonstrated functional decline but still reported relatively high quality of life at one year. Cluster B (n = 877): patients with good pre-ICU health status and lower illness severity at admission, who showed the best physical, mental, and cognitive outcomes. Cluster C (n = 632): younger, predominantly female patients with moderate pre- and post-ICU limitations, who experienced persistent impairments after one year. Cluster D (n = 648): patients with lower educational levels and poor pre-ICU health status, who remained highly impaired at one year, although they showed improvement compared with baseline. The findings indicate that multidimensional clustering beyond diagnostic categories more accurately reflects patient-centred long-term outcomes than disease-based classifications alone. Porter et al. (2025) from the Netherlands. Link. https://link.springer.com/article/10.1007/s00134-025-08052-3
Symptom Burden: A multicentre cohort study demonstrated that among 175 intensive care patients with a high symptom burden during their stay, there was a markedly increased risk of physical, cognitive, and psychological impairments three months after admission. The findings highlight the importance of early interventions to reduce long-term PICS-related burdens. Saltnes-Lillegard et al. (2025) from Norway. Link https://link.springer.com/article/10.1007/s00134-025-07995-x
Psychological Distress in Family Members After Intensive Care (PICS-F): In a cross-sectional study involving 487 family members of intensive care patients in China, post-traumatic stress disorder (PTSD), anxiety, and depression were examined as core symptoms of Post-Intensive-Care Syndrome – Family (PICS-F). Using network analysis, the study demonstrated how closely these symptoms are interconnected. Approximately one quarter of participants showed symptoms of PTSD, and nearly half experienced anxiety or depression. Particularly central were symptoms such as negative thoughts, hyperarousal, restlessness, and difficulty relaxing. These factors acted as “bridges” linking PTSD, anxiety, and depression, thereby increasing the risk of comorbidities. Men more often reported physical tension and fatigue, whereas women more commonly experienced sadness and guilt. The findings emphasise the need for early screening and support for psychological distress among family members of intensive care patients. Targeted interventions focusing on inner restlessness and hyperarousal may help prevent subsequent mental health disorders. Peng et al. (2025). Link. https://www.sciencedirect.com/science/article/abs/pii/S0022395625005333?via%3Dihub
Caregiver Pathway: A structured follow-up guide (Caregiver Pathway) reduced PTSD and anxiety among 101 family members compared with usual care, with the strongest effects observed among relatives of surviving patients. Watland et al. (2025) from Norway. Link https://doi.org/10.1007/s00134-025-08139-x
Family-Centred Care: A group of patients, family members, and intensive care staff developed the key interventions for family- and patient-centred care through a consensus process. The top five were: regular conversations with patients and families about care and goals; ICU diaries; psychological support; a coordinated daily routine; and regular communication with the patient’s primary contact person. Tilburgs et al. (2025). Link https://doi.org/10.1016/j.iccn.2025.104253
PEDIATRIC STUDIES
Diaries for reducing PICS
This study examines how paediatric intensive care unit (PICU) diaries may influence psychological outcomes for children and their parents after critical illness. It addresses the research question of whether a PICU diary intervention is feasible and whether it affects post-intensive care syndrome in children and families (PICS-p/PICS-f). Genna et al. (2025) conducted a non-blinded, single-centre pilot randomized controlled trial in two Italian PICUs. The authors enrolled 119 children, randomising 60 to receive a diary and 59 to usual care. Feasibility benchmarks—such as eligibility, adherence, retention and missing data - were largely met. At one and three months after discharge, parents and children completed validated scales assessing PTSD, anxiety, depression, and behavioural difficulties. No statistically significant differences were found between groups, although at one month parents in the diary group showed a trend towards fewer PTSD symptoms. Parent satisfaction with the diary was high, and qualitative feedback highlighted perceived emotional support and improved communication. Study limitations include its single-centre design, lack of blinding, small sample size and imbalance in baseline characteristics. These factors restrict generalisability and preclude firm conclusions on effectiveness. The authors concludes that a PICU diary trial is feasible and acceptable, supporting the need for larger multicentre trials. Its significance lies in advancing diary-based, family-centred interventions that may help mitigate PICS in paediatric intensive care.
Genna C, Thekkan KR, Cancani F, Di Nardo M, Rossi A, Franci M, Satta T, Chiusolo F, De Ranieri C, Piga S, Tiozzo E, Dall'Oglio I, Cecchetti C, Gawronski O; PICU Diaries Study Group. The impact of the PICU diary on post-intensive care syndrome in children and their parents: A pilot randomized controlled trial. Intensive Crit Care Nurs. 2025 Aug 13;92:104190. doi: 10.1016/j.iccn.2025.104190 https://pubmed.ncbi.nlm.nih.gov/40812125/
OTHER PEDIATRIC STUDIES
PICU Humanisation I: This three-stage Delphi study adapted and validated the first humanisation handbook specifically for paediatric intensive care units, providing a structured and measurable framework that can promote child- and family-centred care and support continuous quality improvement. García-Fernandez et al. from Spain (2024). Link: https://www.sciencedirect.com/science/article/pii/S0964339724001101
PICU Humanisation II: this scoping review examined definitions of child- and family-centred care and identified 40 heterogeneous definitions and 28 models of care, which were developed over time and across different contexts, reflecting the diversity and ongoing evolution of the field. Togo et al. (2025). Link. https://pubmed.ncbi.nlm.nih.gov/40999926/
End-of-Life Care on PICU: This review examines the experiences of end-of-life care for relatives and caregivers in pediatric intensive care units, which take place simultaneously and in parallel. A narrative synthesis of 55 included studies identified seven themes: communication; end-of-life decisions; suffering; preparation for death; at the end of life; after death; and nurse impacts. While the experiences of nursing staff and parents largely coincided, there were some discrepancies between the communication needs of parents and the understanding of nursing staff regarding their role in communication. The authors conclude that improving end-of-life care for children in intensive care units is only possible if it is recognized that relationships and respect for personality are just as important as the correct implementation of clinical procedures. Bloomer et al (2025) Link https://www.sciencedirect.com/science/article/pii/S1036731425002851
PICSp: Psychosocial functioning of children after intensive care stay
With increasing survival rates after a PICU stay, assessing the long-term effects for children is crucial. In a prospective cohort study, 100 children (aged 2–11 years) were compared with a control group six weeks and six months after discharge from the PICU in order to assess psychosocial and adaptive functioning. Parents completed a parent report scale and a questionnaire on the stress they experienced in raising their children. The results showed that children who had been in intensive care had greater psychosocial problems and poorer adaptability up to six months after discharge than children in the control group. Factors such as the number of procedures and parental stress were frequently associated with these impairments. Younger age and length of stay were associated with psychosocial problems six months after discharge. These findings emphasize the need for comprehensive psychological follow-up and the integration of adaptive behavior assessments into the long-term care of children after a PICU stay.
Abdelmageed et al (2025) Link https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-025-06156-9
Palliative Care on NICU
The Belgian study examines the perceptions, experiences, and needs of professionals working in neonatal intensive care units (NICUs) with regard to pediatric palliative care (PPC). Twenty-six complete responses from NICU staff were analyzed from a survey that revealed emotional distress, communication problems, and a need for ethical support and further training. Many found collaboration with a pediatric palliative care center helpful, but some made little use of it. The study recommends greater integration of PPC teams and better training to improve the quality of care and staff well-being.
Brichard et al. (2025) Link https://pubmed.ncbi.nlm.nih.gov/41094695/
Separation of parents and newborns
The ethnographic study examined the effects of separation between parents and newborns after birth, focusing on the psychological, social, and physical implications of these separations. It was conducted in a Danish NICU and included observations and informal interviews with 19 parents whose children required intensive care. The results showed that the first hours in the NICU were often characterized by disjointed rather than consistent care, as nurses focused their attention on the family in a task-oriented manner while parents struggled with the emotional stress of separation. Organizational and structural barriers further complicated reunification and highlighted the need for care models that prioritize closeness, family bonding, and minimal separation. Bjerregaard et al (2025) Link https://bmjopen.bmj.com/content/15/11/e105199.long
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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, Kristin, Manuel, Maria & Peter
Dr. Chu-Won Sim, M.Sc. – Psychologist, Department of Pediatric Cardiology, German Heart Center of Charité (DHZC), Berlin, Germany
Kristin Gabriel – Media Scientist, Art Historian, and Yoga Instructor, Berlin
Manuel Köpper, M.Sc. – Psychologist, Pediatric Intensive Care Unit, University Hospital Tübingen, Germany
Maria Brauchle, GKP – Nursing School Vorarlberg, Feldkirch, Austria
PD Dr. Peter Nydahl, RN BScN MScN – Nursing Research, University Hospital Schleswig-Holstein, Kiel, Germany