NEWS
NEWS
Dear friends of the ICU diary
We hope that you are healthy and fine. Here is another Diary-Newsletter. This time we have new diary studies and several other information.
Enjoy!
Teresa and Peter
DIARY STUDIES
A story with gaps: the function of the intensive care diary from the patient's perspective
In a phenomenological analysis, Flahault and colleagues investigate how patients retrospectively describe their stay in the intensive care unit and what role the intensive care diary has for them. A total of 5 former patients were interviewed about their experiences six months after their stay in the intensive care unit. The patients had a rather shorter stay in the intensive care unit (max. 13 days). Based on the diary, they report different experiences. Authors conclude that the intensive care diary is a "paradoxical object". On the one hand, patients avoid reading it due to an overall avoidance of dealing with the stressful aspects of intensive care treatment. On the other hand, it helps them to form a narrative of the illness and to become aware of the support of their relatives. The authors recommend examining the role of diaries on patients and families during patient recovery. Based on an this analysis recommendations should be derived how diaries can get generate to greatest effect to former patients dependent on their individual needs.
Flahault C, Vioulac C, Fasse L, Bailly S, Timsit JF, Garrouste-Orgeas M. "A story with gaps": An interpretative phenomenological analysis of ICU survivors' experience. PLoS One. 2022 Mar 3;17(3):e0264310. doi: 10.1371/journal.pone.0264310.
Implementation and Feasibility of digital diaries in Dutch ICUs during the Pandemic
Intensive care diaries could not be kept together with the relatives during the pandemic due to visiting restrictions. Digital intensive care diaries were therefore kept in three Dutch intensive care units and the experiences of the nurses with these diaries were examined. Haakma and colleagues interviewed a total of 14 nurses who wrote digital diaries in focus groups. During the visiting restrictions, the digital diary was a way of being in touch with the relatives and supporting them by keeping the diary. However, the nurses also noticed that they did not have enough time to write entries. In addition, the user-friendliness of the digital diary was not high enough.
Haakma T, Tieben R, Sleven B, Buise M, van Mol M. Experiences of nurses with an innovative digital diary intervention in the intensive care unit: A qualitative exploration. Intensive Crit Care Nurs. 2022 Jan 25:103197. doi: 10.1016/j.iccn.2022.103197.
Intensive care diaries should be used regularly in everyday clinical practice
In a brief overview, Janssens summarizes the central results of the diary study by Barreto et al (2021). In this systematic review, qualitative data on patient perceptions of ICU diaries were analyzed. Janssens presents the results in a clear manner and names the main points: 1) most patients find the diary helpful. 2) All healthcare professionals and family members should write entries. 3) The diary should document the daily progress of treatment and the emotional involvement of staff and family members. A coherent effective model of the intensive care diary is still lacking. Nevertheless, based on the existing evidence, the diary should definitely be used regularly as an instrument in everyday clinical practice.
Janssens U. PatientInnenwahrnehmung von Intensivtagebüchern. IntensivNews 1 (2022) 22-24
RELATED STUDIES
Patients write diaries in rehab?
After a critical illness, patients often suffer from cognitive disorders such as mnestic deficits. As a physicians in her rehabilitation rotation, Kirsten Martin had the idea of having patients write diaries as a memory strategy. The patients were asked to write three entries per day in order to be able to remember the contents of the therapies and the medical goals for the day. In addition, the therapists continuously checked the patients' metacognition in order to show them the existing deficits and to support the work on cognitive deficits. According to Martin, the diaries were used intensively by the patients and also by the staff and relatives and thus show another area of application for diaries outside the ICU.
Martin K. (2018) Memory Diaries after Delirium. Link
Relatives of patients with COVID-ARDS have a high prevalence of symptoms of PTSD
In a prospective observational study in 23 intensive care units in France, Azoulay et al. analyzed the psychological burden of relatives of patients after C-ARDS and ARDS caused by other reasons. More than 300 former relatives of patients suffering from C-ARDS and about 270 relatives of patients who had suffered from ARDS for other reasons provided information about their mental state after 90 days: relatives of patients suffering from COVID were with them 35% had a significantly higher prevalence of symptoms of PTSD (relatives of patients without C-ARDS 19%) even after adjustment for age, gender and social support. They were often unable to visit the patient (visit in C-ARDS in 35% of cases vs. 88% in non-C-ARDS) and could only be in contact with the intensive care unit by telephone, since video calls were only rarely available. Relatives of patients with C-ARDS have a higher risk of symptoms of PTSD 90 days after the patient's admission to the intensive care unit compared to relatives of patients who have developed ARDS for other reasons.
Azoulay E et al. Association of COVID-19 Acute Respiratory Distress Syndrome With Symptoms of Posttraumatic Stress Disorder in Family Members After ICU Discharge. JAMA. 2022 Feb 18. doi: 10.1001/jama.2022.2017.
Effects of MBSR therapy in patients shortly after ICU transfer: study protocol
Chen and colleagues publish a study protocol with MBSR as psychological support for patients shortly after their ICU stay. MBSR is a mindfulness-based stress reduction technique. The participating patients complete several excercises of MBSR, such as body scan or mindfulness breathing technique. Endpoints are self-reported anxiety and depression. Patients are randomized into an intervention and a control group (RCT). The study is promising, but unfortunately excludes very relevant patient groups due to very narrow inclusion criteria (e.g. no cognitive impairment, no previous mental illness, first intensive care stay). We're excited to see the results.
Chen Y, Wang R, Yu J, Zhu L, Lu Y, Deng X. Effects of MBSR therapy on negative emotions, fatigue, and sleep quality in "post-ICU patients": A randomized controlled clinical trial protocol. Medicine (Baltimore). 2022 Jan 7;101(1):e28331. doi: 10.1097/MD.0000000000028331.
Post-traumatic growth is predicted by social support, gratitude, and resilience
Post-traumatic growth is a possible development that former patients and their relatives can undergo after a potentially traumatizing event. Lin and colleagues investigated which factors predict post-traumatic growth in family members of intensive care patients. 340 families were surveyed using multiple instruments measuring post-traumatic growth, resilience, social support, and hope. A regression model showed that gratitude, resilience and social support predict post-traumatic growth. From this, the authors conclude that coping strategies of relatives should definitely be supported in order to increase their resilience and sense of hope. Post-traumatic growth of families can be encouraged by defined support strategies for families during ICU stay.
Lin Q, Dong F, Xue Y, Yu Q, Ren J, Zeng L. Predictors of posttraumatic growth of the family members of neurosurgical intensive care unit patients: A cross-sectional study. Intensive Crit Care Nurs. 2022 Feb;68:103134. doi: 10.1016/j.iccn.2021.103134.
Humanizing intensive care medicine
In an impressively clear and at the same time differentiated manual, Spanish intensive care physicians (and nurses?) have proposed strategic goals for the humanization of intensive care medicine and give concrete recommendations based on current evidence. Intensive care units can be certified with the implementation of the recommendations. The systematics of the literature research of the manual is not explained here. The recommendations relate to the areas: - Intensive care unit with open doors: presence and involvement of the family - Communication: within the team, with the patient and with the family - Patient well-being: physical, psychological, promoting patient autonomy - Staff support - PICS: Prevention and management of PICS, follow-up - End of life care - Humanized environment: patient privacy, rest areas for families and staff, use of gardens and similar environments. This manual represents a good framework for change processes in every intensive care unit and can serve as a basis for practical models in intensive care units.
Certification work group HU-CI Project. Manual of good practices to humanise intensive care units. Madrid: HU-CI Project; 2019. Link
You are missing a study?
We cannot read and summarize every study. In case, we missed an important study, please email a short summary and reference to us, and we will be happy to include it in the newsletter!
Take care and best wishes
Teresa & Peter
Dr. Teresa Deffner, Dipl.-Rehapsych. (FH), Psychologist in Intensive Care Medicine and pediatric Intensive Care, University Hospital Jena, Germany
Dr. Peter Nydahl, RN BScN MScN, Nursing Research, University Hospital of Schleswig-Holstein, Germany
Digital Diaries, as seen in the study by Haakma, are becoming more and more interesting!
Digital Diaries
Sonntag, 13. März 2022