Angela Teece (A.M.Teece@leeds.ac.uk) Trainee Lecturer in Adult Nursing, University of Leeds
Critical care is primarily concerned with curative interventions and the use of technology, and nursing and medical care to maintain life. Patients are frequently sedated for long periods of time that can causes memory loss and unusual perceptual experiences which can make it difficult for survivors to piece together the time they spent in critical care (Samuelson and Corrigan, 2009). The presence of delirium, which occurs in 35-80% of critical care patients (Collinsworth et al., 2016) further complicates recovery. The frequently nightmare dreams are more vivid than fragmented true recollections and can prevent patients developing an illness narrative and understanding the traumatic episode (Jones et al., 2001).
Critical care nurses have a duty to provide rehabilitative care (NICE, 2009). So how can nurses make a positive impact on their patients’ psychological recovery? Patient diaries are increasing in popularity in the UK after originating in Scandinavia. The subject of a recent Cochrane review (Ullman et al., 2015), the evidence base for diaries and guidance for those completing them remains scanty. However, the premise is simple and low cost. Nurses complete entries throughout the patient’s critical care admission, describing events and the environment in layman’s terms. The diary is given to the patient after discharge, often at a follow-up clinic where further support can be accessed. The aim is, simply, to fill in memory gaps and encourage discussion.
What do patients think of their diaries?
‘It was hard… to realise that it was actually about me, and that I could have died’ (Storli and Lind, 2009)
‘It is frustrating not to have all the information about one’s critical illness, and much energy is expended trying to piece information together’ (Engström et al., 2009)
‘It’s fantastic that you’ve gone to the trouble of doing this for me!’ (Storli and Lind, 2009)
Have you written in a patient diary?
Reading:
COLLINSWORTH, A. W., PRIEST, E. L., CAMPBELL, C. R., VASILEVSKIS, E. E. & MASICA, A. L. 2016. A Review of Multifaceted Care Approaches for the Prevention and Mitigation of Delirium in Intensive Care Units. J Intensive Care Med, 31, 127-41.
ENGSTRÖM, A., GRIP, K. & HAMRÉN, M. 2009. Experiences of intensive care unit diaries: ‘touching a tender wound’. Nursing in Critical Care, 14, 61-67.
JONES, C., GRIFFITHS, R. D., HUMPHRIS, G. & SKIRROW, P. M. 2001. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Critical Care Medicine, 29, 573-580 8p.
NICE 2009. Rehabilitation after critical illness. In: HEALTH, D. O. (ed.). London: Department of Health.
SAMUELSON, K. A. M. & CORRIGAN, I. 2009. A nurse-led intensive care after-care programme – development, experiences and preliminary evaluation. Nursing in Critical Care, 14, 254-263.
STORLI, S. L. & LIND, R. 2009. The meaning of follow-up in intensive care: patients’ perspective. Scandinavian Journal of Caring Sciences, 23, 45-56.
ULLMAN, A. J., AITKEN, L. M., RATTRAY, J., KENARDY, J., LE BROCQUE, R., MACGILLIVRAY, S. & HULL, A. M. 2015. Intensive care diaries to promote recovery for patients and families after critical illness: A Cochrane Systematic Review. International Journal of Nursing Studies, 52, 1243-1253.