Newsletter February 2023

Dear friends of the ICU diary
We hope that you are all doing well! In this ICU Diary Newsletter we have summarized for you many studies on diaries and other relevant publications.
Enjoy reading!
Teresa, Kristin, and Peter


Staff perceptions of pediatric diaries
The study by Sansone et al. from Italy explores the staff's perception of the implementation, enablers, and barriers to writing diaries for pediatric patients in the Intensive Care Unit (ICU). The researchers conducted interviews with ICU staff and found that the implementation of diary writing was perceived positively by both staff and families, as it was seen to have a positive impact on patients' mental health. One participant said: "It is (important) for the children, at a later time, to be able to reread it and perhaps try to reconstruct as much as possible the days they are a little unaware of.” However, barriers such as lack of time, staff turnover, and concerns over patient privacy were identified. Enablers, such as incorporating diary writing into routine practice, providing education and support, and having a designated coordinator, were also identified to facilitate the implementation of diary writing. The study highlights the importance of considering staff perspectives in implementing diary writing in the ICU and suggests that addressing barriers and incorporating enablers may lead to successful implementation.
Sansone V, Cancani F, Cecchetti C, Rossi A, Gagliardi C, Di Nardo M, Satta T, De Ranieri C, Dall'Oglio I, Tiozzo E, Gawronski O.
Staff perception of the implementation, enablers and barriers to pediatric intensive care unit diary writing: A qualitative study. Intensive Crit Care Nurs. 2022 Dec 7:103351

Review about pediatric ICU diaries
This study by Low et al. is a scoping review that examines the use and impact of diaries in pediatric intensive care units (PICU) and neonatal ICUs (NICU). The researchers conducted a thorough search of the literature and identified 27 studies that met their inclusion criteria. The review found that the use of diaries in PICU and NICU can have a positive impact on both patients and their families, including improved psychological well-being, better recall of events, and increased satisfaction with care. However, the study also identified several challenges to the use of diaries, including concerns around privacy, staff workload, and the need for clear guidelines and protocols. The review highlights the need for further research in this area and the importance of considering the practicalities of implementing diary programs in clinical settings.
Low SZQ, Kirk A, Mok YH, Lee JH.
The Use and Impact of Diaries in PICUs and Neonatal ICUs: A Scoping Review. Pediatr Crit Care Med. 2023 Feb 1;24(2):e84-e90

Reading aloud
An interesting and plausible hypothesis by Johnson et al from the USA: patients may experience unpleasant and frightening situations in the ICU, but during initial memory consolidation, a systematic corrective factual information could attenuate the emotional character of the memories. A pilot study examined the feasibility of reading aloud diary entries shortly after they were written. The intervention group received regular readings from their intensive diaries immediately after writing the entries, while the historical control group received no readings. The study was conducted with patients still partially sedated and also awake. The results show that the intensive care diaries read aloud are feasible in almost 90% of patients and are rated as very beneficial by patients and caregivers. Further adequately powered studies need to investigate whether the intervention can lead to a reduction in post-traumatic stress disorder in patients.
Johnson KR, Temeyer JP, Schulte PJ, Nydahl P, Philbrick KL, Karnatovskaia LV.
Aloud real- time reading of intensive care unit diaries: A feasibility study. Intensive Crit Care Nurs. 2023 Jan 25;76:103400

Diaries written during the pandemic
The study by Galazzi et al from Italy involved the analysis of ICU diaries written by staff in order to gain insights into caring for patients in the ICU. Researchers analyzed the diaries using thematic analysis and found that the diaries provided valuable insights into the emotional experiences of patients and their families, as well as staff reflections on their own emotions and caring experiences. The diaries also highlighted the importance of communication and collaboration between staff and families, and the impact of the physical environment on patient well-being. The study suggests that diaries written by staff can provide valuable information for improving care in the ICU and enhancing the overall patient experience.
Galazzi A, Bruno M, Binda F, Caddeo G, Chierichetti M, Roselli P, Grasselli G, Laquintana D.
Thematic analysis of intensive care unit diaries kept by staff: insights for caring. Intensive Crit Care Nurs. 2023 Jan 24;76:103392

And a group appreciate this study in a letter: diaries are a way to humanize critical care, to reflect nursing care in case of dying patients, and help health care staff to keep a professional relationship to patients and families. “The diary has great potential to humanize the ICU for patients, relatives and staff members”
Nielsen, A. H., Via-Clavero, G., Heras-la Calle, G., & Nydahl, P. (2023.
Diaries for dying patients: An outlet for staff members' grief or a powerful way to humanize the intensive care unit? Intensive and Critical Care Nursing, 103417.


Children as visitors on ICU
When children can visit their parents or grandparents in intensive care units, they certainly contribute to rehabilitation. But in most Units, they are not allowed in at all. This white paper presents the most important recommendations for visiting children in intensive care units (both pediatric and adult), intermediate care units and emergency departments. In ICU and ED in German-speaking countries (and very likely: across the world), visiting arrangements for children and adolescents are very heterogeneously regulated: Sometimes they are allowed to visit patients without restrictions in age and duration, sometimes this is only possible from the teenage years and only for a short time. A visit request from children often triggers different, sometimes restrictive reactions from the staff. Managers are encouraged to reflect on these attitudes with their staff and develop a culture of family-centered care. Despite limited evidence, there are more benefits for than against visitation, including hygienic, psychosocial, ethical, religious, and cultural aspects. Decisions to visit are complex and require careful considerations. We summarize a child- and family-friendly approach in 10 recommendations.
Brauchle M, Deffner T, Nydahl P; ICU Kids Study Group.
Ten recommendations for child-friendly visiting policies in critical care. Intensive Care Med. 2023 Jan 30.

Mental frailty in patients, and the effect on caregivers
The study by Beumeler et al. from the Netherlands investigated the prevalence of mental frailty (anxiety, depression, PTSD) in Intensive Care Unit (ICU) survivors and its impact on informal caregiver strain. The researchers conducted a 1-year retrospective study and found that mental frailty was present in a significant proportion of ICU survivors. Informal caregiver strain was also found to be higher in patients with mental frailty, suggesting a negative impact on the well-being of both patients and caregivers. The study highlights the need for increased attention to mental frailty in ICU survivors and the importance of providing support for informal caregivers in order to improve the overall patient experience.
Beumeler LFE, Bethlehem C, Hoogstins-Vlagsma TT, et al.
The prevalence of mental frailty in ICU survivors and informal caregiver strain: A 1-year retrospective study of the Frisian aftercare cohort. Journal of the Intensive Care Society. 2022;0(0).

The family function experiencing critical care
The study by Ahlberg et al. from Sweden explores the impact of the COVID-19 pandemic on the family functioning of families experiencing intensive care. Researchers conducted interviews with family members and analyzed the data using grounded theory, identifying themes related to the challenges faced by families, the impact on family dynamics, and the coping strategies used to manage the situation. The study found that the pandemic has had a significant impact on family functioning, particularly due to the restrictions on visitation and the need for virtual communication. Families also reported feeling isolated, anxious, and uncertain about the future. The study highlights the importance of recognizing the unique challenges faced by families during this time and the need for support to help them cope with the situation. And the study gives a good reason for self-help groups and aftercare: “Being able to talk repeatedly about existential issues and the anxiety and insecurity in life, with people that have similar experiences helps the patient and their family to consider and gain insight into the unpredictability of life, and thereby better cope with changes in life”.
Ahlberg M, Berterö C, Ågren S.
Family functioning of families experiencing intensive care and the specific impact of the COVID-19 pandemic: A grounded theory study. Intensive Crit Care Nurs. 2023 Jan 23;76:103397

And the rest is Tweet-alike

Delirium & family: in the analysis of interviews with families and former delirious patients, family-based delirium management in the ICU is perceived as very positive. Involving families leads to humanizing ICU care and family-centered care! Pandhal et al (2023) from Great Britain
PICS-Screening: A scoping review of 44 studies identified 25 different assessments to identify postintensive care syndrome, but only 5 of these considered all aspects of PICS. Pant et al. (2023)
Visitor regulations: in 2,931 patients over 65 years of age during the first pandemic wave, the administration of benzodiazepines was significantly higher by 38% in hospitals with visit bans compared with hospitals without visit bans; the administration of antipsychotics did not differ. Brown et al (2022) from the USA
15 Year Critical Care: Catherine White, a former sepsis patient 15 years ago and a representative of the self-help organization
ICUsteps, reflects on the evolution of critical care medicine over the past 15 years and offers recommendations from a patient's perspective. Very worth reading. Link
Spiritual care: proactive care of relatives of critically ill patients by chaplains with regular visits, talks and follow-up care improves well-being and reduces anxiety among relatives. RCT by Torke et al (2022) from the USA
PICS Guideline: the German guideline for neurorehabilitation in Post Intensive Care Syndrome is now published. Central recommendations are a) physical: early mobilization, cycling, neuromuscular electrical stimulation, dysphagia screening; b) psychological: screening, optimization of sleep, pain, noise, intensive care diaries; c) cognitive: delirium prevention, cognitive training. A publication in English language is on the way. Renner et al. (2023)
Information: there are many possibilities to inform long-term ICU patients, e.g. checklists, brochures, communication and decision support tools, etc. Scoping review with 58,378 titles and 96 (!) included studies by Allum. et al. (2022)

Missing a study?
We can't read and summarize every study. If we missed an important study, please email us a brief summary and reference, and we'll be happy to include it in the newsletter!

Stay heathy and best wishes!
Teresa, Kristin & Peter

Dr. Teresa Deffner, Dipl.-Rehapsych. (FH), Psychologist in Intensive Care Medicine, University Hospital Jena, Germany
Kristin Gabriel, Media economist, art historian, and yoga teacher, Berlin
Dr. Peter Nydahl, RN BScN MScN, Nursing Research, University Hospital of Schleswig-Holstein, Germany

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