ICU Diary: Mind the Gap

Purpose:

Critically ill patients have reported gaps in their memories, distorted perceptions and hallucinations which can contribute to the development of posttraumatic stress disorder (PTSD).  A review of literature indicated patients have reported not believing they had been that sick causing mistrust of family members and their healthcare team.  The purpose of this project was to better understand the effect of the ICU diary on the critically ill patient’s transition from the ICU setting.

Methods:

An evidence-based practice project, based on the IOWA Model of EBP, was conducted in an intensive care setting located in Central Texas, USA.  Critically-ill patients (n = 6) who were on the ventilator for at least 24 hours were enrolled in the study.  Registered nurses, ancillary staff and family members wrote in the diaries.  Photographs were taken of the patient on the ventilator and at various points during their stay with the purpose of providing a visual timeline.

Results:

One patient was discharged from the hospital but died shortly afterwards.  One patient was unenrolled from the study.  Four patients completed the study.  Results of the study indicated the diary is a therapeutic tool: 1) the four patients chose to keep their diary and to include the photographs in the diary: 2) three of the four patients reported no memories of their stay in the ICU and; 3) one patient had memories of the ICU which included “horrible” hallucinations. Four patients reported the ICU diary helped them with their transition.  Four patients reported the photographs helped them with their transition. 

Conclusion:

The diary is a cost-effective therapeutic instrument.  Observed implications included: 1) family members appeared calmer 2) improved communication between nursing staff and family members and, 3) diary and pictures had a positive effect as evident by the reaction of the patients at the point of delivery.