Intensive care diaries
The sedation, delirium and sleep deprivation experienced by intensive care patients make them particularly vulnerable to one of the key risk factors for post-traumatic stress disorder (PTSD) - failing to fully process a traumatic experience. Indeed, patients usually have only fragmentary, delusional memories for what happened to them. According to one estimate, one in ten patients in intensive care for more than 48 hours go on to develop PTSD. A new study suggests that an effective way to help reduce this risk could be via the use of a daily text and photo diary kept by the patient's nurse and family.
Christina Jones at the University of Liverpool and her colleagues recruited hundreds of intensive care patients across six European hospitals. Only those who were in intensive care for more than 72 hours and on a ventilator for more than 24 hours were eligible. This left 352 patients who participated and therefore had daily hand-written diaries plus photos of their intensive care stay kept for them by a nurse and their families. The patients were then randomly allocated to receive the diary one month after discharge
(on receipt of the diary, a doctor or nurse explained its contents but didn't instruct the patient in how to use it) or to act as controls. PTSD symptoms were recorded both at this one-month stage and two months later, at which point the controls also received their diary.
The key finding was that just 5 per cent of patients in the diary group went on to develop PTSD between one and three months after their discharge compared with 13 per cent of patients in the control group. Patients' comments about the diaries were also overwhelmingly positive - 49 per cent said the text was most helpful, 36 per cent said the text and photo combination, and 15 per cent highlighted the benefit of the photographs.
'Diaries are not without cost,' the researchers acknowledged in their report published in Critical Care, 'there has to be a commitment from the staff to write something in the diary every day and take photographs when important changes happen. In addition an experienced nurse is needed to go through the diary with the patient to ensure that they understand its contents, but this is not significantly more than might have been provided by an unstructured discussion in the past. Compared with providing formal therapy to all patients struggling to cope with their experiences, diaries are likely to be highly cost-effective.'
In related news, two new studies by Dr Alex Mitchell, a consultant psycho-oncologist at Leicestershire Partnership Trust, suggest that nurses in the front line of patient care often struggle to detect depression in patients (International Journal of Nursing Studies: tinyurl.com/39e3du9; and Psycho-Oncology: tinyurl.com/248smnq). 'Most nursing staff receive little training in mental health and report low experience in this area. It may be unrealistic to expect nurses to remember complex criteria for detection of depression or to apply lengthy screening tools,' Mitchell said. His team are currently developing short, simple methods for identifying mood problems (free at www.psycho-oncology.info).
--Christian Jarrett
