Recovery and Wellness post ICU: Using Patient Diaries

The Intensive Care Unit (ICU) is situated in the Ulster Hospital in Dundonald, Belfast. The hospital is the major acute hospital for the South Eastern Health and Social Care Trust and delivers a full range of acute services for the population. Staff had noticed that ICU patients and their relatives returning to the follow up clinic were describing concerning issues including nightmares, sleep deprivation, hallucinations and flashbacks. These contributed to them being unable to adjust to being home and leading a regular family life, creating stress for both the patient and their family. To build on the work of the follow up clinic and to further improve the psychological support for patients, staff thought that a possible solution was the introduction of patient diaries. Intensive care patient diaries are a simple but valuable tool in helping patients come to terms with their critical illness experience (Bäckman et al., 2010). Developed extensively in the early 1990s in Scandinavia, the success of these journals in piecing together the fragmented memories of a stay in ICU and enhancing psychological recovery has been well documented (Egerod et al., 2011). A successful application was submitted to the Patients First Programme at the Foundation of Nursing Studies (FoNS) for support with the project.

The project team consisted of the staff development sister, research nurse, ward manager, clinical lead sister, deputy ward manager, 5 staff nurses and a health care assistant to represent each area of the nursing team. Key stakeholders were also identified and the team engaged with them throughout the development and implementation of the project. Practice development tools and methodologies were employed to maintain engagement and inclusiveness throughout the project. A workshop, which was facilitated by the project leaders and a FoNS facilitator, was held, primarily so that common ground in terms of values and beliefs could be established. Aims of the project were also explored and set. Subsequent monthly meetings took place to discuss implementation as well as the practicalities that this would involve. A member of the group was empowered to suggest the use of “About Me” templates for patients that could not communicate information about themselves. Informal education sessions relating to the diaries and templates were arranged during lunch breaks and prior to night shift to engage with as many staff as possible. When a sufficient number of nursing staff had attended the sessions, a launch was held to raise the profile of the project and celebrate the achievements of the group and staff within the unit.

Various skills were acquired by team members and staff who engaged with the project. Some examples include enhanced facilitation skills, knowledge of practice development concepts, report writing, project management and the skills required to approach relatives and support them to write diaries.

The project has brought about the use of patient diaries completed by relatives, with the support of the nurses at the bedside. Patient feedback has proved that diaries are a useful tool for patients who survive critical illness and have developed psychological problems as a result. The project has also created an increased awareness amongst nursing staff about the mental health problems that can occur after a stay in ICU. The project continues to flourish. The group have taken patient feedback on board and are now keen to look at the use of photographs with the diaries. The next stage of the project will involve evaluation of the impact of these, perhaps in the form of focus groups of patients, relatives and staff. Although the journey with the Patients First Programme has come to an end, it is the beginning of a new journey in relation to enhancing psychological care for ICU patients and families in the future.

This project was supported by the Foundation of Nursing Studies Patients First Programme in partnership with the Burdett Trust for Nursing.