Original Research: Exploring the Effects of a Nurse-Initiated Diary Intervention on Post–Critical Care Posttraumatic Stress Disorder

Abstract

Background: Critical illness survivors may develop posttraumatic stress disorder (PTSD) following critical illness and hospitalization. Left untreated, PTSD may result in poor health outcomes. Purpose: This study sought to examine the effects of a nurse-initiated diary intervention on PTSD development and symptom severity in critical illness survivors with varying levels of mentation. Methods: The study used a pretest–posttest control group design. Patients who were hospitalized in a critical care unit for more than 24 hours were recruited at a single medical center with two such units. All participants completed a pretest on day 2 of critical care hospitalization; the intervention group participants also received a diary. All participants received a posttest one month after critical care discharge. The variables examined were PTSD severity and symptoms of avoidance, intrusion, and hyperarousal. Variables were measured using the Impact of Event Scale–Revised. Diaries were written by the patient, visitors, and interdisciplinary team members, and kept by the patient. Results: A total of 134 participants completed the study. The intervention group participants experienced significantly fewer PTSD symptoms than the control group participants. PTSD was found to be of concern in 35 (26%) of all participants: five in the intervention group and 30 in the control group. Conclusions: For critical illness survivors, a collaborative diary-writing intervention during hospitalization and after discharge can mitigate post–critical care PTSD. Participants who received diaries had a lower incidence of PTSD symptoms than controls; and at follow-up, they indicated that the diary intervention was worthwhile. We recommend the use of collaborative diary writing to help critical illness survivors in working through their experiences.

Effect of intensive care unit diary on incidence of posttraumatic stress disorder, anxiety, and depression of adult intensive care unit survivors: A systematic review and meta‐analysis

“…In addition to randomized controlled studies, we also included two good quality case-control studies in this meta-analysis (Garrouste-Orgeas et al, 2012;Glimelius et al, 2018). These studies also discussed the influence of diaries on symptoms related to PTSD of ICU survivors, with the comparison of case-control clinical outcomes and the results are consistent with a similar recent study (Torres et al, 2020). An earlier study (Garrouste-Orgeas et al, 2012) explored the influence of ICU diaries on the psychological status of critically ill patients and their families at 3 and 12 months after discharge and the results showed that ICU diary significantly reduced the symptoms related to posttraumatic stress of relatives and ICU survivors within 1 year after hospital discharge.…”

Using Qualitative Synthesis to Explore Heterogeneity of Randomized Trials on ICU Diaries*

“…The first matrix (Fig. 2) included seven trials evaluating the effect of an ICU diary on patients' mental health (7,8,16,(18)(19)(20)(21). In five trials (7,8,16,18,19), the diary was initiated for the group of patients who benefited the most according to healthcare provider perception: patients under mechanical ventilation (MV) for at least 3 days.…”

“…All the effective interventions presented three components that patients reported as helpful: they were written by ICU staff, delivered after hospital discharge, and were read with a healthcare provider with whom the patient could ask questions and talk about the ICU stay. As for the two trials in which the sample consisted of patients spontaneously breathing or mechanically ventilated for less than 3 days, one was positive (20), and the other was negative (21). In the positive trial, family members and patients participated in the diary writing.…”

“…We identified 596 individual titles and abstracts for screening. Four hundred thirty-three were selected for full-text review, of which nine satisfied all inclusion criteria (7,8,(15)(16)(17)(18)(19)(20)(21), but one had feasibility as the primary outcome (17), and it was, therefore, excluded from the final analysis. Figure 1 outlines the flowchart of the search, with respective reasons for study exclusion.…”

Posttraumatic Stress Disorder in Nurses During a Pandemic

“…24 The nurse-initiated diary intervention was found to be effective in decreasing PTSD symptoms among nurses working on hospital inpatient units. 25 Other studies suggest resilience and mindfulness as ways to mitigate the effects of PTSD. 26…”