The ICU Diary. Rüdiger Haupt Johannes WeslingHospital Minden/Nordrhein Westfalen. 25% ofmyjob bedsidenurse, neurologicalandcardiologicalicu

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1 The ICU Diary Rüdiger Haupt Johannes WeslingHospital Minden/Nordrhein Westfalen 25% ofmyjob bedsidenurse, neurologicalandcardiologicalicu

2 The ICU Diary 75% ofmyjob Teacherin theacademie of health care and nursing in Minden Student of nursing sience, University of applied sience in Jena hopefully...

3 What s that? What s its meaning? Howtouseit?

4 In manypatients, stayingin an intensive careunit (ICU) facing the life-threatening situation, perishing and death can cause similar psychological trauma likebeinghijacked, takenhostage, orliketorture, war, terror and rampage experiences. In Germany upto30% ofall ICU patientsdevelop PTSD (Post traumaticstress disorder) between2nd and 6th month after intensive care treatment.

5 Symptoms of PTSD: Depression!!! Anxiety disorders Accomodation disorder!!! Changes in personality and character Attachment disorders Aggressive behavioral patterns Self-inflicted injuries Flashbacks!!! Suicidal tendency

6 A sequelae thatdoesnot strikeus.. but our patients. But whathasptsd todo withtheicu-diary?

7 Recalls of ICU patients: I was layingin a bomb crater, in themiddleofa minesfield, pretending to be dead.

8 I was on a campinggroundabovethecliffsofsouthern England.

9 The Hemofilter sounds like the mechanical milkerin ourcowbarnathome:

10 The ICU Diary Somepatientsupportofcrossingan oceanby ship. (inflatable mattress)

11 The ICU Diary Others remembers epiditions to tropical forrest. (humified oxygen)

12 Many refer to their distinct feeling being dazed. Or of emotional numbness and indifferences to other persons. Sense and perception change rapidly within half an hour of a complete anergic state.

13 Definition: The ICU-Diaryisa documentcontainingevents, changesandprogress, writtenbyhealthcarestaffs, nurses, doctors and relatives during the time of sedation and mechanical ventilation. The patient can read the log later, reconstructing andcomprehendingthetime ofhis/her unconciousness and insensibillity.

14 Reports are given in an esteemed, honest tone and summarized form: the incident leading to admission and therapy of the patient, as well as the up-to-date condition and the progress of recovery.

15 Entries in the booklet can be done by everybody involved in the treatment and care: health care staffs like nurses, doctors, physiotherapists, etc., as well as relatives and visitors. Expenditure of time for an entry is about 3-5 minutes.

16 Records should be done once every shift or day. The first entry should contain a summarized description of the events leading to admission.

17 All further records should include changes, therapeutic procedures, surgical interventions (e.g. tracheotomia) and progress (e.g. physical mobilisation). The surrounding and the noise background should be described and whether somebody/who has visited.

18 Reflexive questions can be posed, e.g.: You have breathed for the first time by yourself andi wonderhowitfeltforyou? The entriesshouldnot becriticalornegative but esteemed and honest. They should not contain diagnoses!!!

19 Studies / literature: The ICU-Diary 1. Bergbrom et al Bäckmann, Walther Akermann Combe Robson Storli, Lind Roulin Jones et al 2008

20 What s itsmeaning? Some statements of former ICU patients: Itgivesmea goodideahowthingsreallywere [ ] andwherei havebeen. " 6 I realizedhowsick I was andwhatmyfamily experienced and went through. 5

21 " It means a lot to me that you [a nurse] were thinking about my well being and that you cared for me. " (Storli et al 2003) " The diary and our talk give me a conception how sick I really was and why my body has changed so much."(ebd. 2003)

22 WhatispossiblewiththeICU-Diary, howisit helpfull? Some study results: The diaryishelpingtoreconstructthelost time of the arteficial ventilation." 1,4,5,6 "Patientsandrelatives assessthediaryvaluable." 1,2,3,4,5

23 The diary demonstrates the solicitousness and sympathyoftheteam." 7

24 Patientsareenabledtogivetheeventa sense and purpose. 7 The bereaved arehelpedtocopewiththelost. 2

25 The ICU-Diary supports and stimulates the conversation and communication in the family.4 The diary seems to alleviate or avoid a possible PTSD.8 Reading diary reduces flashbacks. 8

26 Indications The diary can be used for almost all patients sedated and ventilated for more than 3 days. Contraindication There are none definitive CIs, although it seems not prudent to write a diary for patients not familiar with the language or unable to read (patients mentally retarded, patients with dementia or aphasia).

27 Side effects: Sporadic reports about heavy emotional reactions while reading the diary exist.

28 Statements : Nevertheless-withthebackgroundofan ostensible device dominant health care system we should not be afraid to detect and name early enough causes and sequelae of psychological trauma in ICU patients, to treat themaccordinglyandtopaylong-term respecttothem. Keep recordin a diaryiscertainlya convincingapproach." (Prof. Dr. Janssens, PD Dr. Graf: Angst und Depression nach Intensivbehandlung: Hilfe durch Patiententagebuch? Intensiv-News 2/09)

29 Applications of the ICU-Diary : In use in Scandinavia since 1984!!! Denmark: 19 / 48 ICUs, 39,6% (Egerod 2007) Sweden: 65 / 85 ICUs, 76,5% (Akermann 2008) Norway: 32 / 79 ICUs, 40,5% (Storli 2008) Germany: 0 / 1200 ICUs, 0,0% (Knück,Nydahl 2008)

30 Ready for the next step in evolution?