Magazine article American Nurse Today

ICU Diary: The Gift of care[TM]

Magazine article American Nurse Today

ICU Diary: The Gift of care[TM]

Article excerpt

As an ICU nurse you've probably encountered the critically ill patient who is experiencing hallucinations, delusions, and confusion. Healthcare providers are learning just how detrimental this state of mind can be to the patient's recovery process as he or she transitions from the ICU setting. One proposed intervention, the ICU diary, has been used in Europe since the 1980s but is not widely used in the United States. I conducted the first evidence-based practice (EBP) ICU diary pilot project in an acute care setting located in Central Texas.

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Roots of the project

I first became aware of the ICU diary after a family member returned to the unit and complained that she had developed post-traumatic stress disorder (PTSD) related to her daughter's stay in the ICU. In the past I cared for wounded soldiers returning from Iraq and Afghanistan and witnessed the physical and emotional trauma they have experienced, which can lead to their developing PTSD. I decided I wanted to understand how PTSD can develop in critically ill patients and family members. I conducted an in-depth scholarly review of literature, and that is when I learned about the ICU diary.

Purpose of the diary

The ICU diary provides written factual documentation, designed with the purpose of filling in the patient's gaps in memory of their stay in the ICU. According to experts, it's the patients' inability to remember what happened to them while they were critically ill that can cause them to develop PTSD. Reported psychological problems stem from memories that are based on distorted, vivid, and frightening hallucinations and delusions. The diary is written by the RN and family members and is a written record of what happened to patients while they were critically ill. The diary does not make patients remember what happened but is instead designed to fill in the blank portions of their memories.

When patients are unable to remember what happened to them, their ability to compare how far they have come in their recovery process is based on their state of health before becoming critically ill. The gap in memory can lead to the formation and storing of traumatic memories. Family members and health care providers can fail to understand why the patient does not see how far they have progressed and how well they are doing.

The diary can help patients address what they feel after their ICU stay. (See Physiology and the ICU diary below.)

Physiology and the ICU diary

When critically ill patients are in the ICU, they are fighting for their lives. This creates a condition called "fight or flight" where the brain's perception neural pathway becomes hijacked and the amygdala takes charge. Much of the critically ill patient's path to recovery is spent in the "fight or flight" phase.

There is much to be learned from the process of meeting with patients as they see the photographs and diary for the first time. As a certified professional health and wellness coach, I assist patients by asking probing questions that stimulate them to find the answers from within. The ICU diary and photographs are designed to help patients find the answers from within as well. The ICU diary and photographs shift the neural pathway by sending calming messages of influence that originate from the higher order prefrontal cerebral cortex to the lower order amygdala center. The prefrontal cortex is where the higher-order functions of problem solving, complex thought, and control of emotions take place. …

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