Waking up in an intensive care unit for the first time after suffering from a major health event can be a frightening experience.
“I would see a look of confusion on my patients’ faces,” said Sharon Levine, MSN, RN, CVRNBC, research coordinator for Advanced Heart Disease and former clinical nurse in the Cardiac Intensive Care Unit (CCU). “They come to us critically ill and have no idea how they got here. The last thing they may remember is being at work or with their family.”
Many patients, especially those who have been intubated, experience hallucinations or delirium while in the ICU. Studies have shown that patients can have symptoms of post-traumatic stress disorder when they go home, which can be complicated by their inability to remember their time in the hospital.
To help patients feel safe, Levine and her colleagues introduced a research diary project after learning how a similar intervention benefited ICU patients in Europe. With entries from family members and nurses throughout the patient’s stay, the diary serves as a “reality-sorting tool” that aids patients in connecting their flashbacks and delusional memories to actual events. The nurses found that the diary was an important way to help patients gain clarity of their time in the ICU.
Levine, along with Karen Reilly, DNP, MBA, RN, associate chief nurse; Melanie M. Nedder, MSN, RN, CCRN-CMC, CVRN-BC, of the CCU; and Kathleen Ryan Avery, MSN, RN, CCRN, program director for the Center for Nursing Excellence, published the results of this successful work in the August 2018 issue of Critical Care Nurse, highlighting how the diary helped patients understand and remember what happened during their time in the hospital.
“In addition to patients benefitting from the diary, we also found it to be therapeutic for the families during the hospital stay,” said Caroline Galligan, BSN, RN, of the CCU, who recently led efforts to make the ICU diary available to patients in all intensive care units.
Levine noted that one patient readmitted to the CCU months later brought the diary to continue making entries. “It added to her personal story of her heart disease progression,” said Levine.