Intensive care diaries protect patients from PTSD

Some intensive care patients develop post-traumatic stress syndrome (PTSD) after the trauma of a difficult hospital stay, and this is thought to be exacerbated by delusional or fragmentary memories of their time in the intensive care unit. Now researchers writing in BioMed Central's open access journal Critical Care have found that if staff and close relatives make a diary for patients, featuring information about their stay and accompanied by photographs, PTSD rates can be significantly reduced.

Professor Richard Griffiths and Christina Jones from the University of Liverpool, UK, worked with an international team of researchers to conduct a randomized controlled trial into the effectiveness of the diaries in 352 patients from 12 hospitals in 6 different European countries. Griffiths said, "On average 1 in 10 patients who stay more than 48 hours in intensive care will develop PTSD. It is likely that the fragmentary nature of their memories and the high proportion of delusional memories, such as nightmares and hallucinations, make it difficult for patients to make sense of what has happened to them. These memories are frequently described as vivid, realistic and frightening and may even involve patients thinking that nurses or doctors tried to kill them. Hard evidence of what really happened, in the form of a diary filled out by the treatment staff, may help to allay these fears".

During the study, 162 patients were randomly assigned to receive diaries, and they were found to be less than half as likely to develop PTSD as the control group. The diaries were completed daily by nursing staff and relatives using everyday language and accompanying photographs were taken. After discharge from intensive care, a nurse talked the patient through the diary entries. According to Griffiths, "Diaries are not without cost; there has to be a commitment from the staff to write something in the diary every day and take photographs when important changes happen. In addition an experienced nurse is needed to go through the diary with the patient to ensure that they understand its contents, but this is not significantly more than might have been provided by an unstructured discussion in the past. Compared with providing formal therapy to all patients struggling to cope with their experiences, diaries are likely to be highly cost-effective".