Intensive care diaries

Intensive care patients are particularly vulnerable to one of the key risk factors for post-traumatic stress disorder (PTSD); failing to fully process a traumatic experience, this is due to the sedation, sleep deprivation and delirium.

One in ten patients who are in intensive care for longer than 48 hours later develop PTSD according to a recent estimate. A new study has suggested that an effective way to reduce this risk could be through the use of a daily text and photo diary. This diary would be kept by the patients nurse and family. Christina Jones at the University of Liverpool and her colleagues recruited 352 intensive care patients. They were randomly allocated to receive the diary one month after discharge (a doctor or nurse explained its contents but not how to use it), or in the control group.

PTSD symptoms were recorded at the one month stage and two months, the controls also at this point received their diaries. The main findings were that 5% of patients in the diary group developed PTSD between one and three months after their discharge compared with 13% of patients in the control group. The comments of the patients were also very positive.

When compared with providing formal therapy to all patients struggling to cope with what they have experienced, diaries are likely to be cost-effective at the same time as being effective in helping intensive care patients. However two new studies by Dr Alex Mitchell, a consultant psycho oncologist at Leicestershire Partnership Trust, suggest that nurses involved with patient care struggle very often to detect depression in patients. Most receive very little training in mental health, therefore it may be unrealistic to expect nurses to remember complex criteria to enable them to detect depression and apply lengthy screening tools.

To read more this article can be found in The Psychologist, November 2010 issue. Vol 23 no 11.