Intensive care diaries for ICU survivors

Domain VI · Brief, integrative, trauma, hypnosis & coaching · 1990 · Scandinavia

What it is

An ICU diary is not a psychotherapy. It is a nurse-led, multidisciplinary intervention. ICU staff, and relatives if they want to, write a dated, plain-language account of the patient's ICU stay while it happens, addressed directly to the patient. Photographs are often added. The diary is given to…

Format

• The sources describe a sequence of phases rather than a fixed session count.
• Phase 2: Daily writing (throughout the ICU stay). Goal: a continuous, accurate, humane record. Staff write a short entry daily or on most shifts, plus entries at milestones; relatives write when they wish. Writing takes "a few minutes" a day, and the opening entry takes longer. In Norrköping the…

Who practises it, and how they are trained or regulated

• Phase 0: Programme set-up (before any diary). Goal: a sustainable local service. Form a diary group of interested staff (Norrköping: six people, including nurses, nurse assistants and an occasional doctor; Whiston: nurses of different grades). The group writes local guidelines (purpose, what to write, care of the diary), an information sheet for relatives, a consent form, a photograph-handling procedure and a…
• Where a psychotherapist fits: (a) as a member or consultant of the diary group (writing guidance, staff training, screening pathway); (b) in post-ICU follow-up clinics, where the diary is read and discussed; (c) in later therapy with ICU survivors or bereaved relatives, using the diary as a factual reference. Role (c) is my own extension and is marked where it appears. Outcome evidence is mixed: the RACHEL trial…

Evidence status, as the guide reports it

• Phase 3: Consent and handover (from ICU discharge to about 2 months after). Goal: the survivor receives the diary when ready and agrees to keep it. Practice varies: from handover at ICU discharge to 2 months after it. No study gives evidence for the best timing. Whiston hands it over before…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• do not mistake acceptability for effectiveness.
• opening entries that are medical summaries full of jargon.
• bereaved families had "mixed feelings" about seeing photos. Offer support or a bereavement referral.
• units that over-select, given that the people too confused to consent may be those who would benefit most.
• inappropriate remarks from visitors, which some patients later find upsetting; family conflict played out in the diary.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.