Introduction
Context: A common psychological complication in ICU survivors is post-traumatic stress disorder (PTSD) with research showing that between 20-30% of patients develop PTSD after discharge (1). Intensive care stress, which may be combined with confusion, memory disorders and helplessness increases long-term psychosocial consequences that hinder the process of recovery (2).
Problem Statement: Nevertheless, increasing consciousness of this issue, traditional ICU discharge strategies are commonly not associated with comprehensive psychological treatment that would minimize PTSD adequately, which may lead to the further development of the symptoms and the prolongation of patient suffering (3). This gap underscores the importance of developing low-cost and effective interventions that will enhance post-ICU mental health recovery.
Patient Diaries as an Intervention: Patient diaries are daily records of the patients’ stay in ICU written by the staff as well as the families with the purpose of filling gaps in memories and minimizing conflicts of conscience. The said structured narrative could minimize PTSD symptoms if the patients’ traumatic memories were processed and facilitated psychological recovery (4).
Research Question: Can patient diaries reduce PTSD symptoms in post-ICU patients and serve as an effective tool for mental health rehabilitation?
Background and Rationale
Purpose of Patient Diaries: Patient diaries give the ICU survivors a real life, documented account of their time in the ICU which assists them in piecing together memories that may otherwise be hazy. According to the study, diaries may help relieve psychological suffering and promote recovery since memory deficits for factual events can be compensated for by actual memories (5).
Connection to Rehabilitation: Psychotherapy often entails trauma integration. This may be helped by patient diaries in which patients can remind themselves of more accurate memories of the event and therefore decrease PTSD symptoms such as hyperarousal and avoidance (6).
Discussion/Analysis
Effectiveness of Patient Diaries
Evidence from Research: According to the studies, patient diaries could decrease PTSD symptoms by up to a moderate extent among ICU survivors (7). Meta-analyses of patient diaries to standard care show a statistically significant reduction in PTSD scores, (8). However, these effects differ by PTSD symptom clusters and some symptoms, especially hypervigilance, do not change significantly. Such variability indicates that despite the fact that diaries provide some degree of psychological relief, they do not seem to treat all the symptoms of PTSD.
Critical Analysis of Methodology: The data in the current literature regarding patient diaries is frequently described to be methodologically constrained. Limited sample sizes and observational approaches, which are evident in several investigations, limit the external validity of findings (9). Furthermore, there is some evidence from RCTs about the moderating variables including the time of the diary review and the patient’s propensity for trauma. For example, patients with a history of mental health problems are reported to derive less benefit, which raises the possibility that diary effectiveness depends on the characteristics of the patient (10). These limitations call for more robust studies to develop a standard database of findings.
Comparison with Alternative Therapies: CBT is generally accepted as one of the most effective treatments for PTSD but is time consuming and demands much supervision and expertise (11). Thus, patient diaries, on the other hand, are much more accessible and can be implemented at a relatively low cost. Compared to CBT, diaries are not equipped with an organized therapeutic structure which can be helpful to patients with serious PTSD manifestations. This comparison supports the idea of diaries as an adjunct, not a main, treatment for ICU-related PTSD.
Mechanisms of Rehabilitation
Memory Reframing: The use of diaries in patients can help in memory reframing because they give the patients facts about what transpired in the ICU, and this can help to reduce symptoms of dissociation and anxiety caused by memory loss (12). This narrative assists patients in their ability to make sense of experiences that may otherwise be frightening and disjointed.
Involvement of Family and Staff: Engaging relatives and ICU staff in diary process might make patient feel supported and connected with them. This collective memory working builds a notion of ‘community of care,’ which helps provide therapeutic support in PTSD since a sense of isolation is a key sign that can be identified (13).
Limitations in Diary Use: Although the above benefits are evident, there are patients who do not feel comforted when they read their ICU diaries. Some participants may be reminded of stressful events and experience increased distress when revisiting them without the help of psychological assistance (14). Research has shown that diary review is best facilitated by mental health workers to increase the therapeutic benefits while patients are being psychologically prepared for the process (15).
Evaluation
Critical Appraisal of Evidence: The systematic review shown that the patient diary may have the positive psychological impact, but the result was quite heterogeneous. The presence of a patient’s prior psychiatric disorders, the severity of the ICU experience, and the level of family engagement critically determine the effectiveness of this treatment (16). This variability means that patient diaries can be ineffective and should be used as only one of the tools in a more comprehensive and personalised strategy.
Gaps in Research: The available literature is somehow scanty in terms of the demographic characteristics and frequently, the follow-ups are missing which hampers the investigation of the chronic impacts. However, there is a lack of patient diaries in other cultures, where beliefs about trauma and mental health may influence the use of the diaries (17).
Ethical Considerations: Even if patient diaries can be helpful in PTSD treatment, there are certain ethical concerns, primarily patient’s self-governance. These diaries are usually written without the knowledge of the patient, and questions of agency arise when these are later produced after ICU (18).
Recommendations for Practice
Integrate Patient Diaries with Psychological Support: ICU facilities should make available diaries along with a guided review process which should be conducted by mental health workers to ensure that the patients get a safe means through which they can deal with the experiences that they had while they were in the ICU.
Expand Research: More extensive and heterogeneous samples need to be used in future studies, as well as the potential medium- and long-term consequences of patient diaries. Further research with similar or higher intensity of therapies such as CBT is also advised in order to find the best treatment packages.
Patient-Centered Care: In order to respect patient’s self-determination, ICUs should employ consent mechanism that allows the patients to decide whether they want to read or not their ICU diaries after discharge.
Conclusion
An important emerging approach to decreasing PTSD is the use of patient diaries, especially in the ICU environment and reconstructive mode. Nevertheless, these diaries may contribute to the list of measures that can be included into ICU treatment, if it is complemented by professional assistance, and will help the patient in psychological rehabilitation and in further treatment.