Huvudintresseområde Dagbok patient / närstående                                       
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	Carl Bäckman RN Depht of Anaestesia and Intensive Care, Hospital Norrköping, Sweden E-post adress:  carl.backman@lio.se

Photodiary and follow-up conversation

Introduction. Many intensive care patients have little or no memory of their stay in the Intensive Care Unit ( ICU). The lack of recall might contribute to unrealistic expectations about their speed of recovery and future capabilities. Some patients report spending considerable time and energy understanding what had happened to them during their criticall illness.

The intention with the Photodiary was to describe and explain aspects of the care that we usually not document in the regular patient files. We hoped that this would facilitate recall and interpretation of unpleasant recall.

The purpose of the work we did by sending out questionnaires was to examine patient’s /relatives responses and reflections on a photodiary kept by staff and relatives at the hospital.

Methods. A photodiary is kept on patients that we think will stay for a long time and be sedated and ventilated.

To use this tool is voluntary and it’s up to the personnel to decide and inform about the purpose and also ask the patient or the relative if they want us to use this.

The staff participating in the work with the patient and relatives are encouraged to write and reflect in the diary.

Photographs is taken by the staff occasionally and the writings has to be signed. The diary is kept by the patient’s bedside throughout the stay at the ICU.When the patient is transmitted to the ward the relatives or the patient can continue to write in the diary so therefor we leave it over to them.

2-4 weeks later we invite them back to the ICU and show and explain the photos and together we sit down and use the photodiary as a guide when  we explain the course of the time at the ICU.

They use to have questions and we ask them to tell us what they remember, it use to be very good meetings with a lot of embraces.

We inform them as if  any new questions occurs, they  can  phone us.

A questionnaire was sent by mail 6-8 months later.

Results. The mean (range) age of the patients was 57 years and their lenght of stay was 19 days. Time spent in ventilator was 13 days and they were critically ill with a mean risk of death by APACHE II of 32 %.

26 patients died, the remaining 74 survived and participated the follow-up.

One relative has refuse to take care of the diary after that her mother died and two other relatives wrote that they didn’t like the diary, maybe if the patient had survived it would have been good.

One patient hadn’t read the diary when the questionnaire was sent to him, but he answered that he will.

Three patients thinks that the photos are uncomfortable  but maybe necessary. The rest finds the photos important. 96 % of  the questionnaires has been answered. The photodiaries has been read from a few up to more than 50 times, either by patient, by relative  or by both.

More than 90 % has shown them for relatives and friends.

Respondents expresses that the diaries helps them to understand how ill they were and to interpret nightmares and unpleasant memories.

Relatives to over 80 % of the deceased patients describes that the photodiary and follow-up conversation helps them to cope with their loss.

Conclusion. To keep a diary for the critically ill patient during their stay in ICU is a simple way of helping the patient to cope with memory fatigue and frightful recollections, as well that it can help some of the relatives to cope with their loss.