After being sedated for weeks in an intensive care unit (ICU), a patient may feel confused and disoriented with no memory of what happened during that time.

At UCHealth Memorial Hospital Central, Nicole Muenkel, BSN, RN, CCRN, charge nurse with the medical ICU, introduced a diary process to help these patients understand their care and other details they may not remember – such as visits from friends and family.

“ICU delirium is a big topic we talk about a lot,” said Nicole Guevremont. “We’re hoping we could relieve some anxiety and stress and depression that comes along with ICU delirium, or post-traumatic stress disorder, after long ICU stays.”

Each shift, the care team is encouraged to hand-write brief notes with updates in a small notebook. For example:

• “Your mom was sitting at the bedside, holding your hand, talking about your favorite music and colors.”
• “You weren’t breathing very well today, and we placed a breathing tube.”
• “We’re turning you every couple hours.”

Muenkel developed the ICU diaries for her Level III UEXCEL project. While nurses frequently communicate with patients and families, the diaries help with day-to-day details they may not remember, which can improve their experience and understanding of the ICU stay. Patients have shared that the diary helped them become orientated after sedation.

A sticker on the back of the notebook explains the diary’s purpose for family members. They, too, are welcome to contribute entries, and many have found it to be a great way to become more involved in helping support the patient.

Muenkel said entries including just a few sentences of what happened on a shift can benefit the patient’s experience as they recover.

“When you see how much patients and families appreciate it, that really sticks with you,” she said. “Family members who couldn’t be at the bedside at the time can also read through it.”

 

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