You are safe here: A flyer with re-orientating messages for families of patients with delirium in the intensive care unit.

Patients in delirium require trustful communication and re-orientation. We developed a flyer with positive, re-orientating suggestions for families of delirious patients in intensive care units. Suggestions include creating a safe environment, interpreting unusual behaviours positively and fostering mental resilience. Additionally, families are encouraged to prioritize their own well-being, recognizing their crucial role in supporting their loved ones. This flyer offers practical strategies across four key areas: ensuring security and orientation, reframing noises and body experiences, managing agitation and reshaping perceptions. By equipping families with knowledge and tools, this resource aims to promote understanding, resilience and strength to humanize delirium care.

Intensive care unit diaries-harmful or harmless: A systematic literature review and qualitative data synthesis.

OBJECTIVE: The objective of this research was to evaluate the extent of harm for critically ill patients, family members, and healthcare professionals associated with writing and reading intensive care unit (ICU) diaries. REVIEW METHOD USED: A systematic literature review and a synthesis of qualitative data were performed. The protocol of this study has been registered in the International prospective register of systematic reviews (CRD42022376393). DATA SOURCES: Databases were PubMed, Cochrane Library, CINAHL, PsychNet, and Livivo. REVIEW METHODS: The search included qualitative and mixed-methods studies related to harm with an ICU diary. Deductive content analysis was used to create abstractions of quotations. Study quality was assessed with the Critical Appraisal Skills Programme. RESULTS: Of 12 827 titles, 27 studies with 476 participants were included. Events involving the patients, family members, and healthcare professionals occurred but did not result in harm. A total of 68 quotations from patients, family members, and healthcare professionals were extracted. Those patients, their families, and healthcare professionals who mentioned intense emotions regarding diaries experienced writing and reading diaries as an emotional journey (patients), a help with tears (families), or a question of emotional distance (healthcare professionals). CONCLUSIONS: Writing and reading ICU diaries can be associated with intense emotions, which are natural reactions when coping with a stressful situation. No study reported harm. Based on uncertain qualitative evidence, the benefits of writing and reading ICU diaries as coping strategies outweigh the potential harm. More research is needed. REGISTRATION OF REVIEW: The International prospective register of systematic reviews CRD42022376393.

[Psychological Consequences of Intensive Care Treatment of COVID-19 in Patients and Relatives]. / Psychische Folgen intensivmedizinischer Behandlung von COVID-19 bei Patienten und Angehörigen.

OBJECTIVE: In this study, treatment- and disease-associated consequences of intensive care treatment of COVID-19 in patients and relatives were investigated and compared with data from the general population and sepsis patients. In addition, dyadic associations in symptoms of patients and relatives were analyzed. METHODS: In a monocentric, prospective, non-controlled observational study, patients who underwent intensive care treatment due to Covid-19 disease at Jena University Hospital between November 2020 and March 2021 and their relatives were included. We assessed the long-term outcome between three and six months after discharge from the intensive care unit (ICU) using the Hospital Anxiety and Depression Scale, the Posttraumatic Stress Scale-14, the Multidimensional Fatigue Inventory-10, and the EQ-5D-5L. RESULTS: Seventy-two patients (Mdn 64 years, 67% men) and 56 relatives (Mdn 60 years, 80% women, 80% partners) were included in the study. 39,4% of the patients reported clinically relevant anxiety symptoms, 38,8% depressive symptoms, and 45,1% PTSD symptoms, with most cases having abnormal scores in multiple symptom domains. Among relatives, a smaller proportion had clinically relevant scores (29,2%/15,3%/31,5%). Compared with the general population, Covid 19 patients reported significantly higher anxiety and fatigue scores and a reduced quality of life. In relatives, significantly higher anxiety scores for women and lower quality of life for men were found. Compared to ICU patients with severe sepsis, Covid-19 patients were found to have significantly higher PTSD symptoms and lower quality of life. Significant dyadic associations were found for anxiety and fatigue. DISCUSSION: The results of this study on psychological symptoms after ICU treatment confirm findings from previous studies, but also indicate a stronger PTSD symptomatology, which can be explained by the increased traumatizing potential of isolation and protective measures during treatment. Compared to the general population, particularly elevated anxiety scores of the patients are noticeable, which can be explained by the possible risk of re-infection. CONCLUSION: Psychological long-term consequences of intensive care treatment of Covid-19 disease should be diagnosed and adequately addressed in the outpatient follow-up of affected individuals.

Sedation, sleep-promotion, and non-verbal and verbal communication techniques in critically ill intubated or tracheostomized patients: results of a survey.

BACKGROUND: The aim of this survey was to describe, on a patient basis, the current practice of sedation, pharmacologic and non-pharmacologic measures to promote sleep and facilitation of communication in critically ill patients oro-tracheally intubated or tracheostomized. METHODS: Cross-sectional online-survey evaluating sedation, sleep management and communication in oro-tracheally intubated (IP) or tracheostomized (TP) patients in intensive care units on a single point. RESULTS: Eighty-one intensive care units including 447 patients (IP: n = 320, TP: n = 127) participated. A score of ≤ -2 on the Richmond Agitation Sedation Scale (RASS) was prevalent in 58.2% (IP 70.7% vs. TP 26.8%). RASS -1/0 was present in 32.2% (IP 25.9% vs. TP 55.1%) of subjects. Propofol and alpha-2-agonist were the predominant sedatives used while benzodiazepines were applied in only 12.1% of patients. For sleep management, ear plugs and sleeping masks were rarely used (< 7%). In half of the participating intensive care units a technique for phonation was used in the tracheostomized patients. CONCLUSIONS: The overall rate of moderate and deep sedation appears high, particularly in oro-tracheally intubated patients. There is no uniform sleep management and ear plugs and sleeping masks are only rarely applied. The application of phonation techniques in tracheostomized patients during assisted breathing is low. More efforts should be directed towards improved guideline implementation. The enhancement of sleep promotion and communication techniques in non-verbal critically ill patients may be a focus of future guideline development.

[Psychological aspects during and after intensive care treatment of ARDS]. / Psychologische Aspekte während und nach intensivmedizinischer Behandlung von ARDS.

Approximately 10% of all patients requiring intensive care develop acute respiratory distress syndrome (ARDS). The COVID-19 pandemic led to an accumulation of patients with severe ARDS. The experience of this severe respiratory failure is accompanied by feelings of existential anxiety in many patients.The complexity of the challenges and stresses that the disease and its treatment pose for the ARDS patient require an early multiprofessional approach to treatment already during intensive care. Psychological approaches are suitable to support the patient as well as the relatives in coping with the disease and to minimise risks for potential subsequent stress. Despite the long-term impairments of patients who have survived ARDS and the resulting need for follow-up care, suitable multimodal follow-up care concepts and the necessary care structures are still lacking. The article presents the psychological support during and after the intensive care treatment of ARDS.

[Psychotraumatological aspects in intensive care medicine]. / Psychotraumatologische Aspekte in der Intensivmedizin.

In the context of intensive care medicine, patients, their relatives, and more infrequently members of the ICU team can be affected by potential trauma. Acute stress disorder often results. Psychological symptoms of critically ill patients should therefore be regularly screened in a standardized manner in order to be able to identify and treat patients with a high symptom burden. Some traumatic stressors in intensive care medicine can be reduced using trauma-sensitive communication. Psychological and psychotherapeutic interventions can complement this basic care. High quality communication with relatives contributes to a risk reduction with regard to their subsequent psychological stress. On the part of the ICU team, stress should be differentiated from potentially traumatizing events and both problem areas should be dealt with preventively. After experiencing a traumatic event during work, a procedure analogous to physical work accidents is recommended.

[Recommendations for the support of suffering, severely ill, dying or grieving persons in the corona pandemic from a palliative care perspective : Recommendations of the German Society for Palliative Medicine (DGP), the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI), the Federal Association for Grief Counseling (BVT), the Working Group for Psycho-oncology in the German Cancer Society, the German Association for Social Work in the Healthcare System (DVSG) and the German Association for Systemic Therapy, Counseling and Family Therapy (DGSF)]. / Empfehlungen zur Unterstützung von belasteten, schwerstkranken, sterbenden und trauernden Menschen in der Corona-Pandemie aus palliativmedizinischer Perspektive : Empfehlungen der Deutschen Gesellschaft für Palliativmedizin (DGP), der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), des Bundesverbands Trauerbegleitung (BVT), der Arbeitsgemeinschaft für Psychoonkologie in der Deutschen Krebsgesellschaft, der Deutschen Vereinigung für Soziale Arbeit im Gesundheitswesen (DVSG) und der Deutschen Gesellschaft für Systemische Therapie, Beratung und Familientherapie (DGSF).

The corona pandemic has led to a number of restrictions and prohibitions, which in turn place large psychosocial or spiritual burdens on patients with COVID-19, their families and relatives and the treating personnel in the healthcare system. Patients with COVID-19 are not allowed to receive visitors and many hospitals and nursing homes have completely banned visitors. Many support services have been reduced or stopped completely. Necessary treatment interventions for other patients with critical and life-limiting diseases have been delayed or suspended in order to free resources for the expected COVID-19 patients; however, these people need to feel social connectedness with their relatives. Palliative care patients should be exempted from any ban on visitors. Families should be able to visit dying patients even on intensive care units or isolation wards, using adequate protective equipment. Alternative options, such as video telephone calls or via social media should be explored for patients in isolation. Families should also be enabled to say goodbye to the deceased with adequate protective equipment or should be offered alternative real or virtual options for remembrance and commemoration. Health care professionals coping with the exceptional stress should be continuously supported. This requires clear communication and leadership structures, communication training, psychosocial support, but most of all optimal framework conditions for the clinical work.

[Therapeutic healthcare professional staffing requirements in intensive care units]. / Stellenschlüssel für therapeutische Gesundheitsfachberufe auf Intensivstationen.

BACKGROUND: Therapeutic healthcare professionals in the multiprofessional intensive care unit (ICU) team are important for early mobilization, dysphagia therapy, and psychosocial care of critically ill patients. OBJECTIVE: Despite the high relevance of therapeutic healthcare professions for care in ICUs, there are no recommendations on the specific staffing of therapists in ICUs. RESULTS: Considering the main areas of activity of the individual professional groups and based on productivity time, a requirements analysis for staffing ICUs of different care levels with physiotherapists, occupational therapists, speech therapists, and psychologists was performed. For every 10 beds in the highest care level (LoC3), 1.28 full-time equivalent (FTE) physiotherapists, 0.91 FTE occupational therapists and speech therapists, and 0.80 FTE psychologists should be employed. CONCLUSION: In order to implement multiprofessional patient treatment and support for relatives in the ICU, it is essential to employ a proportionate number of therapeutic healthcare professionals.

[Relatives after a stay on the intensive care unit: a care gap to be closed]. / Angehörige nach Aufenthalt auf der Intensivstation: Eine Versorgungslücke ist zu schließen.

Structures for the care of relatives after a stay on the intensive care unit are present in principle, but no systematic interfaces between the different types of care and the care sectors exists. Therefore, in a first step, the needs of relatives during intensive care treatment should be continuously assessed and addressed as early as possible. Furthermore, proactive provision of information regarding aftercare services is necessary throughout the entire course of hospitalization and rehabilitation, but also in the phase of general practitioner care. The patient's hospital discharge letter with a detailed social history can serve information transfer at the interfaces.

[Position paper on working in the intensive care unit during pregnancy : DIVI recommendations for improving the situation of pregnant employees in the ICU]. / Positionspapier zum Arbeiten in der Schwangerschaft auf der Intensivstation : DIVI-Empfehlungen zur Verbesserung der Lage von schwangeren Mitarbeiterinnen auf einer Intensivstation.

The Maternity Protection Act is intended to protect the mother and the child from hazards, excessive demands and damage to health in the workplace, and from financial disadvantages and loss of employment. However, the objectives defined by the Maternity Protection Act-the safety and health of the pregnant employee on the one hand and the prevention of disadvantages in working life on the other-are not yet adequately achieved in the intensive care unit (ICU). Implementation of the Maternity Protection Act to the benefit of all involved parties should also be promoted in the specialist areas represented by the DIVI, in particular the work of pregnant physicians and nursing staff and other working specialists (respiratory therapists, physiotherapists, speech therapists, psychotherapists, and social workers) in the ICU. The aim of this paper is to raise awareness of the need to consider each pregnant and breastfeeding staff member individually and to work together to find a personal solution for continuing to work in the ICU. Possible ways and solutions to achieve this goal are outlined and practical examples are given for implementation in everyday clinical routine. These are also based on comprehensive presentation of activities according to a traffic light color-code system for all occupational groups. Arguments against pregnant employees working in the ICU are discussed and possible solutions are presented.

[Position paper on working in the intensive care unit during pregnancy : DIVI recommendations for improving the situation of pregnant employees in the ICU]. / Positionspapier zum Arbeiten in der Schwangerschaft auf der Intensivstation : DIVI-Empfehlungen zur Verbesserung der Lage von schwangeren Mitarbeiterinnen auf einer Intensivstation.

The Maternity Protection Act is intended to protect the mother and the child from hazards, excessive demands and damage to health in the workplace, and from financial disadvantages and loss of employment. However, the objectives defined by the Maternity Protection Act-the safety and health of the pregnant employee on the one hand and the prevention of disadvantages in working life on the other-are not yet adequately achieved in the intensive care unit (ICU). Implementation of the Maternity Protection Act to the benefit of all involved parties should also be promoted in the specialist areas represented by the DIVI, in particular the work of pregnant physicians and nursing staff and other working specialists (respiratory therapists, physiotherapists, speech therapists, psychotherapists, and social workers) in the ICU. The aim of this paper is to raise awareness of the need to consider each pregnant and breastfeeding staff member individually and to work together to find a personal solution for continuing to work in the ICU. Possible ways and solutions to achieve this goal are outlined and practical examples are given for implementation in everyday clinical routine. These are also based on comprehensive presentation of activities according to a traffic light color-code system for all occupational groups. Arguments against pregnant employees working in the ICU are discussed and possible solutions are presented.

Einarbeitung in der Intensivmedizin.

As staff shortage in intensive care medicine increases, sustainable recruitment and retention of qualified professionals becomes increasingly crucial. Current surveys indicate that sufficient onboarding is a key element to success in this context. The recommendations outlined in the position paper "Onboarding in intensive care medicine" aim to address this issue by guiding towards comprehensive, structured onboarding of professionals. The primary goal of providing such structured onboarding is to increase employee satisfaction, ensure the well-being and safety of both care providers and patients, and guarantee long-term supply of intensive care medicine for the population. This paper was developed under the leadership of the Junge DIVI, a multidisciplinary and multiprofessional initiative of young professionals, within the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI). It was based on a systematic literature research and consensus-building among various professional groups and disciplines, offering - for the first time - uniform, standardized, practical guidance for implementing structured onboarding for different professionals in intensive care units in Germany.

[The intensive care diary-a communication tool]. / Schriftliche Begleitung einer existenziellen Erfahrung: Das Intensivtagebuch als kommunikativer Brückenschlag.

Diaries in intensive care units (ICU) are mostly written by families and nurses for patients with impaired consciousness. In the diary, the development of the patients is described in plain language by daily reports. Patients can read the diary later and process their experiences and, if necessary, reframe them differently. ICU diaries reduce the risks of psychosocial sequelae of patients and families and are now used worldwide. Diaries have different purposes and also serve as a communication tool: words are written to a person who will hopefully read them later. This can help families to stay connected and cope better with the situation. However, writing a diary can also be perceived as a burden by some relatives and nurses due to lack of time or because it seems to be too close. ICU diaries can serve as a tool for patientand family-centered care.

[Onboarding of young professionals in the intensive care unit : Nationwide online survey by young DIVI - an initiative of the German interdisciplinary association for intensive and emergency medicine (DIVI)]. / Einarbeitung junger Fachkräfte auf der Intensivstation : Eine bundesweite Onlineumfrage der Jungen DIVI ­ einer Initiative der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI).

BACKGROUND: Onboarding of junior staff in the intensive care unit is vital to ensure high-quality critical care treatment. This process depends on beginner's training. AIM: We aimed to determine structure and duration of intensive care onboarding and the job satisfaction of junior professionals in German intensive care units. MATERIALS AND METHODS: We conducted an anonymous, interprofessional online survey regarding quality of onboarding and job satisfaction among young professionals. RESULTS: A total of 554 young professionals participated, about two thirds were physicians. A written concept was used in 59% of the nurse's and 27% of physicians' training. Median duration of training before taking full charge of patient treatment was 30 days among nurses and 7 days among physicians. About one third of nurses and 17% of physicians stated that they were sufficiently prepared after the training period, whereby 49% of physicians often felt overwhelmed. More than 42% can imagine working in critical care longer than the next 3 years. CONCLUSION: Fundamental methods for training of critical care professionals starting their intensive care career are underused in Germany and the duration of training blatantly differs from national guideline recommendations. Although there seem to be deficits concerning material and staff resources, participants are satisfied with learning progress and teamwork.

[DIVI-Recommendations on the infrastruture of adult intensive care units]. / DIVI-Empfehlung zur Struktur und Ausstattung von Intensivstationen 2022 (Erwachsene).

This document on the Structure and Equipment for Intensive Care Units of the German Association for Intensive and Emergency Care (DIVI) aims at providing guidance and recommendations for the requirements of (infra)structure, personal, and organization of intensive care units. The recommendations are based on a systematic literature search and a formal consensus process from a group of multi-disciplinary and multiprofessional specialists from the DIVI. The recommendations comprise a 3-staged level of intensive care units, a 3-staged level of care with respect to severity of illness, the staffing requirement of physicians, nurses, physiotherapists, pharmacists, psychologists, and other specialists. Furthermore, proposals concerning the equipment and the construction of ICUs are supplied.

Recommendations on the structure, personal, and organization of intensive care units.

Background: Intensive care units (ICU) are central facilities of medical care in hospitals world-wide and pose a significant financial burden on the health care system. Objectives: To provide guidance and recommendations for the requirements of (infra)structure, personal, and organization of intensive care units. Design and setting: Development of recommendations based on a systematic literature search and a formal consensus process from a group of multidisciplinary and multiprofessional specialists from the German Interdisciplinary Association of Intensive Care and Emergency Medicine (DIVI). The grading of the recommendation follows the report from an American College of Chest Physicians Task Force. Results: The recommendations cover the fields of a 3-staged level of intensive care units, a 3-staged level of care with respect to severity of illness, qualitative and quantitative requirements of physicians and nurses as well as staffing with physiotherapists, pharmacists, psychologists, palliative medicine and other specialists, all adapted to the 3 levels of ICUs. Furthermore, proposals concerning the equipment and the construction of ICUs are supplied. Conclusion: This document provides a detailed framework for organizing and planning the operation and construction/renovation of ICUs.

[Children visiting intensive care units and emergency departments : Kids are welcome!] / Besuche von minderjährigen Angehörigen in der Intensiv- und Notfallmedizin : Kinder als Besucher willkommen!

In this white paper, key recommendations for visitation by children in intensive care units (ICU; both pediatric and adult), intermediate care units and emergency departments (ED) are presented. In ICUs and EDs in German-speaking countries, the visiting policies for children and adolescents are regulated very heterogeneously: sometimes they are allowed to visit patients without restrictions in age and time duration, sometimes this is only possible from the age of teenager on, and only for a short duration. A request from children to visit often triggers different, sometimes restrictive reactions among the staff. Management is encouraged to reflect on this attitude together with their employees and to develop a culture of family-centered care. Despite limited evidence, there are more advantages for than against a visit, also in hygienic, psychosocial, ethical, religious, and cultural aspects. No general recommendation can be made for or against visits. The decisions for a visit are complex and require careful consideration.

[The intensive care diary-a communication tool]. / Das Intensivtagebuch ­ ein kommunikativer Brückenschlag.

Diaries in intensive care units (ICU) are mostly written by families and nurses for patients with impaired consciousness. In the diary, the development of the patients is described in plain language by daily reports. Patients can read the diary later and process their experiences and, if necessary, reframe them differently. ICU diaries reduce the risks of psychosocial sequelae of patients and families and are now used worldwide. Diaries have different purposes and also serve as a communication tool: words are written to a person who will hopefully read them later. This can help families to stay connected and better cope with the situation. However, writing a diary can also be perceived as a burden by some relatives and nurses due to lack of time or because it seems to be too close. ICU diaries can serve as a tool for patient- and family-centered care.

[Psychosocial care for relatives in the ICU: framework concept]. / Psychosoziale Angehörigenversorgung: Rahmenkonzept für Intensivstationen.

Family-centered care is an important aspect of care in intensive care medicine. But currently there is no agreement about the implementation in intensive care units (ICUs). Specific concepts of palliative medicine and pediatrics offer a good basis, but contents have to be adapted for the field of intensive care medicine. ICUs should formulate and implement a minimum standard based on the goals of shared decision-making, support for relatives in accompanying the patient, and support for the potentially burdened relatives themselves. Related protocols, reportings, and evaluation should be developed. Staff training in family-centered care and liability of provision is of great relevance for the implementation.

Use of Diaries in Intensive Care Unit Delirium Patients: German Nursing Perspectives.

Diaries are written for patients in intensive care units by staff and relatives, especially when patients experience a disorder of their consciousness, such as delirium. Diary entries are written in common language, describing the situation of the patient. The diary can be read by the patient and the family and support the coping and understanding of what happened. It can function as a tool for supporting communication about different experiences and views of critical illness.