Effects of an online information tool on post-traumatic stress disorder in relatives of intensive care unit patients: a multicenter double-blind, randomized, placebo-controlled trial (ICU-Families-Study).

PURPOSE: Intensive care unit (ICU) hospitalization is challenging for the family members of the patients. Most family members report some level of anxiety and depression, sometimes even resulting in post-traumatic stress disorder (PTSD). An association has been reported between lack of information and PTSD. This study had three aims: to quantify the psychological burden of family members of critically ill patients, to explore whether a website with specific information could reduce PTSD symptoms, and to ascertain whether a website with information about intensive care would be used. METHOD: A multicenter double-blind, randomized, placebo-controlled trial was carried out in Austria and Switzerland. RESULTS: In total, 89 members of families of critically ill patients (mean age 47.3 ± 12.9 years, female n = 59, 66.3%) were included in the study. 46 relatives were allocated to the intervention website and 43 to the control website. Baseline Impact of Event Scale (IES) score was 27.5 ± 12.7. Overall, 50% showed clinically relevant PTSD symptoms at baseline. Mean IES score for the primary endpoint (~ 30 days after inclusion, T1) was 24 ± 15.8 (intervention 23.9 ± 17.9 vs. control 24.1 ± 13.5, p = 0.892). Hospital Anxiety and Depression Scale (HADS - Deutsch (D)) score at T1 was 12.2 ± 6.1 (min. 3, max. 31) and did not differ between groups. Use of the website differed between the groups (intervention min. 1, max. 14 vs. min. 1, max. 3; total 1386 "clicks" on the website, intervention 1021 vs. control 365). Recruitment was prematurely stopped in February 2020 due to coronavirus disease 2019 (COVID-19). CONCLUSION: Family members of critically ill patients often have significant PTSD symptoms and online information on critical illness did not result in reduced PTSD symptoms.

Extent and application of patient diaries in Austria: process of continuing adaptation.

BACKGROUND: Diaries written for patients in the intensive care unit (ICU) are offered in many European countries. In Austria, ICU diaries have been relatively unknown, but since 2012, they have started to emerge. AIM: The aim of this study was to explore the extent and application of ICU diaries in Austria in 2015. METHOD: The study had a prospective multiple methods design of survey and interviews. All ICUs in Austria were surveyed in 2015 to identify which ICUs used diaries. ICUs using diaries were selected for semi-structured key-informant telephone interviews on the application of ICU diaries. Interviews were analysed by content analysis. RESULTS: Of the 178 ICUs contacted, 13 had implemented ICU diaries. In all ICUs, diaries were sporadically introduced by a few dedicated nurses. Experiences of participating nurses can be summarized in two main themes: (a) the process of innovation and (b) the process of practice. Sub-themes were: (i) inspiration, creativity and innovation and (ii) purpose, indications, responsibility, authorship, experience, negative reception, and post-ICU practice. Individual nurses at each ICU found ways to organize and format ICU diaries while dealing with ambivalence and legal implications. CONCLUSION: The implementation of a new nursing intervention is an ongoing process. Being innovative and responsible can be challenging, especially in hierarchical team structures. We recommend that nurses work towards national standards for the diary concept in order to enable future research into the process and outcome of ICU diaries. RELEVANCE TO CLINICAL PRACTICE: The implementation of ICU diaries in routine care requires an ongoing adaptive, reflective process. Nurses may experience innovation, leading to the development of their own, feasible adaptions and structures.

Improvement of glucose control in the intensive care unit: an interdisciplinary collaboration study.

BACKGROUND: Strict glycemic control in critically ill patients is challenging for both physicians and nurses. OBJECTIVES: To determine the effect of focused education of intensive care staff followed by implementation of a glucose control protocol. METHODS: A prospective observational study in a medical intensive care unit in a university hospital. After intensive education of nurses and physicians, a glucose control protocol with a nurse-managed insulin therapy algorithm was developed and implemented. Every measured blood glucose value and insulin dose per hour and per day were documented in 36 patients before and 44 patients after implementation of the protocol. RESULTS: Median blood glucose levels decreased after implementation of the protocol (133 vs 110 mg/dL; P < .001). The amounts of time when patients' blood glucose levels were less than 110 mg/dL and less than 150 mg/dL increased after implementation of the protocol (8% vs 44%; 75% vs 96%; P<.001). The median use of insulin increased after implementation of the protocol (28 vs 35 IU/day; P=.002). Diabetic patients had higher median blood glucose levels than did nondiabetic patients both before (138 vs 131 mg/dL) and after (115 vs 108 mg/dL; P<.001) implementation, although median insulin use also increased (before implementation, 33 vs 26 IU/day; P=.04; after implementation, 46 vs 30 IU/day; P < .001). CONCLUSIONS: Use of a collaboratively developed glucose control protocol led to decreased median blood glucose levels and to longer periods of normoglycemia. Despite increased insulin use, glucose control was worse in diabetic patients.