Nydahl-Diary2 - Välkommen till nofi · Nydahl P, Knück D, Bischoff K, Fritzsch A (2011). Evaluationsstudie Das Tagebuch war eine große Hilfe für mich. Pflegen Intensiv 1: 29-34

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Intensive AfterCare

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Peter Nydahl, Nursing Research

Norrkøping, Nov. 28th 2013 The ICU diary network:

Development, progress and future possibilities.

Intensive AfterCare

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•  German Network •  International Network •  Network study •  Ideas for the future

www.acgchicago.com

2006: Do German ICU patients need a diary?

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8 patients have been interviewed 6-24 month after their stay on the ICU in 2006/7. Answers were analysed and categories were build (Mayring 2002). Fears, dreams and delusional experiences are common, a way of follow-up seems to be indicated.

Knück, D.; Nydahl, P: What do ICU patients need to regain their memories after an ICU stay? Not published yet

2008: Are there any diaries in Germany?

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All ICUs in two federal states of Germany (n = 120) were contacted either by phone and/or mail. The recruitment was supported by invitations published in three nursing journals, four internet discussion boards, a postal invitation to 23 universities, and the use of personal contacts by the investigators; all in Germany. Using the above methods, it was found that no adult intensive care units were using patient diaries in 2008.

Nydahl P, Knück D, Egerod I (2010): The extend and application of patient diaries in German Intensive Care Units. Connect – The World of Critical Care Nursing 7 (2): 122-126

2008: Is there an evidence for diaries?

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Systematic literature research (PubMed, Cinahl, handsearch) in 2008. 9 studies were found. Single publications report that the diary i) is accepted well by patients; ii) supports the coping process; iii) leads to better understanding, comprehension and gives a meaning to the ICU therapy in the sense of salutogenesis; iv) has a positive influence on post-traumatic stress disorder, anxiety and depression.

Nydahl P, Knück D (2010): Träume und Traumata – eine systematische Übersichtsarbeit zur Wirkung des Tagebuches auf Intensivpatienten. DIVI 1 (1): 31-37

Implementation in Germany till 2011

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Adaption

•  photos of patients -> photos of empty bed & environment •  no structured follow-up -> diary is handed over at discharge to relatives

Approach

•  6 Articles in different nursing journals •  Website incl. monthly newsletter, sample drafts and informations •  Email support •  Lectures (10 on congresses, 15 regional)

Implementation

•  Implementation in practice by nurses •  Email support & discussions •  Support implementation challenges

Final thesis of Intensive Care education Chapters in Intensive Care books Diary becomes an autonomous idea

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Implementation in Germany till 2011

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Adaption

•  photos of patients -> photos of empty bed & environment •  no structured follow-up -> diary is handed over at discharge to relatives

Approach

•  6 Articles in different nursing journals •  Website incl. monthly newsletter, sample drafts and informations •  Email support •  Lectures (10 on congresses, 15 regional)

Implementation

•  Implementation in practice by nurses •  Email support & discussions •  Support implementation challenges

Final thesis of Intensive Care education Chapters in Intensive Care books Diary becomes an autonomous idea

2009: What are the problems in practice?

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Online-survey with ICUs that use diaries in 2009. 18 (48) ICUs attended. Greatest barriers during the implementation process are bureaucratic barriers and lack of time & lack of staff.

Knück D, Nydahl P (2010): Einführung des Intensivtagebuches: Erste Erfahrungen sind positiv. Pflegen Intensiv 3 (10): 36-40

2010: How do patients & relatives evaluate the diary?

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Multicenter study (4ICUs), questionnaire (26 patients, 16 relatives). Patients and relatives appreciate the diary, honour the idea and engagement. The diary seems to support the communication between the family and is a kind of coping strategy. The adaption of the ICU-diary to German working conditions was evaluated positively.

Nydahl P, Knück D, Bischoff K, Fritzsch A (2011). Evaluationsstudie Das Tagebuch war eine große Hilfe für mich. Pflegen Intensiv 1: 29-34

2011: Is the ICU diary transferable to PICU?

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The diary was transferred to a pediatric ICU to support the coping of the parents of prematured babies. The PICU diary has been evaluated by 18 parents with similar results. The PICU diary is meaningful, useful and practical.

Ansorge, A. (2011). Intensivtagebuch für Frühgeborene. Kinderkrankenschwester 12250 (30): 1-8

www.intensivtagebuch.de

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Information •  About diary •  For clinicians •  For relatives •  For patients •  Newsletter (38) •  Support •  Literature (12 in German) 62 clinicians in newsletter 60-80 ICUs in Germany, Switzerland, Austria

Other

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•  Translation of an Intensive Care guide booklet (icusteps.org) •  German Sepsis Aid (DSH) •  German Critical Care Nursing Society (DGF) •  forwarded to 1600 ICUs

•  Establishing self-help groups •  Online PTSS-tool

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Public information

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•  5 articles in hospitals journals •  4 articles in Newspapers •  1 article in a public psychological journal •  1 report in television •  3 cases of implementation by families!

Development & Contacts

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2006 Knowing diaries

2007 Survey in Germany

2008 Implementation

2009 Barriers

2010

2011 Evaluation

2012

2013

Contact to I. Egerod

Conference in Copenhagen

Contact to Peter Gibb

Conference in Berlin (Jones, Gibb)

www.mobilization-network.org

www.icu-diary.org

ICU-diary Network

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ICU Diary

Network D. Knück

I. Egerod

C. Jones

C. Bäckman

S. Storli E. Akerman

P. Gibb

D. Needham

Mobilization-Network

German Diary

Network

ICU diary Network

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Founded in February 2012 •  Eva Akerman •  Carl Bäckman •  Ingrid Egerod •  Christina Jones •  Dirk Knück •  Peter Nydahl •  Sissel Storli

We offer literature, descriptions and help for implementation. We try to coordinate information, projects and new studies. And we try to connect people.

www.icu-diary.org

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•  Start •  Diary •  Support •  News •  Map •  Literature •  Links •  About us

www.icu-diary.org: diary

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Introduction •  Based on

Nydahl, Knück, Egerod (2010)

•  Reviewed by core group

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www.icu-diary.org: Support

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Help for starting •  Paper forms •  Consent forms •  Examples •  Guidelines

www.icu-diary.org: News

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12 Newsletter •  New studies •  Information Sources: •  icusteps •  ICU Rehab

Network •  RSS Pubmed &

CINAHL

www.icu-diary.org: Map

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Map •  www.batchgeo.com Categories •  Contacts •  Implemented

diaries •  Diary projects

www.icu-diary.org: Map – Feb. 2012

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www.icu-diary.org: Map – Feb. 2013

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www.icu-diary.org: Map – today

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www.icu-diary.org: Literature

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•  32 Studies •  4 Posters •  3 Guidelines •  34 related articles •  10 After Care •  2 books •  1 RSS-feed

www.icu-diary.org: Links

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www.fsaio.net

www.intensivtagebuch.de

www.intensivnachsorge.de

www.hopskinsmedicine.org/OACIS

www.icusteps.org www.icu-diary.org

Web designing?

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iWeb Server in Germany 27 € per year App for iPhone?

Visits on website

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0

200

400

600

800

1000

1200

1400

Dez 12 Jan 13 Feb 13 Mar 13 Apr 13 May 13 Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13

156

832 819

1015 957

877 776

1269

1093

875

1107

797

Visits

Emails incl. “diary”

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0

50

100

150

200

250

300

350

400

49

321 377

2011 2012 2013

Network Disciplines – 112 members

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Network Countries

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Network Growing

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•  Note in EfCCNa Newsletter 1/12 •  Spread by email •  Rehab Conference in Baltimore Mar/Nov 2013 •  Articles in

•  Boston Globe 4/13/2013 •  New York Times 22/7/2013

•  European Mobilization Conference Vienna 11/2nd-3rd/2013

•  ICUsteps conference 11/13/2013

Networking with other networks

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Outcome Evaluation

Sedation Practice

Physical Rehab

Early Mobilization

Mental Rehab

ICU Diaries

Networking with other networks

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Network Challenges

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•  Australia started ... •  Q: Implementation of something new •  A: Just do it

•  Austria is starting •  Q: Bureaucratic challenges •  A: Hierarchical agreements

•  USA & Canada try to start •  Q: Juridical considerations •  A: Implementation in form of studies

Network Challenges

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Implemented diary Perth Brisbane Diary projects Melbourne (2x)

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Network Challenges

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Implemented diary Vienna Innsbruck Diary projects Zams (waiting for 18 month)

Network Challenges

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Implemented diary Bedford Concord San Francisco Diary projects Baltimore Boston Phoenix Stamford Washington

Network Activities

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A lot of people on different ICUs •  Share ideas, knowledge and experiences •  Connect people (US!) •  coordinate activities like conferences •  Enable studies

How much time do nurses need to write an ICU diary?

First Network Study

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Nydahl P, Bäckman CG, Bereuther J, Thelen M. How much time do nurses need to write an ICU diary? Nursing in Critical Care, 2013, in press.

And the second network-study?

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Ideas: •  Network-Survey about implementation incl. aims, barriers etc

•  Comparison btw. countries via online survey, Skype •  Diaries for children

•  Survey •  experimental study for school children or parents

•  Diaries for delirious, non ventilated patients •  RCT – SF-36 & PTSS 10

And the second one?

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Ideas: •  Diaries for dying, non sedated patients and relatives

•  Patients are writing themselves •  Family continues writing •  Interviews, grief, depression

•  Diaries for transplantation patients •  Pre: patients write themselves •  OP: staff & family continues •  Post: patient continues

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And the second one?

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Ideas: •  Electronically diaries & communication: iPads? •  Literature research: juridical cases? •  Literature research: side effects? •  Rejection of the diary: who and why?

ICU diary network

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We offer literature, descriptions and help for implementation. We try to coordinate information, projects and new studies. And we try to connect people. Interest: [email protected]

Documents

Nydahl-Diary2 - Välkommen till nofi · Nydahl P, Knück D, Bischoff K, Fritzsch A (2011). Evaluationsstudie Das Tagebuch war eine große Hilfe für mich. Pflegen Intensiv 1: 29-34