Aiding recovery from critical illness

Guest blog from Christina Jones, winner of
the Medicine Award at the BioMed
Central 5th Annual Research Awards
for her article ‘Intensive care diaries reduce new
onset post traumatic stress disorder following critical illness: a randomised,
controlled trial’

Here, Christina talks about how she became
interested in critical illness recovery and how her research has aided
rehabilitation across the globe

over 20 years ago I became interested in the struggle patients and their families
had in recovering from a stay in intensive care. Intensive care treats some of
the sickest patients in  hospital, but  little was offered to help to rebuild their
strength and cope with the psychological after matter, such as post traumatic
stress disorder (PTSD).

PhD work firstly tested the impact of a patient-directed rehabilitation manual.  This manual contained information about the
critical illness experience, psychological advice to cope with anxiety,
depression or panic attacks and a 6 week exercise programme.  I also examined the impact of different types
of memory  from the patient’s time spent
in intensive care.  It became clear that
those patients who could remember delusional memories, such as hallucinations,
nightmares or paranoid feelings that someone was trying to harm them, were the
most traumatised. Although the use of the rehabilitation manual could accelerate
physical recovery it unfortunately had no impact on psychological recovery.

RACHEL (Raising Awareness of Chronic Health Events in the Longterm) diary study
came out of the need to help patients put these memories into some kind of
autobiographical narrative. The diaries are a simple idea, an everyday account
of the patients’ intensive care stay written mainly by the nurses with
contributions from the family. Once the randomised study was postulated
enthusiasm grew and I got e-mails from around Europe to join the RACHEL group. It
grew from 5 study centres to 12 and gave us a good chance to achieve the
numbers we needed to look at the effect of receiving an intensive care diary on
the development of PTSD. When the randomisation code was broken and it became
clear that the patients receiving the diary had only a 5% incidence of PTSD compared
to the controls, who had a 13% incidence, it was an amazing moment. Since then
I have had requests for the diary guidelines from around the world, mainly from
intensive care nurses wanting to do the best for their patients.     

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