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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., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

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., (Copyright © 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

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., Competing Interests: Neben der im Titel genannten Zugehörigkeit aller Autor*innen zur Fachgesellschaft DIVI erklären die Autor*innen, dass keine Interessenkonflikte bestehen., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

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., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

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., (© 2024. The Author(s).)

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., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

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., (© 2023. The Author(s).)

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., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

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., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

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., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Waydhas, Riessen, Markewitz, Hoffmann, Frey, Böttiger, Brenner, Brenner, Deffner, Deininger, Janssens, Kluge, Marx, Schwab, Unterberg, Walcher and van den Hooven.)

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., (© 2023. The Author(s).)

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., (© 2022. The Author(s).)

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., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

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., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein Erklärung zu nichtfinanziellen Interessen Deffner: Sprecherin Sektion Psychologische Versorgungsstrukturen der DIVI e.V.; Vertreterin der Gesundheitsfachberufe im Präsidium der DIVI, (Thieme. All rights reserved.)

Background: Psychological care should be provided in intensive care units (ICUs) because of the proven mental symptoms of patients and relatives. Even physicians and nurses can benefit from a corresponding care structure. Knowledge is lacking whether and how psychological care for patients and relatives as well as support for staff in German ICUs is implemented. For this reason, a survey was conducted among the members of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) to gain an overview of the current structures and the need for psychological support., Methods: The members of DIVI were invited to participate in a web-based survey. A total of 226 physicians and nurses took part in the survey. Analysis included statistics and group comparisons with Χ 2 methods., Results: In all care areas, psychological care of patients, relatives, and support for staff, respondents indicated a significant undersupply and expressed the need for improved care. A model which provides consular or team-integrated support based on the level of care is conceivable., Discussion: The current state of psychological care in German ICUs does not cover the existing need. Consequently the development of concepts and the beginning of discussions on how appropriate psychological care can be implemented in the future is necessary.

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., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

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.

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.

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.

Intensive care treatment is proven to be associated with patients' mental symptoms. There is a correlation between acute stress and psychological sequelae, which has not yet been sufficiently theoretically substantiated. This case report illustrates the development of mental symptoms during and after intensive care treatment with reference to a psychotraumatological model. Above all, memories that are not related to reality but are associated with fear of death are potentially traumatic. A re-evaluation of these memories can help to prevent psychological sequelae. Psychoeducation, conversation with the staff of the intensive care unit (ICU) and the ICU diary are helpful instruments in this process. Continuous psychological care should be provided if acute psychological stress occurs during intensive care medical treatment.

Background: Intensive care unit (ICU) treatment may be associated with mental symptoms such as anxiety, depressed mood, hopelessness and nightmares in critically ill patients. While many physical symptoms can be detected via standardized measures, an instrument to assess mental symptoms is actually missing., Objectives: An existing validated screening tool to detect mental symptoms in critically ill patients, the Intensive Care Psychological Assessment Tool (IPAT), has been translated into German and tested in two surgical ICUs and an intermediate care unit., Materials and Methods: In addition to the German translation of the IPAT, Stait-Trait-Anxiety-Inventory (STAI-SKD) and Hospital Anxiety and Depression Scale (HADS-D) were used to determine convergent validity. Within a survey period of 3 months, a total of 90 awake and fully oriented patients were included in the study., Results: Internal consistency of the German translation was lower than that of the original study. The initial factor structure was partially replicated. Convergent validity was demonstrated for depressive and anxiety symptoms, but not for the presence of delirium. Patients who completed the screening were frequently suffering from sleep disturbances, tension, anxiety and depressed mood. A total of 37% of the patients exceeded the cut-off and are considered at-risk patients for psychological sequelae., Discussion: With regard to test quality, the results of the German version are currently not satisfactory. This may be due to the small sample size and sample selectivity, which is also the largest limitation of the study. The instrument proved to be practicable if patients can complete it as an interview. The adaptation for external assessment seems to be useful to capture psychological stress in patients with impaired communication and perception.

Background: Diaries are written for patients on intensive care units (ICU) by clinicians and relatives to reduce the risk of psychological complications such as posttraumatic stress disorder (PTSD), anxiety, and depression. The authors of a Cochrane Review on this topic published in 2015, included studies with PTSD diagnoses based on interviews carried out by qualified personnel, and concluded that there is inadequate evidence to support the thesis that ICU diaries reduce the risk of psychological complications., Methods: The present study replicated the design of the Cochrane Review with identical search algorithms, but included additional outcomes data from validated methods of diagnosing psychological complications that were not considered in the original Cochrane Review. The primary outcome was PTSD in patients or relatives with ICU diaries. Secondary outcomes were anxiety and/or depression symptoms. Study quality was evaluated using the Cochrane risk of bias assessment., Results: The replicated search produced 3179 citations, of which there were 6 eligible studies from which 605 patients and 145 relatives could be included in the meta-analysis. Studies ratings ranged from low to good. The meta-analyses of the PTSD outcome demonstrated the following: (a) for ICU patients (4 studies, n = 569 patients) a non-significant reduction (odds ratio [OR] 0.58, 95% confidence interval [CI]: 0.24-1.42, p = 0.23), and (b) for relatives' PTSD (2 studies, n = 145 relatives) a significant reduction (OR 0.17, 95%CI: 0.08-0.38, p < 0.0001). The symptoms anxiety and depression in ICU patients (2 studies each, n = 88 patients) were significantly reduced (OR 0.23, 95%CI: 0.07-0.77, p = 0.02; OR 0.27, 95%CI: 0.09-0.77, p = 0.01, respectively). Heterogeneity was between 0 and 54%., Conclusion: ICU diaries may reduce the risk of psychological complications in patients and relatives after ICU stays.