Can Writing in a Journal Help Family Members Too?
For years I’ve broadcasted that writing in a journal about adverse experiences can help you to process your fears and hopes, your brokenness and inner strength, your grieving and healing. In concert with my experiences, I’d like to share the findings of a recent article, “Journal Writing by Families of Critically Ill” in the journal CriticalCareNurse.[1] This article compiles research studies done on the efficacy of journal writing by family members when a loved one is in a neonatal intensive care unit (NICU), a pediatric intensive care unit (PICU), or an intensive care unit (ICU) setting. The studies included in this review represent journal writing experiences of 426 relatives of critically ill patients.
One research study focused on mothers of infants who were hospitalized in a NICU in the previous two to fourteen months. One group of mothers was required to write in a journal for at least thirty minutes for four days in a row. Mothers were asked to write about their most emotional and upsetting experiences in the NICU. The key finding was that there was a significant decrease in psychological distress for the mothers who participated in the journaling intervention after four weeks compared to the control group of mothers who did not have this intervention.[2]
A different study explored family members’ experiences with reading and writing in a journal in participation with medical staff. The study refers to these journals as “public ICU diaries” because both the family members and the medical staff wrote in the diaries. The only instruction given to family members and medical staff was to refrain from writing about confidential matters that should not be shared. The research found three primary benefits of keeping “public ICU diaries.” 1) Improved communication: Families found that the journals helped to assess, assimilate, and share information. 2) Emotional experience: Families found that the diaries allowed them to confide and keep hope alive. It allowed them to express active feelings and release fears and anxieties. 3) Humanization experience: The diaries allowed families to perceive the staff and patient in a new way and served as a medium for developing a warm relationship with the staff. [3]
One more study explored the experiences of children who were patients and their families as recorded in journals after the patients had been discharged, and the role that journals might have in the process of recovering from a PICU stay. These were “public PICU diaries” in which nurses and family members wrote. They also included photographs of the child during his/her PICU stay. The research identified three primary benefits. 1) Value to the family: The diary helped to improve coherence of the PICU stay for the family and fill in gaps in memories; it provided a common language for the family to start a dialogue with the child about the PICU experience. 2) Creating memories: Rereading the diary helped the children to understand the reality of their PICU stay. 3) Importance of pictures: Pictures of the child in the PICU could be more important than words when explaining situations and events.[4]
Echoing the research done in more than 400 studies of patients who benefitted from writing in a journal while hospitalized, the findings of this review suggest that when family members wrote in a journal while their loved one was in an intensive care setting, the intervention helped to reduce psychological distress and the effects of post-traumatic stress disorder. An additional benefit was the increased understanding of a family member’s stay in an intensive care setting. The article’s authors summarize, “The findings of this review align with previous research indicating that expressive writing in a diary can produce substantial improvement in psychological well-being and reduce stress.”[5] [6]
[1] Nakashima, H, Gallegos, C. Journal writing by families of critically ill patients: An integrative review. Crit Care Nurse. 2020; 40(5): 26-37. https://doi.org/10.4037/ccn2020293
[2] Barry LM, Singer GHS. Reducing maternal psychological distress after the NICU experience through journal writing. J Early Intervent. 2001; 24(4):287-297.
[3] Garrouste-Orgeas M, Perier A, Mouricou P, et. al. Writing in and reading ICU diaries: qualitative study of families’ experience in the ICU. PLoS One. 2014;9(10):e110146. doi:10.1371/journal.pone.0110146.
[4] Mikkelsen G. The meaning of personal diaries to children and families in the pediatric intensive care unit: a qualitative study. Intensive Crit Care Nurs. 2018; 45:25-30. doi:10.1016/j.iccn.2017.10.001.
[5] Pennebaker JW. Emotion, Disclosure and Health. 5th ed. American Psychological Services; 2007.
[6] Lepore SJ, Smyth JM. The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-being. American Psychological Association; 2002.