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Bazzano G, Buccoliero F, Villa M, Pegoraro F, Iannuzzi L, Rona R, Fumagalli R, Giani M, Lucchini A. The role of intensive care unit diaries in the grieving process: A monocentric qualitative study. Nurs Crit Care 2024; 29:706-714. [PMID: 38015002 DOI: 10.1111/nicc.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The growing importance of psychological recovery for patients and their families following intensive care unit (ICU) experiences in recent years cannot be overemphasized. The ICU diary is used to aid patients in reducing the prevalence of post-traumatic stress disorder, anxiety, and depression. The usefulness of maintaining a diary during the grieving process has not yet been thoroughly investigated. AIM To investigate the role of ICU diaries in the grief process experienced by family members of a person who died in the intensive care unit. STUDY DESIGN Nine family members of seven deceased ICU patients with an ICU diary were contacted and interviewed by phone using a semi-structured interview. A qualitative data analysis was performed using thematic synthesis. SETTING Italian general intensive care unit. FINDINGS Interviewed family members felt that the diary helped them during the grieving process. The return of diaries was desired by family members for support and to remember one's loved one. The diary helped them process their losses in various ways, including signs of evidence of care, emotional involvement, consideration, and coping with grief. Four main themes emerged from the analysis: writing the diary, reading the diary, talking about the diary, and the diary during the grieving process. CONCLUSIONS The overall perception of the ICU diary was positive. The diary mostly helped relatives to "give back something of what we lost". This study also affirms the positive link between ICU diaries and bereavement in Italian ICU. Further studies are required to confirm the usefulness of this tool in the grieving process. RELEVANCE TO CLINICAL PRACTICE The ICU diary can help patients' family members understand what happened to their loved one and play an important role in the grieving process. The diary served as a valuable source of information that aided in providing bereavement support to the family by helping them to gain a rational and emotional understanding of the patient's death.
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Affiliation(s)
- Giacomo Bazzano
- Department of Anaesthesia, Emergency and Intensive Care, ASST Valtellina and Alto Lario, Eugenio Morelli Hospital, Sondalo, Italy
| | - Francesco Buccoliero
- Department of Anaesthesia, Emergency and Intensive Care, ASST Nord Milano - Sesto San Giovanni Hospital, Sesto San Giovanni, Italy
| | - Marta Villa
- Department of Emergency and Intensive Care - Adult and Paediatric General ICU, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Flavia Pegoraro
- Department of Emergency and Intensive Care - Adult and Paediatric General ICU, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Luigi Iannuzzi
- Department of Emergency and Intensive Care - Adult and Paediatric General ICU, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Roberto Rona
- Department of Emergency and Intensive Care - Adult and Paediatric General ICU, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Roberto Fumagalli
- Department of Emergency and Intensive Care, ASST GOM Niguarda, University of Milano-Bicocca, Milano, Italy
| | - Marco Giani
- Department of Emergency and Intensive Care - Adult and Paediatric General ICU, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Alberto Lucchini
- Department of Emergency and Intensive Care - Adult and Paediatric General ICU, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
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Daltveit S, Kleppe L, Petterteig MO, Moi AL. Photographs in burn patient diaries: A qualitative study of patients' and nurses' experiences. Intensive Crit Care Nurs 2024; 82:103619. [PMID: 38185023 DOI: 10.1016/j.iccn.2023.103619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To explore burn patients' and burn intensive care nurses' experiences of the photos in patient diaries. DESIGN A qualitative inductive study using thematic analysis was performed. We conducted individual interviews with six former burn patients (age range 20-77 years; four women), and two focus groups with 11 burn intensive care nurses (age range 38-61 years; all women). Data from patients and nurses were analysed together, and the findings reported according to the consolidated criteria for reporting qualitative research (COREQ). SETTING A Norwegian burn centre where the writing of diaries including text and photos has been practiced for approximately two decades. FINDINGS Three main themes were derived from the combined analysis of the two data sets: hesitating when facing photos; visualising others care; and visualising the trajectory from burn trauma to recovery. Although the patients worried beforehand about what they would see in the photos and the nurses feared to select frightening photos, the photos were welcome, and several patients said they would have liked even more. The photos filled in gaps of memory, told more than words, and did not lie. Photos of family, friends or staff demonstrated shared actions that supported memories and recovery. CONCLUSION Both the burn patients and the burn intensive care nurses considered photos to be an essential part of the diary that gave context and provided a factual presentation of the patients' pathway of treatment, care and recovery. IMPLICATION FOR CLINICAL PRACTICE Tailored information about photo content should be offered to patients before a diary is handed over to them. Nurses should attempt to include photos covering the patients' entire stay at the burn centre, as well as photos of family, friends and staff. Individual nurses should be supported in their practical selection of photos for the diary.
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Affiliation(s)
- Siri Daltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway.
| | - Lena Kleppe
- Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, PO Box 1400, 5021 Bergen, Norway
| | - Marie Opsanger Petterteig
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, PO Box 1400, 5021 Bergen, Norway
| | - Asgjerd Litleré Moi
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway; Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, PO Box 1400, 5021 Bergen, Norway; Faculty of Health Sciences, VID Specialized University, Ulriksdal 10, 5009 Bergen, Norway
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Willmeroth T. Nurses' and Parents' View on Neonatal Intensive Care Unit Diaries: A Qualitative Study and Framework Conceptualization. Am J Perinatol 2024; 41:e1800-e1812. [PMID: 37207660 DOI: 10.1055/s-0043-1768959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE The birth of a premature or critically ill newborn can be a traumatic event for the entire family. In these situations, the neonatal intensive care unit (NICU) diary is a relevant coping intervention to support family members. However, a profound theoretical concept is lacking, and there is little evidence about how it is applied by nurses in clinical practice. Therefore, this study aims to investigate how NICU diaries are used by nurses to support family members cope with their experiences and to develop an evidence-guided and theory-based framework for conceptualizing diary usage in the NICU. STUDY DESIGN A qualitative study design containing 12 narrative interviews with nurses from six different hospitals and two focus group interviews with nine parents from two different hospitals was chosen. The qualitative data were analyzed via content analysis inductively and separately and brought together via graphical coding in a second step. RESULTS Four main categories emerged from the analyzed data to describe the NICU diary in nursing practice. Regarding diary (1) "usage," three different types of NICU diaries were identified, which seem to be established largely intuitive. The (2) "content" is constituted by the diary's title, introduction, textual, and nontextual components. Taking into account the diary (3) "function" for the parental coping process, three subcategories emerge: (a) strengthening the parental role, (b) supporting understanding of events, and (c) bringing joy and normality to the situation. (4) "Challenges" address an appropriate writing style, the reading of parental entries by nurses and limited resources. Based on these results and taking into account relevant literature, a framework for conceptualizing NICU diaries was developed. CONCLUSION NICU diaries show great potential to support the parental coping process. Nevertheless, diary conceptualization should be based on a theoretical framework to clarify its usage for nurses and parents. KEY POINTS · NICU diaries are an established intervention used by nurses to support parental coping.. · In nursing practice, different types of NICU diaries emerge.. · Writing styles, content, and reading of entries are reported heterogeneously.. · A conceptualizing framework for NICU diaries is needed..
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Affiliation(s)
- Tabea Willmeroth
- Fachbereich Gesundheit, FH Münster, University of Applied Sciences, Witten, Germany
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Johansson M, Wåhlin I, Magnusson L, Hanson E. The use and application of intensive care unit diaries: An instrumental multiple case study. PLoS One 2024; 19:e0298538. [PMID: 38422059 PMCID: PMC10903823 DOI: 10.1371/journal.pone.0298538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
AIMS AND OBJECTIVES The study aim was to explore the use of an Intensive Care Unit (ICU) diary within four different ICUs units in Sweden and thereby contribute to practice guidelines regarding the structure, content and use of an ICU diary. BACKGROUND ICU diaries are used to aid psychological recovery among critical care patients, but differences remain in diary writing both within and across countries. Few studies have focused on the combined views and experiences of ICU patients, family members and nursing staff about the use of ICU diaries. DESIGN An instrumental multiple case study design was employed. METHODS Three focus groups interviews were carried out with 8 former patients and their family members (n = 5) from the research settings. Individual interviews were carried out with 2 patients, a family member and a nurse respectively. Observations, field notes, documentary analysis and conversations with nursing staff were also conducted. Consolidated criteria for reporting qualitative research (COREQ) was followed. RESULTS The qualitative findings firstly consisted of a matrix and descriptive text of the four ICU contexts and current practices. This highlighted that there were similarities regarding the aims and objectives of the diaries. However, differences existed across the case study sites about how the ICU diary was developed and implemented. Namely, the use of photographs and when to commence a diary. Second, a thematic analysis of the qualitative data regarding patients' and family members' use of the ICU diary, resulted in four themes: i) the diary was used to take in and fully understand the situation; ii) the diary was an opportunity to assimilate warm, personalised and human care; iii) the diary was used to manage existential issues; and iv) the diary was a tool in daily activities. CONCLUSIONS Analysis of the instrumental case study data led to the identification of core areas for inclusion in ICU diary practice guidelines.
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Affiliation(s)
- Maria Johansson
- Intensive Care Department, County Hospital, Region Kalmar County, Kalmar, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Ingrid Wåhlin
- Intensive Care Department, County Hospital, Region Kalmar County, Kalmar, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Research Section, Region Kalmar County, Kalmar, Sweden
| | - Lennart Magnusson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Swedish Family Care Competence Centre, Kalmar, Sweden
| | - Elizabeth Hanson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Swedish Family Care Competence Centre, Kalmar, Sweden
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Nordin A, Engström Å, Strömbäck U, Juuso P, Andersson M. Close relatives' perspective of critical illness due to COVID-19: Keeping in touch at a distance. Nurs Open 2024; 11:e2068. [PMID: 38268262 PMCID: PMC10733604 DOI: 10.1002/nop2.2068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/08/2023] [Accepted: 11/29/2023] [Indexed: 01/26/2024] Open
Abstract
AIM To elucidate the meaning of being a close relative of a critically ill person cared for in intensive care during the initial phase of the COVID-19 pandemic. DESIGN A narrative inquiry design following the COREQ guidelines. METHODS Individual interviews with fifteen close relatives of patients critically ill with COVID-19 were analysed using phenomenological hermeneutics. RESULTS The surreal existence of not being allowed to be near was emotionally difficult. While distancing due to restrictions was challenging, physicians' phone calls served as a connection to their relatives and brought a sense of security. Keeping notes helped them remember what happened and brought order to a chaotic situation. CONCLUSION Close relatives feel secure when they receive regular information about their critically ill relative, not just when their condition worsens. They wish to be physically near to their critically ill person; when this is impossible, digital technology can provide support, but further accessibility developments are needed.
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Affiliation(s)
- Anna Nordin
- Department of Health, Education and Technology, Division of Nursing and Medical TechnologyLulea University of TechnologyLuleåSweden
- Department of Health Science, Faculty of Health, Science, and TechnologyKarlstad UniversityKarlstadSweden
| | - Åsa Engström
- Department of Health, Education and Technology, Division of Nursing and Medical TechnologyLulea University of TechnologyLuleåSweden
| | - Ulrica Strömbäck
- Department of Health, Education and Technology, Division of Nursing and Medical TechnologyLulea University of TechnologyLuleåSweden
| | - Päivi Juuso
- Department of Health, Education and Technology, Division of Nursing and Medical TechnologyLulea University of TechnologyLuleåSweden
| | - Maria Andersson
- Department of Health, Education and Technology, Division of Nursing and Medical TechnologyLulea University of TechnologyLuleåSweden
- Swedish Red Cross University CollegeHuddingeSweden
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Watland S, Solberg Nes L, Hanson E, Ekstedt M, Stenberg U, Børøsund E. The Caregiver Pathway, a Model for the Systematic and Individualized Follow-up of Family Caregivers at Intensive Care Units: Development Study. JMIR Form Res 2023; 7:e46299. [PMID: 37097744 PMCID: PMC10170368 DOI: 10.2196/46299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Family caregivers of patients who are critically ill have a high prevalence of short- and long-term symptoms, such as fatigue, anxiety, depression, symptoms of posttraumatic stress, and complicated grief. These adverse consequences following a loved one's admission to an intensive care unit (ICU) are also known as post-intensive care syndrome-family. Approaches such as family-centered care provide recommendations for improving the care of patients and families, but models for family caregiver follow-up are often lacking. OBJECTIVE This study aims to develop a model for structuring and individualizing the follow-up of family caregivers of patients who are critically ill, starting from the patients' ICU admission to after their discharge or death. METHODS The model was developed through a participatory co-design approach using a 2-phased iterative process. First, the preparation phase included a meeting with stakeholders (n=4) for organizational anchoring and planning, a literature search, and interviews with former family caregivers (n=8). In the subsequent development phase, the model was iteratively created through workshops with stakeholders (n=10) and user testing with former family caregivers (n=4) and experienced ICU nurses (n=11). RESULTS The interviews revealed how being present with the patient and receiving adequate information and emotional care were highly important for family caregivers at an ICU. The literature search underlined the overwhelming and uncertain situation for the family caregivers and identified recommendations for follow-up. On the basis of these recommendations and findings from the interviews, workshops, and user testing, The Caregiver Pathway model was developed, encompassing 4 steps: within the first few days of the patient's ICU stay, the family caregivers will be offered to complete a digital assessment tool mapping their needs and challenges, followed by a conversation with an ICU nurse; when the patient leaves the ICU, a card containing information and support will be handed out to the family caregivers; shortly after the ICU stay, family caregivers will be offered a discharge conversation by phone, focusing on how they are doing and whether they have any questions or concerns; and within 3 months after the ICU stay, an individual follow-up conversation will be offered. Family caregivers will be invited to talk about memories from the ICU and reflect upon the ICU stay, and they will also be able to talk about their current situation and receive information about relevant support. CONCLUSIONS This study illustrates how existing evidence and stakeholder input can be combined to create a model for family caregiver follow-up at an ICU. The Caregiver Pathway can help ICU nurses improve family caregiver follow-up and aid in promoting family-centered care, potentially also being transferrable to other types of family caregiver follow-up.
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Affiliation(s)
- Solbjørg Watland
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Medicine Intensive Care Unit, Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
| | - Elizabeth Hanson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Swedish Family Care Competence Centre, Kalmar, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
- Frambu Resource Center for Rare Disorders, Ski, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Jungestrand L, Holm E, Rose L, Wolf A, Ringdal M. Family member perspectives on intensive care unit in-person visiting restrictions during the COVID-19 pandemic: A qualitative study. Intensive Crit Care Nurs 2023; 75:103347. [PMID: 36470700 PMCID: PMC9637525 DOI: 10.1016/j.iccn.2022.103347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/17/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Family member presence in the intensive care unit is important for patient well-being and recovery. Limitations to visits increase the risk of psychological distress in family members. During the COVID-19 pandemic, in-person visiting restrictions were introduced to prevent the spread of infection. PURPOSE To explore the experience of in-person visiting restrictions imposed during the pandemic on family members of patients with COVID-19 admitted to an intensive care unit. METHOD Qualitative method with thematic analysis. Individual semi-structured telephone interviews were conducted. FINDINGS We interviewed 21 family members. The results are presented in one overall theme with two main themes and five sub-themes. The theme 'Striving for closeness even at a distance describes the experience of being kept at a physical distance when participants needed closeness the most. Even participants who were allowed in-person visits perceived a 'distance' due to personal protective equipment or because they could only view the patient from a window. Participants reported that contact with and information about the patient was of utmost importance. Visits were viewed as essential in providing for the patient's wellbeing. Meaningful contact with the ICU team was vital for getting useful information. Phone calls became a lifeline, with digital aids such as video calls used occasionally to overcome the feeling of distance. CONCLUSION Visiting restrictions imposed during the COVID-19 pandemic made straightforward and comprehensible communication of information from the ICU team more essential to reduce family members' perceptions of distance and exclusion from the intensive care unit.
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Affiliation(s)
- Linda Jungestrand
- Kungälvs hospital, Department of Anesthesiology and Intensive Care, Kungälv, Sweden
| | - Emma Holm
- Sahlgrenska University Hospital, Department of Anesthesiology and Intensive Care, Gothenburg, Sweden
| | - Louise Rose
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Axel Wolf
- Sahlgrenska University Hospital, Department of Anesthesiology and Intensive Care, Gothenburg, Sweden; Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mona Ringdal
- Kungälvs hospital, Department of Anesthesiology and Intensive Care, Kungälv, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Nakashima H, Gallegos C. Journal Writing by Families of Critically Ill Patients: An Integrative Review. Crit Care Nurse 2021; 40:26-37. [PMID: 33000134 DOI: 10.4037/ccn2020293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Families experience high levels of stress during a loved one's critical illness. OBJECTIVE To provide an overview of current evidence on the use of journal writing as a coping mechanism for family members during a loved one's critical illness in a neonatal, pediatric, or adult intensive care unit. METHODS Five databases (MEDLINE, PsycINFO, CINAHL, APA PsycArticles, and Health Source: Nursing/Academic Edition) were searched to identify studies examining the benefits of journal writing for family members of critically ill patients. Eight eligible studies reported data from 426 relatives of critically ill patients. RESULTS Regarding quality assessment, the quantitative studies met 73.1% of relevant quality criteria, whereas qualitative studies met 81.3%. Mixed-methods studies met 82.4% of quantitative and 55% of qualitative criteria. Various key themes were identified: communication and understanding, connection to the patient, emotional expression, creating something meaningful, and the importance of pictures and staff entries. Overall, writing in a diary seems to be beneficial for reducing psychological distress and posttraumatic stress disorder, but none of the studies found that it significantly decreased anxiety or depression. CONCLUSIONS The findings of this review suggest that having family members of critically ill patients write in a diary is a simple and cost-effective intervention that may improve their psychological outcomes. Critical care nurses are in a position to educate families about the potential benefits of writing in a diary. Future research would be valuable regarding the benefits of using a diary and an optimal approach for doing so in this population.
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Affiliation(s)
- Hannah Nakashima
- Hannah Nakashima is a clinical content specialist, Healthwise, Boise, Idaho. She was a nursing student and research assistant at Boise State University, Boise, Idaho, when this article was written
| | - Cara Gallegos
- Cara Gallegos is an associate professor, Boise State University School of Nursing, Boise, Idaho
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Galazzi A, Adamini I, Bazzano G, Cancelli L, Fridh I, Laquintana D, Lusignani M, Rasero L. Intensive care unit diaries to help bereaved family members in their grieving process: a systematic review. Intensive Crit Care Nurs 2021; 68:103121. [PMID: 34373147 DOI: 10.1016/j.iccn.2021.103121] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 06/30/2021] [Accepted: 07/17/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intensive care unit diaries are often used to support patients during their psychological recovery. The intensive care unit stay can be upsetting, disturbing and traumatic for both patients and their families especially when the patient does not survive. AIM To investigate the connection between intensive care unit diaries and the grieving process experienced by family members of adult patients deceased in the intensive care unit. METHODS Systematic literature review according to PRISMA guidelines: PubMed, CINAHL and Cochrane Library were consulted. The Caldwell's framework was used for the quality appraisal. RESULTS Only six studies examine this topic. The potential benefits of intensive care unit diaries in family members' bereavement process may be an aid to realise how extremely ill their loved one was, may provide comfort and may help relatives to cope with their loss. CONCLUSION The use of intensive care unit diaries to help family members' bereavement process may be a useful tool but further research is necessary to better understand their role and benefits.
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Affiliation(s)
- Alessandro Galazzi
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Health Sciences, University of Florence, Florence, Italy.
| | - Ileana Adamini
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giacomo Bazzano
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Livia Cancelli
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden; Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Dario Laquintana
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Laura Rasero
- Department of Health Sciences, University of Florence, Florence, Italy.
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Haruna J, Tatsumi H, Kazuma S, Kuroda H, Goto Y, Aisaka W, Terada H, Masuda Y. Using an ICU Diary to Communicate With Family Members of COVID-19 Patients in ICU: A Case Report. J Patient Exp 2021; 8:23743735211034094. [PMID: 34377772 PMCID: PMC8323441 DOI: 10.1177/23743735211034094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Visitation restrictions for family members are problematic in intensive care management
due to the COVID-19 pandemic. We analyzed the usefulness of an intensive care unit (ICU)
diary about the experiences of family members of critical COVID-19 patients. Four family
members of 2 COVID-19 patients participated in this report. Both patients were transferred
to our ICU after 2 weeks of treatment at another ICU. An ICU diary was given to their
family members post-transfer. The family members were interviewed before and after the
patients’ discharge; the recorded interviews were analyzed and categorized into several
clusters using a text mining method. Five categories regarding their anxious feelings were
classified before the use of the ICU diary, and 3 categories were based on their positive
feelings after the use of the ICU diary. Intensive care unit diaries may be beneficial for
disclosing patients’ information when visitation restrictions are exercised due to the
COVID-19 pandemic.
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Affiliation(s)
- Junpei Haruna
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Hiroomi Tatsumi
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Satoshi Kazuma
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Hiromitsu Kuroda
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Yuya Goto
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Wakiko Aisaka
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Hirofumi Terada
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
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Sansone V, Cancani F, Gagliardi C, Satta T, Cecchetti C, de Ranieri C, Di Nardo M, Rossi A, Dall'Oglio I, Alvaro R, Tiozzo E, Gawronski O. Narrative diaries in the paediatric intensive care unit: A thematic analysis. Nurs Crit Care 2021; 27:45-54. [PMID: 34256419 DOI: 10.1111/nicc.12680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The paediatric intensive care unit (PICU) diary is a shared tool, kept at the patient bedside, written by relatives and health care providers. There is little evidence about its feasibility and how it supports the families of children admitted to the PICU. Currently, there is no evidence about how the PICU diary is used and what we can learn from it. AIM To explore the contents of narrative PICU diaries in an Italian PICU. STUDY DESIGN Qualitative study of PICU diaries conducted with a narrative research approach. METHODS Children sedated and mechanically ventilated for >48 hours were enrolled in a six-bed Italian PICU of a tertiary care paediatric hospital. During the child's PICU admission, caregivers, relatives, friends, and health care providers were invited to report events, thoughts, and messages, and attach drawings/pictures for the child in the PICU diary. A thematic analysis of the PICU diary contents was performed. RESULTS Thirteen PICU diaries were completed between August and December 2020, mainly by parents (n = 95; 45%) and health care providers (n = 52; 25%). Three main themes emerged: "Social and spiritual support," "Caregiver's emotions, feelings and distress," and "PICU life." Diaries offer insight into caregivers' emotions, social support, clinical activities, and interactions with health care providers, and on progression towards recovery. CONCLUSION PICU diaries are valuable in facilitating family-centred care by providing a space for the written account of the child's admission by parents, other visitors, and health care providers. RELEVANCE TO CLINICAL PRACTICE PICU diaries support the relationship and the communication between the family and the team; they provide an informal account of the emotions and needs of parents that has the potential to improve mutual understanding and family-centred care. Social support and spiritual support are key elements reported by parents for coping with their child's PICU admission.
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Affiliation(s)
- Vincenza Sansone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Federica Cancani
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Gagliardi
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Tiziana Satta
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Rossi
- Clinical Psychology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Brandao Barreto B, Luz M, do Amaral Lopes SAV, Rosa RG, Gusmao-Flores D. Exploring family members' and health care professionals' perceptions on ICU diaries: a systematic review and qualitative data synthesis. Intensive Care Med 2021; 47:737-749. [PMID: 34117901 DOI: 10.1007/s00134-021-06443-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/22/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Although the intensive care unit (ICU) diary has been proposed as a tool for preventing psychiatric symptoms in survivors of critical illness, relatives and health care providers may benefit from it too. This study aims to summarize the current qualitative evidence on families' and health care professionals' experiences of writing in and reading the ICU diaries. METHODS We searched MEDLINE, OVID, Embase, and EBSCOhost from inception to February 2021, and included all the studies that presented any qualitative finding regarding relatives' and health care providers' experiences of writing in and reading an ICU diary. We used modified Critical Appraisal Skills Programme (CASP) and Confidence in the Evidence from Reviews of Qualitative Research (CERQual) for quality assessment. A thematic synthesis approach was used to analyze and synthesize the qualitative data. RESULTS Twenty-eight studies were analyzed (15 including family members and 13 including health care professionals). For family members, the ICU diary is an important source of medical information, provides a way for them to register their presence at patient's bedside and express their feelings, and contributes to humanizing the ICU staff. This impression is shared by relatives of patients who did not survive critical illness. Health care providers believe the diary is beneficial for themselves and others; however, they are concerned with possible negative impressions from patients and family that could lead to judicial problems. They also remark on several obstacles they face when constructing the diaries (workload, creativity, and environment for writing), which can make it a distressful process. CONCLUSION This qualitative synthesis shows that family members and health care professionals consider the ICU diary a valuable intervention. It also brings evidence to challenges faced during diary writing, which should be carefully approached in order to reduce the stress associated with this process.
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Affiliation(s)
- Bruna Brandao Barreto
- Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, 40411-900, Brazil. .,Programa de Pós Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Mariana Luz
- Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, 40411-900, Brazil.,Programa de Pós Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Selma Alves Valente do Amaral Lopes
- Department of Paediatrics, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Neonatal Intensive Care Unit, Hospital Martagão Gesteira, Salvador, Bahia, Brazil
| | - Regis Goulart Rosa
- Intensive Care Unit, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Dimitri Gusmao-Flores
- Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, 40411-900, Brazil.,Departamento de Medicina Interna E Apoio Diagnóstico, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Programa de Pós Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Intensive Care Unit, Hospital da Cidade, Salvador, Bahia, Brazil
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13
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Negro A, Villa G, Zangrillo A, Rosa D, Manara DF. Diaries in intensive care units: An Italian qualitative study. Nurs Crit Care 2021; 27:36-44. [PMID: 34053148 DOI: 10.1111/nicc.12668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The literature emphasizes the importance of the intensive care unit (ICU) diary to fill the gaps and recover the delusional memories of patients admitted to ICU in order to build the history of their illness. The ICU diary is a measure originally intended to support the severely ill patient, but it would also seem to be useful for family members and carers. According to our analysis of the literature, this study is the first description of the contents of ICU diaries in the Italian context. AIM The aim of the study was to describe the contents of ICU patients' diaries filled in by their caregivers, in order to explore the experience and significance attributed to the diaries. DESIGN A qualitative longitudinal narrative investigation was conducted at an ICU during the period from April 2016 to April 2017 with a sample composed of 32 families. METHODS The participants were caregivers selected through purposive sampling. An ICU nurse explained the study to caregivers and offered the opportunity to participate. RESULTS The sample included 32 diaries. Through the analysis we identified seven themes: future plans and memories; the people who care for the patient and the context; the love surrounding the patient; the clinical progression of the patient and the passage of time; what happens outside the patient's life; references to the usefulness/non-usefulness of the diary; communication/reflection on the likely death of the patient. CONCLUSIONS Some themes emerged that have never explored in the literature, and it would be necessary to understand whether the themes that emerged depend on cultural issues. RELEVANCE TO CLINICAL PRACTICE The diaries could be adapted to the Italian context and this could make the diary a common practice in Italy as well.
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Affiliation(s)
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- IRCCS San Raffaele Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Debora Rosa
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Duilio F Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
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14
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Drumright K, Jones AC, Gervasio R, Hill C, Russell M, Boehm LM. Implementation of an Intensive Care Unit Diary Program at a Veterans Affairs Hospital. J Nurs Care Qual 2021; 36:155-161. [PMID: 32826699 PMCID: PMC7889738 DOI: 10.1097/ncq.0000000000000510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Intensive care unit (ICU) diaries are recommended to address psychological sequelae following critical illness. Diaries are correlated with reduced prevalence of posttraumatic stress disorder in survivors of critical illness and their families. LOCAL PROBLEM Our ICU was not adequately meeting the psychological needs of patients and families. METHODS We established an interprofessional team to implement an ICU diary program in partnership with implementation of the ABCDEF (Assess, prevent, and manage pain; Both awakening and breathing trials; Choice of analgesia and sedation; Delirium: assess, prevent, and manage; Early mobility and exercise; Family engagement and empowerment) bundle and peer support programs. Staff knowledge and perception of ICU diaries were obtained. INTERVENTIONS Diaries were initiated for patients at high risk for post-intensive care syndrome, and entries by all ICU staff and family members/visitors were encouraged. RESULTS A total of 75 diaries were initiated between January 2017 and January 2019. The ICU diaries have been received positively by patients, family members, and staff. CONCLUSIONS The ICU diary is a cost-effective and efficient intervention to help patients and family members cope with the burden of critical illness.
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Affiliation(s)
- Kelly Drumright
- TN Valley Healthcare System, Nashville Veterans Affairs Hospital, Nashville, TN, USA
| | - Abigail C. Jones
- Vanderbilt University School of Nursing, Nashville, TN, USA
- Critical Illness, Brain dysfunction, and Survivorship Center at Vanderbilt, Nashville, TN, USA
| | - Ralph Gervasio
- TN Valley Healthcare System, Nashville Veterans Affairs Hospital, Nashville, TN, USA
| | - Christopher Hill
- TN Valley Healthcare System, Nashville Veterans Affairs Hospital, Nashville, TN, USA
| | - Margaret Russell
- TN Valley Healthcare System, Nashville Veterans Affairs Hospital, Nashville, TN, USA
| | - Leanne M. Boehm
- TN Valley Healthcare System, Nashville Veterans Affairs Hospital, Nashville, TN, USA
- Vanderbilt University School of Nursing, Nashville, TN, USA
- Critical Illness, Brain dysfunction, and Survivorship Center at Vanderbilt, Nashville, TN, USA
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15
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Schofield R, Dibb B, Coles-Gale R, Jones CJ. The experience of relatives using intensive care diaries: A systematic review and qualitative synthesis. Int J Nurs Stud 2021; 119:103927. [PMID: 33905992 DOI: 10.1016/j.ijnurstu.2021.103927] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/04/2021] [Accepted: 03/10/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Intensive care patient diaries written by staff and/or relatives are widely used in intensive care units (ICUs) across the world. Although the original aim of the diaries was to support patients in their recovery from ICU, a more recent focus of the literature has been the potential benefit of the diaries to the relatives of patients. Meta-analyzes of quantitative studies looking at the impact on the psychological wellbeing of relatives have not consistently found an effect of the diaries, even though qualitative studies suggest that relatives find the diaries to be a useful coping strategy. OBJECTIVES To evaluate and synthesise qualitative studies looking at the experience of relatives writing in ICU diaries. DESIGN A systematic review and qualitative synthesis. DATA SOURCES A structured search using CINAHL, MEDLINE, PsycInfo, Cochrane Central Register of Controlled Trials (CENTRAL), PTSDHubs and Published International Literature Web of Science Conference Proceedings Citation Index - Science and Social Science and Humanities was conducted. REVIEW METHODS All studies published at any time that included qualitative data (including mixed methods studies) about the perceptions of relatives using ICU patient diaries were included. Themes and narrative statements were extracted from included articles and synthesised. Articles were quality assessed using the Critical Appraisal Skills Programme (CASP) qualitative checklist and Mixed Methods Appraisal Tool (MMAT). RESULTS Sixteen studies were included in the review, thirteen qualitative and three mixed methods articles. The themes identified were: 1. Coping (subthemes: 1.1. Emotion-Focused Coping and 1.2. Problem-Focused Coping) 2. Connection (subthemes: 2.1 Method of Communication and 2.2 Developing and maintaining relationships) 3. Developing a Narrative (subthemes 3.1 Understanding 3.2 Shaping the story 3.3 Remembering). CONCLUSIONS Relatives use the diaries in a variety of ways including as a means of coping, a way of staying connected, as a tool to understand and develop a narrative about the experience. These findings link the use of ICU diaries with literature on written emotional exposure, post-traumatic growth and meaning making. The relationship between a relative's use of the ICU diary, coping strategies and/or post-traumatic growth could be a focus for future quantitative trials. PROSPERO protocol number CRD42020165869.
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Affiliation(s)
- Rachel Schofield
- University of Surrey, Stag Hill, University Campus, Guildford GU2 7XH, UK.
| | - Bridget Dibb
- University of Surrey, Stag Hill, University Campus, Guildford GU2 7XH, UK
| | - Rebecca Coles-Gale
- East Sussex Healthcare NHS Trust, St. Anne's House, 729 The Ridge, St. Leonards-on-Sea, East Sussex TN37 7PT, UK
| | - Christina J Jones
- University of Surrey, Stag Hill, University Campus, Guildford GU2 7XH, UK
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16
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Affiliation(s)
- Christina Jones
- Research Manager ICU steps and Visiting Research Fellow, University of Plymouth, United Kingdom
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17
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Tripathy S, Acharya SP, Sahoo AK, Mitra JK, Goel K, Ahmad SR, Hansdah U. Intensive care unit (ICU) diaries and the experiences of patients' families: a grounded theory approach in a lower middle-income country (LMIC). J Patient Rep Outcomes 2020; 4:63. [PMID: 32705412 PMCID: PMC7378135 DOI: 10.1186/s41687-020-00229-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE An intensive care unit (ICU) diary is a relatively new concept in low middle-income countries (LMICs). Illiteracy and socio-cultural inhibitions may affect the use and utility of this intervention, which has proven beneficial to patients and their families in high income countries (HICs). We aimed to explore how families of ICU patients experienced ICU diaries in our set up by using the Grounded Theory (GT) approach. A relatively new research tool, this enables exploration of a phenomenon to build theories in areas hitherto uncharted. METHOD A clinical psychologist did 29 in-depth interviews of relatives of 13 patients admitted in the ICU for > 24 h for whom an ICU diary was being maintained. We used a three-step coding process- open, axial, and selective coding, followed by the formulation of a theory embedded in the data. RESULTS We found that the younger relatives of ICU patients accepted the idea better (age 30, SD 6) Half (48%) had education between 5th to 10th standards. Emergent themes suggested that for the family members, reading and writing the diary brought novelty, acted as a communication enabler, spiritual truss, and improved knowledge leading to change in perspective about the health care system. It also became a bridge to community bonding after patient discharge. Starting with appreciating the novelty of 'diary entries,' which was a new and exciting concept, family members used the diaries to communicate with health care workers (to gain information and understanding about the disease and treatment) and the patient to express their love and to maintain a connection. The diary acted as a confessional for hopes, fears, guilt, and faith for many members. As a tool, it enabled them to understand medical personnel as human beings and to appreciate their efforts, effectively improving confidence in the system. Finally, upon returning home, the diary was a crowd puller for extended family and neighbors encouraging discussions and enhancing bonding and information sharing. CONCLUSIONS Our findings indicate a good acceptance of ICU diaries by family members in our ICU. With less literate, admitted 'shy 'members, in a society where 'diary writing' is not culturally rampant, the appreciation for the novel concept was universal. We see a place for these interventions not only at the patient/ family level but also as a means to 'correct' the image of health care workers in our society by humanizing ourselves to the end-user- the patient and his family.
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Affiliation(s)
| | | | | | | | | | | | - Upendra Hansdah
- Trauma and Emergency Medicine, AIIMS Bhubaneswar, Bhubaneswar, India
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18
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Nielsen AH, Angel S, Egerod I. An ICU diary written by relatives: Who is it really written for? Intensive Crit Care Nurs 2020; 57:102813. [PMID: 32067821 DOI: 10.1016/j.iccn.2020.102813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anne Højager Nielsen
- Department of Anesthesiology, Gødstrup Hospital, Lægårdvej 12, 7500 Holstebro, Denmark.
| | - Sanne Angel
- Section for Nursing, Department of Public Health, Aarhus University, Building 1260, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Ingrid Egerod
- University of Copenhagen, Health and Medical Sciences, Blegdamsvej 3B, 2200 Copenhagen N, Denmark; Intensive Care Unit 4131, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
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19
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Barreto BB, Luz M, Rios MNDO, Lopes AA, Gusmao-Flores D. The impact of intensive care unit diaries on patients' and relatives' outcomes: a systematic review and meta-analysis. Crit Care 2019; 23:411. [PMID: 31842929 PMCID: PMC6916011 DOI: 10.1186/s13054-019-2678-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Memory gaps in intensive care unit (ICU) survivors are associated with psychiatric disorders. The ICU diaries improve the patient's factual memory of the ICU, but it is not clear if they reduce the incidence of psychiatric disorders in patients and relatives after hospital discharge. The aim of this study is to evaluate the literature on the effect of ICU diaries for patients admitted in ICU and their relatives. METHODS Two authors independently searched the online databases PubMed, OVID, Embase, EBSCO host, and PsycINFO from inception to July 2019. Studies were included if the intervention group (ICU diary) was compared with a group with no diaries and the sample was comprised patients ≥ 18 years old admitted in the ICU for more than 24 h and their relatives. Randomized clinical trials, observational studies, letter with original data, and abstracts were included, irrespective of the language. The search was not limited by any specific outcome. Review articles, commentaries, editorials, and studies without a control group were excluded. Structured tools were used to assess the methodological quality ("Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I)" for cohort studies and the "Cochrane Risk of Bias tool" for included RCTs and before/after studies). A random-effects model was employed considering the anticipated variability between the studies. RESULTS Seven hundred eighty-five titles were identified for screening. Two additional studies were selected after a reference search, and after a full-text review, a total of 12 studies were included. When pooling the results, ICU diary was associated with lower risk of depression (RR 0.41, 95% CI 0.23-0.75) and better quality of life (10.3 points higher in SF-36 general health score, 95% CI 0.79-19.8), without a decrease in anxiety or post-traumatic stress disorder (PTSD). For the relatives receiving an ICU diary, there was no difference in the incidence of PTSD, anxiety, or depression. CONCLUSION AND RELEVANCE This systematic review and meta-analysis supports the use of ICU diaries to reduce the risk of depression and preserve the quality of life of patients after ICU admission. ICU diaries do not seem to have any beneficial effect on the relatives of the patients. TRIAL REGISTRATION PROSPERO, CRD42019136639.
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Affiliation(s)
- Bruna Brandao Barreto
- Intensive Care Unit, Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, Bahia 40411-900 Brazil
| | - Mariana Luz
- Intensive Care Unit, Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, Bahia 40411-900 Brazil
| | | | - Antonio Alberto Lopes
- Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
- Departamento de Medicina Interna e Apoio Diagnóstico, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia Brazil
| | - Dimitri Gusmao-Flores
- Intensive Care Unit, Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, Bahia 40411-900 Brazil
- Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
- Departamento de Medicina Interna e Apoio Diagnóstico, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia Brazil
- Intensive Care Unit, Hospital da Cidade, Salvador, Bahia Brazil
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20
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Lynch F, Endacott R, Latour JM. Patient diaries: Survey of paediatric intensive care units in the United Kingdom and Ireland. Nurs Crit Care 2019; 25:31-36. [PMID: 31583802 DOI: 10.1111/nicc.12472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 11/27/2022]
Abstract
AIM The aim of the study was to explore the incidence, use, and scope of patient diaries in paediatric intensive care units (PICUs) in the United Kingdom and Ireland. DESIGN This was an electronic survey sent to 30 PICUs in the United Kingdom and Ireland. RESULTS All PICUs (n = 30) responded, and 43% (n = 13) offered diaries. For those units that did not supply diaries, the reasons given were concerns around the legal and professional implication of using diaries. Parental/carer consent to use a diary was obtained informally (79%, n = 11), and once there was agreement to provide a diary to parents, diaries were usually started immediately (72%, n = 12). Parents were the main contributors to the diaries (94%, n = 17), and the diaries were populated with photographs (94%, n = 15), drawings (100%, n = 16), and stickers (94%, n = 15). The reasons for offering diaries were to fill gaps in memories, to engage with families, and to explain what has happened in lay language. The owner of the diary was reported to be the family (82%, n = 14) and the child (12%, n = 2). CONCLUSIONS The use of patient diaries is an evolving intervention in paediatric intensive care settings in the United Kingdom and Ireland. This national survey has provided a clearer picture of how this intervention is used in the United Kingdom and Ireland. PICU patient diaries are used in a significant number of units, and how these are used is relatively standardized, although in some different ways from general ICUs. RELEVANCE TO CLINICAL PRACTICE This survey provides a baseline for future exploration, understanding, and promotion of patient diaries, as a well evaluated tool for the critically ill child and his or her family.
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Affiliation(s)
- Fiona Lynch
- Women & Children's Division, Western Sussex NHS Trust, Worthing Hospital, Worthing, UK.,School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - Ruth Endacott
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK.,School of Nursing and Midwifery, Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
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21
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Halm MA. Intensive Care Unit Diaries, Part 1: Constructing Illness Narratives to Promote Recovery After Critical Illness. Am J Crit Care 2019; 28:319-323. [PMID: 31263015 DOI: 10.4037/ajcc2019731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Margo A. Halm
- Margo A. Halm is associate chief nurse executive, nursing research and evidence-based practice, VA Portland HealthCare System, Portland, Oregon
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22
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Filling the gaps: A mixed-methods study exploring the use of patient diaries in the critical care unit. Intensive Crit Care Nurs 2019; 51:27-34. [DOI: 10.1016/j.iccn.2018.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/02/2018] [Accepted: 10/29/2018] [Indexed: 11/18/2022]
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23
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Nielsen AH, Angel S, Hansen TB, Egerod I. Structure and content of diaries written by close relatives for intensive care unit patients: A narrative approach (DRIP study). J Adv Nurs 2019; 75:1296-1305. [PMID: 30666697 DOI: 10.1111/jan.13956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/06/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Abstract
AIM To investigate structure and content of a nurse prompted diary written by relatives for intensive care unit (ICU) patients. DESIGN A narrative analysis of ICU diaries. METHODS From September 2015-August 2016, 12 diaries authored by 12 relatives for 12 ICU patients were sampled at 3-4 months post-ICU discharge. We used Ricoeur's hermeneutical phenomenology as a framework for a narrative analysis of the diaries. The first step was naïve reading, followed by structural analysis exploring the internal relations of the text. The structural analysis was broadened by exploring narrative structures. The last step was critical interpretation of the findings. FINDINGS The diaries had a clear narrative structure; the diary-timeline consisted of: Pre-ICU phase, Early ICU phase, Culmination, Recovery and Post-ICU reflection. Three themes described the content of the diary: Struggling to get the story right for the patient; striving to understand what was happening and longing to re-establish a connection with the patient. Keeping a diary was perceived by the relatives as a challenging but rewarding task. CONCLUSION The diary had the potential for reflection and a deeper understanding of the ICU stay. The diary served as a locus for patient and relatives to connect or re-connect, but some diaries might be too personal and emotional to share with the patient. Future research needs to explore advantages and disadvantages of ICU diaries authored by relatives.
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Affiliation(s)
- Anne Højager Nielsen
- Department of Anesthesiology, Regional Hospital Holstebro, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sanne Angel
- Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Torben Baek Hansen
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital Holstebro, Aarhus University, Aarhus, Denmark
| | - Ingrid Egerod
- Health and Medical Sciences, University of Copenhagen, Aarhus, Denmark.,Intensive Care Unit 4131, Rigshospitalet, Copenhagen, Denmark
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24
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Intensive care unit diaries: Developing a shared story strengthens relationships between critically ill patients and their relatives: A hermeneutic-phenomenological study. Int J Nurs Stud 2019; 92:90-96. [PMID: 30753929 DOI: 10.1016/j.ijnurstu.2019.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/18/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND After discharge from the intensive care unit, patients and relatives struggle to rebuild their lives while suffering from fatigue and distress. Intensive care unit diaries written by relatives are a novel approach that may help relatives and patients process the critical illness experience together. OBJECTIVES To explore patients' and relatives' perceptions and use of a diary written by relatives for the critically ill patient. DESIGN Hermeneutical-phenomenological interview study. SETTING Two regional mixed surgical/medical intensive care units in a regional hospital. PARTICIPANTS 10 critically ill patients and 13 relatives. All participants were 18 years or older, all patients had undergone mechanical ventilation. METHODS Dyadic, in-depth interviews conducted at 3-6 months and 8-16 months after discharge from the intensive care unit in 2015-2017. Interviews were analyzed using Ricoeur's theory of interpretation; a three-step process initiated by a naïve reading; followed by a structural analysis exploring the internal relations of the text, and finally, a critical interpretation to identify the most probable interpretation. RESULTS Before sharing the intensive care unit diary, relatives had to feel able to give the diary to the patient, which meant separating themselves from the diary and being available for discussions with the patient. Likewise, the patients had to be prepared to receive the diary and to acknowledge relatives' efforts. Sharing the diary included interpreting the content of the diary, and developing a re-configured story based on the diary. CONCLUSION The diary written by relatives for the critically ill patient was fulfilled when the diary was shared between the authoring relative and patient and a re-configured story was developed. This enabled a strengthened relationship between patient and relative. Not sharing could be disappointing to the relative, but did not preclude discussion of the experience of critical illness. This study provides professionals with knowledge about supporting patients and relatives through intensive care unit diaries written by relatives. Relatives need guidance on when to share the diary with the patient and how to accept patient rejection.
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25
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Johansson M, Wåhlin I, Magnusson L, Hanson E. Nursing staff's experiences of intensive care unit diaries: a qualitative study. Nurs Crit Care 2019; 24:407-413. [PMID: 30680873 DOI: 10.1111/nicc.12416] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/11/2018] [Accepted: 12/21/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Diaries as an intervention to aid psychological recovery among intensive care patients have been used for about 20 years, and findings tend to be positive. The provision of a diary directed at the patient may clarify the story of the intensive care unit (ICU) even for the family members and the family members of non-survivors. Members of nursing staff are the primary authors, but how they themselves experience the use of ICU diaries has been minimally explored. AIMS AND OBJECTIVES This study aimed to explore how nursing staff experienced the use of ICU patient diaries. DESIGN Qualitative design using focus group interviews. METHODS A qualitative methodology was used. Six focus group interviews were conducted with 27 nursing staff recruited from one university and two county hospitals. The data were analysed via thematic content analysis. FINDINGS One overarching theme, 'An effort to do good in words and actions', and four interconnected themes were derived from the analysis. By creating the diary, nursing staff had to deal with a variety of ethical and practical dilemmas, but feedback from patients, family members and ICU follow-up services reinforced the feeling of doing good. This overarching feeling of beneficence encouraged diary authoring and increased motivation and commitment to strive towards excellent patient care. To sustain the use of ICU diaries, collegiate and organizational support was deemed essential. CONCLUSIONS Nursing staff strived to do good in words and actions for patients and their families when writing the diaries. Positive feedback from patients, family members and ICU follow-up services reinforced feelings of doing good, which served to enhance work satisfaction and a commitment to good-quality nursing care. Experiential-based education was recommended to help sustain ICU diary writing. RELEVANCE TO CLINICAL PRACTICE Nursing staff requested mentoring and group discussions concerning the format, content and communication channels of the diary.
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Affiliation(s)
- Maria Johansson
- Intensive Care Department, County Hospital, Kalmar, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Ingrid Wåhlin
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.,Kalmar Countym, Intensive Care Department, County Hospital, Kalmar, Sweden.,Research Section, Kalmar County Council, Kalmar, Sweden
| | - Lennart Magnusson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.,Swedish Family Care Competence Centre, Linnaeus University, Kalmar, Sweden
| | - Elizabeth Hanson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.,Swedish Family Care Competence Centre, Linnaeus University, Kalmar, Sweden
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26
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Nydahl P, Fischill M, Deffner T, Neudeck V, Heindl P. [Diaries for intensive care unit patients reduce the risk for psychological sequelae : Systematic literature review and meta-analysis]. Med Klin Intensivmed Notfmed 2018; 114:68-76. [PMID: 29995235 DOI: 10.1007/s00063-018-0456-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- P Nydahl
- Pflegeforschung, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland. .,Klinik für Anästhesie und operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Brunswiker Str. 10, 24105, Kiel, Deutschland.
| | | | - T Deffner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | | | - P Heindl
- Internistischer Intensivbehandlungsbereich, Notfallmedizin und Intensivbehandlung für Brandverletzte, Allgemeines Krankenhaus der Stadt Wien, Medizinischer Universitätscampus, Wien, Österreich
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27
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Strandberg S, Vesterlund L, Engström Å. The contents of a patient diary and its significance for persons cared for in an ICU: A qualitative study. Intensive Crit Care Nurs 2017; 45:31-36. [PMID: 29295760 DOI: 10.1016/j.iccn.2017.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/15/2017] [Accepted: 12/11/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to describe the contents of a patient diary and its significance for persons cared for in an ICU. RESEARCH METHODOLOGY An empirical study with a qualitative design. Eight telephone interviews and one face-to-face interview were conducted with nine persons previously been treated in an ICU and been given a patient diary. In addition, the person would have read his/her diary. The data have been analysed with qualitative content analysis. FINDINGS The study identified one overarching theme; Gaining understanding, and four categories; The diary is written for me, Creating memories from the time of care, Who writes in the diary and, The ability to return to the diary. The diary meant that participants gained an understanding of their time in the ICU while they were critically ill and the diary was important to be able to return to. CONCLUSION What formerly critically ill patients appreciate most about the diary is that the diary is personally written, which makes them feel confirmed and valuable as a person. Guidelines for how and when a diary should be written and used would likely encourage critical care nurses and relatives to write in it.
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Affiliation(s)
| | | | - Åsa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technology, SE-971 87 Luleå, Sweden.
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28
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Hyde-Wyatt J. Prevention, recognition and management of delirium in patients who are critically ill. Nurs Stand 2017; 32:41-52. [PMID: 29094525 DOI: 10.7748/ns.2017.e10667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2016] [Indexed: 11/09/2022]
Abstract
Delirium is common in patients who are critically ill, often resulting in extended hospital stays and increased mortality and morbidity. There are several subtypes of delirium, which are often undiagnosed and untreated, resulting in suboptimal patient outcomes. This article examines delirium in patients in the intensive care unit, including its signs and symptoms, incidence, causes and subtypes. It outlines the assessment of delirium and the pharmacological and non-pharmacological interventions that can be used to manage the condition, as well as describing the optimal prevention measures.
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Affiliation(s)
- Jaime Hyde-Wyatt
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe, England
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29
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Johansson M, Wåhlin I, Magnusson L, Runeson I, Hanson E. Family members' experiences with intensive care unit diaries when the patient does not survive. Scand J Caring Sci 2017; 32:233-240. [DOI: 10.1111/scs.12454] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/06/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Maria Johansson
- Intensive Care Department; County Hospital; Kalmar Sweden
- Department of Health and Caring Sciences; Linnaeus University; Kalmar Sweden
- Research Section; Kalmar County Council; Kalmar Sweden
| | - Ingrid Wåhlin
- Intensive Care Department; County Hospital; Kalmar Sweden
- Research Section; Kalmar County Council; Kalmar Sweden
| | - Lennart Magnusson
- Department of Health and Caring Sciences; Linnaeus University; Kalmar Sweden
| | - Ingrid Runeson
- Department of Health and Caring Sciences; Linnaeus University; Kalmar Sweden
| | - Elizabeth Hanson
- Department of Health and Caring Sciences; Linnaeus University; Kalmar Sweden
- School of Nursing & Midwifery; University of Sheffield; Sheffield UK
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30
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Tramm R, Ilic D, Murphy K, Sheldrake J, Pellegrino V, Hodgson C. Experience and needs of family members of patients treated with extracorporeal membrane oxygenation. J Clin Nurs 2017; 26:1657-1668. [DOI: 10.1111/jocn.13566] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Ralph Tramm
- Department of Epidemiology and Preventive Medicine; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC); Monash University; Prahan Melbourne Vic. Australia
| | - Dragan Ilic
- Department of Epidemiology and Preventive Medicine (DEPM); Monash University; Prahan Melbourne Vic. Australia
| | - Kerry Murphy
- Department of Epidemiology and Preventive Medicine (DEPM); Monash University; Prahan Melbourne Vic. Australia
| | - Jayne Sheldrake
- Department of Intensive Care and Hyperbaric Medicine; The Alfred Hospital; Prahan Melbourne Vic. Australia
| | - Vincent Pellegrino
- Department of Intensive Care and Hyperbaric Medicine; The Alfred Hospital; Prahan Melbourne Vic. Australia
| | - Carol Hodgson
- Department of Epidemiology and Preventive Medicine; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC); Monash University; Prahan Melbourne Vic. Australia
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31
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Ednell AK, Siljegren S, Engström Å. The ICU patient diary-A nursing intervention that is complicated in its simplicity: A qualitative study. Intensive Crit Care Nurs 2017; 40:70-76. [PMID: 28233651 DOI: 10.1016/j.iccn.2016.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 11/19/2016] [Accepted: 12/03/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Writing a diary for intensive care patients has been shown to facilitate patientrecovery and prevent post-traumatic stress following hospitalisation. AIM This study aimed to describe the experiences of critical care nurses' (CCNs') in writing personal diaries for ICU patients. METHOD The study was conducted with a qualitative design. Ten CCNs from two hospitals participated. Data were collected with semi-structured interviews and analysed using a qualitative thematic content analysis. FINDINGS The result consists of a theme: Patient diary: a complex nursing intervention in all its simplicity, as well as four categories: Writing informatively and with awareness shows respect and consideration; The diary is important for both patient and CCN; To jointly create an organisation that facilitates and develops the writing; Relatives' involvement in the diary is a matter of course. CONCLUSION CCNs are aware of the diary's importance for the patient and relatives, but experience difficulties in deciding which patients should get this intervention and how to prioritize it. Writing a personal diary for an ICU patient is a nursing intervention that is complicated in its simplicity.
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Affiliation(s)
| | | | - Åsa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
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