The ICU patient diary-A nursing intervention that is complicated in its simplicity: A qualitative study

Critical care nurses' assessment of writing diaries for adult patients in the intensive care unit - A qualitative study

BACKGROUND

Patients describe surreal experiences, hallucinations, loss of control, fear, pain, and other discomforts during their stay in intensive care units. Diaries written by critical care nurses can help patients fill-in memory gaps, gain an understanding of their illness after returning home, and enhance recovery. However, critical care nurses have difficulty deciding which patients in the intensive care unit should receive diaries and how to conduct and prioritise this nursing intervention.

OBJECTIVES

The objective of this study was to explore critical care nurses' assessments regarding starting and writing diaries for adult patients in the intensive care unit.

METHODS

A qualitative study with an exploratory descriptive design was utilised. Interviews were conducted with 14 critical care nurses from four hospitals. The data were analysed using systematic text condensation and were reported according to the consolidated criteria for reporting qualitative research checklist.

FINDINGS

Three categories emerged: patients' disease trajectories and prognoses, tailoring the content and language and balancing time, and resources to create diaries that benefit patients.

CONCLUSIONS

Whilst critical care nurses' assessments of the need for diaries are based on patients' disease trajectories and prognoses, patients' conditions can shift rapidly, which makes these assessments challenging. To ensure diary quality, the language and content should be personal and address the individual patient. The time and resources required for diaries are weighed against the benefits to patients. Contributions from colleagues and a common recognition in the intensive care unit of the value of the diaries influence nurses' judgements and are essential for successful diary practices.

The use and application of intensive care unit diaries: An instrumental multiple case study

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.

Finding the right words: A focus group investigation of nurses' experiences of writing diaries for intensive care patients with a poor prognosis

BACKGROUND

The overall purpose of diaries written during an intensive care stay is to help patients fill in memory gaps from the illness trajectory, which might promote long-term psychological recovery. Diaries have also been shown to benefit nurses in maintaining a view of the patient as a person in the highly technical environment and to promote reflection. There is a lack of research on how nurses might be affected by writing a diary for critically ill patients with a poor prognosis.

OBJECTIVES

The aim of this study was to investigate nurses' experience of writing diaries for intensive care patients with a poor prognosis.

METHODS

This study has a qualitative descriptive design and was inspired by the methodology of interpretive description. Twenty-three nurses from three Norwegian hospitals with a well-established practice of writing diaries participated in four focus groups. Reflexive thematic analysis was used. The study was reported according to the Consolidated Criteria for Reporting Qualitative Research checklist.

FINDINGS

The overarching theme resulting from our analysis was "Finding the right words". This theme represents the challenge of writing in view of the uncertainty of the patient's survival and of who would read the diary. It was important to strike the right tone with these uncertainties in mind. When the patient's life could not be saved, the purpose of the diary expanded to comforting the family. To put an extra effort into making the diary something special when the patient was dying was also a meaningful activity for the nurses.

CONCLUSIONS

Diaries may serve other purposes than helping patients to understand their critical illness trajectory. In cases of a poor prognosis, nurses adapted their writing to comfort the family rather than informing the patient. Diary writing was meaningful for the nurses in managing care of the dying patient.

Thematic analysis of intensive care unit diaries kept by staff: insights for caring

OBJECTIVE

To explore recurrent themes in diaries kept by intensive care unit (ICU) staff during the coronavirus disease 2019 (COVID-19) pandemic.

DESIGN

Qualitative study.

SETTING

Two ICUs in a tertiary level hospital (Milan, Italy) from January to December 2021.

METHODS

ICU staff members wrote a digital diary while caring for adult patients hospitalized in the intensive care unit for >48 hours. A thematic analysis was performed.

FINDINGS

Diary entries described what happened and expressed emotions. Thematic analysis of 518 entries gleaned from 48 diaries identified four themes (plus ten subthemes): Presenting (Places and people; Diary project), Intensive Care Unit Stay (Clinical events; What the patient does; Patient support), Outside the Hospital (Family and topical events; The weather), Feelings and Thoughts (Encouragement and wishes; Farewell; Considerations).

CONCLUSION

The themes were similar to published findings. They offer insight into care in an intensive care unit during a pandemic, with scarce resources and no family visitors permitted, reflecting on the patient as a person and on daily care. The staff wrote farewell entries to dying patients even though no one would read them.

IMPLICATIONS FOR CLINICAL PRACTICE

The implementation of digital diaries kept by intensive care unit staff is feasible even during the COVID-19 pandemic. Diaries kept by staff can provide a tool to humanize critical care. Staff can improve their work by reflecting on diary records.

Staff perception of the implementation, enablers and barriers to pediatric intensive care unit diary writing: A qualitative study

OBJECTIVES

To explore how the multi-professional pediatric intensive care unit staff experienced the implementation of the diary.

RESEARCH METHODOLOGY/DESIGN

Qualitative study using the implementation research approach.

SETTING

a six-bed pediatric intensive care unit at a large Italian tertiary care pediatric hospital, treating patients with acute conditions from the Emergency Department or hospital wards.

MAIN OUTCOME MEASURES

Healthcare providers' experiences of the implementation of the diaries. Data was collected by focus groups and interviews and thematic analysis was performed.

FINDINGS

Three focus groups and four interviews with staff were conducted after the implementation of thediaries from August 2020 to June 2021. Staff describe an initial disbelief towards the effectiveness of diaries followed by an increasing perception of their relevance for parents' emotional expression through shared narration. Diaries are reported as a beneficial communication tool between the family, the child, and health care providers, increasing staff understanding of parents' experiences of their child's admission and parents' sense of the care received by their child. For staff, barriers for diary writing were logistics, lack of time, limited sense of ownership, fear of legal retaliation and fear of emotional labor.

CONCLUSION

Health care providers perceived diaries as beneficial for parents and the healthcare team, potentially supporting their partnership as recommended by Family Centered Care models. The enablers and barriers that emerged for diary writing can support the development of implementation strategies to prevent the reported challenges to diary writing in the healthcare team, enhancing their uptake in the pediatric intensive care unit setting.

The Intensive Care Unit diary - A significant complement in the recovery after intensive care. A focus group study

OBJECTIVES

The aim of this study was to gain an increased understanding of the intensive care unit diary and how it affects patients' recovery after intensive care.

METHODOLOGY/DESIGN

The study had a qualitative design and was conducted by two focus group interviews in October 2021 and was analysed with thematic analysis.

SETTING

Ventilator treated intensive care patients with a length of stay ≥ 72 hours who had received a written diary were included. The study was conducted at two university hospitals in the south of Sweden.

FINDINGS

The intensive care unit diary can be an important complement to the medical record and notes taken by family members by enhancing understanding of critical illness. The patients experience several prominent feelings from reading the diary such as guilt, fear, and anxiety as well as feelings of being cared for. The design and content of the diary can be important used as a tool in patients' recovery after intensive care.

CONCLUSION

Understanding their critical illness and the time in intensive care seems important to former intensive care patients. In this respect, the intensive care unit diary on its own does not provide significant information and thus need to be complemented by information from the medical record and notes taken by family members. Therefore, the diary can be used as a complement that might increase patients' sense of coherence and facilitate recovery after intensive care.

Intensive Care Unit Diaries: A Nurse-Led Program

BACKGROUND

Following intensive care unit stays, patients with post-intensive care syndrome can experience mental health symptoms that impact quality of life. Intensive care unit diaries have been shown to improve outcomes for patients and their families.

LOCAL PROBLEM

Identification of limited support for high volumes of intensive care unit patients and families led to implementation of an intensive care unit diary program in a 24-bed adult medical-surgical intensive care unit.

METHODS

Patients requiring mechanical ventilation with an expected intensive care unit stay of more than 24 hours were provided intensive care unit diaries. Nursing staff and patients' families entered daily descriptive narratives of patients' progress during the stay. After intensive care unit discharge, patients and families reviewed the diaries to improve acceptance of their intensive care unit experience. Project evaluation included review of patient and family follow-up calls, a staff nurse feedback survey, and project champion debriefing sessions to gauge implementation success and feasibility.

RESULTS

Twenty diaries were completed and distributed to patients or families at intensive care unit discharge. Follow-up calls illustrated support and gratitude for diaries regardless of patient outcomes. Patients reported that diaries helped fill memory gaps between intensive care unit admission and discharge. Nurse surveys and project champion debriefings confirmed that completion of intensive care unit diary entries had minimal impact on workload, eased communication, and improved staff members' coping skills.

CONCLUSION

Successful intensive care unit diary program implementation has the potential to benefit patients, families, and nursing staff for little organizational cost.

Value of Intensive Nursing Detail Management in Intensive Care Unit Nursing

Objective

To evaluate the value of intensive nursing detail management in intensive care unit (ICU) nursing.

Methods

In this prospective study, 100 ICU patients in Shiyan Maternal and Child Health Hospital between January 2019 and March 2020 were assessed for eligibility and recruited. They were concurrently randomly assigned (1 : 1) to receive either conventional nursing (control group) or intensive nursing detail management (study group). The clinical endpoint was the nursing efficiency.

Results

Intensive nursing detail management was associated with significantly higher scores in basic nursing, quality of nursing, and quality of management versus conventional nursing (P < 0.05). Intensive nursing detail management resulted in a significantly higher adequate nursing rate (96.00%) versus conventional nursing (74.00%) (P < 0.05). The patients given intensive nursing detail management had a shorter hospital stay versus those receiving conventional nursing (P < 0.05). Intensive nursing detail management was associated with a higher nursing satisfaction rate (74.00%) versus conventional nursing (70.00%) (P < 0.05).

Conclusion

Intensive nursing detail management is effective and safe in ICU nursing, so it is worthy of clinical application.

[Ways of supporting relatives in intensive care units : Overview and update]

BACKGROUND

Relatives of patients in the intensive care unit (ICU) face a challenging situation: they often experience an existential crisis with great emotional stress and at the same time they are often actively involved in therapeutic decisions. The visiting restrictions of the coronavirus disease 2019 (COVID-19) pandemic have created new challenges in providing support to relatives.

OBJECTIVES

The aim of this work is to present current and new developments in supporting relatives of critically ill patients in the form of a narrative review.

RESULTS

In recent years, numerous new approaches and projects to support relatives have been developed. They can be assigned to the following six areas: 1) presence of relatives in the ICU, 2) proactive involvement in care, 3) structured communication/information and online offers, 4) multidisciplinary cooperation, 5) organizational management and 6) follow-up offers. The evidence and the current implementation status of these measures are very heterogeneous internationally and nationally.

CONCLUSIONS

Measures for providing support for ICU relatives are diverse. Some can even be implemented despite visit bans. Recent digital developments enable virtual visits and a better exchange of information between the ICU team and relatives.

The Meaning of Critical Illness for People Suffering From COVID-19: When a Frightening Unreality Becomes Reality

The aim of this study was to elucidate the meaning of critical illness for people with COVID-19. This study used a qualitative design. Thirteen people who were critically ill with COVID-19 during 2020 and admitted to a COVID-19 intensive care unit in northern Sweden participated in the study. Data collection was conducted as individual interviews with a narrative approach, and data were analyzed with phenomenological hermeneutic interpretation. The participants did not think they would get critically ill with this unexpected illness. They experienced terrible nightmares where their relatives had been killed, and they missed their relatives both in their dreams and in reality, as they had not been allowed to be with them due to the virus. Gratefulness was described for surviving. Participants described thoughts of not being able to imagine going through this again. They felt fear and loneliness, as a terrifying unreality had become a reality.

Exploring family members' and health care professionals' perceptions on ICU diaries: a systematic review and qualitative data synthesis

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.

Implementation of an Intensive Care Unit Diary Program at a Veterans Affairs Hospital

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.

Original Research: Exploring the Effects of a Nurse-Initiated Diary Intervention on Post-Critical Care Posttraumatic Stress Disorder

BACKGROUND

Critical illness survivors may develop posttraumatic stress disorder (PTSD) following critical illness and hospitalization. Left untreated, PTSD may result in poor health outcomes.

PURPOSE

This study sought to examine the effects of a nurse-initiated diary intervention on PTSD development and symptom severity in critical illness survivors with varying levels of mentation.

METHODS

The study used a pretest-posttest control group design. Patients who were hospitalized in a critical care unit for more than 24 hours were recruited at a single medical center with two such units. All participants completed a pretest on day 2 of critical care hospitalization; the intervention group participants also received a diary. All participants received a posttest one month after critical care discharge. The variables examined were PTSD severity and symptoms of avoidance, intrusion, and hyperarousal. Variables were measured using the Impact of Event Scale-Revised. Diaries were written by the patient, visitors, and interdisciplinary team members, and kept by the patient.

RESULTS

A total of 134 participants completed the study. The intervention group participants experienced significantly fewer PTSD symptoms than the control group participants. PTSD was found to be of concern in 35 (26%) of all participants: five in the intervention group and 30 in the control group.

CONCLUSIONS

For critical illness survivors, a collaborative diary-writing intervention during hospitalization and after discharge can mitigate post-critical care PTSD. Participants who received diaries had a lower incidence of PTSD symptoms than controls; and at follow-up, they indicated that the diary intervention was worthwhile. We recommend the use of collaborative diary writing to help critical illness survivors in working through their experiences.

The structure of qualitative studies: a bibliometric pattern of biomedical literature

The lack of knowledge in the biomedical literature regarding the validity of qualitative studies might be related to the lower number of qualitative studies that have been published. The criticisms range from a lack of theoretical depth to the superficial discussions of empirical findings. The aim of this study was to explore the bibliometric entities and the trends in the structure of qualitative research in the biomedical literature. A bibliometric analysis and mapping of the biomedical literature were used. The number of studies selected was 1,725. The heath themes with the most publications included Health Management (12%) and Women's Health (9.8%), while the authors of the studies had academic affiliation in 76 different countries. The sample sizes were between 11 and 20 participants (27.13%) and the Grounded Theory framework (9.04%) stood out. The improved structuring of a qualitative research extends the effective communication between health providers and researchers, and support in the management of clinical situations.

Brief introduction of medical database and data mining technology in big data era

Data mining technology can search for potentially valuable knowledge from a large amount of data, mainly divided into data preparation and data mining, and expression and analysis of results. It is a mature information processing technology and applies database technology. Database technology is a software science that researches manages, and applies databases. The data in the database are processed and analyzed by studying the underlying theory and implementation methods of the structure, storage, design, management, and application of the database. We have introduced several databases and data mining techniques to help a wide range of clinical researchers better understand and apply database technology.

The impact of intensive care unit diaries on patients' and relatives' outcomes: a systematic review and meta-analysis

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.

Patients' perceptions of an intensive care unit diary written by relatives: A hermeneutic phenomenological study

OBJECTIVE

To explore patients' perceptions of an intensive care unit diary written by relatives including pictures added by staff.

DESIGN

Ten patients were interviewed 3-6 and 8-16 months after discharge from the intensive care unit. Most patients were interviewed with a relative present. Interviews were analysed using Ricoeur's theory of interpretation.

SETTING

Interviews took place in participants' homes.

FINDINGS

Patients found the diary written by relatives with photos taken by staff to be valuable providing information that helped them understand their time in the intensive care unit. The diary text gave patients insight into relatives' experiences and suffering. Patients were touched by the love and care conveyed in the diary, however, the diaries could overwhelm the patients when they were confronted with the grief and agony endured by their relatives.

CONCLUSION

Although diaries kept by relatives confront patients with consequences beyond their own suffering, they are informative and promote understanding of what patient and family experienced during critical illness. The diaries expressed how much the relatives cared for the patient thus paving the way for mutual support and understanding. Diaries authored by relatives represent a new element to ICU diaries that have evolved from a nursing intervention toward family participation.

Structure and content of diaries written by close relatives for intensive care unit patients: A narrative approach (DRIP study)

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.

Nursing staff's experiences of intensive care unit diaries: a qualitative study

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.

The provision of nurse-led follow-up at Norwegian intensive care units

AIMS AND OBJECTIVES

To describe the prevalence, content and administration of intensive care unit diaries and follow-up practices offered to patients and their families in Norway.

BACKGROUND

Intensive care treatment has been associated with risks for new or increased health impairments affecting both patients and their families. These impairments have the potential of continuing beyond the acute phase of treatment. In parallel, preventive actions have gradually become an integrated part of critical care nursing, and in Norway, national recommendations for the use of intensive care unit diaries have been established.

DESIGN AND METHODS

A survey was conducted in Norwegian intensive care units offering care for adult patients, using a questionnaire asking about the frequency, administration and content of the follow-up offered to patients, their relatives, as well as bereaved family members.

RESULTS

Thirty-nine of 66 (59.1%) invited intensive care units answered the questionnaire. The majority (n = 33, 84.6%) of the responding units had follow-up routines. The provision of diaries was the most frequent follow-up activity (n = 24, 61.5%), and consultations postdischarge formed an integrated part of the diary practice. Consultations with bereaved were conducted in 21 (53.8%) of the intensive care units. About one quarter of the responding intensive care units had positions for follow-up nursing staff.

CONCLUSION

Nurse-led follow-up after critical care was a common activity in Norwegian intensive care units, comprising diaries and consultations offered to patients and family members. The follow-up was mainly driven by bottom-up processes conducted by dedicated nurses motivated by the patients' and their families' situation and feedback.

RELEVANCE TO CLINICAL PRACTICE

Adherence to recommendations, as well as the availability of defined positions for aftercare nurses or teams, may improve the implementation of follow-up practices and reduce suffering after discharge from Norwegian intensive care units.

The contents of a patient diary and its significance for persons cared for in an ICU: A qualitative study

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.