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

Enhancing ICU care with nurse-written diaries

BACKGROUND

Patient diaries are a supportive intervention aiding intensive care unit (ICU) survivors and their families post-critical illness. Despite their growing acceptance, ICU diary usage varies across settings.

AIM

This study explored themes in nurse-written ICU diaries and their impact on nursing work and communication.

STUDY DESIGN

This qualitative study employed an interpretative narrative methodology to explore the experiences of ICU nurses. The narrative approach enabled the synthesis of diverse events and impressions into coherent stories, facilitating a deeper understanding of participants' perspectives. Data collection involved thematic analysis of diaries following Braun and Clarke's methodology. The analysis included familiarization, coding, theme identification and validation by the research team. The findings were reviewed by participants and translated into English using the WHO's cultural adaptation guidelines, ensuring reliability and credibility in the study's outcomes.

RESULTS

The sample consisted of 28 ICU nurses, each with professional experience ranging from 1 to 23 years. The hospitalized subjects for whom our sample wrote the diary consist of 13 participants aged 23-79 years. Two main themes emerged from the analysis: (1) simplifying the intensive care situation with specific minimization strategies and (2) attention to nonverbal communication.

CONCLUSIONS

This study highlights the role of nurse-written ICU diaries in making the ICU environment more understandable and less intimidating for patients. Nurse-written ICU diaries contribute to improved communication and emotional support within the ICU environment. Further research is needed to explore these effects more fully and to assess the broader implications of ICU diaries on patient outcomes.

RELEVANCE TO CLINICAL PRACTICE

Nurse-written intensive care unit (ICU) diaries have a significant impact on both patient care and nursing practice in ICUs. ICU diaries serve as a crucial tool for enhancing communication, emotional support and empathetic care within these high-stress environments. By simplifying complex medical information and focusing on nonverbal communication, nurses can make the ICU experience more comprehensible and less intimidating for patients. This approach reduces patient anxiety and psychological stress while fostering a stronger nurse-patient relationship, ultimately improving care quality.

Enhancing family experience in the paediatric intensive care unit through the adoption of the family care journal: A single-center study

BACKGROUND

Multidisciplinary patient care rounds are increasingly seen as a vital complement to patient care management. Family engagement in these rounds, especially in the paediatric population, is important to treatment and outcomes, but there is little information about family experience in the Paediatric Intensive Care Unit (PICU).

AIMS

To develop a process using family care journals (FCJ) to systematically evaluate family experience in the PICU and identify needed supportive resources that will enhance their critical care stay.

STUDY DESIGN

This is a single-centre quasi-experimental design conducted at a large urban quaternary level freestanding children's hospital. A family care journal (FCJ) was distributed to families upon admission to PICU to serve as a resource tool during their stay. An electronic point of care (POC) questionnaire was used to assess families' experiences in the PICU.

RESULTS

Three hundred sixty-six questionnaires were completed (100% response rate) and analysed. Overall, there was an improvement in all phases post FCJ implementation compared with the baseline. Seventy five percent of families found it a useful tool for communication with the PICU team. Open-ended comments revealed improvement opportunities related to communication, environment, and delay in care. Almost all commented on excellent nursing care.

CONCLUSIONS

Introducing FCJ in a paediatric ICU is a practical approach, providing a cost-effective method to assess family experiences and gain insights for ongoing quality improvement efforts. Collaboration among all care team members, including nursing, medical, and administrative leaders, is crucial for empathetically addressing parental needs during hospitalization.

RELEVANCE TO CLINICAL PRACTICE

Combining the use of journals and questionnaires provides the clinical team with an efficient means of collecting valuable feedback from parents regarding their experience in the PICU and the factors that foster ongoing commitment from families. Nurses play a crucial role in encouraging the adoption of these journals, as they promote greater parent involvement in their children's care.

Effects of web neonatal intensive care unit diaries on the mental health, quality of life, sleep quality, care ability, and hormone levels of parents of preterm infants in the neonatal intensive care unit: A randomized controlled trial

OBJECTIVE

To examine the effects of web neonatal intensive care unit diaries on the mental health, quality of life, sleep quality, care ability, and hormone levels of parents of preterm infants in the neonatal intensive care unit.

DESIGN

Prospective randomized controlled parallel-group clinical trial.

SETTING

Maternal and Child Health Hospital, Fujian, China.

METHODS

The control group received routine neonatal intensive care unit care, while the intervention group received a web neonatal intensive care unit diary based on routine care. Outcomes, including anxiety, depression, and post-traumatic stress disorder symptoms, quality of life, sleep quality, care ability, and cortisol and melatonin levels, were evaluated at T1 (Time 1, before the intervention), T2 (Time 2, immediately after the intervention), and T3 (Time 3, 1 month after the intervention).

RESULTS

Seventy pairs of parents of preterm infants in the neonatal intensive care unit were randomly allocated to two groups: intervention (n = 35) and control (n = 35). The anxiety scores in the intervention group were significantly lower at T2 and T3 than those in the control group (P < 0.001). The care ability scores in the intervention group were significantly higher at T2 and T3 (P < 0.001). The prevalence of post-traumatic stress disorder at T3 was significantly different between the groups (P = 0.040). No significant differences were observed in the quality of life or sleep quality between the groups at T2 and T3 (P > 0.05). No significant differences were observed in cortisol and melatonin levels between the groups (P > 0.05).

CONCLUSIONS

Web neonatal intensive care unit diaries effectively relieved anxiety symptoms, reduced the prevalence of post-traumatic stress disorder, and enhanced the care abilities of parents of preterm infants in the neonatal intensive care unit.

IMPLICATIONS FOR CLINICAL PRACTICE

Web neonatal intensive care unit diary can be considered in clinical practice as a convenient psychological intervention method, especially among parents of preterm infants in the neonatal intensive care unit.

Opening Pandora's box by generating ICU diaries through artificial intelligence: A hypothetical study protocol

BACKGROUND

Patients and families on Intensive Care Units (ICU) benefit from ICU diaries, enhancing their coping and understanding of their experiences. Staff shortages and a limited amount of time severely restrict the application of ICU diaries. To counteract this limitation, generating diary entries from medical and nursing records using an artificial intelligence (AI) might be a solution.

DESIGN AND PURPOSE

Protocol for a hypothetical multi-center, mixed method study to identify the usability and impact of AI-generated ICU diaries, compared with hand-written diaries.

METHOD

A hand-written ICU diary will be written for patients with expected length of stay ≥ 72 h by trained nursing staff and families. Additionally at discharge, the medical and nursing records are analyzed by an AI software, transformed into understandable, empathic diary entries, and printed as diary. Based on an appointment with patients within 3 months, diaries are read in randomized order by trained clinicians with the patients and families. Patients and families will be interviewed about their experiences of reading both diaries. In addition, usability of diaries will be evaluated by a questionnaire.

EXPECTED FINDINGS AND RESULTS

Patients and families describe the similarities and differences of language and the content of the different diaries. In addition, concerns can be expressed about the generation and data processing by AI.

IMPLICATIONS FOR PRACTICE

Professional nursing involves empathic communication, patient-centered care, and evidence-based interventions. Diaries, beneficial for ICU patients and families, could potentially be generated by Artificial Intelligence, raising ethical and professional considerations about AI's role in complementing or substituting nurses in diary writing.

CONCLUSIONS

Generating AI-based entries for ICU diaries is feasible, but raises serious questions about nursing ethics, empathy, data protection, and values of professional nurses. Researchers and developers shall discuss these questions in detail, before starting such projects and opening Pandora's box, that can never be closed afterwards.