Use and practice of patient diaries in Swedish intensive care units: a national survey

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.

The diary in the intensive care unit: Concept analysis

INTRODUCTION

Admission to an intensive care unit can cause sequelae to both patients and family members. In some countries, the use of diaries is a preventive action.

AIM

This research proposes to critically examine the concept of 'Intensive Care Unit Diary' by analysing the current state of the scientific literature to develop a precise conception of this phenomenon in nursing practice, since there are multiple unknowns regarding its use and content.

METHOD

A bibliographic search was carried out in the PubMed, Cochrane Library, Scopus and CINAHL databases in January 2023. The terms used to search for their use and definitions in the databases included Nurse, Concept analysis, Family, Uci Diary, Patient Critical, Intensive Care Unit. We use Wilson's concept analysis, later developed by Walker and Avant.

RESULTS

The concept analysis shows that the 'ICU Diary' is a record made in colloquial language by health workers and relatives of the patient admitted to the intensive care unit. Aimed at the patient, with an empathic and reflective style, which offers a narrative of the process, daily life and the conduct or behaviour of the patient during his stay. It is a therapeutic tool led by nurses accepted by patients, families and professionals. Its use benefits the recovery process, reducing post-traumatic stress in family members and patients. It favours communication and the bond between nurses, family members and patients, helping to express feelings and emotions.

CONCLUSIONS

The concept of 'UCI Diary' is complex. Through Wilson's model, a clarification of the concept has been achieved, creating a starting point for more precise research on this phenomenon and its effects on patients, family members, professionals and the health system.

Photographs in burn patient diaries: A qualitative study of patients' and nurses' experiences

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.

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.

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.

The Use and Impact of Diaries in PICUs and Neonatal ICUs: A Scoping Review

OBJECTIVE

Several studies have investigated the impact of diaries in adult ICUs, which have been used as a tool to support recall and reduce post-traumatic stress disorder in patients and their families. We conducted a scoping review to determine the definition of ICU diaries, and the extent, range, and nature of research conducted on NICU and PICU diaries, describe their use and impact, as well as identify gaps in knowledge and areas for future research.

DATA SOURCES

The following databases were searched from inception to March 2022: Cumulated Index to Nursing and Allied Health Literature, Cochrane Library, Embase, PubMed, and American Psychological Association PsycINFO. Searches were also conducted in the following gray literature databases: Google Scholar, University of South Australia, and WorldCat.

STUDY SELECTION

All studies that discussed the use and impact of diaries or journals involving patients (<18 yr old) in PICUs and NICUs and/or their family members were included.

DATA SYNTHESIS

Sixteen studies were identified. Most studies defined diaries as daily entries written by nurses and/or family members regarding the patient's condition during their ICU admission. The majority reported that diaries were beneficial to children and their families as they helped to fill in memory gaps, provided a means to express their feelings, and served as effective health communication tools. Several gaps were identified: extent of the use of diaries as a means of communication, the significance of diaries as a coping mechanism for bereaved parents, and the impact of PICU diaries on the children, their families, and healthcare professionals.

CONCLUSIONS

There is a paucity of data on the use of NICU and PICU diaries. Nonetheless, the limited data revealed that NICU and PICU diaries were beneficial to children and their families. Our review demonstrated a heterogeneity in the terminology, content, use of photos, and the author/s of the NICU and PICU diaries. Further research is needed to investigate the impact of the use of NICU and PICU diaries on patient-reported outcomes.

On photovoice-Applications and reflections to an intensive care context

BACKGROUND

In this paper, we share our experiences of using 'photovoice' methodology as a way to generate data in intensive care units concerning the place and space of care. We have adapted and modified 'photovoice' in researching people's lived experiences of ICU. Researching lived experiences in an intensive care context is challenging because of the complex nature of critical care.

AIM

This study aims to explore and discuss photovoice methodolgy in ICU as a data collection method.

MATERIALS AND METHODS

Photos and interviews collected from patients, loved ones and staff collected in a previous research proejct.

RESULTS

Although there are challenges in using cameras and photographing the environment in the ICU, due to ethics and the voiceless patients therein, many advantages are presented to the researchers in capturing the meaning of lived experiences of various phenomena in the lifeworld in general and in the meaning of place and space. This paper offers applications and reflection over ontological, epistemological and methodological concerns and also offers a detailed approach on how to employ photovoice for successful and rich data generation.

DISCUSSION

developing and adapting scientific methods and methodologies contributes to knowledge development in caring science and is therefore an important subject of matter.

CONCLUSIONS

Photovoice also presents a powerful tool in disseminating the findings as it opens up the closed world of ICU to the public and increases people's understanding of the significance of place and space of caring practice.

Patients' experiences in the intensive care unit in Jordan: A cross-sectional study

AIMS

The purpose of this study was to describe the experiences of Jordanian patients during their stay in intensive care unit (ICU) and to explore associated factors.

BACKGROUND

Various factors can negatively affect patients' experiences and lead to negative consequences that can affect their outcomes.

MATERIALS & METHODS

A descriptive, correlational design was used to collect data from 150 patients using the Intensive Care Experience Questionnaire through structured interviews after being transferred from medical and surgical ICUs to general wards.

RESULTS

The results showed that the longer the length of ICU stay (LOS) (>7 days) the higher frightening experience (r = 0.2, p < 0.05), the lower awareness of surrounding (r = -0.28, p < 0.01), and the lower satisfaction with care (r = -0.22, p < 0.01). The results showed a negative correlation between receiving sedation and awareness of surroundings (r = -0.33, p < 0.01), and recall of ICU experiences (r = -0.23, p < 0.01), and a positive correlation with frightening experiences (r = 0.2, p < 0.05).

CONCLUSION

Health care activities, clinical and socio-demographic factors can affect the psychological experiences of patients in the ICU. Longer ICU stay is associated with more negative experiences.

Use of narrative methods in rehabilitation and palliative care in Scandinavian countries: A scoping review

BACKGROUND

Although narratives-including an ill person's life story, life situation and future perspectives-seem to lie at the core of rehabilitation and palliative care in Scandinavian countries, we lack a scope of how, when and where narrative methods are used. Such a scope could provide knowledge and inspiration on a practical as well as a policy level. The objective of this study is to explore the literature on the use of systematic, narrative methods in rehabilitative and palliative care for people with life-threatening illness in Scandinavian countries.

METHOD

We conducted a scoping review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) where applicable. We performed a systematic search in CINAHL, Medline, PsychInfo, SOCIndex and SveMed+using the search terms 'life threatening illness', 'narratives', 'rehabilitation', 'palliative care' and 'Scandinavia', followed by a search for grey literature. We found 42 records to be eligible for this scope and extracted the data via piloted extraction tables.

RESULTS

We identified 17 narrative methods and present findings concerning four themes: (1) a record of the narrative methods used; (2) an objective and theoretical framework for the narrative methods; (3) the content and form of the narrative methods; and (4) the significance of the narrative methods used.

CONCLUSION

Narrative methods are used in systematic ways in rehabilitation and palliative care in Scandinavian countries and cover a wide variety of objectives, theoretical frames, forms and outcomes. Further development may benefit from more elaboration on definitions and the relationships between objectives, theoretical frameworks and outcomes.

Evaluating the Feasibility and Efficacy of a Pediatric Intensive Care Unit Diary

As the progress of critical care medicine has improved the survival rate of critically ill patients, comorbidities and long-term health care have attracted people's attention. The terms "post-intensive care syndrome" (PICS) and "PICS-family" (PICS-F) have been used in non-neurocritical care populations, which are characterized by the cognitive, psychiatric, and physical sequelae associated with intensive care hospitalization of survivors and their families. An intensive care unit (ICU) diary authored by the patient's family members may alleviate the psychological distress of the patient and his or her family. This quality improvement project focused on the development and implementation of the pediatric intensive care unit (PICU) diary in the pediatric critical care setting. The project aims to evaluate the feasibility and the potential efficacy of the PICU diary, measured through parental acceptance and satisfaction. Seventeen families of critically ill children admitted to the PICU received the PICU diary during the implementation period. Twenty-four parents completed the weekly follow-up, and 15 subsequently completed the diary entry evaluation. The use of the diary in the PICU setting is feasible and considered beneficial by families of critically ill children.

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.

The experience of relatives using intensive care diaries: A systematic review and qualitative synthesis

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.

Approaches to Addressing Post-Intensive Care Syndrome among Intensive Care Unit Survivors. A Narrative Review

Critical illness can be lethal and devastating to survivors. Improvements in acute care have increased the number of intensive care unit (ICU) survivors. These survivors confront a range of new or worsened health states that collectively are commonly denominated post-intensive care syndrome (PICS). These problems include physical, cognitive, psychological, and existential aspects, among others. Burgeoning interest in improving long-term outcomes for ICU survivors has driven an array of potential interventions to improve outcomes associated with PICS. To date, the most promising interventions appear to relate to very early physical rehabilitation. Late interventions within aftercare and recovery clinics have yielded mixed results, although experience in heart failure programs suggests the possibility that very early case management interventions may help improve intermediate-term outcomes, including mortality and hospital readmission. Predictive models have tended to underperform, complicating study design and clinical referral. The complexity of the health states associated with PICS suggests that careful and rigorous evaluation of multidisciplinary, multimodality interventions-tied to the specific conditions of interest-will be required to address these important problems.

Could therapeutic diaries support recovery in psychiatric intensive care?

Despite growing literature surrounding the use of patient diaries in intensive care units within general health care and the positive effects these may have on a patient's psychological recovery from such an admission, no studies exist examining the effects of similar patient diaries in psychiatric intensive care units when used with people experiencing an acute exacerbation of psychosis. This article hypothesises the potential positive effects of diaries kept for patients in psychiatric intensive care units. In the development of strategies to help people in psychiatric crisis understand and manage their own distress and psychological trauma, diaries may be helpful for the prevention of further psychological problems and aid recovery post discharge. Research is required to consider the possible effects of therapeutic diaries and the role of the multidisciplinary team in keeping these within psychiatric intensive care settings.

Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit

Within the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). In this review, we first summarize the literature on the cognitive, psychiatric, and physical correlates of PICS and PICS-F in non-neurocritical patient populations and draw attention to their long-term negative health consequences. Next, keeping in mind the distinction between disease-related neurocognitive changes and those that are associated directly with the experience of a critical illness, we review the neuropsychological sequelae among patients with common neurocritical illnesses. We acknowledge the clinical factors contributing to the difficulty in studying PICS in the neurocritical care patient population, provide recommendations for future lines of research, and encourage collaboration among critical care physicians in all specialties to facilitate continuity of care and to help elucidate mechanism(s) of PICS and PICS-F in all critical illness survivors. Finally, we discuss the importance of early detection of PICS and PICS-F as an opportunity for multidisciplinary interventions to prevent and treat new neuropsychological deficits in the neurocritical care population.

Improving patient diary use in intensive care: A quality improvement report

Background

Patients surviving critical illness are at risk of developing psychological symptoms that affect quality of life and recovery. Patient diaries may improve psychological outcomes by reducing gaps in memory and contextualising what has happened during admission. Factors including lack of guidelines, lack of awareness and time constraints may lead to poor diary use.

Aims

This quality improvement project aimed to increase diary provision and overall multidisciplinary team engagement with diaries for all patients admitted for over 72 h to an intensive care unit.

Methods

Trialled changes implemented via the 'Plan-Do-Study-Act' method included adding alerts to the online patient note system, providing education sessions and introducing a guidance document to facilitate entry completion.

Results

A 'diary provision' target of 100% was achieved (from a baseline of 26.1%). Simple changes have proven effective in establishing routine engagement with diaries, and lessons may be used to improve diary systems elsewhere.

Patient diaries: Survey of paediatric intensive care units in the United Kingdom and Ireland

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.

Feasibility and Perceptions of PICU Diaries

OBJECTIVES

To determine the feasibility of implementing an ICU diary in the pediatric critical care setting and to understand the perceptions held by family members who receive the diaries after PICU discharge.

DESIGN

Observational pilot study.

SETTING

PICU in a tertiary academic hospital in the United States.

PARTICIPANTS

Critically ill pediatric patients admitted to the PICU and their families.

INTERVENTIONS

The addition of a PICU diary to a patient's routine care.

MEASUREMENTS AND MAIN RESULTS

Twenty families of critically ill children admitted to the PICU were enrolled in the PICU diary pilot study between May 2017 and March 2018. Patients who had an anticipated length of stay of at least 3 days and whose families were English-speaking were included. The median age of patients was 6 years, ranging from newborns to 18 years old, and the median length of stay was 11.5 days (interquartile range, 8.5-41 d). A total of 453 diary entries were written in 19 diaries over 433 PICU days, the majority of which were composed by bedsides nurses (63%). Follow-up surveys sent to parents 2 weeks after PICU discharge revealed that of the parents who had contributed to the diary, most enjoyed doing so (7/8). Nine of 12 parents had reviewed the diary at least once since discharge, and all parent respondents found the diary to be a beneficial aspect of their experience after PICU discharge.

CONCLUSIONS

The use of ICU diaries in the PICU setting is feasible and perceived as beneficial by families of critically ill children. Future studies are needed to better understand if PICU diaries may objectively improve psychologic outcomes of patients and family members after PICU admission.

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 impact of follow-up visits and diaries on patient outcome after discharge from intensive care: A descriptive and explorative study

OBJECTIVES

To explore the possible effects of intensive care follow-up visits and diaries on patients physical and psychosocial problems at 2, 6, and 12 months after unit discharge as well as the patient' experiences of follow-up visits and diaries.

METHODS

A descriptive and explorative cohort design. Patients (n = 441) with a length of ICU stay for ≥24 hours, who responded to the 3-set 4P questionnaire were included. Patients were divided into groups depending on when they responded to the questionnaire and if had or had not a follow-up visit or a diary.

RESULTS

Patients found the follow-up visit and the diary valuable and helpful during the recovery. In the univariate general linear model analyses, the follow-up group reported more problems in Mood and Memory. Longer length of stay was a predictor for unfavourable scoring in the domains Change in Appearance and Memory and for favourable scoring in the domain Social Life. The diary group reported more problems in Change in Appearance, Mood, and Memory and fewer problems in Social Life.

CONCLUSION

No strong effects of follow-up or diary on patient outcomes were seen. However, because the patients experienced that the interventions had helped them during recovery, further exploration of the matter is needed in the process of testing these interventions.

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.

Innovation and Technology: Electronic Intensive Care Unit Diaries

Hospitalization in the intensive care unit can be a stressful time for patients and their family members. Patients' family members often have difficulty processing all of the information that is given to them. Therefore, an intensive care unit diary can serve as a conduit for synthesizing information, maintaining connection with patients, and maintaining a connection with family members outside the intensive care unit. Paper intensive care unit diaries have been used outside the United States for many years. This article explores the development of an electronic intensive care unit diary using a rapid prototyping model to accelerate the process. Initial results of design testing demonstrate that it is feasible, useful, and desirable to consider the implementation of electronic intensive care unit diaries for patients at risk for post-intensive care syndrome.

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.

The ICU-Diary study: prospective, multicenter comparative study of the impact of an ICU diary on the wellbeing of patients and families in French ICUs

BACKGROUND

Post-intensive care syndrome includes the multiple consequences of an intensive care unit (ICU) stay for patients and families. It has become a new challenge for intensivists. Prevention programs have been disappointing, except for ICU diaries, which report the patient's story in the ICU. However, the effectiveness of ICU diaries for patients and families is still controversial, as the interpretation of the results of previous studies was open to criticism hampering an expanded use of the diary. The primary objective of the study is to evaluate the post-traumatic stress syndrome in patients. The secondary objectives are to evaluate the post-traumatic stress syndrome in families, anxiety and depression symptoms in patients and families, and the recollected memories of patients. Endpoints will be evaluated 3 months after ICU discharge or death.

METHODS

A prospective, multicenter, randomized, assessor-blind comparative study of the effect of an ICU diary on patients and families. We will compare two groups: one group with an ICU diary written by staff and family and given to the patient at ICU discharge or to the family in case of death, and a control group without any ICU diary. Each of the 35 participating centers will include 20 patients having at least one family member who will likely visit the patient during their ICU stay. Patients must be ventilated within 48 h after ICU admission and not have any previous chronic neurologic or acute condition responsible for cognitive impairments that would hamper their participation in a phone interview. Three months after ICU discharge or death of the patient, a psychologist will contact the patient and family by phone. Post-traumatic stress syndrome will be evaluated using the Impact of Events Scale-Revised questionnaire, anxiety and depression symptoms using the Hospital Anxiety and Depression Scale questionnaire, both in patients and families, and memory recollection using the ICU Memory Tool Questionnaire in patients. The content of a randomized sample of diaries of each center will be analyzed using a grid. An interview of the patients in the intervention arm will be conducted 6 months after ICU discharge to analyze in depth how they use the diary.

DISCUSSION

This study will provide new insights on the impact of ICU diaries on post-traumatic stress disorders in patients and families after an ICU stay.

TRIAL REGISTRATION

ClinicalTrial.gov, ID: NCT02519725 . Registered on 13 July 2015.

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

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.

Extent and application of patient diaries in Austria: process of continuing adaptation

BACKGROUND

Diaries written for patients in the intensive care unit (ICU) are offered in many European countries. In Austria, ICU diaries have been relatively unknown, but since 2012, they have started to emerge.

AIM

The aim of this study was to explore the extent and application of ICU diaries in Austria in 2015.

METHOD

The study had a prospective multiple methods design of survey and interviews. All ICUs in Austria were surveyed in 2015 to identify which ICUs used diaries. ICUs using diaries were selected for semi-structured key-informant telephone interviews on the application of ICU diaries. Interviews were analysed by content analysis.

RESULTS

Of the 178 ICUs contacted, 13 had implemented ICU diaries. In all ICUs, diaries were sporadically introduced by a few dedicated nurses. Experiences of participating nurses can be summarized in two main themes: (a) the process of innovation and (b) the process of practice. Sub-themes were: (i) inspiration, creativity and innovation and (ii) purpose, indications, responsibility, authorship, experience, negative reception, and post-ICU practice. Individual nurses at each ICU found ways to organize and format ICU diaries while dealing with ambivalence and legal implications.

CONCLUSION

The implementation of a new nursing intervention is an ongoing process. Being innovative and responsible can be challenging, especially in hierarchical team structures. We recommend that nurses work towards national standards for the diary concept in order to enable future research into the process and outcome of ICU diaries.

RELEVANCE TO CLINICAL PRACTICE

The implementation of ICU diaries in routine care requires an ongoing adaptive, reflective process. Nurses may experience innovation, leading to the development of their own, feasible adaptions and structures.

A qualitative exploration into the long-term perspectives of patients receiving critical care diaries across the United Kingdom

BACKGROUND

Increasing evidence suggests the use of a diary with entries by nurses, doctors, AHPs and the patient's family can potentially help by "filling in the gaps" and help the patient make sense of a time that they have forgotten or feel confused and have fears about.

AIMS

A qualitative exploration of the impact of diaries on critical care patients around the United Kingdom in order to describe the long-term effects of patient diaries.

METHODS

In-depth qualitative interviews, using principles of grounded theory, via telephone and email were undertaken. The sample included former patients who responded via adverts on critical care charity/support websites. People who had diaries in the previous 1-3 years were asked about their experiences.

FINDINGS

Eight people who had been patients in various critical care units across the United Kingdom and who had a critical care diary were interviewed. All reported value in having diaries, however, participants reported needing support when first receiving the diary to understand events that took place in critical care.

CONCLUSION

Diaries can offer a means of filing the gaps for patients who struggle with coming to terms with their critical care recovery, but should be given to patients with forethought and subsequent support.

Developing a framework for implementing intensive care unit diaries: a focused review of the literature

OBJECTIVE

Intensive care unit diaries have been shown to improve post-critical illness recovery, however, prior reports of diary implementation are heterogeneous. We sought to construct a common framework for designing and implementing Intensive Care Unit diaries based on prior studies.

REVIEW METHOD USED/DATA SOURCES

We conducted a focused review of the literature regarding intensive care diaries based on a systematic search of several databases. Two reviewers assessed 56 studies and data were abstracted from a total of 25 eligible studies conducted between 1990 and 2014. We identified key information regarding the development, design, and implementation of the journals. We then grouped elements that appeared consistently across these studies within three main categories: (1) diary target populations; (2) diary format and content; and (3) the manner of diary return and follow-up.

RESULTS

Most studies were conducted in European countries in adult intensive care units and targeted patients in both medical and surgical units. The timing of diary initiation was based on the elapsed length of stay or duration of mechanical ventilation. We categorised diary format and content as: entry content, authors, use of standardised headings, type of language, initiation, frequency of entries, and physical location of diaries. Diaries were hand written and many studies found that photographs were an essential element in ICU diaries. We categorised the manner of diary return and follow-up. The context in which intensive care unit diaries were returned were felt to be important factors in improving the use of diaries in recovery.

CONCLUSIONS

In conclusion, we describe a common framework for the future development of intensive care unit diaries that revolves around the target population for the diaries, their format and content, and the timing of their use. Future studies should address how these elements impact the mechanisms by which intensive are diaries exert beneficial effects.

Intensive care diaries to promote recovery for patients and families after critical illness: A Cochrane Systematic Review

OBJECTIVES

To assess the effect of an intensive care unit (ICU) diary versus no ICU diary on patients, and their caregivers or families, during the patient's recovery from admission to an ICU.

DESIGN

Systematic review of randomized controlled trials (RCTs) and clinical controlled trials.

DATA SOURCES

CENTRAL, MEDLINE, CINAHL, EMBASE, PsycINFO, PILOT; Web of Science Conference Proceedings, clinical trial registries and reference lists of identified trials.

REVIEW METHODS

Studies evaluated the effectiveness of patient diaries, when compared to no ICU diary, for patients or family members to promote recovery after admission to ICU were included. Outcome measures for describing recovery from ICU included the risk of post-traumatic stress disorder (PTSD), anxiety, depression and post-traumatic stress symptomatology, health-related quality of life and costs. We used standard methodological approaches as expected by The Cochrane Collaboration. Two review authors independently reviewed titles for inclusion, extracted data and undertook risk of bias according to pre-specified criteria.

RESULTS

We identified three eligible studies; two describing ICU patients (N=358), and one describing relatives of ICU patients (N=30). No study adequately reported on risk of PTSD as described using a clinical interview, family or caregiver anxiety or depression, health-related quality of life or costs. Within a single study there was no clear evidence of a difference in risk for developing anxiety (RR 0.29, 95% CI 0.07-1.19) or depression (RR 0.38, 95% CI 0.12-1.19) in participants who received ICU diaries, in comparison to those that did not receive a patient diary. Within a single study there was no evidence of difference in median post-traumatic stress symptomatology scores (diaries 24, SD 11.6; no diary 24, SD 11.6) and delusional ICU memory recall (RR 1.04, 95% CI 0.84-1.28) between the patients recovering from ICU admission who received patient diaries, and those who did not. One study reported reduced post-traumatic stress symptomatology in family members of patients recovering from admission to ICU who received patient diaries (median 19; range 14-28), in comparison to no diary (median 28; range 14-38).

CONCLUSIONS

Currently there is minimal evidence from RCTs of the benefits or harms of patient diaries for patients and their caregivers or family members. A small study has described their potential to reduce post-traumatic stress symptomatology in family members. However, there is currently inadequate evidence to support their effectiveness in improving psychological recovery after critical illness for patients and their family members.

Family members' experiences of keeping a diary during a sick relative's stay in the intensive care unit: a hermeneutic interview study

OBJECTIVE

The aim of the study was to explore family members' experiences with keeping a diary during a sick relative's stay in the ICU.

DESIGN

A qualitative method with a hermeneutic approach was used. Eleven participants, who recorded nine diaries in total, were interviewed. The collected data were analysed using a hermeneutic approach inspired by Gadamer.

RESULTS

The analysis revealed a meta-theme: 'it [writing in the diary] felt like contact' which was created by a feeling of togetherness and the opportunity to communicate with the patient. Keeping a diary likely meets the needs of family members in several ways because it becomes a way to be present at the patient's bedsides, to provide caregiving, to maintain hope and to relay cogent information. However, concerns regarding negative aspects of diary keeping were also raised; for example, the diary created feelings of stress, guilt and failure and exposed intimate details.

CONCLUSION

The diary symbolised the maintenance of relationships with the patients and was a substitute for the usual opportunities for communication. Furthermore, it was instrumental in meeting the needs of the majority of family members in several ways. Nevertheless, the diary did have negative effects for certain individuals, which highlights the importance of an individualised approach.

Diaries for recovery from critical illness

BACKGROUND

During intensive care unit (ICU) admission, patients experience extreme physical and psychological stressors, including the abnormal ICU environment. These experiences impact on a patient's recovery from critical illness and may result in both physical and psychological disorders. One strategy that has been developed and implemented by clinical staff to treat the psychological distress prevalent in ICU survivors is the use of patient diaries. These provide a background to the cause of the patient's ICU admission and an ongoing narrative outlining day-to-day activities.

OBJECTIVES

To assess the effect of a diary versus no diary on patients, and their caregivers or families, during the patient's recovery from admission to an ICU.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 1), Ovid MEDLINE (1950 to January 2014), EBSCOhost CINAHL (1982 to January 2014), Ovid EMBASE (1980 to January 2014), PsycINFO (1950 to January 2014), Published International Literature on Traumatic Stress (PILOTS) database (1971 to January 2014); Web of Science Conference Proceedings Citation Index - Science and Social Science and Humanities (1990 to January 2014); seven clinical trial registries and reference lists of identified trials. We applied no language restriction.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) or clinical controlled trials (CCTs) that evaluated the effectiveness of patient diaries, when compared to no ICU diary, for patients or family members to promote recovery after admission to ICU. Outcome measures for describing recovery from ICU included the risk of post-traumatic stress disorder (PTSD), anxiety, depression and post-traumatic stress symptomatology, health-related quality of life and costs.

DATA COLLECTION AND ANALYSIS

We used standard methodological approaches as expected by The Cochrane Collaboration. Two review authors independently reviewed titles for inclusion, extracted data and undertook risk of bias according to prespecified criteria.

MAIN RESULTS

We identified three eligible studies; two describing ICU patients (N = 358), and one describing relatives of ICU patients (N = 30). The study involving relatives of ICU patients was a substudy of family members from one of the ICU patient studies. There was a mixed risk of bias within the included studies. Blinding of participants to allocation was not possible and blinding of the outcome assessment was not adequately achieved or reported. Overall the quality of the evidence was low to very low. The patient diary intervention was not identical between studies. However, each provided a prospectively prepared, day-to-day description of the participants' ICU admission.No study adequately reported on risk of PTSD as described using a clinical interview, family or caregiver anxiety or depression, health-related quality of life or costs. Within a single study there was no clear evidence of a difference in risk for developing anxiety (risk ratio (RR) 0.29, 95% confidence interval (CI) 0.07 to 1.19) or depression (RR 0.38, 95% CI 0.12 to 1.19) in participants who received ICU diaries, in comparison to those that did not receive a patient diary. However, the results were imprecise and consistent with benefit in either group, or no difference. Within a single study there was no evidence of difference in median post-traumatic stress symptomatology scores (diaries 24, SD 11.6; no diary 24, SD 11.6) and delusional ICU memory recall (RR 1.04, 95% CI 0.84 to 1.28) between the patients recovering from ICU admission who received patient diaries, and those who did not. One study reported reduced post-traumatic stress symptomatology in family members of patients recovering from admission to ICU who received patient diaries (median 19; range 14 to 28), in comparison to no diary (median 28; range 14 to 38).

AUTHORS' CONCLUSIONS

Currently there is minimal evidence from RCTs of the benefits or harms of patient diaries for patients and their caregivers or family members. A small study has described their potential to reduce post-traumatic stress symptomatology in family members. However, there is currently inadequate evidence to support their effectiveness in improving psychological recovery after critical illness for patients and their family members.

The use, prevalence and potential benefits of a diary as a therapeutic intervention/tool to aid recovery following critical illness in intensive care: a literature review

AIMS AND OBJECTIVES

To critically appraise the available literature and summarise the evidence related to the use, prevalence, purpose and potential therapeutic benefits of intensive care unit diaries following survivors' discharge from hospital and identify areas for future exploration.

BACKGROUND

Intensive care unit survivorship is increasing as are associated physical and psychological complications. These complications can impact on the quality of life of survivors and their families. Rehabilitation services for survivors have been sporadically implemented and lack an evidence base. Patient diaries in intensive care have been implemented in Scandinavia and Europe with the intention of filling memory gaps, enable survivors to set realistic recovery goals and cement their experiences in reality.

DESIGN

A review of original research articles.

METHODS

The review used key terms and Boolean operators across a 34-year time frame in: CIHAHL, Medline, Scopus, Proquest, Informit and Google Scholar for research reports pertaining to the area of enquiry. Twenty-two original research articles met the inclusion criteria for this review.

RESULTS

The review concluded that diaries are prevalent in Scandinavia and parts of Europe but not elsewhere. The implementation and ongoing use of diaries is disparate and international guidelines to clarify this have been proposed. Evidence which demonstrates the potential of diaries in the reduction of the psychological complications following intensive care has recently emerged. Results from this review will inform future research in this area.

CONCLUSIONS

Further investigation is warranted to explore the potential benefits of diaries for survivors and improve the evidence base which is currently insufficient to inform practice. The exploration of prospective diarising in the recovery period for survivors is also justified.

RELEVANCE TO CLINICAL PRACTICE

Intensive care diaries are a cost effective intervention which may yield significant benefits to survivors.

Extent and application of ICU diaries in Germany in 2014

BACKGROUND

Diaries written for patients in the Intensive Care Unit (ICU) have been used in many European countries since the early 1990s to support patients and their relatives in their understanding of the ICU experience. ICU diaries have been introduced in Germany since 2008 via the internet, newsletters, newspapers, lectures and publications in German nursing journals.

AIM

The aim of the study was to update our knowledge of the extent and application of ICU diaries in Germany in 2014.

DESIGN

The study had a prospective mixed methods multicenter design.

METHOD

All 152 ICUs in the two German federal states of Baden-Württemberg and Schleswig-Holstein were surveyed to identify units that had implemented ICU diaries. An additional 69 ICUs from other parts of Germany were included in the survey. We excluded diaries used in neonatal ICUs. Out of 43 units using diaries 14 were selected for semi-structured key-informant telephone-interviews on the application of ICU diaries.

RESULTS

According to the survey, 8 out of 152 ICUs in the two federal states of Baden-Württemberg and Schleswig-Holstein had implemented ICU diaries and another six were planning implementation. Another 35 ICUs in other areas of Germany had implemented diaries and three units were planning to do so. Interviews were conducted with nurses at 14 selected ICUs. Informants reported successful adaption of the diary concept to their culture, but variability in application. No units were identified where all nursing staff participated in keeping ICU diaries.

CONCLUSION

Six years after the introduction of ICU diaries, ICU nurses in Germany are becoming familiar with the concept. Nursing shortage and bureaucratic challenges have impeded the process of implementation, but the adaption of ICU diaries to German conditions appears to be successful and is still in progress.

RELEVANCE TO CLINICAL PRACTICE

Implementation of ICU diaries is feasible after adjusting for cultural and legal issues.

Recovery post ICU

Many ICU patients struggle to recovery following critical illness and may be left with physical, cognitive and psychological problems, which have a negative impact on their quality of life. Gross muscle mass loss and weakness can take some months to recover after the patients' Intensive Care Unit (ICU) discharge, in addition critical illness polyneuropathies can further complicate physical recovery. Psychological problems such as anxiety, depression and post traumatic stress disorder (PTSD) are common and have an negative impact on the patients' ability to engage in rehabilitation after ICU discharge. Finally cognitive deficit affecting memory can be a significant problem. The first step in helping patients to recover from such a devastating illness is to recognise those who have the greatest need and target interventions. Research now suggests that there are interventions that can accelerate physical recovery and reduce the incidence of psychological problems such as anxiety, depression and PTSD. Cognitive rehabilitation, however, is still in its infancy. This review will look at the research into patients' recovery and what can be done to improve this where needed.

The use of diaries in psychological recovery from intensive care

Intensive care patients frequently experience memory loss, nightmares, and delusional memories and some may develop symptoms of anxiety, depression, and post-traumatic stress. The use of diaries is emerging as a putative tool to 'fill the memory gaps' and promote psychological recovery. In this review, we critically analyze the available literature regarding the use and impact of diaries for intensive care patients specifically to examine the impact of diaries on intensive care patients' recovery. Diversity of practice in regard to the structure, content, and process elements of diaries for intensive care patients exists and emphasizes the lack of an underpinning psychological conceptualization. The use of diaries as an intervention to aid psychological recovery in intensive care patients has been examined in 11 studies, including two randomized controlled trials. Inconsistencies exist in sample characteristics, study outcomes, study methods, and the diary intervention itself, limiting the amount of comparison that is possible between studies. Measurement of the impact of the diary intervention on patient outcomes has been limited in both scope and time frame. Furthermore, an underpinning conceptualization or rationale for diaries as an intervention has not been articulated or tested. Given these significant limitations, although findings tend to be positive, implementation as routine clinical practice should not occur until a body of evidence is developed to inform methodological considerations and confirm proposed benefits.

Providing critical care patients with a personalised discharge summary: a questionnaire survey and retrospective analysis exploring feasibility and effectiveness

OBJECTIVES

This paper reports on the potential value and feasibility of providing patients with a personalised discharge summary of their critical care stay.

DESIGN AND METHODS

Fifty-one patient discharge summaries, written by nurses during a randomised controlled trial, were retrospectively analysed for readability, structure and quality. A questionnaire survey completed by trial patients (n=42), their relatives (n=21) and nurses (n=170) explored user experience and feasibility. Quantitative questionnaire data were analysed descriptively and inferentially; qualitative data were subjected to content analysis.

RESULTS

Most completed summaries achieved at least an average readability score and were of an acceptable quality. Motivation, time constraints and competing priorities were identified as key barriers to writing an effective summary; however, in the majority of cases, writing them had taken less than 15 minutes. Questionnaire data support that patient discharge summaries can help patients, relatives and ward nurses better understand and patients accept, what happened in critical care.

CONCLUSION

Patient discharge summaries are likely to be a useful adjunct to existing discharge information, but further work is required to determine when and how they should be provided. With appropriate training and support, it is feasible for nurses to write discharge summaries in a busy critical care environment.

How much time do nurses need to write an ICU diary?

BACKGROUND

Diaries in the Intensive Care Unit (ICU) support patients and relatives during and after a stay on the ICU. Barriers to implementation of the ICU diary are workload, unwanted closeness to patients and lack of time.

AIMS AND OBJECTIVES

The purpose of the study was to evaluate the time nurses consume writing an ICU diary. Further questions were to examine whether the first diary entry, which includes a more detailed description about the admission, consumes more time than other entries and whether the time taken depends on experience or workload of the nurses.

DESIGN

Quantitative, prospective, international observational multicentre study in four ICUs within the international diary network in Germany (two ICUs), Sweden and Switzerland (one ICU each).

METHOD

During a 6-month period in 2012/2013 nurses measured the time they consumed writing a diary in minutes and seconds, the number of diaries they contributed to and total number of diary entries, the nurse-patient ratio, their level of experience in writing diaries, interruptions while writing in a diary and additional information like photographs or follow-up visits.

RESULTS

In summary 29 diaries were collected which included 195 written entries. The first entry needed significantly more time than following entries (first entry: mean 13:33 min versus following entries: mean 5:31, p < 0·001). The mean time for following entries differed significantly between the countries: Switzerland: 6:14, Sweden 5:31 and Germany 3:36 (p < 0·001). Nurses with more experience used more time to write a diary (not significant). With increasing nurse-patient-ratio the time decreased for following entries (ratio 1:1: mean 5:42, ratio 1:2: mean 5:27, ratio 1:3: mean 3:12, p = 0·007).

CONCLUSION

Writing a diary for patients and relatives means an additional amount of time and workload, but according to the increased quality of nursing the time seems to be feasible for implementation. The measured time was self-reported, thus including possible bias for the results.

Phenomenologic analysis of healthcare worker perceptions of intensive care unit diaries

Introduction

Studies have reported associations between diaries kept for intensive care unit (ICU) patients and long-term quality-of-life and psychological outcomes in patients and their relatives. Little was known about perceptions of healthcare workers reading and writing in the diaries. We investigated healthcare worker perceptions the better to understand their opinions and responses to reading and writing in the diaries.

Methods

We used a phenomenologic approach to conduct a qualitative study of 36 semistructured interviews in a medical-surgical ICU in a 460-bed tertiary hospital.

Results

Two domains of perception were assessed: reading and writing in the diaries. These two domains led to four main themes in the ICU workers' perceptions: suffering of the families; using the diary as a source of information for families but also as generating difficulties in writing bad news; determining the optimal interpersonal distance with the patient and relatives; and using the diary as a tool for constructing a narrative of the patient's ICU stay.

Conclusions

The ICU workers thought that the diary was beneficial in communicating the suffering of families while providing comfort and helping to build the patient's ICU narrative. They reported strong emotions related to the diaries and a perception of intruding into the patients' and families' privacy when reading the diaries. Fear of strong emotional investment may adversely affect the ability of ICU workers to perform their duties optimally. ICU workers are in favor of ICU diaries, but activation by the diaries of emotions among younger ICU workers may require specific support.

Memories from intensive care unit persist for several years--a longitudinal prospective multi-centre study

INTRODUCTION

In connection with the care received in the intensive care unit (ICU), the patient can experience discomfort and frustration. Earlier studies have shown mechanical ventilation (MV) to be a factor that increases patients' delusional memories in the ICU. The patients who need MV after a physical trauma constitute a vulnerable group who so far has attracted little attention from a long-term perspective.

AIM

The aim for this study is to describe mechanically ventilated trauma patients over time regarding their memories, psychological recovery and health related quality of life (HRQoL).

METHODS

In a multicentre study, 41 patients who had received MV, answered a questionnaire with the SF-36, HAD and ICUM tool on two occasions about one and five years after the injury and care in the ICU.

RESULTS

The patients' memories were stable over time and significantly more patients remembered panic and anxiety. 37% remembered pain one year after the trauma and 46% five years thereafter. The majority of the patients remembered the family's presence from their ICU stay. Half of the patients had thoughts regarding why they had so few recollections. One fourth of the patients experienced clear symptoms of anxiety and the same amount had symptoms of depression one year after the injury. In seven of the patients the symptoms of probable anxiety persisted after five years. In six of the patients the symptoms of probable depression persisted after five years. Two of eight dimensions in HRQoL, the physical and emotional role functions, had improved significantly five years after the injury.

CONCLUSIONS

Five years after the trauma, the memories from the ICU were still the same and the HRQoL improved in only two out of eight dimensions. A smaller group of patients had remaining symptoms of psychological ill-health. MV in connection with trauma may result in continued reduced health in the long term.