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

Abstract

Background: Diaries as an intervention to aid psychological recovery among intensive care patients have been used for about 20 years, and findings tend to be positive. The provision of a diary directed at the patient may clarify the story of the intensive care unit (ICU) even for the family members and the family members of non-survivors. Members of nursing staff are the primary authors, but how they themselves experience the use of ICU diaries has been minimally explored. Aims and objectives: This study aimed to explore how nursing staff experienced the use of ICU patient diaries. Design: Qualitative design using focus group interviews. Methods: A qualitative methodology was used. Six focus group interviews were conducted with 27 nursing staff recruited from one university and two county hospitals. The data were analysed via thematic content analysis. Findings: One overarching theme, 'An effort to do good in words and actions', and four interconnected themes were derived from the analysis. By creating the diary, nursing staff had to deal with a variety of ethical and practical dilemmas, but feedback from patients, family members and ICU follow-up services reinforced the feeling of doing good. This overarching feeling of beneficence encouraged diary authoring and increased motivation and commitment to strive towards excellent patient care. To sustain the use of ICU diaries, collegiate and organizational support was deemed essential. Conclusions: Nursing staff strived to do good in words and actions for patients and their families when writing the diaries. Positive feedback from patients, family members and ICU follow-up services reinforced feelings of doing good, which served to enhance work satisfaction and a commitment to good-quality nursing care. Experiential-based education was recommended to help sustain ICU diary writing. Relevance to clinical practice: Nursing staff requested mentoring and group discussions concerning the format, content and communication channels of the diary.

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

“…31 Heavy workload has been shown to lead to poor communication and affect the time clinicians can allot to certain tasks. 32 For this reason, it is imperative that changes are simple, sustainable and they integrate well into routine. The changes introduced were successful in doing this, as illustrated by primary outcome data.…”

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

“…This is a previously unresearched area of understanding and it would be of value to understand where these concerns have originated from and if these have been grounded in any legal or professional challenge. Other barriers to implementation of diaries such as: lack of time, challenges in constructing content and the attitude of staff, was not reported as a concern by the respondents (Nydahl et al 2014, Johansson et al 2019 Several PICUs reported providing staff with guidelines regarding who to offer diaries to but not how to populate these. In adult critical there are examples of professional guidelines (https://icusteps.org/professionals/patient-diaries, NICE 2009, Beg et al 2016 ) and also educational videos on how to use diaries.…”

Improving Rehabilitation Information-Giving to Intensive Care Unit Survivors to Aid in Physical and Psychological Recovery

“…Furthermore, despite their rise in satisfaction, therapists reported finding the additional task of completing personalised action plans for all eligible patients challenging. As demonstrated in an ICU diary study, an increase in workload in the ICU is often met with resistance, as it adds pressure to an already highly stressful role [28]. This was also reflected in the feedback from patients after PDSA2, who reported that the booklet action plan section was not fully completed.…”

“…At the same time, therapists described action plan completion to become another routine task with practice, which was mirrored in their satisfaction that rose during PDSA3. Indeed, the therapist satisfaction gained from seeing patients benefit from an intervention has been recognised as one of the factors driving compliance [28].…”