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

Abstract

Aim To investigate structure and content of a nurse prompted diary written by relatives for intensive care unit (ICU) patients. Design A narrative analysis of ICU diaries. Methods From September 2015‐August 2016, 12 diaries authored by 12 relatives for 12 ICU patients were sampled at 3–4 months post‐ICU discharge. We used Ricoeur's hermeneutical phenomenology as a framework for a narrative analysis of the diaries. The first step was naïve reading, followed by structural analysis exploring the internal relations of the text. The structural analysis was broadened by exploring narrative structures. The last step was critical interpretation of the findings. Findings The diaries had a clear narrative structure; the diary‐timeline consisted of: Pre‐ICU phase, Early ICU phase, Culmination, Recovery and Post‐ICU reflection. Three themes described the content of the diary: Struggling to get the story right for the patient; striving to understand what was happening and longing to re‐establish a connection with the patient. Keeping a diary was perceived by the relatives as a challenging but rewarding task. Conclusion The diary had the potential for reflection and a deeper understanding of the ICU stay. The diary served as a locus for patient and relatives to connect or re‐connect, but some diaries might be too personal and emotional to share with the patient. Future research needs to explore advantages and disadvantages of ICU diaries authored by relatives.

ICU Survivors Experience of ICU Diaries: An Ancillary Qualitative Analysis of the ICU Diary Study

“…The findings of this study reported results widely published in other qualitative studies ( 13 , 28 – 30 ). The ICU diary provided patients with a chronology of events and with an account of families’ and medical caregivers’ support ( 13 , 31 ).…”

“…The ICU diary provided patients with a chronology of events and with an account of families’ and medical caregivers’ support ( 13 , 31 ). For patients struggling with distorted memories of their stay ( 13 ), the diary did not seem to improve memories “per se” ( 30 ) but was used as a transitional object throughout recovery and into a newly reinvested life ( 28 ). Besides, the written form of the diary conveys an image of permanence, a testimony of what they have been through.…”

“…Reactions to and use of the diary differed greatly from one patient to another. The patient’s understanding of the diary could depend on his or her cognitive function and capacity to revisit potentially negative experiences ( 30 ). It seems that the emotional reaction to reading the diary partly determined the future perception and use of it, either as a hindrance to or as a support for recovery.…”

Diaries in intensive care units: An Italian qualitative study

“…This also corresponds to the view of patients who read the diaries and report that they felt the same sense of security and competence in care and assistance 41 . Furthermore, the diary helped the patients interpret strange and incomprehensible memories and sensations as meaningful and perhaps accept the seriousness of their illnesses 42 …”

Effect of intensive care unit diary on incidence of posttraumatic stress disorder, anxiety, and depression of adult intensive care unit survivors: A systematic review and meta‐analysis

“…Firstly, we need to understand that it is not clear which group of discharged ICU patients will benefit from ICU diaries (Pattison et al, 2019). Secondly, the ICU diaries written by some family members may be too personal and emotional and thus increase the psychological burden of patients with avoidant personality (Nielsen et al, 2019). Finally, there is no unified expert consensus on the ICU diary content, narrator, and the best starting time of ICU diary implementation that may lead to differences in clinical outcomes.…”