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Bosco V, Mercuri C, Nocerino R, Czapla M, Uchmanowicz I, Mazzotta R, Giordano V, Simeone S. Family members' experiences with intensive care unit diaries. BMC Anesthesiol 2025; 25:210. [PMID: 40275152 PMCID: PMC12023576 DOI: 10.1186/s12871-025-03083-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2025] [Accepted: 04/17/2025] [Indexed: 04/26/2025] Open
Abstract
BACKGROUND The admission of a family member to intensive care represents an emotionally complex experience, often characterised by anxiety, stress and uncertainty. ICU diaries, compiled by nurses and family members, have been proposed as a useful tool to support caregivers' psychological well-being, improve communication and humanise the care environment. The aim of the study was to describe the content of ICU diaries filled out by family members to explore the experiences and meanings attributed to the diaries. METHODS The study used a qualitative approach based on thematic analysis of diaries completed by 16 family members of patients admitted to intensive care units. The data were coded and analysed to identify recurrent themes and to understand the emotional and psychological experience of the family members. RESULTS Three main themes emerged from the analysis: time, the family context (including maintaining contact with the patient, the relatives'emotions, fear of suffering, spirituality, the person at the centre of the relatives' lives and connection with the outside world) and the usefulness of the diary in understanding the care process. The diaries facilitated the continuity of the affective bond with the patient, offered a space to express emotions and improved communication with healthcare professionals. CONCLUSION The results highlight the value of ICU diaries in supporting family members during the patient's admission, reducing stress and strengthening the relationship with the healthcare team. The practical implications suggest the importance of promoting the structured use of diaries to foster more empathetic and family-centred care. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Vincenzo Bosco
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
- Department of Clinical and Experimental Medicine, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Caterina Mercuri
- Department of Clinical and Experimental Medicine, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Rita Nocerino
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
- Department of Translational Medical Science, Federico II University Hospital, Naples, Italy
- ImmunoNutritionLab, CEINGE-Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy
| | - Michał Czapla
- Division of Scientific Research and Innovation in Emergency Medical Service, Department of Emergency Medical Service, Faculty of Nursing and Midwifery, Wroclaw Medical University, Parkowa 34, Wroclaw, Poland.
- Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, Logroño, Spain.
- Institute of Heart Diseases, University Hospital, Wrocław, Poland.
| | - Izabella Uchmanowicz
- Division of Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wrocław, Poland
- Centre for Cardiovascular Health, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK
| | - Rocco Mazzotta
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Vincenza Giordano
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Silvio Simeone
- Department of Clinical and Experimental Medicine, University of Catanzaro Magna Graecia, Catanzaro, Italy
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Schol CMA, Ista E, Rinket M, Berger E, Gommers DAMPJ, van Mol MMC. Determinants of digital ICU diary implementation and use by ICU professionals: A cross-sectional survey analysis. Intensive Crit Care Nurs 2025; 87:103921. [PMID: 39733664 DOI: 10.1016/j.iccn.2024.103921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 11/07/2024] [Accepted: 11/26/2024] [Indexed: 12/31/2024]
Abstract
OBJECTIVES To identify the key determinants for implementing and utilizing a digital intensive care unit (ICU) diary among ICU professionals. BACKGROUND Despite the advantages of digital diaries over traditional paper ones, their implementation presents challenges that necessitate tailored strategies considering the influencing factors. DESIGN A multicentre, cross-sectional survey study. METHODS A self-developed questionnaire was administered from March to May 2023, targeting ICU professionals across four hospitals in the Netherlands. Participants rated the relevance of 34 determinants on a 5-point Likert scale across four domains: (1) Digital diary introduction and use, (2) Education and information dissemination, (3) Offering the digital diary to patients' relatives, and (4) Professionals' engagement in diary writing. RESULTS Responses were received from 214 professionals. The most commonly agreed-upon determinants promoting implementation were seamless accessibility (n = 200; 93.5 %), enthusiastic and motivating champions (n = 190; 88.8 %), and comprehensive information and education (n = 184; 86 %). The preferred method for disseminating information was direct instruction from champions in the teams (n = 194; 90.7 %). Promoting factors for providing digital diaries to relatives included understanding its utility (n = 203; 94.9 %) and recognizing its added value (n = 193; 90.2 %). Additionally, 132 professionals (61.7 %) expressed a positive attitude towards co-writing the digital diary. CONCLUSION This study identified key determinants promoting the implementation and utilization of digital diaries in ICUs among professionals. These findings lay a foundation for developing strategies to address challenges and enhance the successful implementation of digital diaries in ICU settings. IMPLICATIONS FOR CLINICAL PRACTICE To maximize the impact of digital diaries, it is essential to involve end users early and tailor the design for ease of use. Selecting influential champions is key, and they should receive training to lead and mentor others. Clear communication of the benefits for patients and families will foster professionals' understanding and motivation, ultimately enhancing patient care.
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Affiliation(s)
- Carola M A Schol
- Department of Intensive Care, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - Erwin Ista
- Department of Internal Medicine, Section Nursing Science, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Martin Rinket
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Elke Berger
- Department of Intensive Care, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Diederik A M P J Gommers
- Department of Intensive Care, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Margo M C van Mol
- Department of Intensive Care, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Sterr F, Hechinger M, Bauernfeind L, Rester C, Palm R, Metzing S. Being an observer of one's own life-a meta-synthesis on the experience of mechanically ventilated patients in intensive care units. Crit Care 2025; 29:105. [PMID: 40057786 PMCID: PMC11889880 DOI: 10.1186/s13054-025-05326-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Accepted: 02/21/2025] [Indexed: 05/13/2025] Open
Abstract
BACKGROUND The experience of patients under mechanical ventilation in the intensive care unit is described as complex and multifaceted, but an overarching and in-depth understanding of the experience is still missing. AIM To provide an in-depth analysis and synthesis of patients' experience when being mechanically ventilated in intensive care units. METHODS We conducted a meta-synthesis according to the methodological recommendations of Sandelowski and Barroso. Our systematic literature search in Medline, CINAHL, and Cochrane was complemented by hand and citation searches. We included only qualitative studies with a rich description of conscious patients' experience under mechanical ventilation. Studies on children, step-down units, noninvasive ventilation and non-scientific journal articles were excluded. After the title, abstract and full-text screening by three reviewers, we performed initial, axial and selective coding and in-depth analysis in MAXQDA. The synthesis was supported by multiple discussion rounds. RESULTS Of the 2,563 records identified, 20 studies were included in our synthesis. This revealed the central phenomenon of patients being observers of their own lives. They are yearning for a stable picture of reality and developing various situation-specific needs. Finally, patients are finding ways to deal with the situation. These concepts are interwoven in time and are experienced repeatedly in different dimensions. CONCLUSION Patients under mechanical ventilation are highly perceptive. Healthcare professionals are particularly responsible for patients. They should reflect on their role in intensive care and must be sensitized to patients' differentiated experience. Registration, Protocol: https://doi.org/10.17605/OSF.IO/G8Q6X.
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Affiliation(s)
- Fritz Sterr
- Faculty of Health, School of Nursing Sciences, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
- Faculty of Applied Healthcare Sciences, Deggendorf Institute of Technology, Land-Au 27, 94469, Deggendorf, Germany.
| | - Mareike Hechinger
- Faculty of Applied Healthcare Sciences, Deggendorf Institute of Technology, Land-Au 27, 94469, Deggendorf, Germany
| | - Lydia Bauernfeind
- Faculty of Applied Healthcare Sciences, Deggendorf Institute of Technology, Land-Au 27, 94469, Deggendorf, Germany
| | - Christian Rester
- Faculty of Applied Healthcare Sciences, Deggendorf Institute of Technology, Land-Au 27, 94469, Deggendorf, Germany
| | - Rebecca Palm
- Faculty of Health, School of Nursing Sciences, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
- Department of Health Services Research, School VI Medicine and Health Sciences, Carl Von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
| | - Sabine Metzing
- Faculty of Health, School of Nursing Sciences, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
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Exl MT, Lotzer L, Deffner T, Jeitziner MM, Nydahl P. Intensive care unit diaries-harmful or harmless: A systematic literature review and qualitative data synthesis. Aust Crit Care 2025; 38:101121. [PMID: 39389847 DOI: 10.1016/j.aucc.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 09/03/2024] [Accepted: 09/11/2024] [Indexed: 10/12/2024] Open
Abstract
OBJECTIVE The objective of this research was to evaluate the extent of harm for critically ill patients, family members, and healthcare professionals associated with writing and reading intensive care unit (ICU) diaries. REVIEW METHOD USED A systematic literature review and a synthesis of qualitative data were performed. The protocol of this study has been registered in the International prospective register of systematic reviews (CRD42022376393). DATA SOURCES Databases were PubMed, Cochrane Library, CINAHL, PsychNet, and Livivo. REVIEW METHODS The search included qualitative and mixed-methods studies related to harm with an ICU diary. Deductive content analysis was used to create abstractions of quotations. Study quality was assessed with the Critical Appraisal Skills Programme. RESULTS Of 12 827 titles, 27 studies with 476 participants were included. Events involving the patients, family members, and healthcare professionals occurred but did not result in harm. A total of 68 quotations from patients, family members, and healthcare professionals were extracted. Those patients, their families, and healthcare professionals who mentioned intense emotions regarding diaries experienced writing and reading diaries as an emotional journey (patients), a help with tears (families), or a question of emotional distance (healthcare professionals). CONCLUSIONS Writing and reading ICU diaries can be associated with intense emotions, which are natural reactions when coping with a stressful situation. No study reported harm. Based on uncertain qualitative evidence, the benefits of writing and reading ICU diaries as coping strategies outweigh the potential harm. More research is needed. REGISTRATION OF REVIEW The International prospective register of systematic reviews CRD42022376393.
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Affiliation(s)
- Matthias Thomas Exl
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Lea Lotzer
- University Hospital of Schleswig-Holstein, Zentrum für Integrative Psychiatrie - ZIP gGmbH, Kiel, Germany.
| | - Teresa Deffner
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany.
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.
| | - Peter Nydahl
- Nursing Research, University Hospital of Schleswig-Holstein, Kiel, Germany; Institute of Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria.
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Högvall LM, Herling SF, Egerod I, Petosic A, Danielsen MER, Rüdiger U, Rustøen T, Berntzen H. The patient experience of a nurse-written ICU-diary intervention: A cross sectional survey. Intensive Crit Care Nurs 2025; 86:103846. [PMID: 39366128 DOI: 10.1016/j.iccn.2024.103846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/22/2024] [Accepted: 09/20/2024] [Indexed: 10/06/2024]
Abstract
BACKGROUND A diary written for intensive care patients might help fill in memory gaps and promote psychological recovery. In Norway intensive care diaries are mainly authored by nurses and national recommendations ensure a systematic approach to the intervention. Studies describing the patient experience of nurse-written intensive care diaries are needed. OBJECTIVES The aim of this exploratory study is to investigate patientś experience of receiving and reading a nurse-written diary. DESIGN AND SETTING This is a cross-sectional multicentre survey among patients discharged from seven intensive care units in Norway. RESULTS Among the 88 patients included, 90 % were satisfied with the diary handover process. As many as 88 % of the respondents agreed that the diary demonstrated good care, helped them realize how critically ill they had been and understand why recovery takes time (76 %), and made them grateful for surviving (74 %). One third of the respondents (30 %) reported that the diary saddened them, 6 % reported that the diary reminded them of a time in their lives they would rather forget, while 17 % reported that critical events were missing in the diary. However, nearly all patients were in favour of continuing the diary intervention (98 %). CONCLUSION Overall, the respondents were satisfied with the nurse-written diary, the handover as well as the content, and they recommended that the intervention should be sustained. IMPLICATIONS FOR CLINICAL PRACTICE The handover of the diary should be tailored to meet the individual preferences of the patients in terms of timing and approach, since the diary intervention may not suit all patients. Improvements to the intervention could be a more complete narrative in the diary including both positive and critical events during the intensive care trajectory.
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Affiliation(s)
- Lisa Maria Högvall
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Suzanne Forsyth Herling
- Faculty of Health & Medical Sciences, University of Copenhagen, Denmark; Department of Neuroanesthesiology, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Egerod
- Faculty of Health & Medical Sciences, University of Copenhagen, Denmark; Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Antonija Petosic
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; The Norwegian Intensive Care Registry, Haukeland University Hospital, Bergen, Oslo, Norway
| | | | - Uta Rüdiger
- Intensive Care Unit, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Helene Berntzen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Egerod I. Should we use artificial intelligence (AI) for writing ICU diaries? Not yet! Intensive Crit Care Nurs 2025; 86:103868. [PMID: 39467478 DOI: 10.1016/j.iccn.2024.103868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2024]
Affiliation(s)
- Ingrid Egerod
- Department of Intensive Care, University of Copenhagen, Copenhagen, Denmark.
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7
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Bosco V, Mercuri C, Giordano V, Froio AM, Commisso D, Nocerino R, Guillari A, Rea T, Mastrangelo H, Uchmanowicz I, Simeone S. Enhancing ICU care with nurse-written diaries. Nurs Crit Care 2024; 29:1355-1362. [PMID: 39308054 DOI: 10.1111/nicc.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/17/2024] [Accepted: 08/31/2024] [Indexed: 10/08/2024]
Abstract
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.
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Affiliation(s)
- Vincenzo Bosco
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Caterina Mercuri
- Department of Clinical and Experimental Medicine, University of Catanzaro MagnaGraecia, Catanzaro, Italy
| | - Vincenza Giordano
- Department of General Surgery and Women's Health, AORN Antonio Cardarelli, Naples, Italy
| | - Anna Maria Froio
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, University of Catanzaro MagnaGraecia, Catanzaro, Italy
| | - Daniele Commisso
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, University of Catanzaro MagnaGraecia, Catanzaro, Italy
| | - Rita Nocerino
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
- Department of Translational Medical Science, Federico II University Hospital, Naples, Italy
- ImmunoNutritionLab, CEINGE-Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy
| | - Assunta Guillari
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Teresa Rea
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | | | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Silvio Simeone
- Department of Clinical and Experimental Medicine, University of Catanzaro MagnaGraecia, Catanzaro, Italy
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Huang Q, Kumarasinghe PJ. Unleashing global opportunities: Exploring the digitalization journey of small and medium-sized enterprises in China and Sri Lanka's thriving E-commerce landscapes. Heliyon 2024; 10:e36621. [PMID: 39263108 PMCID: PMC11386284 DOI: 10.1016/j.heliyon.2024.e36621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 08/09/2024] [Accepted: 08/20/2024] [Indexed: 09/13/2024] Open
Abstract
This study compares hindering and fostering factors for SMEs in China and Sri Lanka in their internationalization efforts through e-commerce. The study uses qualitative research methods to examine how SMEs in both countries utilize e-commerce platforms for global expansion. Narrative and thematic analysis techniques focus on manufacturing sector SMEs actively engaged in global expansion through e-commerce. Purposive sampling is used to select participants. The findings reveal shared patterns and distinctive characteristics in the digital transformation of SMEs. Chinese SMEs benefit from product popularity and advanced technologies, while Sri Lankan SMEs face challenges accessing financial resources and advanced technologies. Perspectives on innovation and regulatory/cross-cultural considerations vary. Supportive government policies and infrastructure are crucial for SME internationalization. The research provides insights for policymakers, researchers, and practitioners to enhance SME development and promote cross-national collaborations in the digital era.
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Affiliation(s)
- Qiubo Huang
- School of Economics and Social Welfare, Zhejiang Shuren University, No.8 Shuren St, Hangzhou, Zhejiang, China
| | - P J Kumarasinghe
- School of Economics and Social Welfare, Zhejiang Shuren University, No.8 Shuren St, Hangzhou, Zhejiang, China
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Schol CMA, van Mol MMC, Berger E, Leerentveld C, Gommers DAMPJ, Ista E. Implementation of a digital diary in the intensive care unit; understanding the facilitators and barriers: A qualitative exploration. Aust Crit Care 2024; 37:672-679. [PMID: 38719673 DOI: 10.1016/j.aucc.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND In the recent years, digital intensive care unit (ICU) diaries have emerged as more advantageous than paper diaries. Despite the advantages of digital diaries, the successful implementation and maintenance of this digital intervention present significant challenges in clinical practice. Therefore, understanding the facilitators and barriers among stakeholders influencing this process becomes imperative for devising a tailored strategy to integrate digital diaries effectively within ICU settings. AIM/OBJECTIVE The aim of this study was to explore facilitators and barriers for implementation of a digital ICU diary from the perspectives of ICU professionals, ICU survivors, and their relatives. METHODS A qualitative design was used, incorporating focus-group interviews with professionals from four Dutch ICUs, along with individual interviews with ICU survivors and relatives. The study spanned from October 2022 to April 2023. Data analysis utilised a mixed inductive-deductive approach, particularly through directed content analysis. The Consolidated Framework for Implementation Research 2.0 guided both data collection and analysis processes. FINDINGS We conducted five focus-group interviews among ICU professionals (n = 32) and 10 individual or dual interviews involving five ICU survivors and nine relatives. Key facilitators for implementing a digital diary according to ICU professionals encompassed a user-friendly interface accessible independent of time and place, with a seamless login process requiring minimal steps, comprehensive training covering all aspects of its use, and feedback from the experiences of both patients and relatives. Barriers for ICU professionals included many steps required to access the digital diary, as well as resistance to (co)writing diary entries. In contrast, professionals' involvement in writing diary entries was highly appreciated among ICU survivors and relatives. An ambiguous factor arose regarding sharing the digital diary with others; both ICU survivors and relatives found it valuable, yet it also raised privacy concerns. CONCLUSIONS This study offers insights into the most important factors influencing the implementation of a digital ICU diary. Strikingly, some factors serve as both barriers and facilitators. When developing the implementation strategy, the identified facilitators can be used to overcome the barriers faced by ICU professionals, ICU survivors, and their relatives in adopting a digital diary.
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Affiliation(s)
- Carola M A Schol
- Department of Intensive Care, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
| | - Margo M C van Mol
- Department of Intensive Care, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Elke Berger
- Department of Intensive Care, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | | | - Diederik A M P J Gommers
- Department of Intensive Care, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Section Nursing Science, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands
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10
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Riegel M, Buckley T, Randall S. Family's preferences for and experiences of writing practices in adult intensive care and its use in early bereavement: A descriptive qualitative study. Aust Crit Care 2024; 37:614-620. [PMID: 38360470 DOI: 10.1016/j.aucc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/14/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Family partaking in writing practices, such as writing intensive care unit (ICU) patient diaries, personal diaries/journaling, social media, or instant messaging services, during ICU admission may allow the family to unintentionally participate in a form of expressive writing. These writing practices could provide structure for the family authors to explore emotions and manage significant life events, including death of a loved one. Limited studies have explored the family's postmortem experiences and perceived value of writing practices maintained during an ICU admission. OBJECTIVES The objective of this study was to explore the family member's preferences for and experiences of writing practices in the adult ICU and its use in early bereavement. METHODS descriptive qualitative design using inductive reflexive thematic analysis from a purposeful, convenience sample of 16 bereaved participants from a tertiary referral, adult ICU in Australia who discussed their experiences of and preferences in writing practices. Reporting adheres to the consolidated criteria for reporting qualitative research checklist. FINDINGS Six participants maintained writing practices during the ICU admission and 10 did not. Three themes were generated from the data: the decision to maintain writing practices was shaped by past behaviours and perceived utility; moments captured were influenced by the loved ones' clinical status and their ability to access the writing medium; and writing practices have limited utility as a memory making object in early bereavement. CONCLUSIONS Based on the generated findings, participants who did not maintain writing practices did not later regret this decision during early bereavement. Participants who did maintain writing practices predominately used a personal diary/journal that they carried with them. As the loved one approached death, the written entries became shorter, then ceased. Most of the written entries were not read during early bereavement, suggesting the writing practices' psychological value might have been predominately gained at the time of writing, rather than during early bereavement.
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Affiliation(s)
- Melissa Riegel
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; Adult Intensive Care Unit, Prince of Wales Hospital, Randwick, NSW, Australia.
| | - Thomas Buckley
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Sue Randall
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; Broken Hill Department of Rural Health, University of Sydney, Australia
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Bazzano G, Buccoliero F, Villa M, Pegoraro F, Iannuzzi L, Rona R, Fumagalli R, Giani M, Lucchini A. The role of intensive care unit diaries in the grieving process: A monocentric qualitative study. Nurs Crit Care 2024; 29:706-714. [PMID: 38015002 DOI: 10.1111/nicc.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The growing importance of psychological recovery for patients and their families following intensive care unit (ICU) experiences in recent years cannot be overemphasized. The ICU diary is used to aid patients in reducing the prevalence of post-traumatic stress disorder, anxiety, and depression. The usefulness of maintaining a diary during the grieving process has not yet been thoroughly investigated. AIM To investigate the role of ICU diaries in the grief process experienced by family members of a person who died in the intensive care unit. STUDY DESIGN Nine family members of seven deceased ICU patients with an ICU diary were contacted and interviewed by phone using a semi-structured interview. A qualitative data analysis was performed using thematic synthesis. SETTING Italian general intensive care unit. FINDINGS Interviewed family members felt that the diary helped them during the grieving process. The return of diaries was desired by family members for support and to remember one's loved one. The diary helped them process their losses in various ways, including signs of evidence of care, emotional involvement, consideration, and coping with grief. Four main themes emerged from the analysis: writing the diary, reading the diary, talking about the diary, and the diary during the grieving process. CONCLUSIONS The overall perception of the ICU diary was positive. The diary mostly helped relatives to "give back something of what we lost". This study also affirms the positive link between ICU diaries and bereavement in Italian ICU. Further studies are required to confirm the usefulness of this tool in the grieving process. RELEVANCE TO CLINICAL PRACTICE The ICU diary can help patients' family members understand what happened to their loved one and play an important role in the grieving process. The diary served as a valuable source of information that aided in providing bereavement support to the family by helping them to gain a rational and emotional understanding of the patient's death.
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Affiliation(s)
- Giacomo Bazzano
- Department of Anaesthesia, Emergency and Intensive Care, ASST Valtellina and Alto Lario, Eugenio Morelli Hospital, Sondalo, Italy
| | - Francesco Buccoliero
- Department of Anaesthesia, Emergency and Intensive Care, ASST Nord Milano - Sesto San Giovanni Hospital, Sesto San Giovanni, Italy
| | - Marta Villa
- Department of Emergency and Intensive Care - Adult and Paediatric General ICU, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Flavia Pegoraro
- Department of Emergency and Intensive Care - Adult and Paediatric General ICU, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Luigi Iannuzzi
- Department of Emergency and Intensive Care - Adult and Paediatric General ICU, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Roberto Rona
- Department of Emergency and Intensive Care - Adult and Paediatric General ICU, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Roberto Fumagalli
- Department of Emergency and Intensive Care, ASST GOM Niguarda, University of Milano-Bicocca, Milano, Italy
| | - Marco Giani
- Department of Emergency and Intensive Care - Adult and Paediatric General ICU, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Alberto Lucchini
- Department of Emergency and Intensive Care - Adult and Paediatric General ICU, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
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Peschel E, Krotsetis S, Seidlein AH, Nydahl P. Opening Pandora's box by generating ICU diaries through artificial intelligence: A hypothetical study protocol. Intensive Crit Care Nurs 2024; 82:103661. [PMID: 38394982 DOI: 10.1016/j.iccn.2024.103661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
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.
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Affiliation(s)
- Ella Peschel
- University Hospital of Schleswig-Holstein, Kiel, Germany
| | | | | | - Peter Nydahl
- University Hospital of Schleswig-Holstein, Nursing Research and Development, Kiel, Germany; Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria.
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Dawson D. It's time to say goodbye and thank you - but first a little reminisce. Intensive Crit Care Nurs 2024; 80:103575. [PMID: 37944335 DOI: 10.1016/j.iccn.2023.103575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Deborah Dawson
- The Royal Hospital for Neuro-disability, West Hill, London SW15 3SW, United Kingdom.
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Chiappinotto S, Bayram A, Grassetti L, Galazzi A, Palese A. Were the unfinished nursing care occurrence, reasons, and consequences different between COVID-19 and non-COVID-19 patients? A systematic review. BMC Nurs 2023; 22:341. [PMID: 37759199 PMCID: PMC10523650 DOI: 10.1186/s12912-023-01513-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Unfinished Nursing Care (UNC) has been documented also during the Coronavirus (COVID-19) pandemic; however, while several secondary studies were conducted before this period to summarise occurrences, reasons, and consequences of UNC and provide a global picture of the phenomenon, no synthesis of the evidence produced during the pandemic has been documented to date. Therefore, the aim of this review is to identify differences, if any, in the UNC occurrence, reasons, and consequences perceived by nurses caring for COVID-19 and non-COVID-19 patients. METHODS This study is a systematic review (PROSPERO CRD42023410602). According to the Population, Exposure, Comparator, and Outcomes framework, primary comparative cross-sectional, longitudinal, and cohort studies, randomised/non-randomised controlled trials were included from Medline, CINAHL, and Scopus, collecting perceptions of nurses with tools measuring UNC between COVID-19 and non-COVID-19 patients and published in English, Italian, or Turkish. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and Johanna Briggs Quality Appraisal Tool were used, and findings were summarised narratively. RESULTS Five hospital-based cross-sectional studies using the self-administered MISSCARE and UNC Survey comparing data collected (a) before the pandemic vs. in the first wave; (b) before, in the second and in the third wave; and (c) simultaneously among COVID-19 and non-COVID-19 patients in the second wave. Three main patterns emerged suggesting a higher UNC occurrence among COVID-19 patients in the first wave, less occurrence among them compared to non-COVID-19 patients in the second wave, and contrasting findings with some in favour and others in contrast to COVID-19 patients. Similar patterns emerged regarding UNC reasons while no studies investigated the UNC consequences. CONCLUSIONS In the first wave, COVID-19 patients were likely to be at increased risk of UNC, while in later waves non-COVID-19 patients were at increased risk of UNC. Reasons also were different across waves. Findings documented during the COVID-19 pandemic may help to prevent UNC in future disasters.
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Bosco V, Froio A, Mercuri C, Sansone V, Garofalo E, Bruni A, Guillari A, Bruno D, Talarico M, Mastrangelo H, Longhini F, Doldo P, Simeone S. The Impact of an Intensive Care Diary on the Psychological Well-Being of Patients and Their Family Members: Longitudinal Study Protocol. Healthcare (Basel) 2023; 11:2583. [PMID: 37761780 PMCID: PMC10531207 DOI: 10.3390/healthcare11182583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/16/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Thanks to medical and technological advancements, an increasing number of individuals survive admission to intensive care units. However, survivors often experience negative outcomes, including physical impairments and alterations in mental health. Anxiety, depression, cognitive impairments, post-traumatic stress disorders, and functional disorders are known collectively as post-intensive care syndrome (PICS). Among the key triggering factors of this syndrome, memory impairment appears to play a significant role. AIMS This study aims to evaluate the impact of an intensive care diary on the psychological well-being of patients and their relatives after discharge from the ICU. DESIGN Prospective observational study. EXPECTED RESULTS The results of this study evaluate the impact of an ICU diary on the quality of life of ICU survivors and their family members.
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Affiliation(s)
- Vincenzo Bosco
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Annamaria Froio
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Caterina Mercuri
- School of Medicine and Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (C.M.); (M.T.)
| | - Vincenza Sansone
- Department of Experimental Medicine, Luigi Vanvitelli University, 80131 Naples, Italy;
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Andrea Bruni
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Assunta Guillari
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy
| | - Daniela Bruno
- School of Medicine and Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (C.M.); (M.T.)
| | - Michaela Talarico
- School of Medicine and Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (C.M.); (M.T.)
| | | | - Federico Longhini
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Patrizia Doldo
- Clinical and Experimental Medicine Department, Magna Graecia University, 88100 Catanzaro, Italy; (P.D.); (S.S.)
| | - Silvio Simeone
- Clinical and Experimental Medicine Department, Magna Graecia University, 88100 Catanzaro, Italy; (P.D.); (S.S.)
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Diaries for dying patients: An outlet for staff members' grief or a powerful way to humanize the intensive care unit? Intensive Crit Care Nurs 2023:103417. [PMID: 36813609 DOI: 10.1016/j.iccn.2023.103417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/22/2023]
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