ABSTRACT
BACKGROUND: Patients describe surreal experiences, hallucinations, loss of control, fear, pain, and other discomforts during their stay in intensive care units. Diaries written by critical care nurses can help patients fill-in memory gaps, gain an understanding of their illness after returning home, and enhance recovery. However, critical care nurses have difficulty deciding which patients in the intensive care unit should receive diaries and how to conduct and prioritise this nursing intervention. OBJECTIVES: The objective of this study was to explore critical care nurses' assessments regarding starting and writing diaries for adult patients in the intensive care unit. METHODS: A qualitative study with an exploratory descriptive design was utilised. Interviews were conducted with 14 critical care nurses from four hospitals. The data were analysed using systematic text condensation and were reported according to the consolidated criteria for reporting qualitative research checklist. FINDINGS: Three categories emerged: patients' disease trajectories and prognoses, tailoring the content and language and balancing time, and resources to create diaries that benefit patients. CONCLUSIONS: Whilst critical care nurses' assessments of the need for diaries are based on patients' disease trajectories and prognoses, patients' conditions can shift rapidly, which makes these assessments challenging. To ensure diary quality, the language and content should be personal and address the individual patient. The time and resources required for diaries are weighed against the benefits to patients. Contributions from colleagues and a common recognition in the intensive care unit of the value of the diaries influence nurses' judgements and are essential for successful diary practices.
