ABSTRACT
BACKGROUND: Many patients who survive an intensive care unit admission develop post-intensive care syndrome and face significant long-term physical, cognitive, and mental health impairments. The intensive care unit diary is a reality-sorting tool that is effective in aiding patients to connect their flashbacks and delusional memories to actual events. OBJECTIVES: To describe implementation of an intensive care unit diary in the cardiac intensive care unit and to describe the patient's perspective of the diary. METHODS: Consent for participation in the study was given by the patient health care proxy or a family member. The study consisted of 3 phases: writing in the diary about the patient's events in the cardiac intensive care unit, a follow-up visit with the patient within 1 week of cardiac intensive care unit transfer, and a follow-up telephone call 2 months after hospital discharge. RESULTS: Of 26 patients, 13 completed all phases of the study. Four themes were identified from the transcripts of the patients' responses: (1) The diary allowed patients to correlate memories to actual events, (2) it enabled patients to read about their families' experiences during their critical illness, (3) recovery was an emotional process that affected the patient's readiness to read the diary, and (4) patients expressed a desire for more entries by caregivers. CONCLUSIONS: The intensive care unit diary can help patients gain clarity of their time in the cardiac intensive care unit. Additional research on the use of the diary and long-term patient follow-up is warranted.
Subject(s)
Caregivers/psychology , Critical Care Nursing , Critical Care/psychology , Family/psychology , Heart Diseases/nursing , Heart Diseases/psychology , Patient Satisfaction , Adult , Aged , Aged, 80 and over , Diaries as Topic , Female , Humans , Male , Middle AgedABSTRACT
Nurse leaders are responsible for a practice environment that fosters safe, quality patient outcomes through excellence in nursing practice. This article describes a reflective practice intervention in the Cardiac Intensive Care Unit of an urban academic medical center led by the unit nursing director and the hospital's nurse ethicist. The twice monthly case-based discussions, called "Nursing Practice and Ethics Rounds," were attended by staff and unit managers (nurse director, assistant nurse director, and clinical educator) and were facilitated by the nurse ethicist. The purpose of this descriptive qualitative study was to identify nurses' perceptions of the rounds on individual practice, unit practice, and the practice of their peers. Two focus groups were conducted with nurses who attended 3 or more sessions. Staff reported that they felt valued; experienced a decrease in moral distress; and improved empathy with patients, families, and other staff members after the intervention. They also reported better understanding of ethical issues and language to better talk about them. The presence of nurse leaders was valued as affirming the importance of practice development and of witnessing the experience of staff nurses. Finally, the process of reflection was valued for the opportunity it provided to process emotional and intellectual aspects of challenging cases.
Subject(s)
Ethics, Nursing , Leadership , Nurse Administrators/organization & administration , Nursing Staff, Hospital/psychology , Adult , Attitude of Health Personnel , Empathy , Female , Focus Groups , Humans , Male , Middle Aged , Qualitative ResearchABSTRACT
BACKGROUND: Nurses in the cardiac intensive care unit often attend professional education opportunities. However, it is difficult to share this information among nursing staff. Varying schedules, different shifts, and patient acuity limit the amount of time available for peer-to-peer sharing of educational information. A review of the literature revealed scant research on blogging for peer-to-peer education in general and particularly in nursing. OBJECTIVES: To explore nurses' perception of the effectiveness of using a blog as a forum to provide peer-to-peer sharing of relevant professional education. METHODS: Using a simple, free blogging website, the unit's nursing practice council developed a private blog for educational information sharing among the nursing staff. An online survey was administered to the unit's staff 15 months after the blog was implemented. RESULTS: Most respondents indicated that they thought the blog is an effective way to share professional education (86%), keeps them abreast of evidence-based practice (81%), and has led to practice change (59%). Nearly 80% of respondents agreed that they are more likely to attend professional conferences, and 62% would consider contributing blog posts. CONCLUSION: The survey results suggest that blogging may be an effective method of peer-to-peer sharing of education, although more rigorous research is required in this area.
