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Intensivvårdsdagbok i Sverige: betydelse och tillämpning
Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
2019 (Svenska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Aim: The overall aim of the thesis was to explore how the Intensive Care Unit (ICU) diary was experienced by family members, family members of non-survivors and nursing staff in the ICU setting, thereby contributing to the development of national clinical practice guidelines regarding the structure, content and use of the ICU diary.

Methods:  A qualitative design was employed for all four studies:  a hermeneutic approach was adopted in studies I and II, whilst a qualitative descriptive design with the use of focus groups interviews was chosen in study III. An Instrumental Multiple Case Study design was carried out in study IV.

Main Findings: The diary symbolised the maintenance of relationships with the patients and was a substitute for the usual opportunities for communication. The diary was instrumental in meeting the needs of the majority of participant family members. The diary provided the means to be present at the patient’s bedside, to feel involved in caregiving, to maintain hope and to relay relevant information. If the critically ill family member did not survive the stay in the ICU, the diary acted as a form of bereavement support by processing the death of the patient. Nevertheless, some family members found the diary too public an arena to write in as the diary entries indicated visiting patterns which in turn provoke feelings of guilt when the visits were infrequent. Further, not knowing what to write was another source of pressure.

Nursing staff experienced that writing diaries often felt meaningful and led to an increased motivation and engagement in patient care and family support. They expressed that they felt they did something good for the patient and family members. Thus, the diary can be seen as a way to promote person-centred care, where family members were offered to participate in the care. However, in the absence of guidelines or clear guidelines about the use of an ICU diary, then not many patients actually received a diary.

Conclusions: Practice guidelines concerning ICU diaries would help to ensure the more widespread and consistent use of diaries for all ICU patients. As family members may benefit from the diary, even if the patient may not always be able to do so. The ICU diary can be seen as a tool to help promote person-centred care by directly involving family members and providing a human touch, thus helping to counterbalance the highly technical physical environment of ICU.

Ort, förlag, år, upplaga, sidor
Växjö: Linnaeus University Press, 2019. , s. 75
Serie
Linnaeus University Dissertations ; 358
Nyckelord [en]
case study research, diaries, experiences, family members, hermeneutics, ICU, nursing staff, thematic analysis
Nationell ämneskategori
Omvårdnad
Forskningsämne
Hälsovetenskap, Vårdvetenskap
Identifikatorer
URN: urn:nbn:se:lnu:diva-89006Libris ID: 8kvqqrsk6xlt1kv4ISBN: 978-91-88898-80-7 (tryckt)ISBN: 978-91-88898-81-4 (tryckt)OAI: oai:DiVA.org:lnu-89006DiVA, id: diva2:1349268
Disputation
2019-09-13, N2007, Västergård, Kalmar, Smålandsgatan 26, Kalmar, 10:00 (Svenska)
Opponent
Tillgänglig från: 2019-09-09 Skapad: 2019-09-07 Senast uppdaterad: 2019-10-04Bibliografiskt granskad
Delarbeten
1. Family members’ experiences of keeping a diary during a sick relative’s stay in the intensive care unit: A hermeneutic interview study
Öppna denna publikation i ny flik eller fönster >>Family members’ experiences of keeping a diary during a sick relative’s stay in the intensive care unit: A hermeneutic interview study
2015 (Engelska)Ingår i: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 31, nr 4, s. 241-249Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective

The aim of the study was to explore family members’ experiences with keeping a diary during a sick relative's stay in the ICU.

Design

A qualitative method with a hermeneutic approach was used. Eleven participants, who recorded nine diaries in total, were interviewed. The collected data were analysed using a hermeneutic approach inspired by Gadamer.

Results

The analysis revealed a meta-theme: ‘it [writing in the diary] felt like contact’ which was created by a feeling of togetherness and the opportunity to communicate with the patient. Keeping a diary likely meets the needs of family members in several ways because it becomes a way to be present at the patient's bedsides, to provide caregiving, to maintain hope and to relay cogent information. However, concerns regarding negative aspects of diary keeping were also raised; for example, the diary created feelings of stress, guilt and failure and exposed intimate details.

Conclusion

The diary symbolised the maintenance of relationships with the patients and was a substitute for the usual opportunities for communication. Furthermore, it was instrumental in meeting the needs of the majority of family members in several ways. Nevertheless, the diary did have negative effects for certain individuals, which highlights the importance of an individualised approach.

Ort, förlag, år, upplaga, sidor
Elsevier, 2015
Nyckelord
Diaries, Experiences, Gadamer, Hermeneutics, ICU, Relatives
Nationell ämneskategori
Omvårdnad
Forskningsämne
Hälsovetenskap
Identifikatorer
urn:nbn:se:lnu:diva-40856 (URN)10.1016/j.iccn.2014.11.002 (DOI)000361146200007 ()2-s2.0-84939262305 (Scopus ID)
Tillgänglig från: 2015-03-16 Skapad: 2015-03-16 Senast uppdaterad: 2019-09-07Bibliografiskt granskad
2. Family members' experiences with intensive care unit diaries when the patient does not survive
Öppna denna publikation i ny flik eller fönster >>Family members' experiences with intensive care unit diaries when the patient does not survive
Visa övriga...
2018 (Engelska)Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, nr 1, s. 233-240Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: The aim of the study was to explore how family members experienced the use of a diary when a relative does not survive the stay in the intensive care unit (ICU).

METHOD: A qualitative method with a hermeneutic approach was used. Nine participants who read/wrote eight diaries in total were interviewed. The collected data were analysed using a hermeneutic technique inspired by Geanellos.

FINDINGS: The analysis revealed an overall theme 'the diary was experienced as a bridge connecting the past with the future', which was a metaphor referring to the temporal aspect where there was the period with the diary up until the patient's death and then the postbereavement period. The diary contributed to both a rational and emotional understanding of the death of the patient and disclosed glimmers of light that still existed before the illness deteriorated. Further, the diary bridged the space between family members themselves and between family and nursing staff. It helped to maintain a feeling of togetherness and engagement in the care of the patient which family members found comforting.

CONCLUSION: Family members of nonsurvivors had a need to have the ICU time explained and expressed. The diary might work as a form of 'survival kit' to gain coherence and understanding; to meet their needs during the hospital stay; and, finally, to act as a bereavement support by processing the death of the patient.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2018
Nyckelord
Gadamer, Diaries, Experiences, Family members, Hermeneutics, Intensive care unit, Relatives
Nationell ämneskategori
Omvårdnad
Forskningsämne
Hälsovetenskap, Vårdvetenskap
Identifikatorer
urn:nbn:se:lnu:diva-68205 (URN)10.1111/scs.12454 (DOI)000426524200023 ()28524380 (PubMedID)2-s2.0-85042564022 (Scopus ID)
Tillgänglig från: 2017-10-04 Skapad: 2017-10-04 Senast uppdaterad: 2019-09-07Bibliografiskt granskad
3. Nursing staff's experiences of intensive care unit diaries: a qualitative study
Öppna denna publikation i ny flik eller fönster >>Nursing staff's experiences of intensive care unit diaries: a qualitative study
2019 (Engelska)Ingår i: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153Artikel i tidskrift (Refereegranskat) Epub ahead of print
Abstract [en]

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.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2019
Nyckelord
Diaries, Experiences, ICU, Nursing staff, Qualitative, Thematic content analysis
Nationell ämneskategori
Omvårdnad
Forskningsämne
Hälsovetenskap, Vårdvetenskap
Identifikatorer
urn:nbn:se:lnu:diva-84583 (URN)10.1111/nicc.12416 (DOI)30680873 (PubMedID)
Tillgänglig från: 2019-06-04 Skapad: 2019-06-04 Senast uppdaterad: 2019-09-09
4. The use and application of intensive care unit diaries: an instrumental multiple case study
Öppna denna publikation i ny flik eller fönster >>The use and application of intensive care unit diaries: an instrumental multiple case study
2019 (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nyckelord
Case study research, Diaries, Experiences, Family members, ICU, Nursing staff
Nationell ämneskategori
Omvårdnad
Forskningsämne
Hälsovetenskap, Vårdvetenskap
Identifikatorer
urn:nbn:se:lnu:diva-89002 (URN)
Tillgänglig från: 2019-09-07 Skapad: 2019-09-07 Senast uppdaterad: 2019-09-25

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