Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark; Faculty of Health & Medical Sciences, University of Copenhagen, Denmark.
Aust Crit Care. 2023 Nov;36(6):1011-1018. doi: 10.1016/j.aucc.2023.02.002. Epub 2023 Mar 16.
The overall purpose of diaries written during an intensive care stay is to help patients fill in memory gaps from the illness trajectory, which might promote long-term psychological recovery. Diaries have also been shown to benefit nurses in maintaining a view of the patient as a person in the highly technical environment and to promote reflection. There is a lack of research on how nurses might be affected by writing a diary for critically ill patients with a poor prognosis.
The aim of this study was to investigate nurses' experience of writing diaries for intensive care patients with a poor prognosis.
This study has a qualitative descriptive design and was inspired by the methodology of interpretive description. Twenty-three nurses from three Norwegian hospitals with a well-established practice of writing diaries participated in four focus groups. Reflexive thematic analysis was used. The study was reported according to the Consolidated Criteria for Reporting Qualitative Research checklist.
The overarching theme resulting from our analysis was "Finding the right words". This theme represents the challenge of writing in view of the uncertainty of the patient's survival and of who would read the diary. It was important to strike the right tone with these uncertainties in mind. When the patient's life could not be saved, the purpose of the diary expanded to comforting the family. To put an extra effort into making the diary something special when the patient was dying was also a meaningful activity for the nurses.
Diaries may serve other purposes than helping patients to understand their critical illness trajectory. In cases of a poor prognosis, nurses adapted their writing to comfort the family rather than informing the patient. Diary writing was meaningful for the nurses in managing care of the dying patient.
在重症监护病房期间写日记的总体目的是帮助患者填补疾病轨迹中的记忆空白，这可能有助于长期的心理康复。研究还表明，日记也有益于护士在高度技术化的环境中保持对患者作为人的看法，并促进反思。然而，对于预后不良的重症患者，护士写日记会受到怎样的影响，这方面的研究还很缺乏。
本研究旨在调查护士为预后不良的重症监护患者写日记的体验。
本研究采用定性描述设计，并受到解释性描述方法学的启发。来自挪威三家医院的 23 名护士参与了四个焦点小组，这三家医院有成熟的写日记实践。采用反思性主题分析。研究报告按照定性研究报告的综合标准清单进行。
我们的分析得出的总体主题是“找到合适的词”。这个主题代表了在考虑到患者生存的不确定性和谁将阅读日记的情况下写日记的挑战。考虑到这些不确定性，把握好恰当的语气非常重要。当患者的生命无法挽救时，日记的目的扩展为安慰家属。当患者即将死亡时，护士额外努力使日记变得特别，这对护士来说也是一项有意义的活动。
日记的目的可能不止于帮助患者理解他们的重症疾病轨迹。在预后不良的情况下，护士会根据需要调整写作内容，以安慰家属，而不是告知患者。写日记对护士管理临终患者的护理具有重要意义。
