Nurses’ experiences of ICU diaries following implementation of national recommendations for diaries in intensive care units: A quality improvement project

ObjectivesTo evaluate critical care nurses’ experiences of ICU diaries following the implementation of national recommendations for the use of diaries for critically ill patients.DesignA quality improvement project describing the development and implementation of national recommendations (2011), as well as the assessment of the use of diaries in intensive care nursing practice (2014).SettingNorwegian intensive care units (ICUs).ParticipantsThirty-nine Norwegian ICUs took part in the study.InterventionA multi-component process for developing national recommendations for the use of diaries in Norwegian ICUs, including recommendations for the target group, when to start, health professionals as authors, diary content, structure, language, use of photographs, handover, access and storage within patient medical records.Main outcome measureA questionnaire asking about experiences of implementing national recommendations on diaries in Norwegian ICUs, as well as their impact and how they are used.ResultsThree years after the implementation of the national recommendations, diaries were provided in 24 (61.5%) of the responding ICUs. Fifty-six per cent of the ICUs had revised their routines, of which 62% had updated and 38% had developed new protocols. Most ICUs kept the diary along with other medical information describing patient care, but only 50% of the ICUs scanned handwritten diaries into the electronic medical records before handing them over to patients or the bereaved. ICU nurses reported that implementing national recommendations had increased their awareness and knowledge on patient and family needs, as well as the long-term effects of critical illness.ConclusionThe results of this quality improvement project indicate that access to national recommendations on the use of diaries for critically ill patients have a potential of changing routines and increase standardisation.     

Experiences of intensive care unit diaries: 'touching a tender wound'

Aim:  The aim of this study was to describe peoples' experiences of a personal diary written when they were critically ill and receiving care in an intensive care unit (ICU).
Background:  In some ICUs, diaries are written by the ICU staff and close relatives of those who are critically ill and mechanically ventilated, but there is a lack of studies that focus on the experiences of the formerly critically ill of personal diaries written when in an ICU.
Methods:  Qualitative personal interviews were conducted with nine people who were formerly critically ill. The interview texts were analysed using qualitative content analysis.
Findings:  From the analysis of the data, one theme emerged – touching a tender wound, with four categories: being afraid and being deeply touched, appreciating close relatives' notes, a feeling of unreality and gaining coherence. The participants were deeply touched when they read the diary for the first time. Parts of it were experienced as unreal, as if they were reading about someone else. The diary provided necessary knowledge about what had happened during the time when the participants were critically ill and from which they had only fragmented or no memories at all. Even though it aroused strong feelings, reading the diary was experienced as an important support for a long time after their stay in the ICU. Experiencing that one was not fully aware of what had happened and then reading about oneself being critically ill and about one's close relatives' experiences was interpreted as touching a tender wound.
Conclusions and relevance to clinical practice:  It is suggested that a diary may be a tool that can help formerly critically ill people to gain a sense of coherence concerning their critical illness experience, but reading it can be painful and demanding.     

The use and usefulness of ICU diaries to support family members of critically ill patients

PurposeTo analyze and describe the use and usefulness of the ICU diary to support family members of critically ill patients.Materials and methodsA socio-technical systems model (SEIPS 2.0) guided data collection and analysis in this study aimed to gain a holistic understanding of factors that shape ICU diary processes and family requirements for support. Triangulated data sources, including interviews, observations, and photographs, were content analyzed for person, task, tool, and context attributes determining the use and usefulness of ICU diaries. Researchers recruited family members of critically ill patients admitted to ICUs in two hospitals (urban, rural) in the southeastern United States.ResultsNineteen female (100%) family members participated in this study. ICU diaries were used and adapted by family members to cope with the ICU experience in multiple ways. Results indicate that staff support, easy access, embedded instructional format, early initiation, and family ownership facilitated ICU diary use by family members. The ICU diary was useful as a medium to process emotions and gain insights, reduce stress, track information, and communicate with the staff and the patient.ConclusionsThe ICU diary is useful to family members as a stress reduction, information management, and communication tool. The design of ICU diary implementations must address system factors to assure family members receive benefits from diary use. Further research is needed to expand our understanding of the optimal structure, process, and content of ICU diary implementations.     

Developing a framework for implementing intensive care unit diaries: a focused review of the literature

ObjectiveIntensive care unit diaries have been shown to improve post-critical illness recovery, however, prior reports of diary implementation are heterogeneous. We sought to construct a common framework for designing and implementing Intensive Care Unit diaries based on prior studies.Review method used/data sourcesWe conducted a focused review of the literature regarding intensive care diaries based on a systematic search of several databases. Two reviewers assessed 56 studies and data were abstracted from a total of 25 eligible studies conducted between 1990 and 2014. We identified key information regarding the development, design, and implementation of the journals. We then grouped elements that appeared consistently across these studies within three main categories: (1) diary target populations; (2) diary format and content; and (3) the manner of diary return and follow-up.ResultsMost studies were conducted in European countries in adult intensive care units and targeted patients in both medical and surgical units. The timing of diary initiation was based on the elapsed length of stay or duration of mechanical ventilation. We categorised diary format and content as: entry content, authors, use of standardised headings, type of language, initiation, frequency of entries, and physical location of diaries. Diaries were hand written and many studies found that photographs were an essential element in ICU diaries. We categorised the manner of diary return and follow-up. The context in which intensive care unit diaries were returned were felt to be important factors in improving the use of diaries in recovery.ConclusionsIn conclusion, we describe a common framework for the future development of intensive care unit diaries that revolves around the target population for the diaries, their format and content, and the timing of their use. Future studies should address how these elements impact the mechanisms by which intensive are diaries exert beneficial effects.     

The effect of family-authored diaries on posttraumatic stress disorder in intensive care unit patients and their relatives: A randomised controlled trial (DRIP-study)

BackgroundCritical illness and mechanical ventilation may cause patients and their relatives to experience symptoms of posttraumatic stress, anxiety, and depression due to fragmentation of memories of their intensive care unit (ICU) stay. Intensive care diaries authored by nurses may help patients and relatives process the experience and reduce psychological problems after hospital discharge; however, as patients particularly appreciate diary entries made by their relatives, involving relatives in authoring the diary could prove beneficial.ObjectivesThe objective of this study was to explore the effect of a diary authored by a close relative for a critically ill patient.MethodsThe study was a multicenter, block-randomised, single-blinded, controlled trial conducted at four medical-surgical ICUs at two university hospitals and two regional hospitals. Eligible for the study were patients ≥18 years of age, undergoing mechanical ventilation for ≥24 h, staying in the ICU ≥48 h, with a close relative ≥18 years of age. A total of 116 relatives and 75 patients consented to participate. Outcome measures were scores of posttraumatic stress symptoms, anxiety, depression, and health-related quality of life three months after ICU discharge.ResultsRelatives had 26.3% lower scores of posttraumatic stress in the diary group than in the control group (95% confidence interval: 4.8–% to 52.2%). Patients had 11.2% lower scores of posttraumatic stress symptoms in the diary group (95% confidence interval: −15.7% to 46.8%). There were no differences between groups in depression, anxiety, or health-related quality of life.ConclusionA diary written by relatives for the ICU patient reduced the risk of posttraumatic stress symptoms in relatives. The diary had no effect on depression, anxiety, or health-related life quality. However, as the diary was well received by relatives and proved safe, the diary may be offered to relatives of critically ill patients during their stay in the ICU.     

Fatal transfusion-associated graft-versus-host disease in an immunocompetent recipient of a volunteer unit of red cells

BACKGROUND:  Transfusion-associated graft-versus-host disease (TAGVHD) is a lethal complication of transfusion of nonirradiated cellular blood components to a susceptible recipient.
CASE REPORT:  An 82-year-old man underwent cardiac surgery during which he received 6 units of red cells (RBCs) and a 6-unit pool of platelets (PLTs). He was discharged with a normal white blood cell (WBC) count and hemoglobin (Hb) level and a PLT count of 104 × 10⁹ per L. He was readmitted 2 weeks later with a diffuse erythematous rash, a sore throat, and difficulty swallowing. His WBC count was 2.1 × 10⁹ per L, his Hb level was 12.0 g per dL, and his PLT count was 131 × 10⁹ per L. The next day he had worsening cytopenias: WBC count, 1 × 10⁹ per L; Hb level, 10.9 g per dL; PLT count, 104 × 10⁹ per L. He also had diarrhea. A marrow biopsy showed a severe hypoplasia without evidence of malignancy. A skin biopsy showed Grade II GVHD. The patient worsened and despite aggressive therapy he expired on Postoperative Day 42. DNA-based HLA testing of the 12 blood donors was performed. One of the RBC donors was found to be homozygous for an HLA Class I and Class II haplotype in the patient.
CONCLUSION:  This is the first reported case in the United States of fatal TAGVHD from RBCs in an immunocompetent patient who received a randomly selected unit of RBCs from a donor who was homozygous for a shared HLA haplotype. The policy of selective irradiation should be reexamined.     

Likelihood evaluation using 15 common short tandem repeat loci: a practical and simulated approach to establishing personal identification via sibling/parental assessments

BACKGROUND: In individual identification, often the only way to circumvent the lack of personal reference materials is to resort to a kinship analysis between the unidentified party (UP) and putative relatives.
STUDY DESIGN AND METHODS: Genotypes of 15 short tandem repeat loci in 20,000 families were simulated and the likelihood ratios (LRs) were calculated based on the frequencies of alleles in the Japanese population. These LR values illustrate the likelihood of whether an alleged kin is related to a UP. First, three sets of kinship were assessed: UP and one parent (or child); UP and two children; and UP and both parents. Next, an UP was compared with one to three alleged siblings (ASs). In the end, these calculations were applied to 21 actual cases where the identity of an individual lay in dispute.
RESULTS: When comparisons were made between a UP and both parents, or two children, the LR median dramatically increased (6.68 × 10¹¹ and 1.10 × 10⁸, respectively) in comparison to assessments involving an UP and one parent or child (48,900). Similarly, when two or three true siblings were made available for comparison, the LR was far greater (7.32 × 10⁶ and 4.50 × 10⁸, respectively) than in cases where only one sibling was available (9,250). Of the 21 actual cases these calculations were applied to, 1 case ended in exclusion with absolute certainty and the remaining 20 cases obtained high LRs.
CONCLUSION: As demonstrated, this system is extremely effective in cases of personal identification where both parents, two or more children, or two or more ASs are available for comparison.     

Testing platelet mass versus platelet count to guide platelet transfusions in the neonatal intensive care unit

BACKGROUND: Platelet (PLT) transfusions can bestow significant benefits but they also carry risks. This study sought a safe means of reducing PLT transfusions to neonatal intensive care unit (NICU) patients with thrombocytopenia by comparing two transfusion guidelines, one based on PLT count and the other on PLT mass (PLT count times mean PLT volume).
STUDY DESIGN AND METHODS: Using a prospective, two-centered, before versus after design, PLT transfusion usage and hemorrhagic events were contrasted during a period when PLT count–based transfusion guidelines were in use (Period 1) versus a period when PLT mass–based guidelines were in use (Period 2).
RESULTS: No differences were observed between Periods 1 and 2 in NICU admissions, sex, race/ethnicity, percentage of inborn patients, or percentage of patients with a PLT count less than 50 × 10⁹ or 51 × 10⁹ to 99 × 10⁹/L. In the first period 3.6% of NICU admissions received one or more PLT transfusions. This fell to 1.9% during the second period (p < 0.002). The number of PLT transfusions administered per transfused patient was the same in both periods: 2.0 (1-23) (median [range]) in Period 1 and 2.0 (1-17) in Period 2 (p > 0.40). Significantly fewer PLT transfusions were given in Period 2 for prophylaxis (patient not bleeding; p < 0.001 vs. Period 1). The number given for bleeding did not change between the two periods. In Period 2 no increases were seen in rate of intraventricular hemorrhage (IVH); Grade 3 or 4 IVH; or pulmonary, gastrointestinal, or cutaneous bleeding.
CONCLUSIONS: The use of PLT mass–based NICU transfusion guidelines was associated with fewer PLT transfusions and no recognized increase in hemorrhagic problems.     

Sec1-FUT2-Sec1 hybrid allele generated by interlocus gene conversion

BACKGROUND: Many single-nucleotide polymorphisms have been identified in the coding region of the FUT2 locus, which encodes secretor type α(1,2)fucosyltransferase. In addition, three recombination alleles have been reported. Of these recombination alleles, a fusion gene generated by an unequal crossing over between Sec1 , a pseudogene that locates 23 kb upstream to and has high sequence homology with FUT2 and FUT2, was identified as a Japanese-specific nonsecretor allele ( se ^fus ).
STUDY DESIGN AND METHODS: During the screening of the se ^fus in Mongolians (n = 118), a hybrid allele of Sec1-FUT2-Sec1 was found.
RESULTS: The DNA sequence suggested that the Sec1-FUT2-Sec1 allele contains a 275-bp sequence (between positions 259 and 533) that is identical to the FUT2 sequence including a 54-bp FUT2- specific region (between positions 417 and 470) and that might have been generated by an interlocus gene conversion.
CONCLUSION: Because the recombination region of se ^fus and the upstream recombination region of Sec1-FUT2-Sec1 are almost identical, this sequence stretch is likely to be the breakpoint for different kinds of recombinations that occur in this family of genes.     

Nursing competencies: Ground work in aged and extended care

Ballantyne A, Cheek J, O'Brien B, Pincombe J. International Journal of Nursing Practice 1998; 4: 156–165
Nursing competencies: Ground work in aged and extended care
Competencies have been formulated for entry level nurses. Specialist and generic advanced nursing competencies are also being developed. This paper describes exploratory groundwork on aged and extended care nursing competencies derived from interviews with nurses, allied health staff, residents and their families from one setting. Critical Incident Technique ¹ was used to guide semistructured interviews with 29 participants. A thematic analysis of the data suggests that the Australian Nursing Council Inc. ² competencies make a useful but incomplete contribution to understanding the perceived role of nursing in aged and extended care. A conceptual framework developed from the data illustrates the interdependence of competencies with the context in which they are observed. The framework proposes a number of elements which have the potential to offer a means to better interpret nursing competence (critical aspects) in aged and extended care contexts.     

Thematic analysis of intensive care unit diaries kept by staff: insights for caring

ObjectiveTo explore recurrent themes in diaries kept by intensive care unit (ICU) staff during the coronavirus disease 2019 (COVID-19) pandemic.DesignQualitative study.SettingTwo ICUs in a tertiary level hospital (Milan, Italy) from January to December 2021.MethodsICU staff members wrote a digital diary while caring for adult patients hospitalized in the intensive care unit for >48 hours. A thematic analysis was performed.FindingsDiary entries described what happened and expressed emotions. Thematic analysis of 518 entries gleaned from 48 diaries identified four themes (plus ten subthemes): Presenting (Places and people; Diary project), Intensive Care Unit Stay (Clinical events; What the patient does; Patient support), Outside the Hospital (Family and topical events; The weather), Feelings and Thoughts (Encouragement and wishes; Farewell; Considerations).ConclusionThe themes were similar to published findings. They offer insight into care in an intensive care unit during a pandemic, with scarce resources and no family visitors permitted, reflecting on the patient as a person and on daily care. The staff wrote farewell entries to dying patients even though no one would read them.Implications for clinical practiceThe implementation of digital diaries kept by intensive care unit staff is feasible even during the COVID-19 pandemic. Diaries kept by staff can provide a tool to humanize critical care. Staff can improve their work by reflecting on diary records.     

Erythroid urea transporter deficiency due to novel JKnull alleles

BACKGROUND: The Kidd blood group antigens Jk^a and Jk^b are encoded by the red blood cell (RBC) urea transporter gene. Homozygosity for silent JK alleles results in the rare Jk(a–b–) phenotype. To date, seven JK ^null alleles have been identified, and of these, two are more frequent in the Polynesians and Finns. This study reports the identification of other JK ^null alleles in Jk(a–b–) individuals of different ethnic or geographic origins.
STUDY DESIGN AND METHODS: Nine Jk(a–b–) samples and a sample from a Jk(a–b+) mother of a Jk(a+b–) baby were investigated. Polymerase chain reaction amplification and sequence analysis of the JK gene was performed. Western blotting and urea lysis were used to confirm Jk(a–b–) RBCs.
RESULTS: Four novel alleles were identified: two different nonsense mutations, 202C>T (Gln68Stop) and 723delA (Ile262Stop) were identified on otherwise consensus JK * 1 and JK * 2 alleles, respectively. A missense mutation, 956C>T (Thr319Met), was identified in a JK * 1 allele from an African-American and a JK * 2 allele in two people of subcontinental Indian descent. Immunoblotting and urea lysis confirmed absence of JK glycoprotein in RBC membranes from a sample carrying the 956C>T mutation. Other previously described JK ^null mutations were found in samples of origins other than in which they were first identified.
CONCLUSION: The molecular bases of the Jk(a–b–) phenotype are diverse and this is the first report of JK ^null alleles in individuals of African and subcontinental Indian descent. Although rare, these alleles should be taken into consideration when planning genotyping strategies for blood donors and patients.     

RBCs labeled at two biotin densities permit simultaneous and repeated measurements of circulating RBC volume

BACKGROUND: The extend potential applications of a nonradioactive method for measuring circulating RBC volume, we tested the hypothesis that RBC volume could be determined independently using two populations of RBCs labeled with low-density biotin (LDB₁) and high-density biotin (HDB).
STUDY DESIGN AND METHODS: In 10 healthy adults, autologous RBCs were labeled with HDB, LDB, or ⁵¹Cr. The labeled RBCs were mixed and transfused. RBC volume was measured in postinfusion peripheral venous blood by quantitating dilution of each population of labeled RBCs.
RESULTS: RBC volume measured using either LDB or HDB cells agreed well with RBC volume measured using ⁵¹Cr. For the regression of RBC volume by LDB versus RBC volume by ⁵¹Cr, correlation = 0.994 and slope = 0.933. For HDB versus ⁵¹Cr, correlation = 0.982 and slope = 0.953. RBC volume measured a second time in four subjects with HDB agreed well; mean CV for the differences between HDB and ⁵¹Cr were less than 5 percent.
CONCLUSIONS: Using RBCs labeled with two different densities of biotin, RBC volume can be accurately measured simultaneously and repeatedly in the same subject without radiation exposure.     

Plasma endothelin-1 levels during transient acute myocardial ischaemia in men: effects of coronary revascularization

The endothelium-derived peptide endothelin-1 (ET-1) was evaluated in 14 male patients [mean age 52.74 years (SEM 1.10)] affected by coronary artery disease during a bicycle electrocardiographic stress test and dipyridamole echocardiogram. Both tests were performed before and after coronary revascularization. Fourteen healthy male subjects served as controls [mean age 53.21 years (SEM 1.63)]. Baseline plasma endothelin-1 levels were higher ( P  < 0^.0001) in ischaemic patients [1^.81 pg mL⁻¹ (0^.15, n  = 14)] than in control subjects [0^.61 pg mL⁻¹ (0^.03, n  = 14)], but did not increase with exercise in both groups. Similar results were obtained with dipyridamole infusion. Endothelin-1 levels significantly decreased after coronary revascularization [before: mean 1^.81 pg mL⁻¹ (SEM 0^.15, n  = 14); after: mean 1^.16 pg mL⁻¹ (SEM 0^.11), P  < 0^.002], without changes in the peptide response to both tests. In conclusion, elevated plasma endothelin-1 concentrations were found in patients with stable angina compared with non-ischaemic subjects. No changes were observed during exercise or dipyridamole infusion in both groups. Coronary revascularization was followed by a significant decrease in plasma endothelin-1 levels.     

Poster Session 2-1: Pharmacological and Cellular Therapy Monday, April 3, 2006, 4:00–5:30pm

Prof. Yuji Nakazato ¹ , Masayuki Yasuda ¹ , Hiroto Tsuchiya ¹ , Akitoshi Sasaki ¹ , Takashi Tokano ¹ , Hiroyuki Daida ^{1   1} Cardiology, Juntendo University, Tokyo, Japan
The purpose of this study is to clarify the efficacy and safety of bepridil for persistent atrial fibrillation (AF). Method: Bepridil (100-200mg/day) was administered to 159 patients (141 males, mean age 58 years) with persistent AF. The effects of conversion and maintenance of sinus rhythm were evaluated. If sinus restoration was not obtained until 3 months observation, DC cardioversion was performed. Results: In 87 of 159 patients (55%), sinus rhythm was restored within an average 2.1 months following administration of bepridil. 74 of those 87 patients (85%) have been maintained in sinus rhythm for the average follow-up of 16 months. The 31 out of remaining 72 patients failed pharmacological conversion and performed DC cardioversion. All of the patients restored sinus rhythm, and 18 of them (58%) maintained sinus rhythm for an average of 20 months. Although ECG revealed significant prolongation of QT interval from 0.38/0.03 to 0.42/0.06 sec, QTc was unchanged and no serious adverse complications including torsade de pointes were recognized. Conclusion: Bepridil is clinically safe and useful with favorable efficacy for conversion and maintenance of sinus rhythm in patients with persistent AF.     

Murine monoclonal anti-s and other anti-glycophorin B antibodies resulting from immunizations with a GPB.s peptide

BACKGROUND: The blood group antigens S and s are defined by amino acids Met or Thr at position 29, respectively, on glycophorin B (GPB). Commercial anti-s reagents are expensive to produce because of the scarcity of human anti-s serum. Our aim was to develop hybridoma cell lines that secrete reagent-grade anti-s monoclonal antibodies (MoAbs) to supplement the supply of human anti-s reagents.
STUDY DESIGN AND METHODS: Mice were immunized with the GPB^s peptide sequence TKSTISSQTNGE T GQLVHRF. Hybridomas were produced by fusing mouse splenocytes with mouse myeloma cells (X63.Ag8.653). Screening for antibody production was done on microtiter plates by hemagglutination. Characterization of the MoAbs was done by hemagglutination, immunoblotting, and epitope mapping.
RESULTS: Eight immunoglobulin G MoAbs were identified. Five antibodies are specific by hemagglutination for s and two MoAbs, when diluted, are anti-S–like, but additional analyses shows a broad range of reactivity for GPB. Typing red blood cells (RBCs) for s from 35 donors was concordant with molecular analyses as were tests on RBCs with a positive direct antiglobulin test (DAT) from 15 patients. The anti-s MoAbs are most reactive with peptides containing the ³¹QLVHRF³⁶ motif, with ²⁹Thr. By Pepscan analyses, the anti-S–like MoAbs reacted within the same regions as did anti-s, but independently of ²⁹Met. One antibody was defined serologically as anti-U; however, its epitope was identified as ²¹ISSQT²⁵, a sequence common for both GPA and GPB.
CONCLUSION: In addition to their value as typing reagents, these MoAbs can be used to phenotype RBCs with a positive DAT without pre-test chemical modification.     

Higher infused CD34+ hematopoietic stem cell dose correlates with earlier lymphocyte recovery and better clinical outcome after autologous stem cell transplantation in non-Hodgkin's lymphoma

BACKGROUND: Lymphocyte recovery after autologous stem cell transplantation (ASCT) has been shown to be associated with positive clinical outcome in non-Hodgkin's lymphoma (NHL). This study sought to identify variables that affect lymphocyte recovery and survival after ASCT.
STUDY DESIGN AND METHODS: A retrospective analysis of outcomes in 97 consecutive patients with NHL who underwent ASCT in a single center from August 1999 to January 2008 was conducted.
RESULTS: A significant relationship was not observed between infused lymphocyte count and days to recovery of absolute lymphocyte count 500 × 10⁶/L or greater after ASCT (ALC500; r = 0.139, p = 0.176), but there was a significant inverse correlation between infused CD34+ cell count and days to ALC500 (r = −0.333, p = 0.001). Univariately, infused CD34+ cell count and recovery of ALC500 by 20th day after ASCT were significant predictors of survival. The median overall survival (OS) and event-free survival (EFS) were significantly longer in patients who received 8.2 × 10⁶ CD34+ cells/kg or more than in those who received fewer than 8.2 × 10⁶ CD34+ cells/kg (OS, not reached vs. 11.6 months, p = 0.001; EFS, not reached vs. 4.8 months, p = 0.003). Multivariate analysis confirmed that infused CD34+ cell count was an independent prognostic factor for OS (p = 0.017) and EFS (p = 0.002).
CONCLUSION: These data suggest that infused CD34+ cell count is predictive of kinetics of lymphocyte recovery after ASCT and is an independent prognostic factor for OS and EFS after ASCT in patients with NHL.     

Experiences of nurses with an innovative digital diary intervention in the intensive care unit: A qualitative exploration

IntroductionDiaries have been used regularly in various intensive care units (ICUs) in international settings. Hard copy diaries written by relatives became impractical during the COVID-19 pandemic due to ICU visiting restrictions and infection control considerations. The implementation of a web based application, named the “Post-ICU” diary, offered relatives the ability to collaboratively write in a digital diary, to easily upload photos, video and audio clips and to feel engaged with the patient at a safe distance. In addition it allowed nurses to easily provide up-to-date information. The aim of this pilot study was to explore the experiences of ICU nurses with the implementation process and application of the Post-ICU diary.MethodsA multicentre qualitative design with focus group interviews was used with ICU nurses in November 2020. Interview data were audiotaped and transcribed verbatim, and then a thematic analysis was performed to categorize the data.ResultsParticipants from three hospitals (n = 14), 57% of whom were women, with a mean age of 40.6 years, described their experiences with the Post-ICU diary. The following themes emerged: implementation process, COVID-19, integration, and motivation. The results showed that ICU nurses perceived the Post-ICU diary to be applicable in daily care and endorsed the added value of the digital Post-ICU diary as a new opportunity to improve interhuman connectedness. However, the nurses also experienced barriers such as non-user-friendly access, lack of time and hesitance to write short messages.ConclusionICU nurses reported that the Post-ICU diary had added value for patients and their relatives. However, in the beginning they also experienced barriers such as lack of time, insufficient integration with their own work processes, and challenges regarding writing short messages themselves. For structural embedding of the intervention, tailored strategies are needed to support ICU nurses in using this innovative Post-ICU diary.