May 30, 2022

Article Review - Journal Rewiew Club


Diaries have been used regularly in various intensive care units (ICUs) in international settings [1, 2]. Hard copy diaries written by relatives of hospitalised ICU patients became impractical during the COVID-19 pandemic due to ICU visit restrictions and infection control considerations.

A web-based diary application, named “Post-ICU”, offered relatives and healthcare professionals the opportunity to collaboratively write in this digital diary, easily upload photos, and keep engaged with the patient at distance. Until now, it is unknown how the innovative post-ICU diary is appreciated by all stakeholders.

A study by Haakma and colleagues (2021) explored the feasibility of the digital diary from the ICU nurses’ perspectives [3]. The authors used a multicenter qualitative design with focus groups and individual interviews from November 2020 to January 2021.

Demographic data were collected with a two-minute survey at the beginning of the interview. In addition, all participants were asked to give a score from 1 (not at all) to 10 (excellent) on how relevant and how useful they assessed the post-ICU diary to be used in daily practice. Interview data were audiotaped and transcribed verbatim. Then a thematic analysis was performed to categorise the data.

The study showed the results of participants (n=14) from three hospitals, 57% of whom were women, with a mean age of 40.6 years, who described their experiences with the post-ICU diary. The following themes emerged: implementation process, COVID-19, integration, and motivation. The mean scores for applicability and relevance of the post-ICU diary were 7.3 and 8.4, respectively.

ICU nurses 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. For structural embedding of the intervention, tailored strategies to support ICU nurses in using this innovative post-ICU diary are essential.


The strength of the study was the qualitative design implemented in several hospitals with a broad exploration of opinions and experiences until data saturation was reached.

A limitation to this study might be a response bias in the overall evaluation due to a high proportion of early adopters of the post-ICU diary who participated.


Participants perceived the web-based post-ICU diary as valuable because it facilitated the social interaction between the relative, their own network and the ICU team. The Post-ICU diary is an appreciated alternative to the paper version, which should both be implemented in every ICU.

This article review was prepared and submitted by Margo van Mol, on behalf of the ESICM N&AHP Journal Review Club.


[1] Brandao Barreto B. et al. Exploring family members’ and health care professionals’ perceptions on ICU diaries: a systematic review and qualitative data synthesis. Intensive Care Med. 2021 Jul;47(7):737-749. doi: 10.1007/s00134-021-06443-w. Epub 2021 Jun 12. PMID: 34117901.

[2] McIlroy P.A. et al. The Effect of ICU Diaries on Psychological Outcomes and Quality of Life of Survivors of Critical Illness and Their Relatives: A Systematic Review and Meta-Analysis. Crit Care Med. 2019 Feb;47(2):273-279. doi: 10.1097/CCM.0000000000003547. PMID: 30431494.

[3] Haakma T. et al. Experiences of nurses with an innovative digital diary intervention in the intensive care unit: A qualitative exploration. Intensive Crit Care Nurs. 2022 Jun;70:103197. doi: 10.1016/j.iccn.2022.103197. Epub 2022 Jan 26. PMID: 35090798.

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