title: How much time do nurses need to write an ICU diary?
abstract: BACKGROUND
  Diaries in the Intensive Care Unit (ICU) support patients and relatives during and after a stay on the ICU. Barriers to implementation of the ICU diary are workload, unwanted closeness to patients and lack of time.
  
  
  OBJECTIVE
  The purpose of the study was to evaluate the time nurses consume writing an ICU diary. Further questions were to examine whether the first diary entry, which includes a more detailed description about the admission, consumes more time than other entries and whether the time taken depends on experience or workload of the nurses.
  
  
  METHODS
  Quantitative, prospective, international observational multicentre study in four ICUs within the international diary network in Germany (two ICUs), Sweden and Switzerland (one ICU each).
  
  
  METHODS
  During a 6-month period in 2012/2013 nurses measured the time they consumed writing a diary in minutes and seconds, the number of diaries they contributed to and total number of diary entries, the nurse-patient ratio, their level of experience in writing diaries, interruptions while writing in a diary and additional information like photographs or follow-up visits.
  
  
  RESULTS
  In summary 29 diaries were collected which included 195 written entries. The first entry needed significantly more time than following entries (first entry: mean 13:33 min versus following entries: mean 5:31, p < 0·001). The mean time for following entries differed significantly between the countries: Switzerland: 6:14, Sweden 5:31 and Germany 3:36 (p < 0·001). Nurses with more experience used more time to write a diary (not significant). With increasing nurse-patient-ratio the time decreased for following entries (ratio 1:1: mean 5:42, ratio 1:2: mean 5:27, ratio 1:3: mean 3:12, p = 0·007).
  
  
  CONCLUSIONS
  Writing a diary for patients and relatives means an additional amount of time and workload, but according to the increased quality of nursing the time seems to be feasible for implementation. The measured time was self-reported, thus including possible bias for the results.
authors.affiliation: P Nydahl, RN, Nursing Research, Director of Nursing and Patient Service, University hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Nydahl
authors.forename: Carl G
authors.initials: CG
authors.lastname: Bäckman
authors.forename: Johannes
authors.initials: J
authors.lastname: Bereuther
authors.forename: Michael
authors.initials: M
authors.lastname: Thelen
mesh_terms: D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008499:Medical Records / Q000592:standards* / Q000706:statistics & numerical data*; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013548:Sweden; D013557:Switzerland; D013997:Time Factors; D016526:Workload / Q000706:statistics & numerical data*; D014956:Writing
keywords: Amount of time; Critical care; ICU diary; Network