Extent and application of ICU diaries in Germany in 2014.
BACKGROUND
Diaries written for patients in the Intensive Care Unit (ICU) have been used in many European countries since the early 1990s to support patients and their relatives in their understanding of the ICU experience. ICU diaries have been introduced in Germany since 2008 via the internet, newsletters, newspapers, lectures and publications in German nursing journals.


OBJECTIVE
The aim of the study was to update our knowledge of the extent and application of ICU diaries in Germany in 2014.


METHODS
The study had a prospective mixed methods multicenter design.


METHODS
All 152 ICUs in the two German federal states of Baden-Württemberg and Schleswig-Holstein were surveyed to identify units that had implemented ICU diaries. An additional 69 ICUs from other parts of Germany were included in the survey. We excluded diaries used in neonatal ICUs. Out of 43 units using diaries 14 were selected for semi-structured key-informant telephone-interviews on the application of ICU diaries.


RESULTS
According to the survey, 8 out of 152 ICUs in the two federal states of Baden-Württemberg and Schleswig-Holstein had implemented ICU diaries and another six were planning implementation. Another 35 ICUs in other areas of Germany had implemented diaries and three units were planning to do so. Interviews were conducted with nurses at 14 selected ICUs. Informants reported successful adaption of the diary concept to their culture, but variability in application. No units were identified where all nursing staff participated in keeping ICU diaries.


CONCLUSIONS
Six years after the introduction of ICU diaries, ICU nurses in Germany are becoming familiar with the concept. Nursing shortage and bureaucratic challenges have impeded the process of implementation, but the adaption of ICU diaries to German conditions appears to be successful and is still in progress.


CONCLUSIONS
Implementation of ICU diaries is feasible after adjusting for cultural and legal issues.
Nursing Research, Director of Nursing and Patient Service University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
Peter
P
Nydahl
Dirk
D
Knueck
Ingrid
I
Egerod
D003422:Critical Care; D005858:Germany; D006801:Humans; D008499:Medical Records; D011446:Prospective Studies
Aftercare; Critical care nursing; ICU diary; Implementation