Critical Care Diaries: An Exploration of Patient Perceptions using Glaserian Grounded Theory

Abstract

Background
Recognition of the psychological needs of critical care patients has been an area of increasing interest in recent years. Use of critical care diaries written on behalf of critically ill patients is one intervention that has been adopted in the study site in South Wales. Little is known about the benefits, limitations or potential for harm of such diaries and fundamentally there is a lack of representation of patients’ views in diary use and development. The aim of this longitudinal qualitative study was to provide an in-depth insight into critical care survivor experiences and use (or not) of a critical care diary during the first 12 months of their recovery to inform development of a theory and future diary use.
Method
Glaserian Grounded Theory (GGT) was the selected methodology for this particular study. It was important that patients’ perceptions and experiences were captured and that a theory about diary use could emerge. Serial qualitative interviews (SQI’s) were used at 2, 6 and 12 months post- ICU discharge. The longitudinal process was fundamental in capturing participants’ experiences, views and interaction with their diary, or not, during the first year of their recovery.
Key findings
The substantive theory is that humans seek coherence about what happened during their critical illness. Part of the process encompasses patients being ready to know what happened. Those patients who feel ready to know need to replace the disruption or rift that has occurred in the normally intact timeline of their lives. In order to do this, patients draw on relevant information available to them. Having a critical care diary can be instrumental in helping patients resolve the uncertainty, anxiety and stress that negatively impacts on their health and recovery. However it can also fail to allay concerns and thus increase anxiety and rumination where questions are left unanswered; acting as a potential hindrance to recovery.
Conclusions
The original contribution to knowledge is in the provision of a longitudinal qualitative study that provides in-depth insight into critical care survivors’ experiences of critical illness, recovery and use, or not, of their diary during this process. Restoring a sense of coherence to disrupted life and identity is important in the aftermath of critical illness and diaries. Diaries may act to help or hinder the recovery process and therefore appropriate supportive mechanisms need to be in place. A diary is one of many means of supporting patients, but should not be used in isolation.

Date of Award	8 Jun 2018
Original language	English
Supervisor	Ruth Northway (Supervisor), Paul Gill (Supervisor) & Marcus Longley (Supervisor)