Implementation of a digital diary in the intensive care unit; understanding the facilitators and barriers: A qualitative exploration

Carola M A Schol; Margo M C van Mol; Elke Berger; Crista Leerentveld; Diederik A M P J Gommers; Erwin Ista

doi:10.1016/j.aucc.2024.04.002

Implementation of a digital diary in the intensive care unit; understanding the facilitators and barriers: A qualitative exploration

Aust Crit Care. 2024 May 7:S1036-7314(24)00075-4. doi: 10.1016/j.aucc.2024.04.002. Online ahead of print.

Authors

Carola M A Schol¹, Margo M C van Mol², Elke Berger³, Crista Leerentveld⁴, Diederik A M P J Gommers², Erwin Ista⁵

Affiliations

¹ Department of Intensive Care, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands. Electronic address: c.schol@erasmusmc.nl.
² Department of Intensive Care, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
³ Department of Intensive Care, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
⁴ Department of Intensive Care, Isala, Zwolle, the Netherlands.
⁵ Department of Internal Medicine, Section Nursing Science, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands.

PMID: 38719673
DOI: 10.1016/j.aucc.2024.04.002

Abstract

Background: In the recent years, digital intensive care unit (ICU) diaries have emerged as more advantageous than paper diaries. Despite the advantages of digital diaries, the successful implementation and maintenance of this digital intervention present significant challenges in clinical practice. Therefore, understanding the facilitators and barriers among stakeholders influencing this process becomes imperative for devising a tailored strategy to integrate digital diaries effectively within ICU settings.

Aim/objective: The aim of this study was to explore facilitators and barriers for implementation of a digital ICU diary from the perspectives of ICU professionals, ICU survivors, and their relatives.

Methods: A qualitative design was used, incorporating focus-group interviews with professionals from four Dutch ICUs, along with individual interviews with ICU survivors and relatives. The study spanned from October 2022 to April 2023. Data analysis utilised a mixed inductive-deductive approach, particularly through directed content analysis. The Consolidated Framework for Implementation Research 2.0 guided both data collection and analysis processes.

Findings: We conducted five focus-group interviews among ICU professionals (n = 32) and 10 individual or dual interviews involving five ICU survivors and nine relatives. Key facilitators for implementing a digital diary according to ICU professionals encompassed a user-friendly interface accessible independent of time and place, with a seamless login process requiring minimal steps, comprehensive training covering all aspects of its use, and feedback from the experiences of both patients and relatives. Barriers for ICU professionals included many steps required to access the digital diary, as well as resistance to (co)writing diary entries. In contrast, professionals' involvement in writing diary entries was highly appreciated among ICU survivors and relatives. An ambiguous factor arose regarding sharing the digital diary with others; both ICU survivors and relatives found it valuable, yet it also raised privacy concerns.

Conclusions: This study offers insights into the most important factors influencing the implementation of a digital ICU diary. Strikingly, some factors serve as both barriers and facilitators. When developing the implementation strategy, the identified facilitators can be used to overcome the barriers faced by ICU professionals, ICU survivors, and their relatives in adopting a digital diary.

Keywords: Barriers; Consolidated Framework for Implementation Research 2.0 (CFIR) framework; Digital; Facilitators; Implementation; Intensive care unit; Intensive care unit diary; Intensive care unit professionals; Intensive care unit survivors.