Writing and reasoning among intensive care nurses in coauthored digital diaries with real-time family access: A...

Digital intensive care unit (ICU) diaries are used to support psychological recovery for ICU survivors and families. In the Dutch coauthored digital format, entries are visible to families in real time, creating not only opportunities for connection but also new challenges for nurses deciding what and how to write.

The objectives of this study were to examine ICU nurses' contributions to coauthored digital diaries with real-time family access by (i) describing the content, tone, and structure of nurse-authored entries and (ii) exploring nurses' motivations, contextual influences, and decision-making processes underpinning their writing.

A qualitative study was conducted (November 2023-March 2025) in four Dutch hospitals (one university medical centre and three tertiary teaching hospitals). Data comprised nurse-authored digital diary entries and semistructured interviews with ICU nurses. Both datasets were analysed thematically using Braun and Clarke's framework. After separate analyses, an integrative step compared theme maps to identify convergences between what nurses wrote and why.

We analysed 110 diary entries, yielding eight themes: The patient as a person; Connecting beyond words; Compassionate presence; Situational context; Nursing domain; Medical and technical aspects; Clinical course and condition; and Writing style, structure, and recurring elements. Interviews with 22 ICU nurses produced six themes on personal motivation, contextual factors, support tools and barriers, content selection, writing style and voice, and family reactions. Across themes, real-time visibility to families shaped how nurses wrote, prompting careful wording, minimisation of jargon, and selective omission or softening of sensitive details. Nurses described diary writing as meaningful yet emotionally demanding and valued peer feedback, example texts, and time to write.

Digital diary writing is not merely documentation but a reflective, relational practice shaped by clinical complexity, emotional awareness, and immediate family readership. Implementations should pair technical integration with ethical guidance, emotional support, and flexible writing resources to sustain authentic, compassionate nurse-authored contributions.