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Additional file 3. S3: Qualitative analysis coding development

Additional file 2. S2: Focus group interview schedules.

Additional file 1. S1: COREQ checklist.

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347, PURPOSE: To guarantee the safety of the public, clinicians and patients during the COVID-19 pandemic, hospital visits were severely restricted internationally. There are limited data on the precise impact of these visiting restrictions on Intensive Care Unit clinicians. Our objectives therefore were to explore the impact of family visitation restrictions on clinicians and care delivery and describe innovation alongside areas for potential improvement. METHODS: A qualitative approach using focus groups was employed. We recruited members of the multi-disciplinary team from Spain, France and the UK. Framework analysis was used to synthesize and interpret data. RESULTS: In total, 28 staff from multiple international sites contributed to data across six focus groups: 12 from the UK, 9 from France and 7 from Spain. In relation to the key aims, we derived four themes: the emergence of new technologies, relationships and rapport establishment, communication challenges and end-of-life care provision. Across each theme, the overarching concepts of clinician emotional exhaustion and emotional distress emerged alongside the negative impact on job satisfaction. CONCLUSION: The impact of COVID-19 family visitation restrictions is far reaching. Future research should examine the wider impact of family presence in the ICU.

Aim: (a) To understand patients' lived experience at intensive care unit (ICU) dis-charge and (b) to evaluate the impact of a nursing empowerment intervention (NEI) on patients' anxiety and depression levels at ICU discharge. Design: A mixed- methods approach will be applied. Methods: In the qualitative phase, the hermeneutic phenomenological method will be used. Participants will be patients from three university hospitals who will be se-lected by purposive sampling. Data will be gathered through in-depth interviews and analysed using content analysis. The qualitative data obtained will be employed to develop the nursing intervention. Subsequently, a multicenter, parallel-group, experi-mental pre-test/post-test design with a control group will be used to measure the effectiveness of the nursing empowerment intervention in the quantitative phase by means of the Hospital Anxiety and Depression Scale (HADS). Simple random proba-bilistic sampling will include 172 patients in this phase. KEYWORDS: ICU discharge, mixed-method design, nursing intervention, post-intensive care syndrome

Resumen Objetivo principal: Analizar el uso del diario en las unidades de cuidados intensivos y sus efectos terapéuticos. Metodología: Revisión cualitativa de la literatura publicada entre 2006 y 2019 en las principales bases de datos biomédicas. Resultados principales: Seleccionados 48 artículos. Los diarios son utilizados en países europeos desde los años 70. Existe controversia metodológica en la redacción y elaboración del diario. Sus efectos terapéuticos son positivos para: familiares (favorecen comunicación y expresión sentimientos), pacientes (ayudan a comprender lo sucedido) y profesionales (producen satisfacción personal/profesional). Conclusión principal: El uso de los diarios es una práctica enfermera habitual en Europa, pero escasa en España. Los diarios mejoran la ansiedad y la depresión a pacientes y a familiares, mejoran el estrés postraumático en familias. Es una herramienta útil que promueve el desarrollo enfermero.