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PURPOSE/OBJECTIVES To gain a deeper understanding of nurses' experience working with a patient diary for tracking and treating side effects during chemotherapy.
. DESIGN A mixed-methods design was used to learn about oncology nurses' use and perceptions of a symptom diary. 
. SETTING Six oncology wards and two outpatient clinics at the University Hospitals Leuven, Belgium.
. SAMPLE 79 nurses completed a survey, and 14 nurses participated in focus group discussions.
. METHODS First, a survey sampled nurses' use and perceptions of the diary. Next, focus group discussions were held with the aim of arriving at a deeper understanding of the survey results.
. MAIN RESEARCH VARIABLES Use and perceptions of a symptom diary.
. FINDINGS Most nurses reported performing diary-related behavior to some extent. The survey and focus groups indicated that many nurses strongly believed in the value of the diary, but some were still hesitant or had concerns about patients' perceptions of the diary. The focus group results showed that nurses' use of the diary in daily practice was influenced by their personal beliefs about the value of the diary, the team's, and those of their patients.
. CONCLUSIONS Although a positive trend was noted, nurses' use of the symptom diary was suboptimal six months after its implementation.
. IMPLICATIONS FOR NURSING This study highlights important issues that need to be addressed to advance the successful implementation of the symptom diary.