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Contents lists available at ScienceDirect

Intensive and Critical Care Nursing

journal homepage: www.elsevier.com/iccn

The contents of a patient diary and its significance for persons cared
for in an ICU: A qualitative study
Sandra Strandberg a , Lisa Vesterlund a , Åsa Engström b,∗
a
Intensive Care Unit 57, Sunderby Hospital, Luleå, Sweden
b
Division of Nursing, Department of Health Science, Luleå University of Technology, SE-971 87 Luleå, Sweden

a r t i c l e i n f o a b s t r a c t

Article history: Objectives: The aim of this study was to describe the contents of a patient diary and its significance for
Accepted 11 December 2017 persons cared for in an ICU.
Research Methodology: An empirical study with a qualitative design. Eight telephone interviews and one
Keywords: face-to-face interview were conducted with nine persons previously been treated in an ICU and been
Diary given a patient diary. In addition, the person would have read his/her diary. The data have been analysed
Confirmation
with qualitative content analysis.
Experience
Findings: The study identified one overarching theme; Gaining understanding, and four categories; The
Involvement
Qualitative
diary is written for me, Creating memories from the time of care, Who writes in the diary and, The ability
Understanding to return to the diary. The diary meant that participants gained an understanding of their time in the ICU
Togetherness while they were critically ill and the diary was important to be able to return to.
Conclusion: What formerly critically ill patients appreciate most about the diary is that the diary is per-
sonally written, which makes them feel confirmed and valuable as a person. Guidelines for how and when
a diary should be written and used would likely encourage critical care nurses and relatives to write in it.
© 2017 Elsevier Ltd. All rights reserved.

Implications for clinical practice

• Patients feel cared for when they read a diary written especially for them.
• Guidelines outlining what should be in a diary would encourage critical care nurses and relatives to write and place photos in it.
• Critical care nurses allocating time daily to write in the diary will reduce gaps in the diary, thereby preventing patients from
wondering what happened during that time.

Background
Any person who is critically ill and is being cared for in an inten-
sive care unit (ICU) is in an extremely stressful environment and
situation. According to several studies (Ullman et al., 2015; Ewens
et al., 2014; Bäckman et al., 2010), those who have been nursed in an
ICU for critical illness have an increased morbidity. When the per-
son recovers, they often experience a state of confusion or suffers
from memory loss. An ICU patient diary has been found beneficial
in reducing ICU patients’ and their relatives’ suffering (Teece and
Baker, 2017; Nydahl et al., 2014; Jones et al., 2012). According to
∗ Corresponding author.
E-mail address: asa.engstrom@ltu.se (Å. Engström).
Nikayin et al. (2016) one third of patients who survived their ICU
experienced anxiety during the first year of recovery; they suggest
physical rehabilitation and ICU diaries merit further investigation
as interventions.
According to Engström et al. (2009), a patient diary can help a
person who has been cared for in an ICU to understand what they
have undergone; the diary can thus assist the person to experience a
sense of coherence (Engström et al., 2009; Engström et al., in press).
Studies show that the diaries make it possible for the person treated
in the ICU to confirm his/her memories and fill in memory slots
(Ewens et al., 2014; Engström et al., 2008; Taylor et al., 2017). Heindl
et al. (2016) show that implementing and developing a nursing
intervention such as the ICU diary demands a process of continuing
adaptation. According to Åkerman et al. (2010), the inspiration to
write a diary increases when colleagues are discussing the impor-

https://doi.org/10.1016/j.iccn.2017.12.004
0964-3397/© 2017 Elsevier Ltd. All rights reserved.

Please cite this article in press as: Strandberg, S., et al., The contents of a patient diary and its significance for persons cared for in an
ICU: A qualitative study. Intensive Crit Care Nurs (2017), https://doi.org/10.1016/j.iccn.2017.12.004
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tance of the diaries. In order to facilitate the recovery of people who
have received a diary, we need to understand which contents of the
diary will likely be significant for them. This study focuses on what
contents in the diary are helpful to the patient.
Aim
The aim of this study was to describe the contents of a patient
diary and its significance for persons cared for in an ICU. The study
answered the following research questions:
1. Is there anything in the content to focus more on?
2. What is important to read about and who should write in the
diary?
3. Is there something that the person who has been cared for in the
ICU thinks that staff and/or relatives should avoid writing in the
diary?
4. How has the diary been used?
Method
Design
The study used an empirical qualitative design (Polit and Beck,
2016). During February–March 2017, eight telephone interviews
and one face-to-face interview were conducted. Data were ana-
lysed using qualitative content analysis as described by Graneheim
and Lundman (2004).
Participants and procedure
Participants were included in the study: 1) if they were over 18
years 2) had previously been treated in an ICU for at least 72 hours,
and 3) had read their diary. Participants were selected by a contact
critical care nurse (CCN) at the ICU who is responsible for following
up with previous intensive care patients. She received information
about the aim and method of the study, and then communicated
with those who met the inclusion criteria and asked if they were
interested in participating in the study. Prospective participants
received oral information about the aim of the study and what tak-
ing part in it would entail. They were also informed that they could
change their minds at any time.
Context
The study took place in a general ICU in the northern part of
Sweden. The ICU has six beds and about 15 postoperative beds.
Patients in the ICU are hospitalised for a variety of medical and
surgical diagnoses, including sepsis and trauma.
Data collection
Semi-structured qualitative telephone interviews were con-
ducted by the first two authors (Table 1). To confirm that the
questions addressed the aim of the study, a pilot interview was
conducted. The interview guide was developed with help of pre-
vious studies (Ednell et al., 2017; Engström et al., 2009). The pilot
interview was conducted under the same premises as the other
interviews, except that it was conducted face-to-face. Since the
pilot interview answered the aim and contained useful content,
the authors chose to include this interview in the study. The first
author conducted four interviews and the second author conducted
five interviews, each one taking between 30 and 60 minutes. The
interviews were recorded, after which they were transcribed on
password-protected computers.
Please cite this article in press as: Strandberg, S., et al., The contents of a patient diary and its significance for persons cared for in an
ICU: A qualitative study. Intensive Crit Care Nurs (2017), https://doi.org/10.1016/j.iccn.2017.12.004
Table 1
Interview Guide.
Please tell us what happened. Why were you in the ICU?
How do you feel today? How is your physical condition? Can you tell me about
your mental mood?
Can you tell me if you have any memories of your time in the ICU? Dreams?
Nightmares? (Usually during and after the event)
Can you tell us something you thought about in reality? Can you tell me if
there is something confirmed in your diary?
When did you get your diary?
When was the first time you read it?
How did it feel?
How many pages did you read?
How many times have you read it? When did you read it the most?
How would you describe the contents of your diary? Pictures? Concrete
descriptions of your care, like examinations or operations, etc. or . . .?
Who has written in your diary (CCNs? Other staff? Relatives?)?
Can you describe how it felt like reading it?
Is there anything that you remember or wonder about which the diary helped
you with?
Any content or any pages that were particularly significant?
Any content or pages that concern you emotionally?
Was there anything missing from the content?
Was there anything special that you wanted to have written in it?
Do you feel that the diary made you feel more involved in the care process?
If yes, under what conditions?
How would you like it to be designed to help you more?
Was there anything in the content that you did not want to read?
Have you visited the ICU since you were discharged? Did you go through the
contents of the diary then?
Is there anything more you want to add about the content of your diary that
we haven’t mentioned yet?
Supplementary questions:
Can you tell me more?
Can you clarify?
In what way?
Why do you think you feel so?
Ethical considerations
The University Ethics Committee approved the study (LTU-781-
2017). Informational letters and a written request to carry out the
study were sent to the ICU medical director at a hospital in northern
Sweden. After receiving written approval for the study, participants
were contacted in writing. All participants verified their participa-
tion by filling in and returning a reply to the authors; the reply
slip was included with the information letter. As each interview
began, the authors checked that the participant understood the aim
of the study by going over the information letter. They were also
informed that they could cancel their participation at any time and
that their decisions would not affect their care. The participants
were guaranteed confidentiality in the presentation of the findings.
Data analysis
Demographic data included age and length of ICU stay was
describing using median (Mdn) and range. Qualitative content anal-
ysis was conducted of the interviews following Graneheim and
Lundman (2004) and Graneheim et al. (2017). The analysis was con-
ducted by the authors reading the collected material in its entirety
repeatedly. This created a “feeling” for the collected material. Based
on the aim of the study, “meaning units” were extracted from
the material along with surrounding text to ensure each meaning
unit could provide understandable context. In total, 178 meaning
units consisting of sentences and phrases addressing the aim of
the study were identified. The meaning units were then condensed
to retain the essence of the text without changing or reinterpret-
ing the content. The next step, categorisation, took place in three
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Table 2
Overviews of categories (n = 4) and theme (n = 1) constructed from the analysis of
the interviews.
Category Theme
The diary is written for me Gaining understanding
To create memories from the time of care
Who writes in the diary
To be able to return to the diary
stages. Four categories were identified, which reflected the con-
tent. Based on these categories, the authors identified a theme. The
theme reflected the entirety of the data so the theme can be seen
as a thread running through the findings.
Findings
Participants
All nine people who were contacted agreed to participate in the
study. The study included five women and four men. The ages of
participants varied between 30 and 78 years (M = 55 years). The
participants are residents of different parts of northern Sweden and
were cared for in the same ICU. Three of the participants had also
been cared for in another ICU during the same time of care and one
of the participants had been cared for at the same ICU at an earlier
date. Patient ICU length of stay varied from 11 to 83 days (M = 38
days) and they were cared for in the ICU between autumn 2015 and
autumn 2016. The reasons for the participants being nursed in the
ICU included respiratory failure, sepsis and trauma.
The analysis of the interviews resulted in one theme with four
categories. These are presented in Table 2.
Theme: gaining understanding
After the participants had read their diary they gained under-
standing of what they had previously found difficult to imagine.
This was made possible by the fact that staff and relatives wrote in
the diary. As participants did not remember all their time in ICU,
the diary provided insight into their time in ICU; participants could
also use it in the future to deal with emotions that may arise or to
revisit when their memories began to fade again.
The diary is written for me
The descriptions in the diaries could be how a certain night
had been, whether the participant had slept well or been worried
and whether the participant’s relatives had visited him/her. The
participants found such information important to know, as some
had weak memories of those times. The diary featured nursing
interventions and clinical observations, such as turning the person
away from an ulcer or injury, that the participant was in a special
adjustable bed and that the participant had opened his or her eyes
for the first time.
“Today you opened your eyes for the first time, well something like
that. It was good. (Participant 1)”
“These are the things that I have read there, like they’ve written
that there’s a bed that moves so I won’t have pressure ulcers . . . I
have a feeling there was a bed that was never still. (Participant 7)”
The personal information made them feel well received by the
staff describing everyday nursing situations. This personal infor-
mation made the participants perceive that the diary was written
personally for him or her and that what was written was not
addressed to just anyone.
Please cite this article in press as: Strandberg, S., et al., The contents of a patient diary and its significance for persons cared for in an
ICU: A qualitative study. Intensive Crit Care Nurs (2017), https://doi.org/10.1016/j.iccn.2017.12.004
3
“It feels quite good that they write a diary; in some ways you
feel commitment . . . you can experience when lying there that I
mean that there are many people around and you don’t always
understand what they are doing. (Participant 7)”
The participants did not want the text to be computer-written
instead of handwritten, as the handwritten text felt more personal
and separated the diary from a medical record. The information
described in the diary was about what had happened to the par-
ticipants, the reason why they were in the ICU, and the medical
measures taken. There were descriptions of operations performed
on the participants, of x-rays being taken during the day and what
they showed, and explanations of what test results meant. Par-
ticipants described that it was unpleasant to read about specific
investigations into their bodies, and it was difficult to understand
why they did not remember or had not known about them.
“The only thing I was shocked about was that they had gone down
with a camera in the lungs and looked. It was unpleasant. But it
doesn’t matter. I thought, why didn’t I know anything? (Participant
1)”
Several participants described how they read that they were
connected to the ventilator and how they were weaned off the
ventilator. Participants appreciated this information as it was
complicated and difficult to remember. It was also this type of
information that the participants could return to several times to
confirm that they understood what had happened if they did not
have a medical record to read. The diary was described as very inter-
esting and the participants described that even relatives read this
information and were able to confirm what had happened, recall
how events actually occurred, and how they were shocked when
the participant had become critically ill and needed intensive care.
“Yes, the diary is for . . . what should I say . . . for relatives. When
they come there and visit you. Then they can read what has hap-
pened before and after stuff. It’s a good thing. (Participant 3)”
The information that the participants received from the diaries
helped them to feel more or less involved in their own care, because
they could access information as they read in the diary. Sometimes
words that were difficult to understand, such as medical concepts
and Latin terms, appeared. Some of the participants used Google
when they encountered a hard word that they did not understand.
“It has given me the answer to the exact details of what has
happened. . . That makes me feel involved, that I know what hap-
pened to me. I can read the medical terms in the diary and so on.
It’s not just my parents or relatives explaining that they had given
me some medicine; it actually states there what medicine it was
and what is the reason for that medicine. It makes me feel a part,
absolutely! (Participant 9)”
The majority of the participants had photographs in their diary;
they considered that the pictures were a good addition to what was
written in the diary. The photographs were also considered to be a
positive complement, as they could be shown afterwards to rela-
tives who had not visited them in the ICU. Some of the participants
who had photographs said they made it possible to imagine them-
selves in that environment and how it looked, not just having it all
reported to them.
“I think this is great with photography. To see yourself in that envi-
ronment and so on. How I looked, just for me who has hallucinated
and been in a significantly worse environment. I felt it was nice to
see that I lay and looked calm and I see . . . I’m like stuffed with
pillows. . . I’m comfortable in bed and so on. I think that’s great,
really valuable. (Participant 9)”
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One participant, who was received extracorporeal membrane
oxygenation (ECMO), told that there were pictures of the machine
itself in the diary. Other participants had pictures in the diary that
showed when they sat up for the first time, and seeing such a picture
was part of understanding the progress that had taken place during
the care period. Some wished they had more pictures; they wanted
to see how they looked when they breathed on the ventilator.
“It’s fine . . . you get to see what it looked like, because everyone
thought it looked so terrible when you lay there with all the tubes
and equipment and everything they had; you do not feel it when
you are lying there. There, it is certainly a lot, but you do not see it.
(Participant 5)”
However, participants described it also as unreal to see them-
selves with all the medical equipment connected to them and that
it felt difficult to see themselves in that situation. They admitted
that they barely recognised themselves in the pictures and they
realised how bad the situation was when they saw photographs.
Creating memories from the time of care
Most participants felt that they did not remember much of any-
thing from their time being cared for in the ICU, and that it was
important for them to read in the diary to try to recreate memories
from their time there.
“Because I don’t even remember that . . . I don’t remember the traffic
accident or those days I lay as deeply deep as you can only be. So I
don’t remember it at all and then it was valuable to read about
everything possible. Like . . . that I didn’t breathe, I got a fever,
40 degrees fever and I got an allergic reaction to a medicine . . .
(Participant 6)”
Participants described that it was demanding to read the diary as
everything washed over them again and it made them remember
how hard and difficult everything was. They realised how much
they had struggled in the meantime, and that it was difficult to
keep tears back when they read in the diary.
“Just to read such things when you started to recover, it’s incred-
ibly valuable. While it’s sad to know how bad it actually was, it
feels important to know what happened. Because it is actually life.
(Participant 6)”
However, there were two participants who did not want to
remember the time in the ICU, as they experienced it as a difficult
time in their lives.
“Yes, I think it’s great that I do not remember anything, because
obviously this was a very hard time. (Participant 8)”
On the other hand, one participant who had been awake and
had a relatively good memory of the nursing time thought it was
good to have the diary because it was hard for her to remember
everything she experienced during her time in the ICU. There were
even moments when, as described in the diary, the participants
were perceived as being awake, but they themselves felt they did
not really remember what had happened.
“But just that with the memories, with the help of that diary, I
remember more of the stay in ICU than I actually remember myself.
The days I was there I developed incredibly fast and just getting it
told, it is amazing. (Participant 6)”
The participants expressed great gratitude because they had
received a diary but wished there would be no gaps in their time of
care. Several participants wondered what had happened on those
days that nothing was noted in the diary. Some wondered if the staff
chose not to write some days because they felt that nothing new
had happened, while others believed that the staff had too many
tasks to do and work was too stressful to write down something
every day. They felt an understanding of the staff, but at the same
time, they wanted some memory blanks to be filled, even though
they had relatives who could inform them and had visited them in
the ICU.
“Then, too, I miss it, I said more could have been written . . . some
parts are not all concerning. . .it caused complications with menin-
gitis and there were spots in the lungs and this is not included in
the diary at all. (Participant 7)”
In addition to highlighting the importance of continuity, which
all participants did, the participants felt that the content was good
and did not think any changes to what the diary should contain was
necessary.
Who writes in the diary
It was usually critical care nurses (CCNs) who wrote and this was
appreciated by the participants. They perceived that these people
had the best insight into their everyday life and health condition.
It was appreciated by the participants when the staff wrote their
notes with their names, thus making the notes more personal. They
described that the staff notes contained a feeling that they cared for
them, even on a personal level and participants suggested that also
other staff could write in the diary, for instance the physiothera-
pists. Participants felt that the staff had positive feelings for them
and that the staff felt hopeful even when the patients themselves
were close to giving up.
“And then it is that they had hope for you. You would just like to
pull down the blind, but they’re hoping for you (Participant 4)”
The staff documented how the participants progressed and how
they stabilised. Participants felt very positive to read about the
things they did for the first time and how they became better and
better at performing certain movements. These little moments of
progress were considered valuable to read about in the midst of
everything feeling serious.
“Yes, but just this, you see progress. That they had written it down,
that’s why it wasn’t so hopeless at least. (Participant 4)”
Some of the participants had relatives who wrote in the diary.
The relatives’ notes were greatly appreciated because they were
great emotional support. Reading what the relatives wrote drew
strong feelings and could also be burdensome to read about.
“It felt good to read it; it’s very hard because they have written from
the heart. . . So I see their suffering in the text. . . It’s still hard to
read. It’s not unmanageable but it’s . . . so there were quite a few
tears. (Participant 9)”
Those participants, who did not have notes from close relatives,
considered that the staff’s notes contained emotional commitment
that strengthened them.
The ability to return to the diary
The participants had different routines for when they chose to
read the diary. The moment they read it the first time varied, and
there was also a variation about how many times they chose to read
it. Participants described relatives reading the diary for them when
they were still in the ICU because they could not see well enough to
read it themselves. Other participants described that they wanted
to return to their normal life before they started reading it and chose
to do so when they arrived home from the hospital. It caused such
strong feelings for some of the participants to read the diary that

Please cite this article in press as: Strandberg, S., et al., The contents of a patient diary and its significance for persons cared for in an
ICU: A qualitative study. Intensive Crit Care Nurs (2017), https://doi.org/10.1016/j.iccn.2017.12.004
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it was impossible for them to read the whole diary at once. Some
participants described how they had not read the diary carefully the
first or second time, but that they read it properly the third time
and it was then that they were able to look at the content with other
eyes. It was also described by participants that the most arresting
experience was when they read the diary for the first time and after
that it felt easier to read it.
“The first time I read it was very, very moving. Now, I know, like
what has happened and what I’ve been through. To read about it
now becomes just a rehearsal of what has happened. But it is very
valuable to have it marked. (Participant 6)”
Most participants described that they read the diary many times
after their time in the ICU. Those participants that only read it a
few times still thought it was good and very important. For some
participants, the diary has been a way to effect closure on what has
happened. The participants described that the diary is something
that they can see in the future again and it will serve as an aid to
review the feelings that may possibly rise up again.
“It [the diary] will always come with me, and I think sometimes I
will look in it again. At the moment, it doesn’t feel like I need it as I
and my relatives have now moved on. (Participant 9)”
Discussion
The aim of this study was to describe the contents of a patient
diary and its significance for persons cared for in an ICU. The
findings showed that the diary meant that participants gained an
understanding of their time in the ICU and while they were critically
ill. Participants feeling cared about is consistent with the results
of Storli and Lind (2009), where participants expressed that the
diaries made them feel more important as individuals. According
to Roulin et al. (2007), the staff in an ICU see the diary as a tool for
communicating with the ill person, where they can provide con-
crete information and express the empathy, joy and hope they feel
for the person. Ednell et al. (2017) showed that when CCNs write in
the diary, they focused on what the person is experiencing and what
they think the person would want to read about. Ekman et al. (2011)
view the patient as the central starting point with the diary being
a way of encouraging the staff to pay attention to the person being
cared for in the ICU thereby creating person-centred care. Feeling
that others really care about you confirms the patient as a person
which is essential throughout a person’s life, especially when being
vulnerable as during critical illness. Not being confirmed means not
being seen or taken seriously, which undermines a person’s dignity
(Nåden and Eriksson, 2000).
The information that participants learned through the diary con-
tributed to them feeling more involved in their own care. They
received information that they previously did not perceive or could
not have absorbed during their care time. This type of information
meant that participants knew what had happened and in which
order events took place. According to Eldh et al. (2010), informa-
tion delivered to an ill person in hospital is a prerequisite for feeling
involved.
Our study identified that the staff did not always have time to
write in the diary, yet participants expressed the importance of con-
tinuity. According to Teece and Baker (2017), incomplete diaries
are frustrating for the patients. Ednell et al. (2017) showed that
the first note takes the longest time to write and emphasised the
importance of starting a diary as early as possible. The longer the
time before the first note is written, the more onerous the task will
be. Research illustrates CCNs find it difficult to write a diary and
emphasised the importance for support in writing (Nydahl et al.,
2014; Ednell et al., 2017). Phillips (2011) argues there are both pos-
itive and negative consequences associated with using guidelines
Please cite this article in press as: Strandberg, S., et al., The contents of a patient diary and its significance for persons cared for in an
ICU: A qualitative study. Intensive Crit Care Nurs (2017), https://doi.org/10.1016/j.iccn.2017.12.004
5
for the diary’s design. There is a risk that the guidelines may inhibit
the staff in their writing if they feel guided by what to write and
how it should be written. However, with guidelines continuity is
achieved, which in turn is crucial for the person to be able to create
a memory from his/her time of care.
Patients’ relatives have not been a focus of the diary, however,
some participants revealed that they themselves wanted it to be
available to them. According to Engström (2008), close relatives
of a severely ill person in the ICU find the situation very stressful
and difficult to bear. She describes the close relatives as having a
great need to be close to the ill person. Johansson et al. (2015) show
that relatives writing in the diary can create a feeling of together-
ness by using the opportunity to communicate with the critically
ill person. According to Jones et al. (2012) contacting and commu-
nicating with the ill person via the patient diary, reduces the risk
of post-traumatic stress, anxiety and depression. The diary acts as
a good support for the relatives too as it helps them understand
and handle strong emotions (Garrouste-Orgeas et al., 2014; Ewens
et al., 2014; Jones et al., 2012). The notes of the staff are important
to the close relatives and are perceived to be easier to understand
than oral information, which often contains medical concepts that
are difficult to understand.
Limitations
In this study, most interviews were done over the phone. There
has been some criticism about not meeting the participants face-
to-face, but telephone interviews have been shown to have several
benefits. It might be easier to narrate one’s experiences when not
seeing the other party, focusing solely on the voice (Ward et al.,
2015). Using a purposive sample, including those who had received
and read their diary, was done to answer the aim of the study, but
we also know that there are people who do not want to remem-
ber their stay in the ICU (Engström et al., 2013; Teece and Baker,
2017); for some relatives, diary writing may have negative effects
(Johansson et al., 2015). The lack of evidence for the effect of this
intervention may also open this study to criticism (Aitken et al.,
2017). However, this study has answered the questions of what
should be in the ICU diary and who should write in it.
Conclusion
It appears that what formerly critically ill patients appreciate
most about the diary is that the diary is personally written for them,
which makes him/her feel valued as a person. Furthermore, it is
important for the diary reader to be given the opportunity to under-
stand what has happened, and also follow their progress. Having
notes from both relatives and staff complement each other. What
the staff write contain more general information, while what rela-
tives write is on a more emotional level. Although the diaries create
strong emotions when it is read, there was nothing in the diary that
the participants thought was inappropriate to read about. Possibil-
ities for improvement do exist, such as maintaining continuity in
the diary. Guidelines for how and when a diary should be written
and used would likely encourage CCNs and relatives to write in it.
These measures will then benefit the patients who have been cared
for in the ICU and their relatives who supported them through their
ICU stay and discharge home.
Funding source
Department of Health Science, Luleå University of Technology,
supported this study.
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6 S. Strandberg et al. / Intensive and Critical Care Nursing xxx (2017) xxx–xxx
Conflicts of interest
The authors declare there is no conflict of interest.
Author contribution
Design: LV, SS, ÅE, data collection: SS, LV, data analysis: SS, LV,
ÅE, manuscript preparation: ÅE, LV, SS, revising the manuscript:
ÅE, LV, SS.
Ethical considerations
The University Ethics Committee approved the study (LTU-781-
2017). Informational letters and a written request to carry out the
study were sent to the ICU medical director at a hospital in northern
Sweden. After receiving written approval for the study, participants
were contacted. The people who were asked to participate were
given verbal and written information about the study and those
interested in participating signed a written request for informed
consent. They were also informed that they could cancel their par-
ticipation at any time and that their decisions would not affect
their care. The participants were guaranteed confidentiality in the
presentation of the findings.
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