Abstract: Aims and objectives: The study aim was to explore the use of an Intensive Care Unit (ICU) diary within four differentICUs units in Sweden and thereby contribute to practice guidelines regarding the structure,content and use of an ICU diary.

Background: ICU diaries are used to aid psychological recovery among critical care patients, but differencesremain in diary writing both within and across countries. Few studies have focused onthe combined views and experiences of ICU patients, family members and nursing staffabout the use of ICU diaries.

Design: An instrumental multiple case study design was employed.

Methods: Three focus groups interviews were carried out with 8 former patients and their family members(n = 5) from the research settings. Individual interviews were carried out with 2 patients,a family member and a nurse respectively. Observations, field notes, documentary analysisand conversations with nursing staff were also conducted. Consolidated criteria for reportingqualitative research (COREQ) was followed.

Results: The qualitative findings firstly consisted of a matrix and descriptive text of the four ICU contextsand current practices. This highlighted that there were similarities regarding the aimsand objectives of the diaries. However, differences existed across the case study sitesabout how the ICU diary was developed and implemented. Namely, the use of photographsand when to commence a diary. Second, a thematic analysis of the qualitative data regardingpatients’ and family members’ use of the ICU diary, resulted in four themes: i) the diary was used to take in and fully understand the situation;ii) the diary was an opportunity to assimilate warm, personalised and human care; iii) the diary was used to manage existential issues; and iv) the diary was a tool in daily activities.

Conclusions: Analysis of the instrumental case study data led to the identification of core areas for inclusionin ICU diary practice guidelines.