Writing a Diary for “You” —Intensive care nurses' narrative practices in diaries for patients: A qualitative study

Background: Diaries written by nurses for critically ill patients have been implemented in some intensive care units as an intervention to construct patients' “lost time” and fill in their gaps in memory. Studies have shown that diaries have an impact on patients' psychological recovery after intensive care. However, little is known about how nurses view and carry out the process of writing a diary on behalf of a patient. Objective: To investigate the choices nurses make in content and language, the rationale by which they make them, and how these narrative aspects shape the story of critical care that is constructed in the diary. Design: The study was conducted using a qualitative approach informed by narrative methodology. Setting: Three intensive care units at a university hospital in Denmark. Participants: Nine nurses with experience in diary writing. Each of the participants handed in five anonymized diary notes written for different patients they had cared for. Methods: The study combined textual analysis of the diary notes and a thematic analysis of individual interviews with nurses about their narrative choices when writing the diary. Findings: Three prominent strategies that characterize nurses' choices of content and language were identified: 1) Making the situation of intensive care more manageable, 2) Showing acts of perceiving the patient, and 3) Constituting relations through actions and interactions. The study showed that on one hand these strategies engage the patient and depict nurses' care, empathy and support, yet on the other, reveal the nurses' power to interpret, passivize and downplay the patient's experiences. Conclusion: It was demonstrated that although the diary narrative is written about and for the patient, who is referred to and addressed as you, the nurse's interpretations, evaluations, perceptions, and actions figure prominently throughout the diary. Narrating for a you to some degree relegates the patients to a secondary position in their own diary. With the power to control the diary narrative, nurses' linguistic choices may either narrow down or expand possibilities for the patient's own understanding when reading the diary after intensive care. Permission to produce and store all data was obtained from the Danish Data Protection Agency (no. 18/60944).