The participants in this study were twelve COVID-19 survivors, including 9 men and 3 women aged 19 to 59 years with a history of admission to the ICU. Table 2 shows the participants’ demographic characteristics.

Table 2 The participants’ demographic characteristics

A total of 250 initial conceptual codes were extracted from the data and eventually, three main themes emerged: (1) better resources and facilities, (2) unpleasant physical and psychological experiences, and (3) suffering relievers (Table 3).

Table 3 Extracted Sub-themes and themes from data analysisBetter resources and facilities

Since most of the patients had been admitted to the acute respiratory unit before being admitted to the ICU, they stated that the conditions and facilities of the ICU were much better than those of the acute respiratory units.

Expert and supportive team work

Most of the participants stated that the healthcare and medical staff, especially ICU nurses and doctors, were professional, kind, dedicated, supportive, and accessible people who provided comprehensive support to their patients. They stated that the healthcare staff performed their duties beyond the patients’ expectations. This was contrary to their experience in normal respiratory units, where due to the lack of personnel, the healthcare staff and personnel were not able to provide comprehensive care and support. Accordingly, one of the patients who had fought in the Iran-Iraq war said, “I have been in the war. I saw the ICU personnel like soldiers of the war. Being in the ICU reminded me of the fire of battle. I saw they (the healthcare staff) gave their lives to save the patient’s life” (Participant #5).

More equipment and supplies

The participants reported that the ICU had more and better facilities, medicines, and equipment than did the respiratory units, the waiting time for receiving care was lessened, and the central oxygen supply made them feel more relaxed. One of the patients (Participant #8) stated, “In the ICU, there was a central oxygen supply that had good pressure. This was very good, while in the respiratory unit, I was always worried about running out of oxygen capsules, and they had to a spare one next to me so that I could feel at ease”.

Unpleasant physical and mental experiences

This theme refers to the physical and mental problems experienced by patients in the ICU.

The severity of physical symptoms

Most of the patients stated that they suffered from severe physical symptoms such as severe cough, severe shortness of breath, chest pain, fever and chills, the feeling of suffocation, and severe physical weakness. One of the patients said, “I took the doctor’s hand and said, kill me in any way you can because I can’t bear this pain anymore” (Participant #3).

Ambivalent feelings

The participants in this study stated that they had conflicting emotions that they had not experienced before being admitted to the ICU. Feelings such as swinging between hoping to survive and despair, wishing for survival and accepting death as a part of life, feeling happy about the emptying of the ICU bed and getting admitted due to the death of a patient, and remorse for being happy about the death of another person, feeling sad about the death of a patient with happiness that the patient died but you are still alive, and the desire to receive information about the severity and progress of one’s illness and the fear of receiving this information. Most of the participants stated that getting along with these emotional fluctuations and conflicting feelings was difficult. One of the female patients stated, “I used to be happy that another person died and I was alive, and then I was feeling guilty that I was happy about the death of another person” (Participant #1).

The unpleasant atmosphere of the ICU

All participants reported that they had unpleasant experiences related to the conditions of the ICU. They stated that things such as loud noise, frequent blood draws, restrictions on visiting relatives and feelings of loneliness, impaired perception of time, observation of critically ill patients, and death were the most unpleasant experiences for them. One of the participants said “My roommates were sick and were in a bad mood. They kept talking about the high probability of their death, this along with seeing the dead body being taken out of the ward, scared me” (participant #7). “There were a lot of noise in the ICU that did not let me sleep well” (participant # 11).

Fear, anxiety, and worry

The most important cause of fear and worry in patients was the incipient risk of death because the patients experienced severe physical symptoms (such as shortness of breath, weakness, and lethargy). On the other hand, they frequently noticed other patients becoming sick and dying, which caused them to worry and experience anxiety. They often stated that they were afraid of being the next patient to die. One of the female patients said, “When I saw seven or eight doctors and nurses attending the bed of a sick patient, but they did not succeed in keeping her alive, I had a terrible feeling, and I was afraid that I would be the next one (to die)” (Participant #1).

The participants also stated that they were afraid of COVID-19 as a newly emerged disease, its duration, long-term and short-term complications, and treatment is unknown. One of the patients said, “I was worried because it was a new viral disease that even doctors did not know how to treat” (Participant #6).

Some participants also stated that they were afraid and anxious due to exposure to complex equipment and devices. Another factor that made all the participants worried was family concerns. Missing, worrying about the future (welfare, mental and economic conditions) of the family members in case of the patient’s death, and worrying about the health of other family members infected with COVID-19 were among the main concerns experienced by the patients in the ICU. One of the patients said, “I was worried about my husband and child that they would be alone after my death, even in that situation I was looking for a suitable partner for my husband who would be kind and treat them well after my death” (Participant #1).

Suffering relievers

Most of the patients were not defenseless in the face of worry, fear, and anxiety, but some factors reduced their mental pain and suffering:

Coping strategies

The patients reported that they used different strategies to address the stress experienced in the ICU, the most frequent of which were diversion of thoughts in different ways (such as video calls with family members, limited activity, exercise in the bed, repeating positive and hopeful words and sentences, and focusing on the here and now) and resorting to spirituality and God. One of the male patients (Participant #4) said, “I left everything to God, there (in the ICU) no one could help except the divine power”. A female patient said, “I was trying to bring peace to myself by mentally reconstructing the conditions at home” (Participant #1).

Professional and family support

Support, encouragement, and reassurance from the healthcare staff, admiration of the smallest improvement by the healthcare staff, and effective and supportive communication were among the factors that provided comfort to patients in stressful situations. In addition, the physical and virtual, practical, and emotional support of family members, especially meeting with close relatives and family members, was a positive experience for patients and helped them cope with the stressful conditions of the ICU. One of the male patients (Participant #10) said, “The pandemic conditions did not allow anyone to see me, but all my relatives talked to me through video calls. This gave me a lot of morale.”

In short, the availability of experienced and supportive staff in the RICU along with facilities and equipment in this ward made the participants feel that they were admitted in a high professional ward. At the same time, due to the severity of the physical symptoms and experience of conflicting and ambivalence feelings and the unpleasant atmosphere in the RIC, and fear, anxiety and worrying they were experiencing unpleasant physical and mental feelings, but using some coping strategies and family support along with the staff support relieved their physical and mental pain and suffering.