Bearing witness and being bounded: The experiences of nurses in adult critical care in relation to the survivorship needs of patients and families.

Abstract

To discern and understand the responses of nurses to the survivorship needs of patients and family members in adult critical care units. The critical care environment is a demanding place of work which may limit nurses to immediacy of care, such as the proximity to death and the pressure of work. A constructivist grounded theory approach with constant comparative analysis. As part of a wider study and following ethical approval, eleven critical care nurses working within a general adult critical care unit were interviewed with respect to their experiences in meeting the psychosocial needs of patients and family members. Through the process of constant comparative analysis, an overarching selective code was constructed. EQUATOR guidelines for qualitative research (COREQ) were applied. The data illuminated a path of developing expertise permitting integration of physical, psychological and family care with technology and humanity. Gaining such proficiency is demanding, and the data presented reveal the challenges that nurses experience along the way. The study confirms that working within a critical care environment is an emotionally charged challenge and may incur an emotional cost. Nurses can find themselves bounded by the walls of the critical care unit and experience personal and professional conflicts in their role. Nurses bear witness to the early stages of the survivorship trajectory but are limited in their support of ongoing needs. Critical care nurses can experience personal and professional conflicts when caring for both patients and families. This can lead to moral distress and may contribute to compassion fatigue. Critical care nurses appear bounded to the delivery of physiological and technical care, in the moment, as demanded by the patient's acuity. Consequentially, this limits nurses' ability to support the onward survivorship trajectory. Increased pressure and demands on critical care beds have contributed further to occupational stress in this care setting.