Maintaining emotional wellbeing in the intensive care unit: A grounded theory study from the perspective of experienced nurses

Abstract

This Grounded Theory study developed a substantive theory to explore and explain the experienced nurse’s perspective of maintaining emotional wellbeing in the Intensive Care Unit (ICU). Data were collected by recorded interviews of 15 experienced ICU registered nurses from an ICU of a metropolitan hospital in Perth, Western Australia. Emotional wellbeing was described by the participants as feelings of satisfaction and happiness, derived from the delivery of best care to patients and their families. This formed the context of the study. The core problem shared by ICU nurses was the Inability to Protect Self from Distress. Distress was described as feelings of grief, sadness, frustration and anger in response to caring for patients who were critically ill, and their families.Conditions were also identified that impacted the nurse's ability to protect self from distress: Best care; Autonomy; Teamwork; and Previous nursing and life experience. The Basic Social and Psychological Process used by nurses to protect themselves from distress, and therefore maintain their emotional wellbeing was called Protecting Self from Distress. The process was described under three phases: Delivering best care, Validating care episodes, and Distancing self from distress. The process described how nurses protected self from distress, including strategies to overcome or promote the conditions that impacted nurse wellbeing. Nurses maintain their emotional wellbeing through the delivery of best care. Best care referred to giving the best care possible given the nature of critical illness and limitations of critical care.Understanding the conditions that impacted nurse wellbeing provides valuable insight into factors that help or hinder the delivery of best care. The substantive theory outlined processes that enabled nurses to maintain their emotional wellbeing and succeed in providing best care to patients and families in the ICU. Minimising threats to the delivery of best care will promote nurse satisfaction, happiness, enhance wellbeing and may contribute to higher retention rates. The satisfaction and happiness enjoyed by nurses was found to be the reason the group in this study remained nursing in ICU.