The emotion: A crucial component in the care of critically ill patients

Abstract

Background:

The acquisition of experience is a major concern for nurses in intensive care units. Although the emotional component of the clinical practice of these nurses has been widely studied, greater examination is required to determine how this component influences their learning and practical experience.

Objective:

To discover the relationships between emotion, memory and learning and the impacts on nursing clinical practice.

Research design:

This is a qualitative phenomenological study. The data were collected from open, in-depth interviews. A total of 22 intensive care unit nurses participated in this research between January 2012 and December 2014.

Ethical considerations:

The School of Nursing Ethics Committee approved the study, which complied with ethical principles and required informed consent.

Findings:

We found a clear relationship between emotion, memory and the acquisition of experience. This relationship grouped three dimensions: (1) satisfaction, to relieve the patient’s pain or discomfort, give confidence and a sense of security to the patient, enable the presence of family members into the intensive care unit and provide family members with a realistic view of the patient’s situation; (2) error experience, which nurses feel when a patient dies, when they fail to accompany a patient in his or her decision to abandon the struggle to live or when they fail to lend support to the patient’s family; and (3) the feel bad–feel good paradox, which occurs when a mistake in the patient’s care or handling of his or her family is repaired.

Conclusion:

Emotion is a capacity that impacts on nurses’ experience and influences improvements in clinical practice. Recalling stories of satisfaction helps to reinforce good practice, while recalling stories of errors helps to identify difficulties in the profession and recognise new forms of action. The articulation of emotional competencies may support the development of nursing ethics in the intensive care unit to protect and defend their patients and improve their relationships with families in order to maximise the potential for patient care.

Keywords

Critical care emotion ethics education learning and emotion moral distress narratives nursing

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References

Bunkers

. What stories and fables can teach us? Nurs Sci Quart 2006; 19(2): 104–107.

Holloway

Freshwater

. Narrative research in nursing, in narrative research in nursing. Oxford: Blackwell Publishing Ltd, 2007.

Lai

CKY

. Narrative and narrative enquiry in health and social sciences. Nurse Res 2010; 17(3): 72–84.

Rejnö

Berg

Danielson

. The narrative structure as a way to gain insight into peoples’ experiences: one methodological approach. Scand J Caring Sci 2014; 28(3): 618–626.

Acebedo-Urdiales

Medina-Noya

Ferré-Grau

. Practical knowledge of experienced nurses in critical care: a qualitative study of their narratives. BMC Med Educ 2014; 14: 173

Polkinghorne

. Narrative knowing and the human sciences. Albany, NY: State University of New York Press, 1988.

Ricoeur

. Time and narrative, vol. I. Chicago, IL: University of Chicago Press, 1990.

Bruner

. Actos de significado [Acts of meaning]. Más allá de la revolución cognitiva. Madrid: Alianza editorial, 2006.

Dirkx

. The meaning and role of emotions in adult learning. New Dir Adult Cont Educ 2008; 2008(120): 7–18.

10.

McGaugh

. Memory and emotion: the making of lasting memories. New York: Columbia University Press, 2003.

11.

Damasio

. The feeling of what happens, body and emotion in the making consciousness. New York: Harcourt & Brace Co, 1999.

12.

Nussbaum

. Upheavals of thought: the intelligence of emotions. New York: Cambridge University Press, 2003.

13.

Toulmin

. Return of reason. London: Harvard University Press, 2001.

14.

Benner

. The roles of embodiment, emotion and life world for rationality and agency in nursing practice. Nurs Philos 2000; 1(1): 5–19.

15.

Benner

Tanner

Chesla

. Expertise in nursing practice caring, clinical judgment, and ethics. New York: Springer, 1996.

16.

Haidt

. Elevation and the positive psychology of morality. In: Keyes

Haidt

(eds) Positive psychology and the life well-lived. Washington, DC: Flourishing, 2003, pp. 275–289.

17.

Kroll

Egan

. Psychiatry, moral worry, and the moral emotions. J Psychiatr Pract 2004; 10(6): 352–360.

18.

Tangney

Stuewig

Mashek

. Moral emotions and moral behavior. Annu Rev Psychol 2007; 58: 345–372.

19.

Haidt

. The moral emotions. In: Scherer

Davidson

Goldsmith

(eds) Handbook of affective sciences. Oxford: Oxford University Press, 2003, pp. 852–870.

20.

Henderson

: Emotional labor and nursing: an under-appreciated aspect of caring work. Nurs Inq 2001; 8(2): 130–138.

21.

McQueen

ACH

. Emotional intelligence in nursing work. J Adv Nurs 2004; 47(1): 101–108.

22.

Huynh

Alderson

Thompson

. Emotional labour underlying caring: an evolutionary concept analysis. J Adv Nurs 2008; 64(2): 195–208.

23.

O’Connell

. Therapeutic relationships in critical care nursing: a reflection on practice. Nurs Crit Care 2008; 13(3): 138–143.

24.

De Boer

Van Rikxoort

Bakker

. Critical incidents among intensive care unit nurses and their need for support: explorative interviews. Nurs Crit Care 2014; 19(4): 166–174.

25.

Hammonds

Cadge

. Strategies of emotion management: not just on, but off the job. Nurs Inq 2014; 21(2): 162–170.

26.

Lange

. El Libro de las emociones: siento. luego existo. Madrid: Edaf, 2004.

27.

Benner

Gordon

. Caring practice. In: Gordon

Benner

Noddings

(eds) Caregiving: reading in knowledge, practice, ethics, and politics. Philadelphia, PA: University of Pennsylvania, 1996, pp. 40–55.

28.

Losa

Becerro de Bengoa

. Prevalence and relationship between burnout, job satisfaction, stress, and clinical manifestations in Spanish critical care nurses. Dimens Crit Care Nurs 2013; 32(3): 130–137.

29.

Rushton

Batcheller

Schroeder

. Burnout and resilience among nurses practicing in high-intensity settings. Am J Crit Care 2015; 24(5): 412–420.

30.

Wiegand

Funk

. Consequences of clinical situations that cause critical care nurses to experience moral distress. Nurs Ethics 2012; 19(4): 479–487.

31.

Benner

Hooper-Kyriakidis

Stannard

. Clinical wisdom and interventions in critical care, a thinking-in-action approach. Philadelphia, PA: W.B. Saunders, 1999.

32.

Averill

. Un enfoque constructivista de la emoción [A constructivist view of emotion]. In: Mayor

(ed.) Psicología de la emoción [Emotion: Theory, research and experience: Vol. I. Theories of emotion]. Valencia: Promolibro, 1988, pp. 193–238.

33.

Denzin

. On understanding emotion. San Francisco, CA: Jossey-Bass, 1984.

34.

Benner

. From novice to expert: excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley Publishing, 1984.

35.

Gadamer

. Truth and method. 2nd ed. London: Stag Books, 1989.

36.

Benner

. The role of narrative, experience, and community in expert ethical comportment. Adv Nurs Sci 1991; 14(2): 1–21.

37.

Giorgi

. Phenomenology. In: Smith

(ed.) Qualitative psychology. London: Sage, 2003, pp. 25–50.

38.

Connelly

Clandinin

Larrosa

. Relatos de Experiencia e Investigación Narrativa.Déjame que te cuente. Ensayos sobre narrativa y educación [Narrative inquiry. Experiencie and story in qualitative research]. Barcelona: Laertes, 1995, pp. 15–59.

39.

Vetlesen

. Perception, empathy, and judgment: an inquiry into the preconditions of moral performance. Philadelphia, PA: Penn State University Press, 1994.

40.

Wong

FKY

Lee

. A phenomenological study of early nursing experiences in Hong Kong. J Adv Nurs 2000; 31(6): 1509–1517.

41.

Morse

Anderson

Bottorff

. Exploring empathy: a conceptual fit for nursing practice image? J Nurs Scholarship 1992; 24(4): 273–280.

42.

Kunyk

Olson

. Clarification of conceptualizations of empathy. J Adv Nurs 2001; 35(3): 317–325.

43.

Watson

. Nursing: human science and human care: a theory of nursing. Sudbury, MA: Jones and Bartlett, 1999.

44.

La Monica

. Construct validity of an empathy instrument. Res Nurs Health 1981; 4(4): 389–400.

45.

Sánchez-López

Díaz-Agea

. La atención a los familiares en el contexto de las emergencias: una asignatura pendiente [The attention to the family in the contest of the emergence: A pending subject]. Evidentia 2013; 10(44): 44–48.

46.

Zaforteza

. Elementos facilitadores y limitadores del cambio en la atención a los familiares del paciente crítico [Limiting and facilitating factors of changes in the care of families of the critically ill patient]. Enfermería Intensiva 2012; 23(3): 121–131.

47.

Freitas

Menezes

Mussi

. Conforto na perspectiva de familiares de pessoas internadas em Unidade de Terapia Intensiva [Comfort from the perspective of families of people hospitalized in the Intensive Care Unit]. Texto Contexto Enferm 2012; 21(4): 896–904.

48.

Nussbaum

. Women and human development: the capabilities approach. Cambridge: Cambridge University Press, 2000.

49.

Fields

Hojat

Gonnella

. Comparisons of nurses and physicians on an operational measure of empathy. Eval Health Prof 2004; 27(1): 80–94.

50.

Figley

. Treating compassion fatigue. New York: Brunner-Routledge Publishers, 2002.

51.

Sabo

. Compassion fatigue and nursing work: can we accurately capture the consequences of caring work? Int J Nurs Pract 2006; 12(3): 136–142.