Abstract
Male intensive care unit (ICU) nurses bring energy and expertise along with an array of beliefs and practices to their workplace. This article investigates the experiences of male ICU nurses in the context of caring for dying patients and their families. Applying a gender analysis, distilled are insights to how masculinities inform and influence the participants’ practices and coping strategies. The findings reveal participants draw on masculine ideals of being a protector and rational in their decisive actions toward meeting the comfort needs of dying patients and their families. Somewhat paradoxically, most participants also transgressed masculine norms by outwardly expressing their feelings and talking about emotions related to these experiences. Participants also reported renewed appreciation of their life and their families and many men chronicled recreational activities and social connectedness as strategies for coping with workplace induced stresses. The findings drawn from this study can guide both formal and informal support services for men who are ICU nurses, which in turn might aid retention of this subgroup of workers.
Critically ill patients are cared for in the intensive care unit (ICU), and the primary ICU treatment goal is to stabilize and restore patients to their prior state of health (Espinosa, Young, Symes, Haile, & Walsh, 2010). However, 15% to 35% of the patients who are admitted to the ICU die during intensive therapy (Seymour, 2000), and the majority of ICU deaths involve withholding or withdrawing life-sustaining treatments (Espinosa et al., 2010). With patient deaths regularly occurring in ICU, nurses can be challenged to care for dying patients and their families. McMillen (2008) confirmed that adjusting the focus from providing active resuscitation to withdrawal of active treatment is demanding for nurses who have to reset their care goals accordingly. ICU nurses who deliver terminal care can also experience stress, moral distress, death anxiety, and suffering (Espinosa et al., 2010; Poncet et al., 2007), which in turn can lead to emotional exhaustion, depersonalization, decreased enthusiasm for the job, decreased job performance, and burnout (Young, Derr, Cicchillo, & Bressler, 2011). All these factors can directly affect the quality of patient care, safety, and ultimately their health outcomes.
Masculinities and Male ICU Nurses
Connell’s (1995) masculinities framework has been adapted by researchers to describe a plurality of gender performances that are taken up by male nurses. According to Oliffe and Han (2014), two principles underpin much of this social constructionist approaches to gender work: (a) patriarchal power and characteristics including hegemonic masculine ideals of self-reliance and competitiveness, influence men’s practices and experiences; and (b) a plurality of context-dependent masculine roles, relations and identities emerge to align, reconfigure or disrupt those hegemonic ideals of masculinity. Within the context of paid work, men tend to have their own unique approach to coping with workplace stress. For example, men can handle stress by spending time with their friends and families; outwardly exhibiting positive, carefree, and cheerful attitudes about life, thus allowing them to optimize their ability to enjoy life (Hollnagel, Malterud, & Witt, 2000). Some men suggest that job satisfaction enables them to “feel strong” and that work pressure can drive them to perform in their jobs, even when they are unwell (Hollnagel et al., 2000). Emslie, Hunt, and O’Brien (2004) asked whether men “live to work” or “work to live,” and suggested that masculine ideals celebrate and revere “real” men as embodying a “live to work” ethic. Similarly, according to Oliffe et al. (2013), men’s societal and self-worth is often indirectly measured by their performance, ability, and accomplishments in their workplace.
Though the profession of nursing attracts relatively few men, an emergent literature has drawn connections between masculinities and male nurses. Traditionally, male nurses have been perceived as physically powerful, which situates them as having the strength to protect others (Evans, 2004). Male nurses are expected to fight in defense of their patients and female colleagues, which, according to Evans (2004), promotes the image of male nurses as neither gentle nor caring. These performances can affirm the masculine identity of male nurses, distancing them from the feminine image of nursing (Evans, 2004). Matthews (2001) reported that when asked to describe the care they provide, male nurses tended to focus on technical aspects, including taking blood pressure and dispensing medications. Similarly, Evans (2004) pointed out that male nurses gravitated toward managerial positions (positions of power) and areas of high technology as a way of maintaining their masculinity. Within acute care practice, many male nurses work in ICUs and emergency departments, and this high adrenaline clinical work, though challenging, demands autonomy and can garner respect from others (Schoonover-Shoffner, 2006). Though the masculinities and work literature has included male nurses, the nuances and somewhat unique nature of ICU nursing has garnered little research attention, particularly in relation to the care of dying patients. The goal of this study was to describe the connections between masculinities and male ICU nurses’ experiences of caring for dying patients and their families.
Method
Guided by interpretive descriptive methods, an approach used to extend understandings of practical importance to the applied disciplines (Thorne, 2008), a clinical phenomenon was explored—male ICU nurses’ experiences of caring for dying patients and their families.
Data Collection
Following university and health authority research ethics approval, recruitment was initiated in consultation with two British Columbian ICUs at urban acute care hospitals. Posters advertising the study were placed on notice boards in the ICUs, and within a few weeks, three potential participants volunteered to complete an individual semistructured interview focused on understanding their experiences of caring for dying patients and their families. Snowball, convenience sampling, wherein participants refereed other male ICU nurses to the study, was used by the first author (TW) to bolster recruitment. The location of the interview was chosen by the participant, and interviews were held at hospital family meeting rooms, restaurants, cafeterias, and in participants’ homes. All interviews were conducted by the first author.
At the beginning of each interview, the purpose of the study, processes for protecting participant confidentiality, data collection methods, audio-recording methods, and data storage details were explained, and signed consent and participant demographic data were collected (Table 1). After each interview, field notes and reflective memos were written to aid recall and reflection about what was observed during the interviews, including details about what participants wore and their posture and body language. Because participation had the potential for psychological harm (e.g., distress, discomfort), written information about the availability of workplace counseling services were provided to each participant prior to the interview. To promote confidentiality, participant pseudonyms were assigned by the research team, and these names are linked to the men’s excerpts illustrating key thematic findings.
Participant Characteristics.
Participants
A total of 15 male nurses currently working full-time or part-time in an ICU and who had cared for dying patients in the ICU participated in the study. Participants ranged in age from 28 to 48 years and had worked in the ICU for 2 months to 16 years (M = 8 years; Table 1).
Data Analysis
The interview data were transcribed verbatim and checked for accuracy against the audio-recordings. The transcribed interview data were reviewed line-by-line, examining similarities and differences while developing tentative codes for organizing and allocating segments of the data (Holloway & Wheeler, 2010). After reviewing the coded data several times, inductively derived themes and subthemes began to emerge through a process of comparing the coded data within and across participant interviews. Memos were used to jot down key elements, inquiries, reflections, and analysis to help further develop interpretations and descriptions of the data. In returning to the full interviews, illustrative quotes were color coded, and allocated to themes and subthemes. The interviewer and first author (TW) was a female ICU nurse, and her own perspectives, experiences, and recollections about caring for dying patients may have influenced the interpretation and analyses of the data; thus, to minimize potential biases, reflexive strategies including keeping a written journal and memos to reflect on potential biases, actions, feelings, and conflicts were used. In addition, the three coauthors, all of whom have ICU nursing experience, contributed to the data analyses and helped build consensus about the predominant findings. In this regard the results and decisions regarding the illustrative quotes used in this article were achieved through discussions among the authors (three females and a male), all of whom had contributed to data analysis. Trustworthiness in qualitative studies is shaped by credibility and dependability (Lincoln & Guba, 2000) and refers to the extent to which findings reflect the meanings and experiences described by participants (Lietz, Langer, & Furman, 2006). The current study included an audit trail to chronicle the analytic decisions, consensus about the findings was reached through discussion among the authors, and the preliminary findings were shared with participants to ensure the credibility of the results.
To theorize the findings, Connell’s (2005) masculinities framework along with relevant existing empirical literature were reviewed and integrated to conceptually advance the analyses. The thematic findings—(a) ensuring a dignified death, (b) changing the focus from patient to family, and (c) being emotionally attached, though interconnected—are presented separately in what follows.
Results
Ensuring a Dignified Death
In caring for dying patients, the primary goal of most participants was to ensure they were free of pain and anxiety. Participants also believed that dying patients should have some control over how and with whom they spent their remaining time. When asked about providing comfort for dying patients, most participants stated that ensuring a dignified death, such as respecting a patient’s wishes and ensuring their comfort were crucial. As Philip asserted, “no pain and no fear” were primary goals in end-of-life patient care:
There’s only two things that I need to worry about if I go to a dying patient; one of them is that he’s not in pain, and the other one is that they’re not scared. . . . That’s my job.
Evident in Philip’s and many other participants’ interviews were compassion amid rational forthright approaches to managing the dying patient’s pain and anxiety. Though these efforts could follow pre-printed, standing analgesia and sedation orders most participants included additional measures. Institutional routines and some regulations were worked around where possible, which participants explained emerged from purposefully letting patients decide what might aid them best, both physically and emotionally. Luke asserted that it was a personal time during which patients and their families decided how they wanted to spend their final moments together:
In the occasion when you look after a patient who’s interactive, then you kind of want to ask him, “Well, what do you want to do? Well, this is all about you, this is your time.” Um, you know, he would make the decision of how comfortable he wants to be. [Some patients] . . . have zero tolerance of any discomfort, just you know, go and focus on the physical component of it, but other patients might just want to hang out with the family longer, and then maybe, some degree of physical discomfort is tolerable. . . . So it’s really what the patient wants and then if the patient is not interactive at all then it will be, basically the physical component of comfort.
Comfort care focused on how patients wanted to spend their final moments in meaningful ways. Often, patients had to choose between physical suffering and quality time with their family. In this regard, while participants focused on patient’s comfort, they also sought to empower patients to have some control over what might most ably soothe them.
When asked about analgesia and sedative infusion protocols, most participants believed that the medications quickened the dying process, though their own comfort levels were diverse about administering those drugs. Many participants agreed that these pharmacological strategies were the appropriate comfort measures, as Jacob explained:
It’s for comfort and it’s also to expedite the process. It’s also, um, it’s the reality of life, you know, death is not, we are very far removed from the natural way of death. I mean, a hundred years ago, death was not this sanitized process. It takes people days to die, weeks sometimes, and people died slow, agonizing deaths in their bed, in their house or wherever they were. . . . We don’t allow that to happen here because we don’t have to. So, the drugs are comfort. You know, between us and as any nurse knows, and doctors know, they expedite the process. It takes something that would take two weeks and gets it done in 12 hours. That’s really what it does. Um, and I guess it’s ultimately, and I mean, I don’t have an issue in that at all because I would want that done for myself or for anyone I loved. You know, it’s the most humane thing.
Evident were assertions that the health care team had some control over the dying process and medications in this regard were understood as a key component of being able to ensure patient comfort and a peaceful death. Distancing, objectifying, means-to-an-ends, and rational in the intent and desired effect, participants adapted a strength based approach to ensuring a comfortable and dignified death.
Changing the Focus From Patient to Family
Within the process of providing care to dying patients, participants explained that oftentimes the family was a significant consideration. Family members exhibited an array of emotions including sadness, anger, regret, guilt, and uncertainty, and supporting the family through care plans that were transitioning toward palliative measures was especially challenging. Henry explained,
You have to shift your focus somewhat, you’re still doing all your basic requirements at the bedside, but your focus may shift more from the actual patient on the bed which you are still maintaining, but to that of sensitivity and encompassing the whole healthcare team, in dealing with the family, and how best to make the experience okay for them.
Within this transition participants juggled patient care and the family’s needs. In terms of masculine ideals, men are typically depicted as less able and less likely to provide emotional support to others (Robinson, Bottorff, Pesut, Oliffe, & Tomlinson, 2014). However, within the context of caring for the family of a dying patient, most participants suggested that fulfilling the family’s emotional needs took precedent, to such an extent that the institutional rules or policies of the ICU might not be strictly followed. Philip explained that providing holistic care for both the patient and the family “trumped” unit policy; in sharing two poignant and powerful stories:
She [wife of a patient] didn’t sleep at her hotel so she came, and we moved him [the patient] over, made sure that he was clean, you know, moved him over, and she crawled into bed. You know, the beds are so tiny, turned him on his side and with his floppy arm, put it across her, and she fell asleep, and she said that it was, I guess she slept for like two hours, and she just was out, “It’s [the] best thing through the whole thing” she said.
Philip’s second example revealed how compassion could help toward a peaceful death in describing how he honored the request of a dying patient’s mother:
When I say that I do whatever they [family] need. The mom whose son was in this awful car accident, flipped his car, and he was in an anoxic brain injury from drowning, and um, she crawled into bed with him, and had his head on her chest so that when we pulled the tube [breathing tube], she could hold him as he died.
Philip understood how facilitating human touch and emotional connectedness between the family and patient afforded important comfort, and in the case of the mother, some closure in holding her son as he passed away. Philip’s actions revealed how compassion and caring can be mustered through manly virtues including being assertive and unafraid of breaking the rules for the greater good of the family. These actions may also reflect how caring and protecting a dying patient’s family can be a natural extension of male stereotypes supporting and protecting their own families. Similarly, other participants pointed to the importance of being empathetic about what the family was going through, and several participants reflected on the memory of the final moments that a family had with their loved one. Some participants suggested that they could create a positive memory for the family during such a vulnerable time, as Carl explained,
I try to turn the negative into a bit more of a positive, and be like, it’s really special that you get to be here with their loved one as they’re passing, and you know that a lot of people don’t get that opportunity when someone’s dying in an accident or in the middle of the night or something. So it’s actually like, I try and bring out more of the positives in it. . . . You know, yeah, just trying to make them feel encouraged a little bit in that they are gonna be a part of it.
Focused on inclusivity of the family, Carl also embodied strength within a demanding situation, and what he referred to as his “sturdy oak” identity was imbued with the conviction that reformulating death as a positive event was an important strategy providing the family someone to depend and lean on.
Of course, these well-intended strategies did not always work and participants also contrasted less idyllic outcomes in caring for the families of dying patients. Among the most challenging of situations was the projection of anger directed toward nurses, as Carl reported,
When a family doesn’t agree with, you know, hasn’t accepted the fact that their family member is dying. And instead of . . . dealing with it, they kind of like, project that onto you because they’re angry about the person passing away, and um, you’re the person there, you’re the outlet almost in a way, and so that’s why a lot of their frustration gets directed towards you, which I find makes a really, really hard situation.
Like Carl, most participants were able to depersonalize such situations but a few men felt vulnerable and frustrated in being blamed and misunderstood by the patients’ families. For example, Alan suggested that some families were biased in suggesting that male nurses were less likely than females to understand the feelings and emotions of others:
I think most traditional families . . . in Canada we have a lot of them, they feel more comfortable with the female because they think that maybe the females have a better understanding of their emotions than a male does. That’s my opinion.
Such challenging events around caring for the families of dying patients called for men to accept what might be unfairly cast on them, including gender stereotyping that ignored their efforts toward comforting family members.
Being Emotionally Attached
Though the first two themes revealed men as rational, decisive, and resilient in working through challenging situations most participants also shared instances about becoming emotionally attached to dying patients and their families. Several participants thought that being with their patients when they died was a powerful experience, and believed that human touch, their presence and words of comfort aided dying patients. As Carl confirmed,
Physical touch is important at that point. I always want to hold my patient’s hand. When I come to see them, I just want to like put my hand on them and . . . I want to give them comfort as they’re passing, and know that they’re not alone, so I want to, lots of times they’re not looking around or anything, that they could still feel my presence there if I like put my hand on their shoulder or holding their hand, or um, I will talk to them.
Participants believed that connecting to their patients in these ways was important, and evident was some men’s emotional attachment. While masculine norms tend to focus on the strength to restrain emotions, such ideals were sometimes transgressed by participants in the context of caring for a dying patient. Participants indicated that they could feel the pain of the patients’ families during the dying process. Some participants unapologetically revealed instances when they had cried at the bedside. Phillip, for example, framed crying as a positive:
I think it’s OK to cry at the bedside. I don’t think it’s OK to sob. That sobby thing, I think that means you’ve lost perspective. But I think it’s OK to cry at the bedside with the family. I think it’s OK to bring it home because it’s been a long day, you know? It’s a long day when you, it’s exhausting, it’s an emotionally exhausting experience sometimes, and of course, you need some recovery time. I mean, for the most part, I’d leave the job, the hospital, but you know, there are some days, and it’s usually the dying patients that I’d take home with me. But I think to myself, when I do that, I think I did a good job. You know? I did a good job with the family. I did a good job with them. I made it easy for them, to say goodbye and to be that patient advocate.
Philip suggested that crying and reflecting on his experiences of caring for a dying patient without losing perspective or failing to do his job was acceptable. Many participants said that working as an ICU nurse had changed their perspectives about life and that they were grateful that nursing had allowed them to see the fragility of life. Participants explained that they realized that life should include working toward and treasuring better health and relationships as Philip reiterated how important it is to tell your loved ones how much they are loved:
I think that it’s important that you don’t live your life with regrets. I mean, no matter how cranky I am with my significant other, the last words that he hears as he leaves the house are still, “I love you.” You know, because, God forbid, he should be hit by a bus or something and the last words that he heard were, “Oh my god, you left your socks on the floor again!”
Others were less comfortable about such practices, suggesting the best self-protections were afforded by staying strong and separating work from their lives. As Vincent suggested these feelings were not always easy to reconcile with doing his job:
I try not to think, because I have that one experience with the trigger point, you know, I really didn’t like that feeling because I couldn’t really function. I couldn’t function. I had to go away for about five minutes to kind of pull myself [together]. I think, it happened one time, I didn’t like . . ., I still make sure I don’t let that happen because it affects the job . . ., I don’t like things to affect my job. I’m the one that needs to make sure that things are OK. The one word I really should use is “vulnerability.”At that time, I felt very vulnerable. I didn’t like that.
Vincent’s admission revealed how losing control heightened his vulnerabilities and could distance him from doing his job in a workmanlike “objective” fashion. Evident also were potential departures from masculine identities premised on having strong analytic and motor skills to competently care for the patient. Instead, potentially infiltrating were emotions that might render him ineffectual, and unable to do his job. Some participants remedied such risks by separating their work and personal lives. Timothy, for example, assured us that he did not allow his job to affect his emotions:
It’s not my family member. I have no direct relationship or connection with [the patients]. Um, I can feel sorry for what the family is going through, um and I can offer what comforts I can, but I do not become emotionally attached.
Drawing on masculine ideals, Timothy, and other participants, indicated that they were able to handle the situation, in large part by objectifying and depersonalizing the death of patients. Such strategies can be understood as self-protection measures to maintain one’s own well-being in this regard.
When participants were asked to give one or two examples of their most memorable stories about a dying patient, many told stories about looking after a dying patient for the first time. When asked how they coped with stress, most participants said they tended to talk and share their feelings with their nursing colleagues. In addition, some participants used distractions to relieve their stress, including watching TV/movies, hanging out and drinking with friends, and the use of humor. Moreover, participants also focused on doing activities they enjoyed including cooking/baking; playing chess, soccer, and photography; spending time with their family and children; exercising and doing outdoor activities; going on vacation; sleeping; and praying to relieve stress. Some expressed that they needed colleagues from the same gender to make jokes with, share laughter, and cope with difficult times—for male colleagues understood their emotions better than their female colleagues. Isaac recalled what he had seen at his workplace and the spirit of kinship that was present:
Um, I think the boys, sort of have a little camaraderie, among ourselves, you know supporting ourselves, but I don’t think . . . like when you look at [male nurse 1] and [male nurse 2] . . ., they are huge pranksters, particularly among themselves. Um, doing a lot of pranks whether it’s locking somebody’s locker with a lot of plaster of Paris, or um, just pranks like that. I think that there is a little bit of a kinship.
Implicit to Isaac’s quote is recognition that being emotionally attached to male coworkers affords some respite from work pressures. Evident also is how humor can be used by men to connect emotionally with other men in masculine ways as previously reported by Oliffe, Ogrodniczuk, Bottorff, Hislop, and Halpin (2009). Besides gaining benefits from a healthy lifestyle, a few participants mentioned used counseling services to counter high levels of stress. Leo explained that he had a strong “feminine” side:
Me personally, I’m kind of a mommy’s boy from when I was a kid, so, I think I have more female traits than male traits when it comes to my emotions, um, my wife’s completely aware of that. I cry like a 5-year-old girl every now and again, and that’s OK. . . . Um, I don’t see a problem with that. Um, I think it’s probably worse if you just kind of keep it in and it just keeps building up and building up, at some point, something’s gonna give. So I think, this kind of release in the pressure cap every now and again, is OK.
Most participants agreed that the gratitude expressed by patients, families, and even doctors were sources of happiness. Thank you cards, letters, hugs, cookies, little gifts, and mentions in obituaries and both the verbal and nonverbal expressions of appreciation helped participants to feel good. When asked whether or not it was important to be happy at their workplace, most participants felt that it was crucial. Some participants stated that “happiness” seemed to be general and better replaced by other terms like satisfaction, sense of purpose, productivity, value, pride, or joy. They also felt that if they were not happy at work, they would not be able to show their full potential and would burn out faster. Henry suggested,
We all have good days and bad days, but the quality of care would be directly influenced by our degree of happiness. Of course, and I think, on purely a core level, if you’re happy, um, that will directly relate to your ability to perform better at the bedside. You’re more tuned to your environment. You’re thinking on a clearer level, your skills are more pronounced, you’re perceiving things and more attuned to everything.
Recognition of their performance enhanced job satisfaction, which positively correlated with the quality of patient care. Moreover, intrinsic satisfaction about their job allowed participants to fulfill their potential and do their best at their job.
Discussion and Conclusion
The findings drawn from the current study add to three fields: (a) men and work, (b) masculinities and male nurses, and (c) gender and men’s health. Moreover, in the specific context of caring for dying patients and their families, this study affords some much needed empirical weight toward understanding and creatively thinking about how best to support and aid the retention of male ICU nurses.
In the context of men and work, long-standing masculine ideals have positioned men as providers and protectors, focused on the financial and material needs of their families (Oliffe & Han, 2014). However, participants in the current study extended protector roles at work when caring for dying patients and their families. While men in the workplace are idealized as authoritative and in control, rarely talking about their feelings (Cecil & McCaughan, 2010), the current study highlighted how men could simultaneously embody and counter such gender ideals (i.e., strong patient advocacy amid crying at the bedside and/or openly sharing their feelings with others). These specific workplace practices emerge in contrast to much of the general men and work literature (Cecil & McCaughan, 2010; Lomas, Cartwright, Edginton, & Ridge, 2013). Of course, this might be explained as a by-product of nursing work, as well as the current study focus on caring for a dying patient. However, afforded are important details about the specificities of the work male ICU nurses take up, and the array of strategies for “doing” that work, both of which mark distance from career emphasis which dominates the men and work literature.
Making sense of these unique and challenging work experiences may also have enabled participants to act outside male roles typically linked to paid-work. Being witness to the dying process, for example, forced participants to reflect on their own mortality and life values, which shaped some men’s lives outside of work. As distinct from preoccupation with career advancement, participants suggested that being happy in their workplace was essential, and that their contentment was nourished by a sense of purpose, value, and pride, and the affirmation of others for a job well done. So while Oliffe et al. (2013) noted that career success strengthens men’s self-esteem and purchase on masculine ideals, the current study findings suggest the nature of nursing work most often provided those benefits to participants. In addition, a work–life balance was understood as key to their overall well-being, and sustaining their work in the ICU, and this finding contests claims that real men live to work rather than work to live (Emslie et al., 2004).
The current study findings add to the literature concerning masculinities and male nurses. For example, Dyck, Oliffe, Phinney, and Garrett’s (2009) assertion that male student nurses tend to take up protector role and be more extroverted and assertive in taking the lead prevailed among the current study participants. Likewise, Evans’s (2004) finding that the ways and means by which male nurses meet patients’ needs draws on as well as runs counter to masculine ideals was affirmed by our findings. There was evidence that men, in the specific context of caring for a dying patient, were empathetic and comfortable with the emotions that could accompany that experience, even though society tends to inhibit the development of these performances, as previously argued by Brown (2009). Indeed, the current study findings confirm that a plurality of masculine ideals and performances can be articulated through emotions and men’s expressions of those feelings. So, while Pollack (1995) and Lomas et al. (2012) suggest boys are taught to suppress their desire for love and connection and build a wall of toughness around them to be accepted as men, most participants broke with such norms by expressing their emotions and acknowledging their vulnerabilities when caring for dying patients and their families. Some participants were insightful and articulate about their struggles and trigger points for stress, demonstrating an awareness of their emotional states. Similarly, to cry at the bedside or cry in front of their colleagues or the patient’s family was understood as flowing from their empathy and care. While, according to Brown (2009), men are “discouraged from the expression of grief and upset through tears, and encouraged to suppress emotion, except anger, and to ignore physical and emotional pain” (p. 123), it was clear that some participants drew on alternative masculine scripts.
Overall, this finding contrasts what Cecil and McCaughan’s (2010) described as characteristics of hegemonic masculinity—to show little or no emotional sensitivity, in that, contextually, and it seems completely reasonable (if not therapeutic) to be touched by death given the very nature of the participants’ work. Traditionally, men tend to internalize their feelings and act tough, which “involves suppressing, denying or disconnecting from feelings of fear and sadness, as well as not showing vulnerability” (Lomas et al., 2012, p. 8). In contrast, the experience of witnessing the dying and death of their patients led participants to reflect, value, and reprioritize their lives. Connell (1995) and Creighton and Oliffe (2010) indicated that masculine identity is reconstituted under the influence of what is adjacent. This caveat to masculinities was supported and illustrated by the findings that introspection and change could come from caring for dying patients and their families.
Yet male ICU nurses did not entirely transgress masculine norms. Participant narratives also illustrated that while striving to provide empathetic and emotional support to their patients, these men recognized that they needed to be in control. For example, most participants stated that their primary job was to provide care and fulfill the needs of their patients, and based on their discretionary power some actions resided outside the policies of the unit. Participants located themselves as providers in this regard, akin to Adinkrah’s (2012) suggestion that successful masculinity is measured by the ability to meet the material needs and daily expenditures of others.
In terms of gender and men’s health research, the focus has tended to reside on men’s illness experiences as distinct from the well-being of health care providers. In this regard, the current study offers some novel and important insights to how male ICU nurses do self-health. The general men’s health literature, for example, has linked men’s poor health outcomes to stoicism, suggesting that men don a mask of emotional bravado that leaves them isolated, whereby vulnerable, empathic, caring emotions, “get repressed and pushed down as a result of being teased or shamed” (Pollack, 1995, p. 42). However, evident in our findings were unapologetic assertions that expressing one’s feelings afforded some therapeutic value. Of course, also evident in the participants’ narrative was emotional toughness and resilience as key performances, but instead of stoicism mustering those qualities, men shared their feelings and pursued healthy lifestyles for respite, and as a means to sustain their work in the ICU. In addition, though Addis and Mahalik (2003) suggested that men are reluctant to ask for help or to talk about their vulnerabilities, the current study findings revealed participants as purposeful in their efforts to connect with others to reduce their stress levels. As such, participants’ talk and social connectedness likely protected them from burn out amid aiding the quality of patient care. Overall, the study findings support the work of Lomas et al. (2012), who indicated that men are able to cope adaptively with difficult emotions.
In terms of transitioning our descriptive study findings toward tangible supports for male ICU nurses, three recommendations are made. First, participants had important insights to effective health promotion strategies toward being “fit to work.” In this respect, they may also be amenable to workplace health promotion activities (e.g., pre- or postshift meditation, yoga, etc.). Second, the masculine norms round stoicism and emotional restraint were less rigid given the nature and unique demands of the men’s work. However, the explicit permission of other men to be emotive and “do” self-health emerged as a potent driver of effective workplace health norms for some participants. Again, this suggests that formal workplace health promotion could be taken up en masse by this subgroup of workers. Third, related to the previous point, the benefits of formal peer support might be an effectual cost-effective way to support men who are new (or not so new) to nursing and the ICU environment.
The current study findings are drawn from a small cohort within the specific locale of British Columbia, Canada. Therefore, the findings are not claimed as generalizable to all male ICU nurses practicing within or outside British Columbia or Canada. Moreover, the cross-sectional study design does not account for changes that may occur with multiple or cumulative exposures and experiences. These limitations however can guide future research, which might include site and gender comparisons, longitudinal studies, and/or mixed-methods designs to distill the patterns and diversity that resides among ICU nurses. Such insights could also inform interventions for promoting male nurses’ health and well-being. This seems an especially important research area given the global shortage of nurses. In addition, several recommendations can be made with regard to masculinities and men’s health research, based on the study findings. Stereotypes often ignore the diversity and plurality evident within the category of male nurses, and future research may build on the current study findings to reveal other aspects of male nurses’ identity work, as these insights may help reconsider the espoused connections between idealized masculinities, work, and men’s careers. Public and health care professional education might also incorporate some of the strategies used by male ICU nurses to quell stress as a means of influencing the practices of other men and women in a variety of occupations.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received financial support for the research, authorship, and/or publication of this article from the Katherine McMillan Director’s Discretionary Fund, University of British Columbia, School of Nursing