Insights on compassion and patient-centred nursing in intensive care: A constructivist grounded theory

Aims and objectives: To explore patient-centred nursing, compassion satisfaction and compassion fatigue from intensive care nurses' perspectives. Background: Compassion satisfaction and compassion fatigue can influence critical care nurses' decisions to either continue or leave the profession, and could impact the compassionate patient-centred nursing care patients receive during their ICU admission. Design: This qualitative research design was informed by Charmaz's Grounded Theory Constructivist methodology. Methods: In-depth interviews were conducted with 21 critical care nurses of two ICUs in Australia during 2016. Interview data were analysed using grounded theory processes. Results: Findings reflected positive and negative impacts on critical care nurses' ability to deal compassionately with their patients. Effects on patient-centred nursing and critical care nurses' own well-being were revealed. A core category of "Expectations" emerged, explaining the tension between critical care nurses' biomedical, clinical skills and knowledge versus compassionate, patient-centred nursing care. This tension was clarified and expanded in subcategories of "Life in the Balance," "Passion and Pressure," "Understanding and Advocacy" and "Tenacity and Fragility". Conclusion: Providing patient- centred nursing may enhance critical care nurses' experience of compassion satisfaction, in turn impacting delivery of compassionate patient- centred nursing to generate a virtuous circle. Critical care nurses who feel respected and supported by their management team and colleagues experience feelings of compassion satisfaction, leading to greater engagement and care towards their patient. Relevance to clinical practice: Systematically addressing critical care nurses' needs to successfully balance biomedical with compassionate nursing care may lead to greater well-being in the critical care nursing workforce and improve patient experience of intensive care.