Normalizing the Abnormal: Self-Identified Traumatic Events and Critical Care Nurses, A Focused Ethnography

According to The National Institute for Occupational Safety and Health (2022), 20 million healthcare workers in the United States (U.S.) are at risk for symptoms of mental unhealthiness directly related to their work environment and experiences. Despite nurses reporting higher levels of burnout and other adverse effects within their work environment, approximately two-thirds of nurses indicate they are not receiving supportive resources for mental health, which is known to impact physical health (Berlin et al., 2023). The pandemic has shed light on pre-existing conditions for nurses, such as the workplace culture and understaffing, leading to unmanageable patient loads, which all minimize nurses' mental health (Bowie, 2022). Critical care nurses (CCNs) encounter singular and often repetitive traumatic events (TEs) within the work environment, which lead to adverse effects such as anxiety, depression, post-traumatic stress disorder, secondary traumatic stress disorder, burnout, compassion fatigue, moral distress, substance use, and suicidal behaviors. A TE is described as an extreme event causing an individual’s ability to cope to be threatened, resulting in unusual and strong cognitive, emotional, or behavioral reactions (Kleim et al., 2015).

A limited number of studies have directly addressed the experiences of self-identified TEs among CCNs in the clinical work environment. This study aims to describe the CCN’s TE, explore potential psychological impacts on the CCN, explore work culture impacts on the CCN’s response, and examine resources offered to the CCN. A focused ethnography (Roper and Shapira, 2000) methodology was used for the study and was guided by the research question, “What are CCNs’ experiences and responses to a self-identified traumatic event(s) in the emergency department or intensive-care unit settings that caused them distress?”

Purposive and snowball sampling was used for recruitment. CCNs (n=11) representing various regions in the U.S. participated in semi-structured interviews. Study data included demographic data, transcribed interviews, field notes, and methodological journals. Collected data was analyzed using the constant comparative method (Glaser, 1998; Glaser and Strauss, 1967) until redundancy and data saturation occurred. The study utilized Beck’s (1993) criteria to demonstrate scientific rigor. Data analysis revealed four themes of normalizing the abnormal, suffering in silence, badge of honor, and resilience: we are CCNs.