Title : The voices of the south african registered nurses after the implementation of a self-care model in different intensive care units
Objectives: To describe recommendations to facilitate self-care of registered nurses caring for critically ill patients in an intensive care unit in a public hospital in Gauteng.
Method: The researcher utilised a qualitative, exploratory, descriptive and contextual research design. The four criteria to evaluate trustworthiness in qualitative research were adhered to, to ensure that the findings of the research reflected the truth value of this study: credibility, dependability, confirmability and transferability. A total of six participants aged between 28 and 64 years were interviewed online and three themes emerged during data analysis and supported with the literature control.
Results: The recommendations to facilitate self-care of registered nurses caring for critically ill patients in an intensive care unit in a public hospital in Gauteng were described.
Conclusions: The recommendations can be used in nursing practice, nursing research and nursing education.
Keywords: Recommendations, Self-care, facilitation, registered nurses, critically ill patients, intensive care units
Introduction: This study utilised the concept of self-care as defined by WHO. The World Health Organisation defines self-care as activities that individuals do for themselves to establish and maintain health and includes self-assessment and personal development. These activities include exercising, eating a nutritious diet, enough sleep, good relationships with others, physical examination, abstaining from substance abuse and meditation (WHO, 2019). According to Richards (2017:8) the self-care actions are chosen intentionally by an individual to take care of oneself and to achieve the goal of finding a state of optimal physical, mental and emotional health. Self-care consists of six domains which include the physical (healthy eating, exercise), mental (education, mindful awareness), emotional (personal therapy and trusting relationship), spiritual (meditation and purpose in life), aesthetic (beauty in life) and work life balance (maintaining a healthy equilibrium) (Manning-Jones, de Terte & Stephens, 2016:20-29).
The American Holistic Nursing Association (2016, 2021), states that the three components of self-care include the body, mind and spirit. Bodily self-care refers to grooming, exercise, breathing, yoga and nutrition while mindful self-care practices include meditation, healing music and laughter. Spiritual practices of self-care involve praying, reading spiritual literature, positivity and being kind. Registered nurses should integrate self-care, spirituality and self-responsibility into their daily lives. The American Nursing Association (ANA) (2016) focuses on holistic nurses and emphasises that self-care is about finding time and balance. A healthy nurse is someone who actively focuses on creating and maintaining a balance between the physical, mental, emotional and spiritual well-being. Registered nurses should live life to their fullest capacity and should act as role models and educate others about self-care. Self-care is needed to relieve occupational stress experienced in a rapidly changing health environment in order to prevent burnout syndrome which can result in devastating consequences for nurses themselves and those under their care (Halm, 2017:344; Leão, Fabbro & Oliveira, 2017:2).
Aster (2019:1) and Malelelo-Ndou, Ramathuba & Netshisaulu (2019:1-8) indicate that an intensive care environment is very demanding and challenging due to the criticality of the patients who need continuous monitoring, advanced technological equipment and the patients’ life threatening illnesses. Critical care nurses experience high levels of traumatic stress and suffer from compassion fatigue on a daily basis as they care for highly complex, critically ill patients. Prolonged exposure to stress results in compassion fatigue and they develop symptoms such as lack of confidence, depression and a diminished sense of purpose at the workplace.
Critical care nurses are reported to be the lowest in participating in self-care activities. Despite their knowledge about health-promoting behaviours. The Women’s Health Study conducted by the Women’s Hospital indicates that their knowledge doesn’t translate to their own self-care. The study has shown that the intensive care environment contributes to the failure of nurses to engage in health-promoting behaviours due to standing long hours, work overload and shift working. There is a need to further explore the self-care barriers and effective self-care strategies that would be beneficial to them. Behavioural changes such as unhealthy habits, lack of motivation to change and lack of decision making are causes of poor self-care. Knowledge gaps exist that can be addressed to influence behavioural changes in healthcare professionals, such as building resilience, and the influence of culture on self-care. Other interventions to promote behavioural change include education, training, support from family and peers and skills-based approaches that build self-care (Riegel et al., 2019:1-6.; Mills, Wand & Fraser, 2018:1-18; Ross et al., 2017:268).
Self-regulation and self-care planning are important due to increased workload in the critical care settings; planning times for taking meal breaks and recreational leave (Mills, Wand & Fraser, 2017:1). The researcher was motivated to develop, describe, implement and evaluate a model to facilitate self-care of registered nurses caring for critically ill patients in South Africa. The following research question emerged from the problem statement:
What can be done to facilitate self-care of registered nurses caring for critically ill patients?