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To explore the lived experiences of intensive care nurses caring for patients with limited English proficiency.
A hermeneutic, interpretive phenomenological design was used.
Semi-structured interviews were conducted with intensive care nurses recruited through purposive sampling. Data collection included Qualtrics screening surveys and semi-structured Zoom interviews. The research team, comprising linguistically diverse faculty and undergraduate research assistants, employed reflexivity techniques to minimise bias and enhance interpretive rigour. Data were analysed via inductive analysis using the hermeneutic circle.
Five main themes emerged organically from the data: Complications of Care Relating to Verbal Communication Challenges. Benefits and Barriers of Nursing Informatics in Linguistic Care. The Universal Language: Nursing Effort Builds Trust. The Ripple Effect: Chronological Considerations for Patient Care. Moving Forward: Where Do We Go From Here?
Based on these findings, a four-phase model was developed to guide individual and system-level interventions to reduce nurse moral distress and improve language equity in critical care.
Language barriers in the intensive care unit hinder communication, increase stress for patients and nurses, and impact care quality. While nurses' efforts to bridge these gaps are valued, systemic changes (such as expanded interpreter availability and improved cultural safety training) are necessary to support culturally, linguistically, and medically appropriate care.
Findings highlight the need for increased institutional support, additional resources for night-shift staff, and the integration of cultural humility education into intensive care training. The Limited English Proficiency Moral Distress Action Cycle for Critical Care Nursing, developed from this study, offers a flexible framework to guide the implementation of these improvements and reduce nurse moral distress. Future research should explore interventions to promote cultural and linguistic competence in multilingual patient populations.
Q: What problem did the study address?
A: The nurse-identified clinical, ethical, and workflow risks created when interpreters or translation tools are inadequate for critical care.
Q: What were the main findings?
A: Language barriers jeopardise teaching, informed consent, and symptom reporting. Video and phone interpreters or translation apps are vital but are often scarce, unreliable, or impersonal, particularly during night shifts. Nurses bridge these gaps by building trust through empathy, non-verbal communication, and learning key phrases. Yet, effective care for patients with limited English proficiency requires extra time, increasing workloads and fuelling moral distress related to language-discordant care. Nurses consistently called for 24/7 interpreter coverage; more reliable devices and cultural humility training must be implemented system-wide.
Q: Where and on whom will the research have an impact?
A: Findings can guide nurses, managers, leaders, and administrators to improve both language concordant and discordant nursing care and train nurses in cultural and linguistic competencies for a multilingual patient population. Ultimately, these efforts have been shown to improve the quality, outcomes, and cost-effectiveness of patient care. The study also identifies moral-distress triggers and introduces the Limited English Proficiency Moral Distress Action Cycle (LEP-MDAC). This model is proposed for use in other high-acuity settings worldwide that seek to provide language-concordant or language-discordant care effectively.
SRQR.
None.
The purpose of this study was to explore undergraduate nursing students' lived experiences with secondary traumatic stress.
The design was an interpretivist, hermeneutic-phenomenological approach. Data collection took place in the United States from September through November of 2024. Undergraduate nursing students who scored ≥ 38 (moderate, high, or severe) on the Secondary Traumatic Stress Scale were purposively recruited for face-to-face interviews with biometric and audiovisual recordings. Data analysis followed an iterative, inductive approach using principles from Heidegger's hermeneutic approach and Benner's interpretive framework for nursing.
Four main themes emerged from the data, illuminating student lived experiences on (1) How an Event Becomes ‘Traumatic,’ (2) Maladaptive or Ineffective Coping in Response to an Event, (3) Nursing Culture as a Conduit for Secondary Traumatic Stress and (4) The Student Journey Toward Effective Coping.
Findings revealed largely unaddressed secondary traumatic stress in undergraduate nursing students, a hidden driver of burnout and early exit from the profession. During synthesis, a four-step cascade emerged: (1) an emotionally charged event, (2) experiencing distorted thoughts, (3) symptoms of physiological arousal and (4) demonstrated behavioural avoidance, intensified by an underlying professional expectation of stoicism. Although students reported using relational, spiritual, cognitive and physical coping tools, these strategies alone rarely interrupted the cascade.
Three educational imperatives follow: (1) embed explicit secondary traumatic stress literacy in educational modules, (2) normalise brief peer/faculty debriefings and (3) train preceptors to frame vulnerability as a form of competence. Trauma-informed pedagogy built on these steps can foster integrated (rather than sustained) trauma, curb attrition and help secure the future nursing workforce.
Undergraduate nursing students frequently experience secondary traumatic stress during clinical training, yet curricula and clinical cultures provide little explicit preparation or support. This gap accelerates burnout and early departure from the profession, worsening nurse shortages and threatening patient safety.
The study uncovered a four-step STS cascade: a clinical event led to distorted thoughts, which resulted in physiological arousal and produced behavioural avoidance (amplified by the hidden curriculum of stoicism misinterpreted as professional resilience). Students improvised multi-layered coping toolkits, but these alone were perceived as insufficient. Targeted, real-time interventions can interrupt the cascade and transform distress into manageable, integrated memories.
The research will influence educators, clinical mentors, and health-system managers who shape the day-to-day experiences of nursing students and new graduates, with ripple effects for patient safety and workforce sustainability across comparable healthcare contexts worldwide.
SRQR.
This study did not include patient or public involvement in its design, conduct, or reporting.
FreshRSS 