Date of Award
2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Nursing
Committee Chair
Jennifer Bail
Committee Member
Bettina Lampert
Committee Member
Preston Miller
Committee Member
Suzanne Prevost
Committee Member
Leigh Ann Bray Dayton
Research Advisor
Jennifer Bail
Subject(s)
Nurse and patient--United States, Intensive care nursing--United States--Psychological aspects, Terminal care--United States--Psychological aspects, Adjustment (Psychology), Empathy
Abstract
Intensive care unit (ICU) nurses repeatedly provide end-of-life care (EoLC) and experience significant emotional distress, burnout, and moral distress that can lead to leaving the profession. Detached concern (DC), a dual-process emotional-regulation strategy which balances empathetic concern with emotional detachment, may support ICU nurses' emotional well-being; however, DC among nurses remains vastly understudied. This qualitative descriptive study gained deeper understanding of DC among ICU nurses providing EoLC in the United States. The study was guided by a conceptual model adapting Lampert and Glaser's dynamic DC process within Elfenbein's emotional regulation framework. The overarching research question explored ICU nurses' perspectives on DC and its role when providing EoLC. Using maximum variation sampling, 24 ICU nurses (age 22-69, mean 38 years; 83% female) with ICU experience ranging from 8 months to 45 years participated in semi-structured interviews until data saturation was met. Inductive thematic analysis yielded four themes describing DC's role among ICU nurses providing EoLC: (1) Caring at the Center: Detached Concern and Relational Complexity at End- of-Life; (2) Emotional Experiences of Death and Their Role in Detached Concern; (3) Negotiations of Detached Concern in End-of-Life Care; and (4) Shaping Detached Concern and Professional Identity Through EoLC in the ICU. Findings revealed that ICU nurses focus on patient-centered care while navigating complex relationships with patients, families, and colleagues. Death exposure shapes emotional responses, with participants reporting sadness, frustration, anger, moral distress, and acceptance of mortality. Nurses dynamically negotiate DC based on emotional availability, patient/family connections, and clinical circumstances, including unexpected losses and COVID-19 pandemic experiences. Influential factors affecting DC balance include individual personality traits, clinical circumstances, institutional elements, and support systems. Nurses identified gaps in formal education about emotional regulation during EoLC, relying instead on experiential learning and mentorship. This first qualitative study examining DC among U.S. ICU nurses shows DC functions as a vital self-preservation strategy enabling nurses to provide compassionate care while protecting their emotional well-being. Results suggest incorporating DC education into nursing curricula and providing formal institutional support could enhance nurse resilience, sustainability, and retention in critical care settings.
Recommended Citation
Miasek, Melissa Milton, "Exploring detached concern, a dual-process emotional-regulation strategy, among intensive care nurses providing end-of-life care in the United States" (2026). Dissertations. 487.
https://louis.uah.edu/uah-dissertations/487
Comments
Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the joint Nursing Science Program ...