Aims: This article aims (a) to get insight into intensive care nurses' most critical work-related incidents, (b) their reactions and coping and (c) perceived support, in a Dutch intensive care unit. Background: Research about the impact of critical incidents has largely been aimed at ambulance and emergency nurses; knowledge about intensive care nurses in this respect is scarce. Persistent stress reactions after critical incidents may cause symptoms of post-traumatic stress disorder, depression and anxiety. Unresolved problems may also cause poor behaviour towards patients. In response, nurses reduce work hours or even resign. Social support alleviates emotional problems, but little is known about actual support perceived. Design: This study is a qualitative explorative study. Method: Thematic analysis of semi-structured interviews was performed among a purposive sample of 12 intensive care nurses in a university hospital in The Netherlands. Findings: Four main themes have been identified in critical incidents: high emotional involvement in patient-related incidents (in contrast to major life-threatening events as such), avoidable incidents, sub-standard patient care and intimidation. Themes discerned in nurses' reactions after critical incidents were physical reactions, emotional reactions and cognitive/behavioural reactions. After critical incidents, nurses talked with colleagues, friends or relatives, but would have appreciated additional support. Conclusions: Incidents under emotionally demanding circumstances are among the most difficult situations, but may not be recognized as critical incidents by colleagues. Both adequate and inadequate coping strategies, with long-lasting problems after critical incidents, were reported. Feelings of anger, shame and powerlessness, may have hindered recovery. Talking to colleagues was perceived to be helpful, but intensive care nurses' need for support was insufficiently met. Relevance to clinical practice: Managers should acknowledge the effects of critical incidents on intensive care nurses and take preventive measures: reducing critical incidents, improving open communication, imposing a buddy-system for collegial support, and timely evaluating the necessity of professional help.

Critical incidents, Health care providers, Nurses, Post-traumatic stress, Work-related stress,
Nursing in Critical Care
Department of Pediatrics

de Boer, J, van Rikxoort, S, Bakker, A.B, & Smit, B. (2013). Critical incidents among intensive care unit nurses and their need for support: Explorative interviews. Nursing in Critical Care. doi:10.1111/nicc.12020