Defending an Ethic of Care: An Autoethnography Reflecting on Emotional Health in Critical Care Medicine

Abstract

Occupational stress is widely experienced. Receiving adequate support for occupational stress is not. While a healthy recovery from occupational stress is possible, developing maladaptive coping strategies to mitigate occupational stress is common for healthcare providers. Specifically, critical care workers are uniquely positioned in that they must care for profoundly sick patients under extreme working conditions, such as high work strain, workload, and work responsibility. All of this leads to high levels of stress. These stressors, if ignored, can contribute to disordered ways of operating in the workplace, such as learned helplessness, dissociation, and self-neglect. Ideally, an individual's feelings are addressed prior to the onset of protective behavioural mechanisms, such as withdrawal or avoidance. However, early intervention requires acknowledging an individual's exposure to significant workplace stress, a practice that is not yet commonplace in Canadian hospitals. The primary goal of this research is to understand occupational stressors in critical care medicine using self-study or autoethnography. This research is qualitative and involves the use of retrospective self-observation for data collection, and thematic analysis for sorting and examining the data. I present a case for how care ethics (CE), which emphasizes the significance of relationships to ethical thinking, and trauma-informed care (TIC), which emphasizes the use of compassion towards traumatised individuals, are frameworks that better address caregiver distress than alternative models such as resilience or positive psychology. By weaving together theoretical work, empirical work, and my reflections as a health care worker, I provide evidence to answer the following research questions: (1) Do repressed, ignored, or unprocessed emotions contribute to occupational stress in critical care? (2) Does the culture of shame in contemporary medical institutions contribute to/perpetuate occupational stress? (3) Can a critical examination of personal experience (what is felt by a single healthcare worker) teach us about occupational stress? The evidence presented in this project indicates that while the causes and symptoms of occupational stress are varied, six core themes show striking positive and negative correlations with stressful situations in the ICU. These core themes highlight specific aspects of critical care delivery that must be better understood to address the problem of occupational stress, each theme representing a unique and salient property, and acting as touchstones for analysis. The themes include (1) the effects of the workplace on personal identity, (2) the extent of personal awareness on the job, (3) the extent of emotional work required, (4) the degree of trust and wholeness (or integrity) felt in the workplace, (5) the degree of alienation or a problematic disconnection from the fruits of one’s labour that is experienced, and lastly, (6) the overall meaning given to the care work conducted. The six core themes provide a launching point for a concluding discussion on what is needed to support and maintain a healthy work environment.