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.