Burns Open 2 (2018) 47–52

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Burns Open
journal homepage: www.burnsopen.com

Coping strategies among nurses in the Burn Intensive Care Unit: A

qualitative study
Jonathan Bayuo a,b, Pius Agbenorku b,c,⇑
a
Department of Nursing, Faculty of Health and Medical Sciences, Presbyterian University College, Agogo, Ghana
b
Burns Intensive Care Unit, Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
c
Division of Plastic & Reconstructive Surgery, Department of Surgery, Komfo Anokye Teaching Hospital, School of Medical Sciences, College of Health Sciences, Kwame
Nkrumah University of Science & Technology, Kumasi, Ghana

a r t i c l e i n f o a b s t r a c t

Article history: Background: Working in the Intensive Care Unit has been noted to be stressful. Also, caring for a burn
Received 7 July 2017 injured patient has been observed to present various stressors to nurses. Thus, working in the Burn
Received in revised form 10 October 2017 ICU may be filled with various stressors that nurses need to respond to. However, there is paucity of
Accepted 12 October 2017
studies exploring how nurses in the Burn ICU cope.
Available online 16 October 2017
Objective: To explore and describe coping strategies exhibited by nurses working in the Burn ICU.
Methodology: An exploratory-descriptive approach was utilised to explore coping strategies exhibited by
Keywords:
nurses. Purposive sampling was used to recruit nurses from the Burns Intensive Care Unit (n = 13). Face to
Coping
Nurses
face semi-structured interviews were conducted with an interview guide, proceedings audio-recorded
Intensive Care Unit and transcribed verbatim. One follow up interview was conducted after the initial interview. Analysis
Burns was undertaken using thematic analysis to generate themes.
Findings: Three themes with corresponding sub-themes were identified: seeking and obtaining support,
distancing oneself and recreation.
Conclusion: Considering the useful role that senior nurses played in the unit, there is a need to develop
strategies to retain them as well as support the on-going professional development of all nurses. There
is also a need to create avenues of release to enable nurses’ talk about their experiences as they provide
care to burned patients.
Ó 2017 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).

1. Introduction
Nursing professionals who work in Intensive Care Units (ICUs)
have been noted to be faced with high levels of stress emanating
from the patients’ critical condition, quick decision required for
patient care and the complex care environment [1]. Despite this
fact, ICUs exist to manage patients with various conditions or crit-
ically ill persons of different age groups. Thus in terms of disease
conditions, there are areas such as Surgical Intensive Care Unit
(SICU) and Cardiac Intensive Care Unit. Similarly in terms of age,
there exists the Paediatric Intensive Care Unit and Neonatal
Intensive Care Unit. Inasmuch as these ICUs may have the charac-
teristic of being a stressful work environment, there is reason to
believe that their differences in terms of the nature of patients
who are attended to may imply that the experience of stressors
⇑ Corresponding author at: Burns Intensive Care Unit, Directorate of Surgery,
Komfo Anokye Teaching Hospital, Kumasi, Ghana.
E-mail address: pimagben@yahoo.com (P. Agbenorku).
may differ among nurses working in these areas though previous
studies may have not considered these subtle nuances.
Burn injury is a form of traumatic injury which can cause con-
siderable morbidity and mortality [2]. Though the care of the burn
injured patient requires the expertise of various health care practi-
tioners, much of the care requirements have been noted to be nurs-
ing functions. These include intensive physiological monitoring,
maintaining proper nutrition, wound care, assessment and man-
agement of multifaceted burns pain. Thus, nurses working in the
Burn Intensive Care Unit may perform some roles which may be
absent in other ICUs and these central roles performed by nurses
in the Burn ICU has been noted to be a major source of stress. A
recent exploratory-descriptive study in the Burn Intensive Care
Unit (BICU) of the Komfo Anokye Teaching Hospital (K.A.T.H)
revealed several aspects of burn care that were physically and
emotionally exhausting for nurses. These included the extent of
burn wounds; intensive monitoring required by the burned
patient, poor pain control and end of life symptoms which made
nurses feel powerless [3]. These causes of physical and emotional

https://doi.org/10.1016/j.burnso.2017.10.004
2468-9122/Ó 2017 Published by Elsevier Ltd.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
48 J. Bayuo, P. Agbenorku / Burns Open 2 (2018) 47–52
exhaustion have been described as occupational stressors to which
burn care nurses must respond to by coping [4].
Coping has been defined as the constantly changing cognitive
and behavioural efforts to manage specific external or internal
demands that are appraised as taxing or exceeding the resources
of the person [5]. Lazarus and Folkman [5] have further delineated
coping activities into either problem-focused (directed externally
and involve attempts to manage or change the problem causing
the stress) or emotion-focused (internally directed and involve
attempts to alleviate emotional distress). Furthermore, they have
identified and described eight coping strategies people use to con-
tend with stress: confrontive coping, distancing, self-control, seek-
ing social support, accepting responsibility, escape-avoidance,
planful problem-solving and positive reappraisal.
Further to the above, Lee [6] has noted that the most frequently
used coping strategies on the Work Stress Checklist among Hong
Kong nurses included being organised, helping others, continuing
education, ensuring up-to-date knowledge of equipment and drug
regimes, maintaining social communication, being more tolerant,
talking to others, making an effort to relax and having a hobby.
McGrath, Reid and Boore [7] also observed comparable findings
in their study and these included of higher income, experienced
colleague’s support, decrease in work load and attending educa-
tional programmes. Similarly, McFarlane, Duff and Bailey [8]
observed that strategies such as humour and attending stress man-
agement classes were techniques utilised by nurses and physicians
working in the Accident Emergency Unit. Beeby [9] also reported
‘‘having experience or expertise” in the study that involved Regis-
tered Nurses working in a Coronary ICU. Fouché [10] however
noted a unique theme labelled as ‘‘unpredictability” from her phe-
nomenological study as a feature of working in the ICU and reiter-
ated that this could make working in the critical care environment
more difficult as it interfered with the ability to assess a situation
in an attempt to predict nursing outcomes with some degree of
accuracy. This feature of uncertainty has been noted to trigger
emotion-focused coping strategies such as absenteeism among
nurses [11].
Considering the intense nature of emotional and physical
exhaustion experienced by burn care nurses in the Burn ICU of
KATH, they still provide care [3]. Though there is a clear under-
standing of the contributing factors to burn care nurses’ experi-
ences of physical and emotional exhaustion, it is unclear how
they cope in the face of exhaustion. It is worth noting that previous
studies have identified that a high degree of exhaustion among
nurses may predict lower self-rated performances and higher
intention to quit work [12,13] which makes it cogent to under-
stand coping strategies exhibited specifically by burn care nurses
as it might offer valuable insights into how to support them.
2. Objective of the study
The aim of this study was to explore and describe coping
strategies among nurses working in BICU of KATH.
3. Materials and methods
3.1. Design
An exploratory-descriptive approach which is a form of qualita-
tive method was utilised to achieve the aim of this study. Denzin
and Lincoln [14] have specified that qualitative methods allow
researchers to study things in their natural settings, attempting
to make sense of, or interpret phenomena in terms of the meanings
people bring to them. Also, qualitative methods are helpful in
exploring unknown or understudied phenomenon and to promote
the development of conceptual and theoretical frameworks as it
enables the generation of rich textual descriptions of experiences
[15]. Furthermore, Polit and Beck [16] have indicated that the qual-
itative stance is an inductive process in which the researcher
selects participants who are experiencing the phenomena of inter-
est and collects data until saturation is reached. The assumption
underlying this stance is that nurses in the Burn ICU have experi-
enced coping whilst caring for burned patients and they continu-
ally construct personal meanings from their experiences as well
as possess individual interpretations which makes the qualitative
stance best suited for the study.
3.2. Setting
The Komfo Anokye Teaching Hospital (KATH) in Kumasi is the
second-largest hospital in Ghana and a tertiary health institution
in the middle belt of the country. It is the main referral hospital
for the Ashanti, Brong Ahafo, the Northern, Upper West and Upper
East regions of the country. The hospital was built in 1954 and
affiliated to the School of Medical Sciences (SMS) of the Kwame
Nkrumah University of Science and Technology (KNUST). The hos-
pital currently has 1000 beds, with an annual hospital attendance
of about 679,050 patients made up of both out- and in-patients.
The hospital has two units dedicated to burns care: Burns Intensive
Care Unit and Ward D2C. These units have a six bed capacity each
and attend to patients with varying degrees of burns [17]. However
as the study considered the unique nature of the Burn Intensive
Care Unit, its focus remained on nurses working in BICU only.
The Burn ICU has a total of 15 nurses but one was on annual leave
at the time of the study. The Burn Units of KATH renders care to
persons of all ages with varying degrees of burns. The Burn ICU
has been specially designed to manage severely burned patients,
patients with burns affecting special parts of the body such as gen-
italia or burns in special population groups such as elderly persons,
neonates and pregnant women. Patients with inhalational injury
are also admitted to the Burn ICU for specialist airway manage-
ment alongside other burn care modalities such as wound care.
In-patient statistics indicate that ages of patients admitted with
burns ranged from 0.25 to 92 years with a mean age of 15.5 years.
Also, 77% of the patients were aged 20 years or less; 45% were chil-
dren aged 10 years or younger [25]. Adu and Koranteng [25] fur-
ther notes that scalds comprised 60% of the injuries with hot
water accounting for 45% and dry heat was responsible for 37%
of the burns with Total Burned Surface Area (TBSA) ranging from
5% to 98%.
3.3. Participant and participant recruitment
Purposive sampling approach was used to recruit Registered
Nurses who have worked in BICU for a minimum of six months.
The study was discussed with all nurses’ in the unit at an initial
staff meeting and each nurse was later approached face to face.
Upon accepting to participate, an interview date was scheduled.
In all thirteen (13) nurses participated in the study.
3.4. Data collection
The face to face semi structured approach was utilised to obtain
data. The semi-structured approach allowed new ideas that
emerged during the interview to be explored further and that
enabled in-depth coverage of the coping among burn care nurses
[18]. Before each interview, the researcher recorded all personal
thoughts regarding the phenomena in a diary. As the interview
proceeded, any thoughts that were aroused by participant’s
description were also noted in the diary. The interview processes
were audio recorded alongside field notes. Data collection
 J. Bayuo, P. Agbenorku / Burns Open 2 (2018) 47–52
continued till data saturation [18]. The stage of data saturation was
noted at a point where there was no new information from partic-
ipants. Participants were encouraged to view the interviewer as a
researcher interested in understanding their experiences. Initial
data collection lasted approximately 35–48 min. This was followed
by a second meeting to discuss codes, sub-themes and themes with
each participant separately. The interview commenced with a
broad question ‘‘how has it been for you working in the Burn ICU?”
Also, they were asked ‘‘how have you been coping here?” As partic-
ipants talked about their experiences, probes and prompts were
used to ensure discussion of their experiences. Iterative mode of
questioning was utilised in some instances to ensure honesty in
the responses.
3.5. Data analysis
Data analysis occurred concurrently with data collection. All
audio recordings from the interview sessions were transcribed ver-
batim in Microsoft Word 2010 and codes developed from them.
Thereafter, thematic analysis was undertaken which involved iden-
tifying, interpreting and reporting patterns within the data and
recognising themes that were gradually incorporated into higher
order themes [19]. The authors coded the interview transcripts inde-
pendently and allowed another Registered Nurse in another depart-
ment to undertake the same activity. Discrepancies were discussed
between the researchers to reach a consensus. All sub-themes and
themes were discussed with participant to ensure that findings
and interpretations depicted their descriptions. This action ema-
nated from the fact that the authors are burn care specialists and
wanted to ensure transparency in describing participants’ experi-
ences. However, no themes or sub-themes changed in the process.
3.6. Rigour
Trustworthiness was ensured by participant validation, pro-
longed engagement with participants, maintaining an audit trail
and maintaining a reflexive diary throughout the study period.
3.7. Ethical clearance
Ethical clearance for this study was obtained from KNUST
School of Medical Sciences/KATH Committee on Human Research,
Publications and Ethics, Kumasi. In addition, each participant was
given a thorough description of the study to enable them make a
decision as to whether to participate or not. Oral consent was also
sought prior to commencement of the interviews. Participants
were assured of confidentiality and were not coerced to participate
in the study. They were informed that the study aimed to under-
stand their experiences and findings will be used to enhance policy
formulation. They were also assured that though management
team members may read the study report, pseudo-names would
be used in the study so that no one can trace the source of informa-
tion they have provided. As the authors are burn care specialists, a
reflexive diary was maintained in which all thoughts that were
aroused throughout the interview process were recorded.
4. Findings
4.1. Participants’ background
Thirteen (13) Registered Nurses comprising of seven females
and six males participated in the study. Participants were aged
between 25 to 57 years and had worked for a minimum of six
months in the Burn Intensive Care Unit. Four nurses were identi-
fied to have worked in the unit for more than five years and as such
49
were classified as senior nurses. Six nurses were also noted to have
worked in the unit for between one to four years and the remaining
three nurses had worked in the unit between seven months to one
year.
4.2. Themes and Sub-themes
From the analysis, three major themes were identified and
these are presented alongside the sub-themes in the table below
(see Table 1).
4.3. Seeking and obtaining support
Caring for the burn injured patient was described as tiring due
to the care requirements such as continuous monitoring, ensuring
frequent position changes and dressing large wounds. Also, partic-
ipants felt emotionally exhausted due to the nature of extensive
burn wounds and inability to resolve the pain complaints of
patients. In such instances participants, notably those who have
worked in the unit for a period of seven months to one year dis-
cussed their challenges with senior nurses in the unit to under-
stand how they have coped as well as obtain encouragement.
They noted that they obtained a lot of encouragement from the
senior nurses. In such instances, they learned how senior nurses
have handled these issues and learned from them. Also, they spec-
ified that the senior nurses were of great assistance in acquiring
skills and knowledge needed for successful burn care practice
and that helped them cope especially as they noted that the unit
is a highly skilled facility:
‘‘It has been very challenging here especially in the first few months
seeing all the big wounds and sometimes difficult pain to manage.
Some of the nurses offer pieces of encouragement that keep us
going and some are really experienced who are able to help you
acquire skills. This unit was a new place for me but the nurses were
really helpful and they helped me transition well. A patient comes
with something I never know of, the experienced nurses are able to
teach you and assist you know the nitty–gritty of it all. It has been
helpful and some of them give us lectures and tutorials as well
especially those who have undertaken research” (Male Nurse).
It was observed that support from senior colleagues was readily
available in the unit. Participants reiterated that the senior nurses
appeared to be used to all happenings in the unit as they always
appeared calm even under intense pressure in the unit. Though
these participants hoped for a period they could also develop this
feature, they indicated that they hoped they did not lose their feel-
ing of empathy for the burned patient:
‘‘But you see I think some of the old nurses here I think they are just
used to the work here to the extent that they say something and it
happens. When I appear shaken about what is happening to a
patient, they appear not to be moved at all. The first time I experi-
enced death here, the senior nurse just went eating after we had
finished preparing the body. It was like he was okay with what
had happened and I could not eat that whole day” (Female Nurse).
Table 1
Themes and sub-themes.
Themes Sub-themes
Seeking and Obtaining  Encouragement from senior nurses
Support  Learning from experienced nurses
 Engaging in on-going professional learning
 Faith practices
Distancing oneself  Avoidance
Recreation  Enjoying off days
 Teasing
50 J. Bayuo, P. Agbenorku / Burns Open 2 (2018) 47–52
Interactions with four senior nurses who had worked in the unit
for more than five years revealed that they were used to happen-
ings in the unit and they could, in some instances, foretell what
would happen to a burned patient given a particular situation.
They noted that this did not make them lose their feelings of empa-
thy for the patient but it rather helped them to have balanced
hopes in caring for the burned injured patient and that enabled
them to approach care in a realistic manner but still doing their
best to achieve recovery or a peaceful death. As they offered pro-
fessional support to other nurses, they also learned from it:
‘‘Things do happen and it is not like I am super human but when I
see a bad case, I just know it. Sometimes we stretch ourselves too
much for the patient but they don’t make it. So I have learned from
experience and know how to have a balanced view of the work
such that I don’t push myself too much. This work is really tiring
I must say so having a balanced view helps a lot and also assisting
others helps me to also keep learn” (Female Nurse).
Further to the above, participants re-echoed that given the chal-
lenging nature of caring for the burn injured patient, they felt the
need to do their best for the patient at any point in time. Doing
one’s best was associated with engaging in continuous professional
learning to ensure that patients receive the best form of care. By
engaging in continuous professional learning, participants estab-
lished their commitment to life-long learning to ensure that the
care they provided was of a high standard. Though this was a form
a coping strategy exhibited by all participants at all times, it was
particularly associated with caring for a severely burned patient
who might die. In this way, participants noted that they did not
feel any guilt after the person had died. In addition, it was observed
that participants critiqued their own practice to identify how well
they have performed and how they can improve their practice. This
strategy was identified to enable participants cope with the chang-
ing demands of patients:
‘‘For me it is a whole new experience working in an ICU environ-
ment. I have to learn a lot about burns and I am always learning
a lot on the job to be up to task and ensure that I deliver the best
possible care. As we keep nursing them, I come to the realisation
that those with high TBSA has very poor prognosis. For some too,
with proper management, they make significant progress. No mat-
ter the outcome, there is always that challenge to learn more and
be able to cope with the care delivery process” (Male Nurse).
‘‘So if a patient comes in and is severely burned, I do not really have
my hopes high but I do the best I can to make sure a peaceful death
is achieved. So long as I am at peace with myself, I know I have
done the best I could do for the patient. But this gets challenging
for patients who appear to be well and then suddenly, they die
and it is sad in this circumstances. But you see in all these circum-
stances, I give off my best and make sure that I keep learning and
learning” (Female Nurse).
Furthermore, it was observed that participants engaged in faith
practices to cope with the demands of caring for the burn injured
patient. This included praying and caring with the belief that all life
is in the hands of God. Thus, participants sought support from God
in order to be able to meet the care requirements of the patient:
‘‘It is even more tedious with wound dressing and the patients with
higher TBSA. For me, I have psyched myself that this is an ICU and
so I am prepared to face the challenges associated with these tasks
especially when the patient gets weak and needs more assistance.
Also, I pray too for myself and the patients” (Male Nurse).
‘‘Oh yes I do pray most times for the patient and for a calm shift
because this place is really tiring and it is so unpredictable working
here. I see it as a way of preparing myself whilst hoping that my
patients also get better” (Female Nurse).
4.4. Distancing oneself
Aside seeking support, it was observed that participants occa-
sionally avoided certain situations. Some of the junior nurses
avoided challenging patient care situations and rather handed
them over to the more experienced nurses as they also learned
from the situation:
‘‘The patient went in for amputation because the electrical burns
had affected the right arm and started bleeding during the night.
I felt lost and called one of the senior staff. I stood back and
watched how skilfully he managed the situation and it was an awe-
some learning experience for me” (Male Nurse).
‘‘There are sometimes you just have to get behind the senior nurses
and see what they will do because they have worked here and they
know the work real well. So if there is something that is very diffi-
cult for me, I just get behind them and learn from how they handled
the situation” (Female Nurse).
In addition some participants occasionally avoided colleagues so
as to focus solely on the patient. It was noted that this action ema-
nated from the fact that participants felt lonely as those they worked
with on a particular shift did not appear to see the intensity of
patient care required. Avoiding colleagues at work involved giving
them the silent treatment or giving them straight responses without
the usual jokes played in the unit. In some instances, participants
noted that they avoided specific comments by colleagues in order
to concentrate on caring for the patient Thus, in this instance they
avoided their colleagues but proceeded to work alone:
‘‘Hmmmmmmm yes I have encountered such periods and I just do
not mind them when I realise that they want to play lazy. I report
to work early but some may come late and not be actively involved
in the work. In such situations, I do not even listen to them. Even
when they ask questions, I remain quite or answer simply with
no jokes because it is annoying” (Female Nurse).
Despite attempts to avoid some comments by colleagues, it was
observed that participants still preferred to maintain good commu-
nication with colleagues especially if it had to do with patient care.
Thus, even though they attempted to avoid some colleagues, they
were willing to verbally communicate if it was in relation to
patient care:
‘‘I just avoid colleagues causing trouble on my shift by remaining
silent unless I see that what they are going to do might not help
the patient. . .. . .. . . in that instance, I break the silence. Sometimes
too if they pass sarcastic comments, I just pretend as if I have not
heard it and then move on. The work continues all the same”
(Female Nurse).
4.5. Recreation
Further to the above, it was observed that participants enjoyed
various forms of recreations in order to ease the demands of caregiv-
ing. These recreational activities were usually enjoyed on days they
were off duty from direct patient care. Though they noted that the
day off was not adequate to ease the pressure, they still enjoyed it:
‘‘I just love my days off because they are periods I do not come into
contact with any patient. It is just 24 h but I try to enjoy every part
of it by doing things I love. In a way by the time I get back to work, I
feel ready to face the challenging atmosphere here” (Male Nurse).
‘‘Two days off in a week is quite okay to be away from work and it
is very important because I can imagine if I am always here seeing
big wounds and getting tired. I will definitely wear out.” (Male
Nurse).
 J. Bayuo, P. Agbenorku / Burns Open 2 (2018) 47–52
In addition, teasing was identified as a means of coping among
nurses in the Burn ICU. This involved creating humour within the
unit. The sources of jokes were varied and ranged from previous
happenings in the unit or personal issues:
‘‘We create lots of jokes here because it sometimes gets too tiring
that we need to lighten ourselves up with some laughter. It makes
me feel better and makes me feel a part of the group because we
laugh together, sometimes so loud that our director comes to warn
us but you cannot help it at times. The laughter is really good for us
here” (Male Nurse).
Furthermore, some form of teasing was noted to occur in the
unit after a group of nurses on a particular shift have experienced
the death of a patient. This act of teasing was usually carried out by
the incoming staffs who asked questions to create humour in the
unit and lighten the atmosphere after experiencing the death of a
patient. This is because experiencing the death of a patient was
associated with feelings of sadness or lack of accomplishment.
Though participants noted that this act helped them cope with
the reality of the loss, it reminded them of the fact that they had
to write a death report covering the patient. Uniquely, the term
‘‘you have killed the patient” was identified. This was noted to be
a terminology among staff in the unit that is ascribed to nurses
who experience the death of a patient. However, it was observed
that the terminology implied ‘‘sorry for losing a patient but get
ready to write the death report”. Participants reiterated that
though it helped them to also deal with the reality of the loss, it
reminded them of the death report they had to write:
‘‘When the death occurs in my shift, the nurses will be like, ‘‘you
have killed the patient”. The first time a patient died on my shift,
I felt terrible and it was even worse when my colleagues told me
‘‘you have killed the patient”. I know I did everything I could do
for the patient but the patient died. But later, I got to know what
that implied and I realised it was something they do in such
instances. I got to know that anytime they said that, they meant
it is sad to have lost the patient but it is okay so get ready to write
the death report” (Male Nurse).
‘‘It is like gentle teasing and we say that a lot. After the patient dies,
we say ‘‘you have killed the patient”. It does not imply the literal
meaning as it sounds but it is way of easing the pressure off the unit
and it also means the nurses who were present during the period
the patient died will be required to write a death report for the
patient” (Female Nurse).
5. Discussion
Caring for the burn injured patient has been described as a
source of stress to health professionals [20]. As nurses are at the
centre of the multi-disciplinary burn care team, they probably
experience greater levels of these stressors [21] to which they
respond to by coping.
In the current study, nurses who had worked in the Burn ICU for
seven months to a year were noted to avail themselves to learning
offered by senior nurses. This approach was observed to enable
these nurses acquire skills, knowledge and encouragement
required to function in this highly skilled unit. Thus, in this
instance the willingness of the senior nurses to share their exper-
tise and offer assistance played an essential role. Also, it was iden-
tified that this form of expertise enabled the senior nurses also
cope with the demands of burns caregiving. Thus, being in posses-
sion of expertise appeared to play a dual coping role: helping the
bearer of the expertise to have a balanced view of caring for the
burned patient and mentoring others as well. This strategy can
be viewed as a form of support exhibited by nurses in the unit
51
[5]. This finding is in line with those of McGrath et al. [7] as they
noted that experienced colleague’s support enabled nurses to cope
with the demands of caregiving. In similar lines Beeby [9] and
Fouché [10] also observed that ‘‘having experience or expertise”
enhanced nurses’ survival in the Intensive Care Unit. In part this
may be related to highly skilled nature of burns care coupled with
the nature of work in the Intensive Care Unit which makes experi-
ence an essential tool. Further to this, it was noted in the current
study that as the senior nurses assisted others, they also gained
from the learning moment and this may be a reason why Lee [6]
has indicated that ‘‘helping others” is a coping strategy utilised
among nurses. This finding could mean that no matter the type
of ICU nurses found themselves, developing and maintaining one’s
expertise is an essential component in their professional develop-
ment. The implication of this could be that the hospital may need
to have strategies in place to retain more senior nurses as their
support appears to be of great value in the Burn ICU. Also, this form
of peer support may need to be encouraged and formalised as it
serves as a significant means of knowledge and skills acquisition
[3].
Aside learning from senior nurses to cope with the demands of
caring for a burned patient, it was observed in this study that
nurses working in the Burn ICU were engaged in continuous pro-
fessional learning in order to maintain standard patient care.
Though they aimed to maintain high care standards, they also
engaged in continuous learning to avoid guilt of not doing one’s
best especially when the patient died and this finding is unique
in relation to the current study. In addition, they also critiqued
their own practice on regular basis. This action can be described
as a form of planful problem-solving that prepared them for any
task [5]. Though this study did not uncover the forms of continuous
professional education participants are engaged in, McGrath et al.
[7] have indicated that attending educational programmes helped
nurses to cope with the demands of patient care. Similarly, Lee [6]
has cited continuing education as a coping strategy that enabled
nurses to deal with work related stressors. The implication of this
finding could be that there may be a need to create avenues for
structured educational programmes for nurses in the Burn ICU as
well as encourage self-directed learning. In addition, participants’
expression of doing their best so as to avoid the feeling of guilt
after the death of a patient may require further exploration.
Furthermore, participants in this study were observed to engage
in some faith practices which reflect their beliefs. This may mean
that nurses employed spiritual strategies in coping with the
demands of caring for the burned patient. In similar lines, Jannati
et al. [1] also noted from their grounded theory study that Iranian
nurses employed prayers, reading the Koran and trust in God as
means of coping. Also, faith practices have been reported as a
major coping resource among practitioners in hospice/palliative
care units which takes the form of prayers and meditation [22].
Further to these, Bakibinga, Vinje, and Mittelmark [23] have noted
that faith in God helped Ugandan nurses remain in their jobs no
matter how stressful it was as their faith helped them to accept
the stressful situation and provide a source of living in life. This
may mean that spirituality may play a central role in caring for
patients and its impact may need further exploration.
Participants who were classified as junior nurses were noted to
avoid challenging patient situations. However in this instance, they
stayed and observed how the senior nurses handled the situation.
What may be worrying is the fact that some participants avoided
avoid colleagues in some circumstances as they focused on the
patient. Dominquez-Gomez and Rutledge [26] have asserted that
getting away from the patient is an avoidance strategy employed
by emergency nurses. The reason for this action, as indicated by
McGrath et al. [7], is to avoid the stressful situation or lessen their
stress levels. Thus, nurses working in the Burn ICU need to be
52 J. Bayuo, P. Agbenorku / Burns Open 2 (2018) 47–52
encouraged to resolve issues with colleagues as soon as feasible
instead of utilising the avoidance strategy so as to maintain an
atmosphere that permits constant interaction with colleagues.
In addition, recreational activities which were enjoyed by par-
ticipants during their day off were noted to be a coping strategy
employed by nurses in the Burn ICU. Recreational activities or hob-
bies may enhance relaxation and help nurses recover from the
periods of exhaustion and this may be a form of distancing oneself
from the source of stress [5]. In similar lines, Lee [6] has reported
that making an effort to relax and having a hobby serve as coping
strategies for nurses. Though participants described the off days as
inadequate, they still enjoyed it. An essence of taking a day off from
work is seen in the case study by Coffey, Everett, Miller and Brown
[24] as they noted that nurses were faced with various challenges
as they rendered care to a patient with 65% Total Burned Surface
Area (TBSA) burn extent. This continued to the extent that nurses
had to request not to care for the patient more than a day at a time
until the patient died. This evidence may strengthen the fact that
nurses working with burned patients require days off from work.
Thus, innovative strategies may need to be considered to re-
organise nursing care delivery in the unit or increase the number
of nurses in the unit so as to increase the number of days off from
work.
Further to the above, creation of humour in the form of teasing
was identified as a coping strategy exhibited by nurses in the unit.
The use of this strategy was more pronounced after the death of a
patient as it was noted that the atmosphere in the unit was tense
and there was a need to lighten it. In relation, previous studies
have also cited creating humour or laughter as a coping strategy
[6,8]. However In the current study the act of teasing appeared
to serve two purposes: creating humour and reminding nurses of
the need to complete a death report. Thus even though former
aimed to ease the tension of losing a patient, it may further stress
nurses as completing the death report was not a task they really
enjoyed. This finding could also mean that the death of a patient
stressed nurses such that they required avenues for release which
were absent in the unit [3] and this specifies the need to create
such avenues and encourage nurses to talk about their experiences.
6. Limitation
Though the study reveals an overview of how nurses cope in the
Burn ICU, the findings are still limited in that, the study focused on
only nurses working in the Burn ICU of KATH and findings may be
unique to this setting.
7. Conclusion
Nursing patients in the Intensive Care Unit has been described
as generally stressful and for nurses working in the Burn ICU, there
may be added sources of stress: nature of burn wounds and care
requirements of the burned patient. Thus this study sought to
identify coping strategies exhibited by these nurses as it could pro-
vide useful insights in supporting them. Findings from this study
indicate that the hospital management team may need to have
strategies in place to retain senior nurses as they appeared very
useful in the unit. Also, there is a need to create avenues of release
to enable nurses’ talk about their experiences and receive support
in that regard. Nurses may also need to be encouraged to confront
issues with colleagues as soon as feasible to enable the availability
of an atmosphere that allows constant interaction with colleagues.
Conflict of interest
None declared.
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