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. 2025 Jul 2;24(1):822.
doi: 10.1186/s12912-025-03509-8.

Resilience in the shadows of loss: a hermeneutic phenomenological study of neonatal intensive care nurses' coping after infant loss in Saudi Arabia

Nadia Bassuoni Elsharkawy  1 , Osama Mohamed Elsayed Ramadan  2 , Alaa Hussain Hafiz  3 , Nouran Essam Katooa  3 , Areej Abunar  3 , Dena Marwan A Attallah  4 , Mashael Dewan  4 , Majed Mowanes Alruwaili  5 , Abeer Nuwayfi Alruwaili  5 , Enas Mahrous Abdelaziz  6 , Arab Qassim Alkhadam  7 , Marwa Mohamed Ouda  8
Affiliations

Resilience in the shadows of loss: a hermeneutic phenomenological study of neonatal intensive care nurses' coping after infant loss in Saudi Arabia

Nadia Bassuoni Elsharkawy et al. BMC Nurs. .

Abstract

Background: Neonatal intensive care unit (NICU) nurses face profound emotional distress due to frequent exposure to infant loss. This emotional burden, coupled with limited organizational support, can lead to significant psychological and professional challenges. Cultural and religious contexts uniquely shape resilience and coping mechanisms, particularly within Saudi Arabia, where these aspects remain understudied.

Aim: To explore and describe the lived experience of resilience and coping strategies among neonatal intensive care nurses following infant loss in NICUs in northern Saudi Arabia.

Methods: An interpretive phenomenological design grounded in Heidegger's hermeneutic tradition was employed, with Lazarus and Folkman's stress and coping theory providing the theoretical framework for analysis. Eighteen registered nurses from four NICUs (three public, one private) participated in semi-structured interviews and completed reflective journals. Purposive sampling ensured diversity in professional experience, cultural backgrounds, and religious affiliations. Data were analyzed using thematic analysis with concurrent collection and interpretation.

Results: Four thematic domains characterized NICU nurses' experiences: (1) Emotional Processing of Loss (initial grief, disenfranchised professional grief, cultural-religious interpretations); (2) Adaptive Coping (faith-based practices, selective detachment, end-of-life ritualization, meaning-making through family support); (3) Resilience Development (career-stage evolution, professional identity integration, post-traumatic growth); and (4) Contextual Influences (institutional support disparities, multicultural team dynamics, resource constraints).

Conclusion: NICU nurses' experiences of infant loss profoundly impact their psychological and professional well-being. Despite emotional and organizational challenges, nurses actively employ diverse coping strategies that are deeply influenced by their cultural and religious beliefs. Over time, these strategies facilitate significant professional growth and sustained compassion.

Implications for practice: Healthcare institutions should adopt structured, culturally sensitive interventions, including formal debriefing, psychological support services, and education programs that focus on resilience-building, to enhance the well-being and professional sustainability of NICU nurses.

Clinical trial number: Not Applicable.

Keywords: Coping strategies; Grief; Infant loss; Infant mortality; Neonatal nurses; Resilience; Saudi Arabia.

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Conflict of interest statement

Declarations. Institutional review board statement: This research was granted ethical clearance by the Jouf University Bioethics Institutional Review Board (Approval No. 7526) in accordance with the Declaration of Helsinki. Each participant provided written informed consent after receiving a thorough explanation of the study protocol, including assurances of confidentiality and the right to withdraw at any time. Consent for publication: This manuscript does not contain any individual images or identifiable personal data. Informed consent: Prior to participation, all individuals provided written informed consent after receiving a comprehensive briefing on the study’s objectives, procedures, and their right to withdraw at any time. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Analytical process for interpretative phenomenological analysis of NICU nurses’ resilience following infant loss
Fig. 2
Fig. 2
Conceptual model of NICU Nurses’ resilience and coping trajectory following infant loss
See this image and copyright information in PMC

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