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

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

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