Self-Care Strategies of Emergency Nurses in Armed Conflict Areas: Experiences From the Field.

BACKGROUND: Emergency nurses working in conflict zones face extraordinary psychological, physical, and ethical challenges in environments characterised by violence, resource scarcity, and moral distress. Despite increasing recognition of core competencies in emergency nursing for armed conflict contexts, self-care strategies that enable sustained professional practice remain underexplored in the literature.

OBJECTIVE: The primary objective of this study was to explore the lived experiences and self-care strategies of nurses working in healthcare settings along the Saudi-Yemeni border. The secondary objectives were to identify the specific components of their self-care ecosystems and to understand how these strategies are influenced by the unique challenges of a conflict-affected environment.

METHODS: A qualitative descriptive design was employed using semi-structured interviews with twelve emergency nurses working in active conflict zones. Data were analysed using Braun and Clarke's six-phase thematic analysis framework, following COREQ guidelines. Roy's Adaptation Model guided interview question development across physiological, self-concept, role function, and interdependence domains.

RESULTS: Four major themes emerged from the analysis: (1) Holistic Self-Care Strategies encompassing physical, psychological, and spiritual dimensions; (2) Professional competency as a protective factor through skills enhancement and boundary management; (3) Collective resilience and social support systems involving peer support, leadership presence, and mentorship; and (4) Systematic approaches to chaos and risk management through safety protocols and operational systems. Participants employed multidimensional self-care approaches that were fundamentally collective rather than individual, integrating personal resilience with professional competence, mutual support, and systematic organisation to maintain well-being and effective patient care in extreme environments.

CONCLUSION: Self-care represents a foundational rather than supplementary component of conflict-zone emergency nursing practice. Integration of self-care strategies into core competency frameworks and institutional policies is essential to ensure the well-being of healthcare workers and sustainable care delivery in humanitarian crises. Findings indicate a need for paradigmatic shifts from individual to collective approaches in supporting healthcare workers in extreme environments.

IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY: This study demonstrates the need to integrate collective self-care as a core clinical competency in emergency nursing education and practice, particularly in conflict-affected regions. Professional development programmes should incorporate training in psychological resilience, team-based support systems, and systematic approaches to chaos management. Health policies must support structured wellness programmes, access to mental health resources, and trauma-informed leadership practices. Integration of collective self-care indicators into institutional performance metrics and national emergency preparedness plans may enhance nurse retention, improve care quality, and strengthen health system resilience.