Sustaining presence under depletion: A grounded theory study of family-centered care, compassion fatigue, and nursing-sensitive quality outcomes in pediatric settings.

BACKGROUND

Pediatric nurses face challenges delivering family-centered care while managing compassion fatigue, with potential consequences for care quality and patient safety.

AIM: This study explored the social processes through which pediatric nurses navigate family-centered care and compassion fatigue, and how these were perceived to shape nursing-sensitive quality outcomes.

METHOD: A constructivist grounded theory design was employed. Twenty-two pediatric and neonatal intensive care nurses participated in semi-structured interviews. Data collection and constant comparative analysis occurred concurrently, progressing through open, focused, axial, and theoretical coding until theoretical saturation.

RESULTS

Participants' main concern was maintaining meaningful family partnerships and safe care during emotional depletion. The core category, Sustaining Presence Under Depletion, emerged as the central psychosocial process managing this tension, encompassing four categories: The Emotional Labour of Family-Centered Care, Compassion Depletion and Care Erosion, Adaptive Strategies for Sustaining Presence, and Structural and Relational Conditions. Senior nurses developed adaptive micro-practices to sustain care, whereas early-career nurses faced overwhelming demands. Structural supports, including charge nurse monitoring and family liaisons, were described as critically enabling sustained care quality.

CONCLUSION

This substantive grounded theory explains how pediatric nurses perceive they sustain or compromise family-centered care under compassion fatigue. Care quality was described as existing on a continuum from genuine partnership to tokenistic presence, with perceived implications for patient safety and nursing-sensitive outcomes.

IMPLICATIONS TO PRACTICE: Interventions should support nurses' emotional capacity. Organizations must implement structural supports like workload redistribution, family liaisons, and wellbeing monitoring. Education should teach adaptive micro-practices enabling meaningful engagement under constraints.