Supplementary file 2_Key enablers and barriers to ICU nurses’ professional identity: a qualitative study.docx

ObjectivesTo explore the key enablers and barriers influencing the professional identity among Intensive Care Unit (ICU) nurses.
MethodsThis is a qualitative study that employed a purposive sampling approach and was conducted in the intensive care units (excluding pediatric ICUs) of two tertiary hospitals in Chengdu, China. One-on-one, semi-structured in-depth qualitative interviews were conducted with 37 ICU nurses. The Ecological Systems Theory (EST) provided the theoretical framework for this study. Thematic analysis approach was used to analyze the data.
ResultsWe developed four themes to explain the qualitative data: Individual Motivation and Achievement System (IMAS), Team Collaboration and Support System (TCSS), Technology and Societal Support System (TSSS), Sociocultural and Values System (SVS). IMAS highlighted intrinsic motivation, professional competence, and patient satisfaction as key enablers, while lack of research and innovation capabilities, excessive workload, frequent night shifts, and misunderstanding from patients’ families constitute major challenges. TCSS reflected the importance of effective teamwork and multilevel support, with improper collaboration identified as a barrier. TSSS emphasizes the dual role of advanced technology and public health emergencies, representing both opportunities and challenges. SVS reflects the beneficial effect of positive social perceptions and cultural values, contrasted with social cognitive biases as obstacles.
ConclusionThis study underscores enablers and barriers influencing ICU nurses’ professional identity within the EST framework. Professional competence and a sense of irreplaceability enhance intrinsic motivation, whereas excessive workload and promotion pressure undermine stability. Interprofessional collaboration and multilevel support reduce burnout, while technological advances both improve efficiency and increase skill-related anxiety. Interventions such as optimizing workload and work environment, providing professional development, improving performance evaluation, and implementing hospital policies and broader healthcare reforms in China may strengthen professional identity, improve job satisfaction, and support the sustainable development of ICU nursing practice.

研究目的 探讨影响重症监护病房（Intensive Care Unit, ICU）护士职业认同的关键促进因素与阻碍因素。
研究方法 本研究为质性研究，采用目的性抽样方法，在中国成都两家三级医院的重症监护病房（不含儿科ICU）开展。对37名ICU护士开展一对一半结构化深度质性访谈。本研究以生态系统理论（Ecological Systems Theory, EST）作为理论框架，采用主题分析法对数据进行分析。
研究结果 本研究归纳出四类阐释质性数据的主题：个体动机与成就系统（Individual Motivation and Achievement System, IMAS）、团队协作与支持系统（Team Collaboration and Support System, TCSS）、技术与社会支持系统（Technology and Societal Support System, TSSS）以及社会文化与价值系统（Sociocultural and Values System, SVS）。其中，IMAS维度将内在动机、专业能力与患者满意度列为核心促进因素，而研究与创新能力不足、超负荷工作、频繁夜班以及患者家属误解则构成主要挑战。TCSS维度体现了高效团队协作与多层级支持的重要性，不当协作则被视为阻碍因素。TSSS维度凸显了先进技术与公共卫生突发事件的双重作用，二者兼具机遇与挑战属性。SVS维度反映了积极社会认知与文化价值观的正向作用，与之相对的社会认知偏差则为阻碍因素。
研究结论 本研究基于生态系统理论框架，明确了影响ICU护士职业认同的促进与阻碍因素。专业能力与不可替代性感知可提升内在动机，而超负荷工作与晋升压力则会削弱职业认同稳定性。跨专业协作与多层级支持可缓解职业倦怠，而技术进步一方面可提升工作效率，另一方面也会加剧与技能相关的焦虑情绪。在中国，可通过优化工作量与工作环境、提供专业发展支持、完善绩效评估机制、落实医院相关政策及推进更广泛的医疗卫生改革等干预措施，强化ICU护士的职业认同，提升工作满意度，助力重症监护护理实践的可持续发展。