Comprehensive care in critical services: a spanish qualitative study

Academic Edi o : Jose G ane o-Molina Recei ed: 16 Feb ua y 2025 Re ised: 24 Ma ch 2025 Accep ed: 26 Ma ch 2025 Published: 27 Ma ch 2025 Ci a ion: de Diego-Co de o, R.; Flo es-Alp esa, T.; Fe nández- Rod íguez, M.; Vega-Escaño, J.; Pé ez-Jiménez, J.M. Comp ehensi e Ca e in C i ical Se ices: A Spanish Quali a i e S udy. Heal hca e 2025,13, 745. h ps://doi.o g/10.3390/ heal hca e13070745 Copy igh : © 2025 by he au ho s. Licensee MDPI, Basel, Swi ze land. This a icle is an open access a icle dis ibu ed unde he e ms and condi ions o he C ea i e Commons A ibu ion (CC BY) license (h ps://c ea i ecommons.o g/ licenses/by/4.0/). A icle Comp ehensi e Ca e in C i ical Se ices: A Spanish Quali a i e S udy Rocío de Diego-Co de o 1,2 , Thalía Flo es-Alp esa 3, Mi iam Fe nández-Rod íguez 4, Juan Vega-Escaño 1,* and José Miguel Pé ez-Jiménez 1,2,5,* 1Depa men o Nu sing, School o Nu sing, Physio he apy and Podia y, Uni e si y o Se ille, 41009 Se ille, Spain; [email p o ec ed] 2 Resea ch G oup CTS1149: Comp ehensi e and Sus ainable Heal h: Bio-Psycho-Social, Cul u al and Spi i ual App oach o Human De elopmen , 41009 Se ille, Spain 3San Hila io Heal h Cen e , Dos He manas, 41701 Se ille, Spain; halia lo [email p o ec ed] 4Juan Ramón Jiménez Uni e si y Hospi al, 21005 Huel a, Spain; [email p o ec ed] 5Anes hesiology and Resusci a ion Clinical Managemen Uni , Uni e si y Hospi al Vi gen Maca ena, 41009 Se illa, Spain *Co espondence: [email p o ec ed] (J.V.-E.); [email p o ec ed] (J.M.P.-J.) Abs ac : Backg ound/Objec i es: Comp ehensi e ca e is c ucial in eme gency heal hca e. In in ensi e ca e uni s, a holis ic app oach may be di icul o implemen due o he condi- ions o he pa ien s and exis ing wo k p o ocols aimed a main aining i al unc ions o he su i al o pa ien s. The p esen s udy aims o explo e and desc ibe he knowledge, a i udes, and pe cep ions o c i ical ca e and eme gency heal h p o essionals ega ding he implemen a ion o in eg a ed ca e p ac ices wi hin in ensi e ca e uni s, wi h he goal o iden i ying ba ie s and acili a o s o adop ing a holis ic app oach in eme gency heal hca e se ings. Me hods: This s udy implemen ed an explo a o y and desc ip i e quali a i e design wi h a phenomenological app oach h ough semi-s uc u ed in e iews wi h heal h p o essionals who had wo ked in in ensi e ca e uni s o eme gency se ices o bo h public and p i a e heal h ins i u ions in Spain (n = 25). The s udy was conduc ed du ing he yea s 2023 and 2024, using a con enience sampling me hod along wi h snowball sampling, and a na a i e discou se analysis was pe o med. The MAXQDA 2022 so wa e p og am was used. This s udy was g an ed due pe mission by he Resea ch E hics Commi ee belonging o he Jun a de Andalucía, unde p o ocol code 0768-N-20. Resul s: The o al sample consis ed o 25 heal hca e p o essionals om c i ical ca e and eme gency se ices in Spain. The main hemes, as key indings, we e knowledge and pe cep ion, de e mining ac o s, esou ces and in as uc u e, he bioe hical dimension, pe spec i es on comp ehensi e ca e, and mul idimensional impac . Mos o he p o essionals we e amilia wi h comp ehensi e ca e, bu lack o esou ces and ime p e en ed hem om ca ying i ou in hei uni s. Conclusions: Fo c i ical ca e and eme gency p o essionals, comp ehensi e ca e is impo - an o hei clinical p ac ice, bu ba ie s o i s ealiza ion s ill exis . Unde s anding he impo ance o hese p o essionals o he applica ion o comp ehensi e ca e is undamen al o es ablishing measu es o i s implemen a ion in hese se ices. I is also a mo i a ion o con inue p o iding humanized and compassiona e ca e ha espec s he pa ien ’s digni y. I is a p io i y o p o ide he necessa y in as uc u e and human esou ces so ha pa ien s admi ed o hese uni s can be ca ed o wi h his ool. Keywo ds: c i ical ca e; in e iews; quali a i e esea ch; comp ehensi e heal hca e; eme gency se ice hospi al Heal hca e 2025,13, 745 h ps://doi.o g/10.3390/heal hca e13070745 Heal hca e 2025,13, 745 2 o 16 1. In oduc ion Due o he global heal h c isis caused by he inc easingly p essing sho age o human esou ces, in Spanish hospi als he numbe o hospi aliza ions in in ensi e ca e uni s (ICUs) has led o a conside able inc ease in he wo kload o nu ses, whose numbe s a e well below he nu se–pa ien a io wo ldwide [ 1 ]. Acco ding o he WHO, Spain is 61s in he wo ld anking, wi h a a io o 5.73 s. 8.77 nu ses pe 1000 inhabi an s, while in e ms o doc o s we a e in 26 h posi ion [2]. In ensi e ca e and eme gency uni s a e en i onmen s cha ac e ized by wo k o e load, s a e-o - he-a echnology, he execu ion o complex asks, s ess, and he c ea ion o de ensi e emo ions du ing he ca e o highly complex pa ien s. In he ICU, some imes he wo k p o ocols and he condi ions o pa ien s make he holis ic app oach o ca e di icul [ 3 ]. In his en i onmen , i is common o b eak he pa ien ’s connec ion wi h his o he en i onmen , which means ha humanized ca e is depended on as he cen al axis [4]. Comp ehensi e heal hca e e e s o “ he se o ac ions ha p omo e and acili a e e icien , e ec i e and imely ca e, which is di ec ed mo e a people conside ed in hei physical and men al in eg i y, as social beings belonging o di e en amilies and communi- ies, who a e in a pe manen p ocess o in eg a ion and adap a ion o hei physical, social and cul u al en i onmen , a he han a he pa ien o he disease as isola ed ac s” [ 5 , 6 ]. The e o e, in he uni s o which we e e , i becomes mo e necessa y and is shown as a gua an ee o high-quali y ca e, aking in o accoun no only he physical and symp oma ic aspec s o he pa ien , bu also he en i e global, biological, psychological, social, cul u al, and spi i ual sphe e [7]. In mos pa ien s, being admi ed o o isi ing he eme gency oom o a hospi al gene a es anxie y, mo i a ed by ea o he unknown, o a doub ul u u e, and possible in- con eniences o hei illnesses, placing hem in a momen o ulne abili y and weakness in hei li es [ 3 ]. The e o e, i is necessa y o o e hem comp ehensi e ca e, which gua an ees an app oach o all phases and dimensions o he pe son, oge he wi h mul idisciplina y wo k [8]. A g ea emo ional and spi i ual con usion has been gene a ed in pa ien s, ela i es, and p o essionals. Knowing and unde s anding hese complexi ies allows he building o mo e cohe en and humane in e en ions, which a e necessa y no only o p o ide an immedia e esponse a he ime o he disas e bu also o build an e ec i e, empa he ic, and asse i e accompanimen , aking in o accoun he biopsychosocial sphe e o pa ien s [9]. Comp ehensi e ca e has been discussed in heal hca e o yea s, and esea ch in his a ea has been sca ce. The echnological p og ess achie ed in he diagnosis and ea men o diseases has no gone hand in hand wi h p og ess in he de elopmen o non echnical skills in heal hca e eams (awa eness, humaniza ion, empa hy, asse i eness, e c.). This is why pa ien s and hei amilies yea n o comp ehensi e ca e, e en mo e so in he con ex o c isis and hospi aliza ion in an ICU [7]. P e ious s udies ha e shown ha he e has been a de e io a ion in he quali y o humanized ca e and ha i is e y necessa y o know wha aspec s hinde he p o ision o humanized ca e in he ac o ca ing, since he esul s will acili a e knowing he eali y o he undamen al p og ess o pa ien s and heal h p o essionals [ 10 ]. S ill, esea ch in he ield o comp ehensi e ca e in eme gency depa men s and eme gency se ices con inues o be insu icien . Fu he mo e, i is e iden ha he e is a wide a ie y o in e en ions o ien a ed owa ds in eg a ed ca e in eme gency depa men s; howe e , i is di icul o pu hese in o p ac ice due o he sho ime equi ed in his a ea, as wo k in hese depa men s leads o emo ional o e load and s ess o he nu sing p o essionals [ 11 ]. In e en ions a ge ing psychological esilience a e needed o educe nu ses’ s ess pe cep ions [12]. Heal hca e 2025,13, 745 3 o 16 The goal o his s udy was o explo e and desc ibe he knowledge, a i udes, and pe - cep ions o c i ical ca e and eme gency heal h p o essionals ega ding he implemen a ion o in eg a ed ca e p ac ices wi hin in ensi e ca e uni s, wi h he goal o iden i ying ba ie s and acili a o s o adop ing a holis ic app oach in eme gency heal hca e se ings. 2. Ma e ials and Me hods 2.1. Resea ch Design An explo a o y and desc ip i e quali a i e design wi h a phenomenological app oach was used [ 13 ], employing semi-s uc u ed in e iews which aimed o desc ibe he meaning o an expe ience by iden i ying hemes and sub hemes bo n ou o pa icipan obse a ion and discou se [14]. A quali a i e app oach g an s esea che s signi ican lexibili y, allows o a deepe unde s anding o pa icipan s’ pe spec i es, acili a es he de elopmen o mul iple in- e p e a ions o esponden s’ iewpoin s on a opic, and helps unco e conce ns ha su ey-based me hods alone may o e look. This app oach helps esea che s comp ehend he li es and necessi ies o o he s by helping o ecognize and o se aside heo e ical and ideological biases and is cha ac e ized by (a) a concep ual o ien a ion p o ided by a esea ch eam, (b) a ocus on a disc e e communi y, (c) a ocus on a p oblem wi hin a speci ic con ex , (d) a limi ed numbe o pa icipan s, (e) he use o pa icipan s who may hold speci ic knowledge, and ( ) he use o selec ed episodes o pa icipan obse a ion [15]. 2.2. Se ing and Pa icipan s The s udy was conduc ed wi h heal hca e p o essionals (physicians, eme gency oom echnicians, nu ses, and nu sing assis an s) wo king in in ensi e ca e and eme gency depa men s a se e al hospi als and p ima y ca e cen e s in sou he n Spain. Speci ically, he pa icipan s included p o essionals om he Vi gen del Rocío Uni e si y Hospi al (Se ille), he Juan Ramón Jiménez Uni e si y Hospi al (Huel a), he Vi gen de Valme Uni e si y Hospi al (Se ille), he Uni e si y Hospi al o Je ez (Cádiz), and suppo se ices om he Sou he n and Eas e n Dis ic s o Se ille (Se ille). In pa icula , he pa icipa ing hospi als ha e mode n ICUs ha o e comp ehensi e ca e o c i ically ill pa ien s. These ICUs a e equipped wi h cu ing-edge echnology and a mul idisciplina y eam ha wo ks oge he o p o ide he bes possible ca e. Fu he mo e, he hospi als and p ima y ca e cen e s ha e eme gency se ices ha ope a e 24 h a day, ea ing bo h medical and su gical eme gencies. These se ices a e designed o ensu e p omp and e ec i e ca e, p io i izing pa ien com o and sa e y. 2.3. Sampling and Eligibili y C i e ia Con enience sampling and he snowball me hod we e ca ied ou , acco ding o which pa icipan s a e selec ed based on p ede e mined c i e ia. The main c i e ion was he amilia i y o he pa icipan s wi h he phenomenon unde in es iga ion. The esea che s looked o in o man s who had collec i ely encoun e ed he phenomenon, e en hough hey also di e ed in hei cha ac e is ics and in hei own pe sonal expe iences, o suppo he achie emen o he aims [ 14 ]. Thus, in o ma ional messages we e sen h ough social ne wo ks, Wha sApp wo k g oups, and by email. Supe iso s o eme gency se ices and ICUs om he di e en hospi als, who ac ed as key agen s, we e also con ac ed. Pa icipan s who esponded o he in o ma ional messages dissemina ed h ough he a o emen ioned elec onic media o we e in i ed o pa icipa e olun a ily h ough key in o man s we e en olled in he s udy a e accep ing and signing he in o med consen o m sen o hem Heal hca e 2025,13, 745 4 o 16 ia email. This sample ec ui men p ocedu e gua an eed he anonymi y o he in o man s un il he ime o he in e iews by he esea che s. Finally, pa icipan s we e included p o ided hey we e heal h p o essionals wo king in (ICUs) o eme gency se ices o bo h public o p i a e heal h ins i u ions in Spain and ea ing c i ically ill pa ien s. While he ICU heal h p o essionals wo ked in hospi als, eme gency ca e was p o ided in hospi als, p ima y ca e, and ou pa ien eme gency uni s. Heal h p o essionals who we e wo king ou side ICUs o eme gency se ices, as well as hose no ca ing o pa ien s (i.e., academic o managemen le el), we e excluded. 2.4. Da a Collec ion The da a collec ion was pe o med h ough semi-s uc u ed in e iews. These we e conduc ed in wo momen s by 2 esea che s: om Ma ch 2023 o June 2023 and om Sep embe 2023 o Decembe 2024, in he Spanish language, and las ed app oxima ely 50 o 60 min. Da a collec ion con inued un il da a sa u a ion was eached. The in e iews occu ed indi idually a a ime con enien o he pa icipan s, ha is, espec ing hei p e e ences. Mos in e iews we e conduc ed in pe son, so he AudioLab mobile app ( e sion 1.3) was used o eco d and ansc ibe he in o ma ion ob ained. When dis ance was a ba ie , in e iews we e conduc ed emo ely ia Zoom ideocon e ences. The same app was also used o ensu e no in o ma ion was los . In he case o ace- o- ace in e iews, wi h p io ag eemen be ween he esea che and he in o man , b eaks in he wo k en i onmen , speci ically in he s a lounge, we e used, accompanied by a cup o co ee, acili a ing elaxed and amilia si ua ions as much as possible. The objec i e was o he in o man s o eel com o able esponding o he se ies o ques ions posed by he esea che ollowing a semi-s uc u ed in e iew sc ip , which acili a ed he smoo h and o de ly de elopmen o he con en . Meanwhile, he online in e iews we e conduc ed a he in o man s’ quie es momen s, usually when hey we e ee a home, hus acili a ing hei pa icipa ion. On bo h occasions, dis ac ions in he en i onmen we e a oided, hus ensu ing he absence o addi ional pa icipan s. Al hough, especially in he i s case, his seemed p ac ically impossible o achie e, i was qui e easy, since he es o he wo k en i onmen la gely espec ed he momen . An in e iew sc ip was used, and he ques ion sc ip was designed o encou age pa icipan s o ell hei pe sonal expe iences, including eelings and emo ions, and o en ocus on a pa icula expe ience o speci ic e en s (Table 1). Following ou concep ual amewo k and adop ing a phenomenological app oach, ou objec i e was o elucida e and in e p e he signi icance o an encoun e , equen ly accomplished h ough he iden i i- ca ion o undamen al subo dina e and majo hemes. The esul o a phenomenological in es iga ion is a comp ehensi e depic ion o hese hemes, encapsula ing he undamen al essence o a “li ed” expe ience [14]. Table 1. In e iew guide. 1. A e you amilia wi h he concep o in eg a ed ca e? Wha does i mean o you? 2. In his comp ehensi e ca e, wha a e he easons ha mo i a e o discou age you o p o ide i ? 3. Wha esou ces do you hink a e necessa y o ca y ou comp ehensi e ca e (economic, ma e ial, pe sonal, aining. . .)? 4. In he si ua ion you a e li ing in due o he lack o human esou ces, do you hink ha his comp ehensi e ca e is s ill possible? 5. Ha e you had/obse ed any con lic du ing his heal h c isis in comp ehensi e ca e? Ha e you expe ienced any e hical dilemmas in hese ci cums ances? 6. Finally, e lec on comp ehensi e ca e in he ield o c i ical ca e and eme gency ca e, how would you desc ibe he le el o impo ance, in wha si ua ions do you hink his app oach is mos needed, do you hink i would be help ul o you pa ien s, o he pa ien ’s amily membe s, o you sel , and why? Heal hca e 2025,13, 745 5 o 16 2.5. Da a Analysis A phenomenological app oach, which ollowed he Amadeo Gio gi heo y [ 16 ], was used o da a analysis. The goal o Gio gi’s me hod is o iden i y and exp ess he meanings ha pa icipan s expe ience h ough he phenomenon unde in es iga ion. Ul ima ely, using Amedeo Gio gi’s phenomenology as a me hodological basis in he s udy o e e y- day expe iences allows us o unde s and he unique pe spec i e om which pa icipan s pe cei e he eal wo ld, and he ypical ca ego ies o daily li e help cla i y he in e p e- a ion gi en o he mo i a ions and ac ions. In addi ion, hema ic analysis, as desc ibed by [ 17 ], was also used, ollowing hese s eps: (1) amilia iza ion wi h he da a; (2) gen- e a ion o ca ego ies; (3–5) sea ch, e iew, and de ini ion o hemes; and (6) inal epo , which was p epa ed wi h he s a emen s o he in o man s, indica ed by pa icipan le e s, gende , and age, and ansc ip ion, li e al eading, and heo e ical manual ca ego iza ion we e pe o med. Ini ially, some ca ego ies we e designed ha , applying he cha ac e is ic ci cula i y o quali a i e esea ch, we e expanded wi h o he eme ging ca ego ies ha appea ed du ing he de elopmen o he in e iews: “knowledge and pe cep ion”, “de- e mining ac o s”, “ esou ces and in as uc u e”, “bioe hical dimension”, “pe spec i e on comp ehensi e ca e”, and “mul idimensional impac ”, he la e wo being eme ging ca ego ies. In addi ion, analysis and ea men o MAXQDA 2022 quali a i e da a we e pe o med. MAXQDA is a so wa e p og am designed o use in quali a i e, quan i a i e, and mixed-me hods esea ch. 2.6. T us wo hiness T us wo hiness e e s o he ex en o which esea ch indings can be conside ed c edible, ans e able, con i mable, and dependable. In quali a i e esea ch, es ablishing us wo hiness equi es speci ic s a egies o ensu e he c edibili y, ans e abili y, con- i mabili y, and dependabili y o he s udy’s indings [ 18 ]. To add ess hese aspec s, se e al c i e ia a e o en conside ed, including c edibili y, ans e abili y, con i mabili y, and de- pendabili y. He e is a b eakdown o wha was done speci ically o ensu e each o hese c i e ia: (1) C edibili y: This c i e ion e e s o he accu acy and au hen ici y o he da a and indings. To ensu e c edibili y, membe checking was conduc ed, whe e pa icipan s we e asked o e iew and alida e he indings. Addi ionally, p olonged engagemen wi h he da a allowed o a deepe unde s anding, ensu ing ha in e p e a ions we e g ounded in he pa icipan s’ pe spec i es. T iangula ion o da a sou ces was also used, compa ing ind- ings ac oss di e en in e iews and obse a ions o inc ease he c edibili y o he esul s. (2) T ans e abili y: This e e s o he ex en o which he indings can be applied in o he con ex s. To enhance ans e abili y, hick desc ip ion o he esea ch con ex , pa icipan s, and p ocesses was p o ided, allowing eade s o de e mine whe he he indings could be ans e ed o simila si ua ions o se ings. De ailed con ex ual in o ma ion abou he pa icipan s’ backg ounds and he se ing was also sha ed o suppo he eade ’s assessmen o ans e abili y. (3) Con i mabili y: This c i e ion ocuses on ensu ing ha he indings a e based on he da a and no esea che bias o pe sonal pe spec i es. To ensu e con i mabili y, a clea audi ail was main ained, documen ing he esea ch p ocess, he decisions made, and how conclusions we e d awn om he da a. Pee deb ie ing was also ca ied ou , whe e colleagues e iewed he esea ch p ocess and indings, p o iding eedback and ensu ing ha he conclusions e lec ed he pa icipan s’ pe spec i es a he han he esea che s’ in e p e a ion. (4) Dependabili y: Dependabili y e e s o he con- sis ency and eliabili y o he esea ch p ocess o e ime. To es ablish dependabili y, an in-dep h esea ch p ocess was documen ed and audi ails we e kep , which ou lined he me hodology, and decisions made h oughou he s udy. Code– ecode p ocedu es we e applied, whe e da a we e coded a di e en s ages and hen ecoded o ensu e consis ency Heal hca e 2025,13, 745 6 o 16 in he coding p ocess. Addi ionally, he esea ch eam conduc ed egula discussions o ensu e consis ency in da a in e p e a ion and decision-making. The p ima y conce ns ega ding us wo hiness du ing he p epa a ion phases we e ela ed o he eliabili y o he da a collec ion me hod, he sampling s a egy, and he selec ion o an app op ia e uni o analysis. To add ess hese aspec s, he au ho s ollowed a checklis which helped hem o e lec on us wo hiness [19]. In addi ion, his esea ch ollowed he Consolida ed C i e ia o Repo ing Quali a i e S udies (COREQ) [ 20 ] This is an all-encompassing checklis ha encompasses essen ial elemen s o s udy design ha need o be documen ed. The c i e ia wi hin his checklis can assis esea che s in de ailing i al aspec s o he esea ch eam, s udy me hods, s udy con ex , indings, analysis, and in e p e a ions. P e ious esea ch has indica ed ha hese checklis s ha e enhanced he quali y o epo ing in a ious s udy ypes ele an o each checklis . These epo ing guidelines a e p esen ed in Table A1. 2.7. E hical Conside a ions The guidelines o he Decla a ion o Helsinki we e complied wi h o he pe o mance o his s udy, and accep ance was ob ained om he E hics Commi ee o he Jun a de Andalucía on 21 Decembe 2020, wi h he in e nal code 0768-N-20. All pa icipan s ga e hei w i en in o med consen , and all da a we e anonymized o p o ec pa icipan con iden iali y. 3. Resul s 3.1. Pa icipan s The inal sample consis ed o 25 heal h p o essionals om c i ical ca e and eme - gency/eme gency se ices. All o he p o essionals wo ked in eme gency and eme gency se ices. Rega ding na ionali y, 100% we e Spanish (Table 2). O he ini ial sample ec ui ed, 15 pa icipan s declined o pa icipa e o wo k- ela ed easons, lack o ime, o pe sonal easons. S a ing wi h he main heme o ou s udy, he indings we e sys ema ically classi ied h ough an i e a i e p ocess ypical o quali a i e esea ch, esul ing in six hemes, wo o which we e eme gen . Subsequen ly, hese hemes we e e ined and expanded wi h addi ional subca ego ies ha eme ged du ing he in e iews. This classi ica ion o hemes and sub hemes is ep esen ed in he coding ee below and was in o med by collabo a i e discussions among membe s o he esea ch eam (Figu e 1). Heal hca e2025,13,xFORPEERREVIEW8o 16   P2029Female9Nu seHospi alAdul hospi al eme gencies Specializa ioninc i i‐ calca e,u gencies, andeme gencies P2134Male8Nu seP ima yca eCCED/PCES* Cou sesinc i ical ca e,u gencies,and eme gencies P2238Female5Nu seP ima yca eCCED/PCES* Specializa ioninc i i‐ calca e,u gencies, andeme gencies P2337Female5Nu seHospi alGynecological eme gencies Specializa ioninc i i‐ calca e,u gencies, andeme gencies P2425Male5Nu seP ima yca e T ans e so  c i ical pa ien s Cou sesinc i ical ca e,u gencies,and eme gencies P2526Male5Nu seP ima yca e T ans e so  c i ical pa ien s Cou sesinc i ical ca e,u gencies,and eme gencies *CCED:C i icalCa eandEme gencyDe ice;PCES:P ima yCa eEme gencySe ice. S a ingwi h hemain hemeo ou s udy, he indingswe esys ema icallyclassi ied h oughani e a i ep ocess ypicalo quali a i e esea ch, esul inginsix hemes, woo  whichwe eeme gen .Subsequen ly, hese hemeswe e e inedandexpandedwi had‐ di ionalsubca ego ies ha eme geddu ing hein e iews.Thisclassi ica iono  hemes andsub hemesis ep esen edin hecoding eebelowandwasin o medbycollabo a i e discussionsamongmembe so  he esea ch eam(Figu e1).  Figu e1.Coding eewi h hemesandsub hemes. 3.2.KnowledgeandPe cep ion Fi s , hep e iouspe cep ions ha  hepa icipan shadabou comp ehensi eca e and hedeg eeo  ainingin hissubjec we ein es iga ed.Somep o essionalsanswe ed ha  heywe eunawa eo  heconcep andneededab ie explana iono i .The es  Figu e 1. Coding ee wi h hemes and sub hemes. Heal hca e 2025,13, 745 7 o 16 Table 2. Pa icipan s’ cha ac e is ics. Pa icipan Code Age (Yea s) Gende Wo k Expe ience (Yea s) Cu en Posi ion Wo kplace Se ice/ Depa men G adua e Cou se P1 25 Female 14 Nu se Hospi al Adul hospi al eme gencies Specializa ion in c i ical ca e, u gencies, and eme gencies P2 29 Male 8 Nu se Hospi al Adul hospi al eme gencies Specializa ion in c i ical ca e, u gencies, and eme gencies P3 28 Female 8 Physician Hospi al In ensi e ca e uni Specializa ion in c i ical ca e, u gencies, and eme gencies P4 30 Female 10 Nu se Hospi al In ensi e ca e uni Cou ses in c i ical ca e, u gencies, and eme gencies P5 31 Male 6 Nu se Hospi al Adul hospi al eme gencies Specializa ion in c i ical ca e, u gencies, and eme gencies P6 36 Male 8 Heal h eme gency echnician P ima y ca e CCED/PCES * Specializa ion in c i ical ca e, u gencies, and eme gencies P7 22 Female 8 Nu se P ima y ca e CCED/PCES * Specializa ion in c i ical ca e, u gencies, and eme gencies P8 26 Female 7 Nu se Hospi al In ensi e ca e uni Specializa ion in c i ical ca e, u gencies, and eme gencies P9 58 Male 10 Heal h eme gency echnician P ima y ca e CCED/PCES * Cou ses in c i ical ca e, u gencies, and eme gencies P10 40 Male 6 Physician P ima y ca e CCED/PCES * Specializa ion in c i ical ca e, u gencies, and eme gencies P11 42 Male 6 Nu se Hospi al In ensi e ca e uni Specializa ion in c i ical ca e, u gencies, and eme gencies P12 46 Female 9 Nu se Hospi al Adul hospi al eme gencies Specializa ion in c i ical ca e, u gencies, and eme gencies P13 38 Male 10 Nu se P ima y ca e CCED/PCES * Specializa ion in c i ical ca e, u gencies, and eme gencies P14 33 Female 7 Nu se Hospi al Adul hospi al eme gencies Cou ses in c i ical ca e, u gencies, and eme gencies P15 33 Male 8 Nu se P ima y ca e CCED/PCES Specializa ion in c i ical ca e, u gencies, and eme gencies Heal hca e 2025,13, 745 8 o 16 Table 2. Con . Pa icipan Code Age (Yea s) Gende Wo k Expe ience (Yea s) Cu en Posi ion Wo kplace Se ice/ Depa men G adua e Cou se P16 31 Female 11 Nu se Hospi al Adul hospi al eme gencies Specializa ion in c i ical ca e, u gencies, and eme gencies P17 34 Male 5 Nu se Hospi al Gynecological eme gencies Specializa ion in c i ical ca e, u gencies, and eme gencies P18 32 Female 10 Nu se P ima y ca e CCED/PCES * Cou ses in c i ical ca e, u gencies, and eme gencies P19 44 Female 10 Technician in auxilia y nu sing ca e Hospi al Adul hospi al eme gencies Specializa ion in c i ical ca e, u gencies, and eme gencies P20 29 Female 9 Nu se Hospi al Adul hospi al eme gencies Specializa ion in c i ical ca e, u gencies, and eme gencies P21 34 Male 8 Nu se P ima y ca e CCED/PCES * Cou ses in c i ical ca e, u gencies, and eme gencies P22 38 Female 5 Nu se P ima y ca e CCED/PCES * Specializa ion in c i ical ca e, u gencies, and eme gencies P23 37 Female 5 Nu se Hospi al Gynecological eme gencies Specializa ion in c i ical ca e, u gencies, and eme gencies P24 25 Male 5 Nu se P ima y ca e T ans e s o c i ical pa ien s Cou ses in c i ical ca e, u gencies, and eme gencies P25 26 Male 5 Nu se P ima y ca e T ans e s o c i ical pa ien s Cou ses in c i ical ca e, u gencies, and eme gencies * CCED: C i ical Ca e and Eme gency De ice; PCES: P ima y Ca e Eme gency Se ice. 3.2. Knowledge and Pe cep ion Fi s , he p e ious pe cep ions ha he pa icipan s had abou comp ehensi e ca e and he deg ee o aining in his subjec we e in es iga ed. Some p o essionals answe ed ha hey we e unawa e o he concep and needed a b ie explana ion o i . The es desc ibed comp ehensi e ca e as a o m o ca e and a en ion di ec ed o he pa ien , whe e no only he pe son in ques ion was conside ed bu also hei amily, en i onmen , and any e en su ounding hem. “In my opinion, he concep o comp ehensi e ca e is based on ying o p o ide he pa ien wi h ca e in all i s aspec s, ha is, ake in o accoun bo h hei amily and hei social, psychosocial aspec and ob iously hei physical heal h”. (p. 25) “I I ell you he u h, I don’ know wha i . I could deduce i , and I could say ha comp ehensi e ca e comes om in eg al, which means comple e, so I would da e o say Heal hca e 2025,13, 745 9 o 16 ha comp ehensi e ca e is comple e ca e, igh ? Bu . . . hones ly i ’s no a concep I know”. (p. 14) 3.3. De e mining Fac o s The p o essionals’ le els o mo i a ion and he implica ions in ela ion o his subjec we e in es iga ed. The majo i y p o ided mo i a ing and demo i a ing conside a ions, bu i is no ewo hy ha he las we e mo e nume ous. Gene ally, he in e iewees we e mo i a ed by aspec s such as o e ing quali y ca e whose objec i e is well-being and p o- g ession o pa ien and amily imp o emen , he oppo uni y o o e humanized assis ance wi h empa hy, he es ablishmen o an asse i e communica ion ela ionship be ween he pa ien and he p o essionals, and he sign o g a i ude. Rega ding he easons o demo i a ion, in he i s place, we ound ha hese de i ed om insu icien inancing, high wo kloads, lack o ime, and low p o essional–pa ien a ios caused by lack o s a . The lack o suppo om some heal h colleagues and he lack o empa hy o he pa ien s o he s a we e also impo an . “Wha mo i a es me mos a e he bene i s ha his ype o ca e b ings he pa ien , o example, mo e con idence, since hey a e a ended aking in o accoun hei needs”. (p. 23) “Wha mo i a es me o p o ide he mos comp ehensi e ca e possible is he eedback ha is gene a ed wi h he pa ien , ha esponse o com o ha ansla es in o a clima e o us . In he end I hink i is some hing ha also challenges he p o essionals and he eam, so mo e wa m h is gene a ed in he a en ion”. (p. 16) 3.4. Resou ces and In as uc u e Rega ding whe he hey conside ed he o ganiza ion accep able o insu icien , in e ms o economic s uc u e and human esou ces, o be able o o e comp ehensi e ca e, 96% o he pa icipan s s a ed ha he p ima y esou ce equi ed was economic. This was ollowed by pe sonal esou ces, which we e indica ed by 88% o he pa icipan s; ma e ial esou ces, indica ed by 76% o he pa icipan s; and aining esou ces, indica ed by 68% o he pa icipan s. In his ega d, 11.7% o he pa icipan s highligh ed he impo ance o emo ional aining. Addi ionally, 12% o hose in e iewed made e e ence o he impo ance o ha ing an “in ospec i e look” o de ec he needs ha should di ec hei heal hca e. “To ca y ou comp ehensi e ca e, economic esou ces a e needed abo e all, since ha ing mo e money would make you ha e mo e s a , so he e would be less wo kload and consequen ly a comple e and quali y ca e could be o e ed. In addi ion, his g ea e economic esou ce would also mean be e heal h acili ies, he e would be mo e acili ies and help o pa ien s, in sho , i would imp o e ca e”. (p. 19) 3.5. Bioe hical Dimension On his occasion, pa icipan s we e asked whe he hey had expe ienced o obse ed any con lic s du ing hei ca e wo k in ela ion o he comp ehensi e ca e o pa ien s and whe he hey had expe ienced any e hical dilemmas in such ci cums ances. Nine y-six pe cen o he esponden s answe ed a i ma i ely o bo h ques ions. The con lic s we e ela ed o si ua ions o physical and men al exhaus ion and isola ion o pa ien s, along wi h neglec o he amily on many occasions, in addi ion o s ic isi ing ules. The p o essionals in e iewed epo ed ha ing expe ienced e y di icul si ua ions due o he peculia i y o he se ice, he high demand, and he sca ci y o heal h esou ces. Heal hca e 2025,13, 745 16 o 16 9. Lee, J.Y.; An, J.-S.; Suh, K.-H. The Double Media ing E ec o Social Isola ion and Emo ional Suppo on Feelings o En apmen and Mo i a ion o Reco e y among Ko ean Alcoholic Inpa ien s. In . J. En i on. Res. Public Heal h 2021,18, 4710. [C ossRe ] 10. 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