Psychodynamic Aspects of Uncertainty among Patients in Intensive and High-Acuity Care: A Conceptual Analysis
DOI:
https://doi.org/10.35898/ghmj-931375Keywords:
Uncertainty, Critical care, Defense mechanisms, Psychological stress, Concept analysisAbstract
Background: Patients receiving intensive or high-acuity care often face sudden, life-threatening medical crises that can cause profound psychological distress. However, uncertainty in critical care is commonly discussed in terms of limited information or difficulties in understanding a patient's condition. This perspective may overlook the deeper intrapsychic and emotional processes that arise when individuals confront acute medical trauma. This theoretical gap hinders the understanding of the emotional subjective dynamics of this specific category of patients.
Aims: This study conducted a systematic concept analysis to define and theoretically refine the psychodynamic dimensions of uncertainty among adult patients in critical and high-acuity care settings.
Methods: The literature search was initially conducted using a scoping-oriented approach and subsequently informed a concept analysis based on Walker and Avant’s framework. Four database sources were represented in the search records: PubMed, MEDLINE via EBSCO, APA PsycArticles via ProQuest, and Scopus. This study looked at the aspects of Uncertainty that patients feel when they are in intensive and high‑acuity care.
Results: This conceptual analysis found five attributes: 1) A constant feeling of danger to life; 2) Hidden ways the mind protects itself such as denial, dissociation and splitting; 3) A sense of how the body is changing; 4) A need for relationships to keep emotions in check; 5) The trouble making sense of events and keeping a story together. These attributes seem to come from causes, especially deep psychological upset, dependence on medical machines and Uncertainty about the outcome.
Conclusion: Uncertainty is more than a thought problem. It is a feeling that lives in the body in the mind and in relationships. It goes beyond mental models of Uncertainty. Paying attention to hidden defensive processes and the role of relationships in emotional regulation provides a broader view of how patients cope with critical illness. This perspective may inform caring practices and interventions that support patients’ emotional recovery after intensive care.
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Copyright (c) 2026 Niken Sri Lestari, S.Kep., Ns., Assoc. Prof. Suhartini Ismail, S.Kp., MNS., Ph.D., Dr. Ns. Elsa Naviati S.Kep., M.Kep., Sp.Kep. An., Assoc. Prof. Dr. Haliza Hasan, RN, Ph.D.
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