"Watching Over and Helping Each Other": a constructivist grounded theory of collective support processes among Chinese clinical nurses during emerging infectious disease outbreaks

BACKGROUND: Emerging Infectious Diseases (EIDs) such as COVID-19 pose significant global health challenges. Nurses, as key responders in pandemics, endure substantial impacts on their physical and mental health. Thus, developing a comprehensive framework to enhance nurses’ psychological coping and resilience during public health crises is crucial. OBJECTIVE: This study aims to understand the experiences of Chinese nurses during the COVID-19 pandemic and to establish a theoretical foundation for disaster nursing. DESIGN: This qualitative study employs a constructivist grounded theory approach rooted in symbolic interactionism. SETTINGS AND PARTICIPANTS: The research includes 53 frontline nurses from 11 provincial capitals in China, recruited between May 2020 and June 2022. METHODS: Utilizing semi-structured interviews guided by existing research, the study conducted in-depth interviews. The theoretical saturation determined the sample size. Data were analysed using the constructivist grounded theory method. RESULTS: We propose a dynamic three-phase process—involvement, adjustment, and integration and growth—in which nurses progress from rapid engagement under high demands, and eventually rebalancing as resources increase, to resilient practice supported by mutual helping and renewed purpose. CONCLUSIONS: The developed conceptual model emphasizes the importance of resources, support systems, and coping strategies in addressing stressors faced by nurses. It provides a conceptual model to enhance nursing education and support systems, advocating for policies that promote resilience and well-being. The study also stresses the need to challenge persistent social stereotypes by fostering a professional, gender-neutral image.