Escaping voluntary confinement: A framework to address Stockholm syndrome in cardiac nursing.

Abstract

Background: Due to high burnout and intense emotional investment in patient outcomes, nurses may inadvertently become trapped in dysfunctional interpersonal dynamics at work, resembling Stockholm syndrome. Understanding and managing this phenomenon requires field research. This study explores intervention strategies to address organizational Stockholm syndrome among nursing staff in cardiac care hospitals in Isfahan.

Methods: This sequential exploratory mixed-methods study comprised qualitative and quantitative phases. In Phase I, 21 cardiac nursing specialists were purposively recruited and interviewed using semi-structured, in-depth interviews. Data were analyzed using Braun and Clarke's thematic analysis, and trustworthiness was ensured according to Lincoln and Guba's criteria. In Phase II, the qualitative findings informed the development of a structured survey administered to 276 staff working in cardiovascular wards in Isfahan. Participants rated eight qualitatively derived strategic domains using a 5-point Likert scale. A hierarchical model was tested in AMOS 22 to examine the higher-order organization and conceptual coherence of the proposed framework.

Results: The findings support a hierarchical framework for addressing organizational Stockholm syndrome among cardiac nurses, highlighting coordinated strategies across individual, interpersonal, and organizational domains. The three higher-order dimensions were Individual Empowerment (positive affect, psychological development, and self-belief), Interpersonal Development (social capital and communication climate), and Improving Organizational Climate (social hope and morale). The quantitative findings indicated acceptable hierarchical coherence among the domains, providing preliminary structural support for the proposed framework.

Conclusion: The proposed tri-level framework offers a practical approach for hospital management to address organizational Stockholm syndrome by supporting empowerment initiatives, strengthening organizational voice, and enhancing transparency. Integrating these strategies may improve psychological safety, promote staff well-being, and ultimately contribute to better quality of patient care.