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.
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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
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