Comprehensive care in critical services: a spanish qualitative study

Academic Editor: Jose Granero-Molina Received: 16 February 2025 Revised: 24 March 2025 Accepted: 26 March 2025 Published: 27 March 2025 Citation: de Diego-Cordero, R.; Flores-Alpresa, T.; FernándezRodríguez, M.; Vega-Escaño, J.; Pérez-Jiménez, J.M. Comprehensive Care in Critical Services: A Spanish Qualitative Study. Healthcare 2025,13, 745. https://doi.org/10.3390/ healthcare13070745 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/ licenses/by/4.0/). Article Comprehensive Care in Critical Services: A Spanish Qualitative Study Rocío de Diego-Cordero 1,2 , Thalía Flores-Alpresa 3, Miriam Fernández-Rodríguez 4, Juan Vega-Escaño 1,* and José Miguel Pérez-Jiménez 1,2,5,* 1Department of Nursing, School of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; [email protected] 2 Research Group CTS1149: Comprehensive and Sustainable Health: Bio-Psycho-Social, Cultural and Spiritual Approach to Human Development, 41009 Seville, Spain 3San Hilario Health Center, Dos Hermanas, 41701 Seville, Spain; thaliaflor[email protected] 4Juan Ramón Jiménez University Hospital, 21005 Huelva, Spain; [email protected] 5Anesthesiology and Resuscitation Clinical Management Unit, University Hospital Virgen Macarena, 41009 Sevilla, Spain *Correspondence: [email protected] (J.V.-E.); [email protected] (J.M.P.-J.) Abstract: Background/Objectives: Comprehensive care is crucial in emergency healthcare. In intensive care units, a holistic approach may be difficult to implement due to the conditions of the patients and existing work protocols aimed at maintaining vital functions for the survival of patients. The present study aims to explore and describe the knowledge, attitudes, and perceptions of critical care and emergency health professionals regarding the implementation of integrated care practices within intensive care units, with the goal of identifying barriers and facilitators to adopting a holistic approach in emergency healthcare settings. Methods: This study implemented an exploratory and descriptive qualitative design with a phenomenological approach through semi-structured interviews with health professionals who had worked in intensive care units or emergency services for both public and private health institutions in Spain (n = 25). The study was conducted during the years 2023 and 2024, using a convenience sampling method along with snowball sampling, and a narrative discourse analysis was performed. The MAXQDA 2022 software program was used. This study was granted due permission by the Research Ethics Committee belonging to the Junta de Andalucía, under protocol code 0768-N-20. Results: The total sample consisted of 25 healthcare professionals from critical care and emergency services in Spain. The main themes, as key findings, were knowledge and perception, determining factors, resources and infrastructure, the bioethical dimension, perspectives on comprehensive care, and multidimensional impact. Most of the professionals were familiar with comprehensive care, but lack of resources and time prevented them from carrying it out in their units. Conclusions: For critical care and emergency professionals, comprehensive care is important to their clinical practice, but barriers to its realization still exist. Understanding the importance to these professionals of the application of comprehensive care is fundamental to establishing measures for its implementation in these services. It is also a motivation to continue providing humanized and compassionate care that respects the patient’s dignity. It is a priority to provide the necessary infrastructure and human resources so that patients admitted to these units can be cared for with this tool. Keywords: critical care; interviews; qualitative research; comprehensive healthcare; emergency service hospital Healthcare 2025,13, 745 https://doi.org/10.3390/healthcare13070745 Healthcare 2025,13, 745 2 of 16 1. Introduction Due to the global health crisis caused by the increasingly pressing shortage of human resources, in Spanish hospitals the number of hospitalizations in intensive care units (ICUs) has led to a considerable increase in the workload of nurses, whose numbers are well below the nurse–patient ratio worldwide [ 1 ]. According to the WHO, Spain is 61st in the world ranking, with a ratio of 5.73 vs. 8.77 nurses per 1000 inhabitants, while in terms of doctors we are in 26th position [2]. Intensive care and emergency units are environments characterized by work overload, state-of-the-art technology, the execution of complex tasks, stress, and the creation of defensive emotions during the care of highly complex patients. In the ICU, sometimes the work protocols and the conditions of patients make the holistic approach to care difficult [ 3 ]. In this environment, it is common to break the patient’s connection with his or her environment, which means that humanized care is depended on as the central axis [4]. Comprehensive healthcare refers to “the set of actions that promote and facilitate efficient, effective and timely care, which is directed more at people considered in their physical and mental integrity, as social beings belonging to different families and communities, who are in a permanent process of integration and adaptation to their physical, social and cultural environment, rather than at the patient or the disease as isolated facts” [ 5 , 6 ]. Therefore, in the units to which we refer, it becomes more necessary and is shown as a guarantee of high-quality care, taking into account not only the physical and symptomatic aspects of the patient, but also the entire global, biological, psychological, social, cultural, and spiritual sphere [7]. In most patients, being admitted to or visiting the emergency room of a hospital generates anxiety, motivated by fear of the unknown, of a doubtful future, and possible inconveniences of their illnesses, placing them in a moment of vulnerability and weakness in their lives [ 3 ]. Therefore, it is necessary to offer them comprehensive care, which guarantees an approach to all phases and dimensions of the person, together with multidisciplinary work [8]. A great emotional and spiritual confusion has been generated in patients, relatives, and professionals. Knowing and understanding these complexities allows the building of more coherent and humane interventions, which are necessary not only to provide an immediate response at the time of the disaster but also to build an effective, empathetic, and assertive accompaniment, taking into account the biopsychosocial sphere of patients [9]. Comprehensive care has been discussed in healthcare for years, and research in this area has been scarce. The technological progress achieved in the diagnosis and treatment of diseases has not gone hand in hand with progress in the development of nontechnical skills in healthcare teams (awareness, humanization, empathy, assertiveness, etc.). This is why patients and their families yearn for comprehensive care, even more so in the context of crisis and hospitalization in an ICU [7]. Previous studies have shown that there has been a deterioration in the quality of humanized care and that it is very necessary to know what aspects hinder the provision of humanized care in the act of caring, since the results will facilitate knowing the reality for the fundamental progress of patients and health professionals [ 10 ]. Still, research in the field of comprehensive care in emergency departments and emergency services continues to be insufficient. Furthermore, it is evident that there is a wide variety of interventions orientated towards integrated care in emergency departments; however, it is difficult to put these into practice due to the short time required in this area, as work in these departments leads to emotional overload and stress for the nursing professionals [ 11 ]. Interventions targeting psychological resilience are needed to reduce nurses’ stress perceptions [12]. Healthcare 2025,13, 745 3 of 16 The goal of this study was to explore and describe the knowledge, attitudes, and perceptions of critical care and emergency health professionals regarding the implementation of integrated care practices within intensive care units, with the goal of identifying barriers and facilitators to adopting a holistic approach in emergency healthcare settings. 2. Materials and Methods 2.1. Research Design An exploratory and descriptive qualitative design with a phenomenological approach was used [ 13 ], employing semi-structured interviews which aimed to describe the meaning of an experience by identifying themes and subthemes born out of participant observation and discourse [14]. A qualitative approach grants researchers significant flexibility, allows for a deeper understanding of participants’ perspectives, facilitates the development of multiple interpretations of respondents’ viewpoints on a topic, and helps uncover concerns that survey-based methods alone may overlook. This approach helps researchers comprehend the lives and necessities of others by helping to recognize and to set aside theoretical and ideological biases and is characterized by (a) a conceptual orientation provided by a research team, (b) a focus on a discrete community, (c) a focus on a problem within a specific context, (d) a limited number of participants, (e) the use of participants who may hold specific knowledge, and (f) the use of selected episodes of participant observation [15]. 2.2. Setting and Participants The study was conducted with healthcare professionals (physicians, emergency room technicians, nurses, and nursing assistants) working in intensive care and emergency departments at several hospitals and primary care centers in southern Spain. Specifically, the participants included professionals from the Virgen del Rocío University Hospital (Seville), the Juan Ramón Jiménez University Hospital (Huelva), the Virgen de Valme University Hospital (Seville), the University Hospital of Jerez (Cádiz), and support services from the Southern and Eastern Districts of Seville (Seville). In particular, the participating hospitals have modern ICUs that offer comprehensive care for critically ill patients. These ICUs are equipped with cutting-edge technology and a multidisciplinary team that works together to provide the best possible care. Furthermore, the hospitals and primary care centers have emergency services that operate 24 h a day, treating both medical and surgical emergencies. These services are designed to ensure prompt and effective care, prioritizing patient comfort and safety. 2.3. Sampling and Eligibility Criteria Convenience sampling and the snowball method were carried out, according to which participants are selected based on predetermined criteria. The main criterion was the familiarity of the participants with the phenomenon under investigation. The researchers looked for informants who had collectively encountered the phenomenon, even though they also differed in their characteristics and in their own personal experiences, to support the achievement of the aims [ 14 ]. Thus, informational messages were sent through social networks, WhatsApp work groups, and by email. Supervisors of emergency services and ICUs from the different hospitals, who acted as key agents, were also contacted. Participants who responded to the informational messages disseminated through the aforementioned electronic media or were invited to participate voluntarily through key informants were enrolled in the study after accepting and signing the informed consent form sent to them Healthcare 2025,13, 745 4 of 16 via email. This sample recruitment procedure guaranteed the anonymity of the informants until the time of the interviews by the researchers. Finally, participants were included provided they were health professionals working in (ICUs) or emergency services for both public or private health institutions in Spain and treating critically ill patients. While the ICU health professionals worked in hospitals, emergency care was provided in hospitals, primary care, and outpatient emergency units. Health professionals who were working outside ICUs or emergency services, as well as those not caring for patients (i.e., academic or management level), were excluded. 2.4. Data Collection The data collection was performed through semi-structured interviews. These were conducted in two moments by 2 researchers: from March 2023 to June 2023 and from September 2023 to December 2024, in the Spanish language, and lasted approximately 50 to 60 min. Data collection continued until data saturation was reached. The interviews occurred individually at a time convenient for the participants, that is, respecting their preferences. Most interviews were conducted in person, so the AudioLab mobile app (version 1.3) was used to record and transcribe the information obtained. When distance was a barrier, interviews were conducted remotely via Zoom videoconferences. The same app was also used to ensure no information was lost. In the case of face-to-face interviews, with prior agreement between the researcher and the informant, breaks in the work environment, specifically in the staff lounge, were used, accompanied by a cup of coffee, facilitating relaxed and familiar situations as much as possible. The objective was for the informants to feel comfortable responding to the series of questions posed by the researcher following a semi-structured interview script, which facilitated the smooth and orderly development of the content. Meanwhile, the online interviews were conducted at the informants’ quietest moments, usually when they were free at home, thus facilitating their participation. On both occasions, distractions in the environment were avoided, thus ensuring the absence of additional participants. Although, especially in the first case, this seemed practically impossible to achieve, it was quite easy, since the rest of the work environment largely respected the moment. An interview script was used, and the question script was designed to encourage participants to tell their personal experiences, including feelings and emotions, and often focus on a particular experience or specific events (Table 1). Following our conceptual framework and adopting a phenomenological approach, our objective was to elucidate and interpret the significance of an encounter, frequently accomplished through the identification of fundamental subordinate and major themes. The result of a phenomenological investigation is a comprehensive depiction of these themes, encapsulating the fundamental essence of a “lived” experience [14]. Table 1. Interview guide. 1. Are you familiar with the concept of integrated care? What does it mean to you? 2. In this comprehensive care, what are the reasons that motivate or discourage you to provide it? 3. What resources do you think are necessary to carry out comprehensive care (economic, material, personal, training. . .)? 4. In the situation you are living in due to the lack of human resources, do you think that this comprehensive care is still possible? 5. Have you had/observed any conflict during this health crisis in comprehensive care? Have you experienced any ethical dilemmas in these circumstances? 6. Finally, reflect on comprehensive care in the field of critical care and emergency care, how would you describe the level of importance, in what situations do you think this approach is most needed, do you think it would be helpful to your patients, to the patient’s family members, to yourself, and why? Healthcare 2025,13, 745 5 of 16 2.5. Data Analysis A phenomenological approach, which followed the Amadeo Giorgi theory [ 16 ], was used for data analysis. The goal of Giorgi’s method is to identify and express the meanings that participants experience through the phenomenon under investigation. Ultimately, using Amedeo Giorgi’s phenomenology as a methodological basis in the study of everyday experiences allows us to understand the unique perspective from which participants perceive the real world, and the typical categories of daily life help clarify the interpretation given to the motivations and actions. In addition, thematic analysis, as described by [ 17 ], was also used, following these steps: (1) familiarization with the data; (2) generation of categories; (3–5) search, review, and definition of themes; and (6) final report, which was prepared with the statements of the informants, indicated by participant letters, gender, and age, and transcription, literal reading, and theoretical manual categorization were performed. Initially, some categories were designed that, applying the characteristic circularity of qualitative research, were expanded with other emerging categories that appeared during the development of the interviews: “knowledge and perception”, “determining factors”, “resources and infrastructure”, “bioethical dimension”, “perspective on comprehensive care”, and “multidimensional impact”, the latter two being emerging categories. In addition, analysis and treatment of MAXQDA 2022 qualitative data were performed. MAXQDA is a software program designed for use in qualitative, quantitative, and mixed-methods research. 2.6. Trustworthiness Trustworthiness refers to the extent to which research findings can be considered credible, transferable, confirmable, and dependable. In qualitative research, establishing trustworthiness requires specific strategies to ensure the credibility, transferability, confirmability, and dependability of the study’s findings [ 18 ]. To address these aspects, several criteria are often considered, including credibility, transferability, confirmability, and dependability. Here is a breakdown of what was done specifically to ensure each of these criteria: (1) Credibility: This criterion refers to the accuracy and authenticity of the data and findings. To ensure credibility, member checking was conducted, where participants were asked to review and validate the findings. Additionally, prolonged engagement with the data allowed for a deeper understanding, ensuring that interpretations were grounded in the participants’ perspectives. Triangulation of data sources was also used, comparing findings across different interviews and observations to increase the credibility of the results. (2) Transferability: This refers to the extent to which the findings can be applied in other contexts. To enhance transferability, thick description of the research context, participants, and processes was provided, allowing readers to determine whether the findings could be transferred to similar situations or settings. Detailed contextual information about the participants’ backgrounds and the setting was also shared to support the reader’s assessment of transferability. (3) Confirmability: This criterion focuses on ensuring that the findings are based on the data and not researcher bias or personal perspectives. To ensure confirmability, a clear audit trail was maintained, documenting the research process, the decisions made, and how conclusions were drawn from the data. Peer debriefing was also carried out, where colleagues reviewed the research process and findings, providing feedback and ensuring that the conclusions reflected the participants’ perspectives rather than the researchers’ interpretation. (4) Dependability: Dependability refers to the consistency and reliability of the research process over time. To establish dependability, an in-depth research process was documented and audit trails were kept, which outlined the methodology, and decisions made throughout the study. Code–recode procedures were applied, where data were coded at different stages and then recoded to ensure consistency Healthcare 2025,13, 745 6 of 16 in the coding process. Additionally, the research team conducted regular discussions to ensure consistency in data interpretation and decision-making. The primary concerns regarding trustworthiness during the preparation phases were related to the reliability of the data collection method, the sampling strategy, and the selection of an appropriate unit of analysis. To address these aspects, the authors followed a checklist which helped them to reflect on trustworthiness [19]. In addition, this research followed the Consolidated Criteria for Reporting Qualitative Studies (COREQ) [ 20 ] This is an all-encompassing checklist that encompasses essential elements of study design that need to be documented. The criteria within this checklist can assist researchers in detailing vital aspects of the research team, study methods, study context, findings, analysis, and interpretations. Previous research has indicated that these checklists have enhanced the quality of reporting in various study types relevant to each checklist. These reporting guidelines are presented in Table A1. 2.7. Ethical Considerations The guidelines of the Declaration of Helsinki were complied with for the performance of this study, and acceptance was obtained from the Ethics Committee of the Junta de Andalucía on 21 December 2020, with the internal code 0768-N-20. All participants gave their written informed consent, and all data were anonymized to protect participant confidentiality. 3. Results 3.1. Participants The final sample consisted of 25 health professionals from critical care and emergency/emergency services. All of the professionals worked in emergency and emergency services. Regarding nationality, 100% were Spanish (Table 2). Of the initial sample recruited, 15 participants declined to participate for work-related reasons, lack of time, or personal reasons. Starting with the main theme of our study, the findings were systematically classified through an iterative process typical of qualitative research, resulting in six themes, two of which were emergent. Subsequently, these themes were refined and expanded with additional subcategories that emerged during the interviews. This classification of themes and subthemes is represented in the coding tree below and was informed by collaborative discussions among members of the research team (Figure 1). Healthcare2025,13,xFORPEERREVIEW8of16   P2029Female9NurseHospitalAdulthospital emergencies Specializationincriti‐ calcare,urgencies, andemergencies P2134Male8NursePrimarycareCCED/PCES* Coursesincritical care,urgencies,and emergencies P2238Female5NursePrimarycareCCED/PCES* Specializationincriti‐ calcare,urgencies, andemergencies P2337Female5NurseHospitalGynecological emergencies Specializationincriti‐ calcare,urgencies, andemergencies P2425Male5NursePrimarycare Transfersof critical patients Coursesincritical care,urgencies,and emergencies P2526Male5NursePrimarycare Transfersof critical patients Coursesincritical care,urgencies,and emergencies *CCED:CriticalCareandEmergencyDevice;PCES:PrimaryCareEmergencyService. Startingwiththemainthemeofourstudy,thefindingsweresystematicallyclassified throughaniterativeprocesstypicalofqualitativeresearch,resultinginsixthemes,twoof whichwereemergent.Subsequently,thesethemeswererefinedandexpandedwithad‐ ditionalsubcategoriesthatemergedduringtheinterviews.Thisclassificationofthemes andsubthemesisrepresentedinthecodingtreebelowandwasinformedbycollaborative discussionsamongmembersoftheresearchteam(Figure1).  Figure1.Codingtreewiththemesandsubthemes. 3.2.KnowledgeandPerception First,thepreviousperceptionsthattheparticipantshadaboutcomprehensivecare andthedegreeoftraininginthissubjectwereinvestigated.Someprofessionalsanswered thattheywereunawareoftheconceptandneededabriefexplanationofit.Therest Figure 1. Coding tree with themes and subthemes. Healthcare 2025,13, 745 7 of 16 Table 2. Participants’ characteristics. Participant Code Age (Years) Gender Work Experience (Years) Current Position Workplace Service/ Department Graduate Course P1 25 Female 14 Nurse Hospital Adult hospital emergencies Specialization in critical care, urgencies, and emergencies P2 29 Male 8 Nurse Hospital Adult hospital emergencies Specialization in critical care, urgencies, and emergencies P3 28 Female 8 Physician Hospital Intensive care unit Specialization in critical care, urgencies, and emergencies P4 30 Female 10 Nurse Hospital Intensive care unit Courses in critical care, urgencies, and emergencies P5 31 Male 6 Nurse Hospital Adult hospital emergencies Specialization in critical care, urgencies, and emergencies P6 36 Male 8 Health emergency technician Primary care CCED/PCES * Specialization in critical care, urgencies, and emergencies P7 22 Female 8 Nurse Primary care CCED/PCES * Specialization in critical care, urgencies, and emergencies P8 26 Female 7 Nurse Hospital Intensive care unit Specialization in critical care, urgencies, and emergencies P9 58 Male 10 Health emergency technician Primary care CCED/PCES * Courses in critical care, urgencies, and emergencies P10 40 Male 6 Physician Primary care CCED/PCES * Specialization in critical care, urgencies, and emergencies P11 42 Male 6 Nurse Hospital Intensive care unit Specialization in critical care, urgencies, and emergencies P12 46 Female 9 Nurse Hospital Adult hospital emergencies Specialization in critical care, urgencies, and emergencies P13 38 Male 10 Nurse Primary care CCED/PCES * Specialization in critical care, urgencies, and emergencies P14 33 Female 7 Nurse Hospital Adult hospital emergencies Courses in critical care, urgencies, and emergencies P15 33 Male 8 Nurse Primary care CCED/PCES Specialization in critical care, urgencies, and emergencies Healthcare 2025,13, 745 8 of 16 Table 2. Cont. Participant Code Age (Years) Gender Work Experience (Years) Current Position Workplace Service/ Department Graduate Course P16 31 Female 11 Nurse Hospital Adult hospital emergencies Specialization in critical care, urgencies, and emergencies P17 34 Male 5 Nurse Hospital Gynecological emergencies Specialization in critical care, urgencies, and emergencies P18 32 Female 10 Nurse Primary care CCED/PCES * Courses in critical care, urgencies, and emergencies P19 44 Female 10 Technician in auxiliary nursing care Hospital Adult hospital emergencies Specialization in critical care, urgencies, and emergencies P20 29 Female 9 Nurse Hospital Adult hospital emergencies Specialization in critical care, urgencies, and emergencies P21 34 Male 8 Nurse Primary care CCED/PCES * Courses in critical care, urgencies, and emergencies P22 38 Female 5 Nurse Primary care CCED/PCES * Specialization in critical care, urgencies, and emergencies P23 37 Female 5 Nurse Hospital Gynecological emergencies Specialization in critical care, urgencies, and emergencies P24 25 Male 5 Nurse Primary care Transfers of critical patients Courses in critical care, urgencies, and emergencies P25 26 Male 5 Nurse Primary care Transfers of critical patients Courses in critical care, urgencies, and emergencies * CCED: Critical Care and Emergency Device; PCES: Primary Care Emergency Service. 3.2. Knowledge and Perception First, the previous perceptions that the participants had about comprehensive care and the degree of training in this subject were investigated. Some professionals answered that they were unaware of the concept and needed a brief explanation of it. The rest described comprehensive care as a form of care and attention directed to the patient, where not only the person in question was considered but also their family, environment, and any event surrounding them. “In my opinion, the concept of comprehensive care is based on trying to provide the patient with care in all its aspects, that is, take into account both their family and their social, psychosocial aspect and obviously their physical health”. (p. 25) “If I tell you the truth, I don’t know what it. I could deduce it, and I could say that comprehensive care comes from integral, which means complete, so I would dare to say Healthcare 2025,13, 745 9 of 16 that comprehensive care is complete care, right? But . . . honestly it’s not a concept I know”. (p. 14) 3.3. Determining Factors The professionals’ levels of motivation and the implications in relation to this subject were investigated. The majority provided motivating and demotivating considerations, but it is noteworthy that the last were more numerous. Generally, the interviewees were motivated by aspects such as offering quality care whose objective is well-being and progression to patient and family improvement, the opportunity to offer humanized assistance with empathy, the establishment of an assertive communication relationship between the patient and the professionals, and the sign of gratitude. Regarding the reasons for demotivation, in the first place, we found that these derived from insufficient financing, high workloads, lack of time, and low professional–patient ratios caused by lack of staff. The lack of support from some health colleagues and the lack of empathy of the patients for the staff were also important. “What motivates me most are the benefits that this type of care brings the patient, for example, more confidence, since they are attended taking into account their needs”. (p. 23) “What motivates me to provide the most comprehensive care possible is the feedback that is generated with the patient, that response of comfort that translates into a climate of trust. In the end I think it is something that also challenges the professionals and the team, so more warmth is generated in the attention”. (p. 16) 3.4. Resources and Infrastructure Regarding whether they considered the organization acceptable or insufficient, in terms of economic structure and human resources, to be able to offer comprehensive care, 96% of the participants stated that the primary resource required was economic. This was followed by personal resources, which were indicated by 88% of the participants; material resources, indicated by 76% of the participants; and training resources, indicated by 68% of the participants. In this regard, 11.7% of the participants highlighted the importance of emotional training. Additionally, 12% of those interviewed made reference to the importance of having an “introspective look” to detect the needs that should direct their healthcare. “To carry out comprehensive care, economic resources are needed above all, since having more money would make you have more staff, so there would be less workload and consequently a complete and quality care could be offered. In addition, this greater economic resource would also mean better health facilities, there would be more facilities and help for patients, in short, it would improve care”. (p. 19) 3.5. Bioethical Dimension On this occasion, participants were asked whether they had experienced or observed any conflicts during their care work in relation to the comprehensive care of patients and whether they had experienced any ethical dilemmas in such circumstances. Ninety-six percent of the respondents answered affirmatively to both questions. The conflicts were related to situations of physical and mental exhaustion and isolation of patients, along with neglect of the family on many occasions, in addition to strict visiting rules. The professionals interviewed reported having experienced very difficult situations due to the peculiarity of the service, the high demand, and the scarcity of health resources. Healthcare 2025,13, 745 16 of 16 9. Lee, J.Y.; An, J.-S.; Suh, K.-H. The Double Mediating Effect of Social Isolation and Emotional Support on Feelings of Entrapment and Motivation for Recovery among Korean Alcoholic Inpatients. Int. J. Environ. Res. Public Health 2021,18, 4710. 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