The weight of caring: emotional labour, burnout risk, and the need for supportive practice environments in Saudi Arabian mental health nursing.

Résumé

BACKGROUND: Mental health nursing involves significant emotional labour, yet the experiences of nurses in the Kingdom of Saudi Arabia (KSA) remain under-researched. This study explored nurses' experiences of emotional labour when caring for women with psychosis in KSA, where unique cultural and organisational factors may compound emotional demands.METHODS: A hermeneutic phenomenological design, guided by van Manen's lifeworld existentials and emotional labour theory, was employed. Semi-structured interviews were conducted with a purposive sample of 21 female nurses from two mental health facilities in Riyadh, KSA. Data were analysed using van Manen's selective highlighting approach.RESULTS: One overarching theme emerged: Nurses' experiences of providing care to women with psychosis in KSA: understandings and emotions. This encompassed two key themes: (1) Fragmented knowledge in under-resourced environments, capturing how educational gaps and chronic staffing shortages shape nurses' capacity to understand and respond therapeutically to psychosis; and (2) Carrying the weight without a net: emotional labour in the absence of support, illuminating the constellation of distress responses, including sympathy-driven over-caring, fear, sadness, and unrecognised transference, that accumulate when clinical supervision and formal psychological support are entirely absent. Participants reported intense feelings of sadness, anger, fear, and helplessness, exacerbated by a lack of clinical supervision or debriefing structures.CONCLUSIONS: Mental health nurses in KSA perform substantial emotional labour without formal professional support systems. Notably, the collectivist cultural resources available to nurses, spirituality, family networks, and collegial belonging, provided informal coping, but did not substitute for structured clinical supervision or debriefing. Secondary stigma, manifesting as social distancing from colleagues upon disclosure of emotional difficulties, further limited help-seeking among some participants. The convergence of chronic staff shortages, limited specialist mental health nursing education (i.e., postgraduate or pre-registration psychiatric nursing preparation), and absent clinical supervision creates a high risk for burnout. To ensure nurse wellbeing and care quality, it is essential to establish supportive practice environments, including formal clinical supervision, resilience training, and protected time for specialist education.CLINICAL TRIAL NUMBER: Not applicable.