Inside the ICU nurse’s mind: how nurses mentally step into their patients’ shoes

Deep inside an intensive care unit, where ventilators hum and monitors flash with life-or-death data, a quieter cognitive process unfolds every shift: nurses deliberately imagining what it feels like to be the unconscious, frightened patient in the bed. A new qualitative study from Iran, published in BMC Nursing, offers one of the most detailed descriptions to date of how cardiac surgery ICU nurses use perspective-taking — the cognitive and emotional act of understanding a patient’s experience from the patient’s own viewpoint — to guide empathic, patient-centered care in one of medicine’s most technologically saturated environments.

The research team, led by Marziyeh Mohammadi of Tehran Medical Sciences, Islamic Azad University, together with colleagues from Iran University of Medical Sciences and the Institute for Humanities and Cultural Studies, conducted in-depth interviews with 12 purposively sampled ICU nurses — eight women and four men — working in a cardiac surgery intensive care unit in Iran. Interview transcripts were analyzed sequentially, in the original order the interviews were conducted, using conventional content analysis, a systematic coding method in which researchers derive categories and themes directly from the data rather than from a pre-existing theoretical framework. Analysis continued until saturation specific to perspective-taking was reached, the point at which new interviews stopped generating new insights about the phenomenon.

Rigor was not left to chance. The authors describe three classic qualitative safeguards: prolonged engagement, meaning the researchers spent extended time in the field and with the data to build trust and depth; member checking, in which participants reviewed and confirmed the researchers’ interpretations of their own accounts; and audit trails, documented records that allow independent reviewers to trace every analytical decision from raw transcript to final theme. Together, these techniques address the central vulnerability of qualitative research — the possibility that findings reflect the analysts’ assumptions rather than the participants’ reality.

From this process, three related but distinguishable themes emerged. The first, and most vivid, was imagining oneself in the patient’s position. Nurses described mentally placing themselves in the bed: picturing the strangeness of being intubated, the vulnerability of being turned and washed by strangers, the disorientation of waking from anesthesia surrounded by machines. This imaginative simulation is not idle daydreaming; it is a deliberate cognitive act that converts abstract clinical knowledge about a procedure into a felt sense of what that procedure means to the person undergoing it.

The second theme was understanding patients’ emotions through autobiographical and embodied experience. Here the study reveals something technically interesting about the architecture of empathy: nurses did not rely on imagination alone. They mined their own life histories — memories of illness, hospitalization, or caring for sick relatives — and their own bodily experiences to anchor their interpretations of what patients were feeling. In cognitive terms, autobiographical memory functions as a simulation library: when a nurse sees a patient grimace as a chest tube is adjusted, stored first-person experience of pain provides a template for decoding that expression. Embodied experience, the felt knowledge of one’s own body, supplies the emotional resonance that pure imagination can lack.

The third theme was gaining deeper insight by understanding others. Perspective-taking, the nurses reported, was not confined to the patient. By attending to the emotional states of families gathered anxiously at the bedside — and by understanding colleagues and the wider social web of the ICU — participants reported arriving at a richer, more layered comprehension of each clinical situation. Families in a cardiac surgery ICU are often the patient’s voice: the patient may be sedated or ventilated, so reading the family’s fear and exhaustion becomes a diagnostic channel into the patient’s unspoken needs.

Participants consistently described perspective-taking as helpful for addressing the emotional needs of patients and families. Some perceived that their sensitivity grew with experience — that years at the bedside sharpened rather than dulled their capacity to step into the patient’s position. The authors are careful, however, to frame this as participants’ perception rather than established evidence. Because the study was cross-sectional and conducted at a single site, it cannot rule out emotional desensitization in critical care, a phenomenon long debated in the literature in which repeated exposure to suffering may blunt emotional responsiveness. What the study documents is how these particular nurses experience and use the process, not how the process changes across a career.

The authors also flag a methodological subtlety that matters for interpreting the findings. Interview probes directly asked nurses about imagining themselves in the patient’s position. The three themes therefore reflect participants’ responses to targeted questioning rather than spontaneous, unprompted accounts. This is a technical distinction with real consequences: targeted probes can activate reflective narratives that might not surface naturally in the flow of a shift, so the study maps what nurses can articulate when asked, which is a different claim from what they spontaneously do. The authors present this transparency as part of the study’s descriptive honesty, and it gives future researchers a precise target for follow-up work using unobtrusive observation or experience sampling.

Why does this matter beyond the ICU? Perspective-taking sits at the core of empathic care, and empathic care is not a soft luxury in critical care — it is linked in the broader nursing literature to patient satisfaction, adherence, and the human dignity of people who are often too ill to advocate for themselves. In a cardiac surgery ICU, where patients pass through anesthesia, intubation, sternotomy recovery, and the psychological aftershock of open-heart surgery, the nurse’s ability to simulate the patient’s viewpoint is one of the few tools that addresses the emotional dimension of an overwhelmingly physical ordeal. The findings can directly inform reflective-practice training for critical care nurses — educational programs in which practitioners systematically examine their own experiences, memories, and assumptions to build clinical insight. The study suggests such training could deliberately harness the mechanisms the nurses described: guided autobiographical reflection, embodied awareness exercises, and family-inclusive perspective-taking.

The road ahead is clear from the study’s own limitations. The authors call for testing these findings in larger, multi-site samples, and for research designs that can disentangle the growth of sensitivity from the risk of desensitization over time. The work was funded by the Vice-Chancellor at Tehran Islamic Azad University of Medical Sciences, and the authors declare no competing interests. As a piece of the puzzle, this study does something rare: it takes a process everyone praises and few have mapped — the mental act of stepping into a patient’s shoes — and describes, in the nurses’ own terms, how it actually works at the bedside. In the machine-dense world of the ICU, the study’s quiet conclusion is striking: the most powerful monitoring equipment may still be a trained human imagination, running the patient’s experience on the nurse’s own mind.

Subject of Research: How ICU nurses use perspective-taking to understand and care for critically ill patients

Article Title: Perspective-taking in ICU nurses: a qualitative descriptive study

Article References: Mohammadi, M., Fazeli, N., Yekta, Z. P., & Peyrovi, H. (2026). Perspective-taking in ICU nurses: a qualitative descriptive study. BMC Nursing. https://doi.org/10.1186/s12912-026-05509-8

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05509-8

Keywords: ICU nursing, perspective-taking, empathy, qualitative research, critical care, nursing research, patient-centered care, BMC Nursing, nurses, qualitative, descriptive, scientific research