Holding the Unspoken: Oncology Nurses' Experiences of Using Creative Expression to Support Emotional Processing in Older Adults with Cancer.
OBJECTIVES To explore oncology nurses' experiences of using expressive relational practices to support emotional processing among older adults with cancer and to develop a practice-oriented conceptual model intended to inform clinical practice and nursing education. METHODS A qualitative interpretive descriptive study was conducted in two tertiary cancer services in Saudi Arabia. Eighteen oncology nurses with direct experience in geriatric cancer care participated in semi-structured interviews. Of 41 eligible nurses approached, 18 were enrolled. Data were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Two researchers independently coded the first five transcripts and iteratively refined a shared codebook; remaining coding and theme development were discussed in regular analytic meetings. Rigor was enhanced through member reflection, peer debriefing, and reflexive journaling. RESULTS Four interconnected themes emerged: (1) creating space for what cannot be said, reflecting nurses' attunement to silence and indirect distress; (2) expression beyond clinical dialogue, including storytelling, life review, and symbolic or sensory pathways; (3) holding emotional weight, capturing emotional containment and professional vulnerability; and (4) negotiating boundaries in expressive care, shaped by cultural mediation and institutional constraints. These findings informed an integrative model conceptualizing expressive care as a cyclical process of relational attunement, facilitated expression, emotional containment, and contextual negotiation. CONCLUSIONS AND IMPLICATIONS FOR NURSING PRACTICE In this culturally specific setting, expressive relational care appears to function as an integral, rather than adjunct, dimension of person-centered geriatric oncology nursing. Structured expressive communication training, culturally responsive practice guidelines, and institutional recognition of emotional labor may enhance patient dignity and nurse resilience; patient- and family-focused research is needed to test the transferability of these findings.