An exploration of emotional protection and regulation in nurse-patient interactions: The role of the professional face and the emotional mirror

Emotional labour and turnover intention among nurses in China: Mediating effects of nurse-patient relationship and self-rated health

AIM

This study tested the mediating role of the nurse-patient relationship and self-rated health in the effect of emotional labour on turnover intention among nurses in China.

BACKGROUND

The underlying mechanism behind the effect of emotional labour on turnover intention remains inadequately understood.

INTRODUCTION

Nurses with a high level of emotional labour are predisposed to experiencing poor health and tension in their relationships with patients, which may increase turnover intention.

METHODS

A cross-sectional survey of 527 nurses in a public tertiary hospital in Qiqihar, located in China's Heilongjiang province, was conducted. Emotional labour and turnover intention were assessed using existing validated scales containing multiple items, while the nurse-patient relationship and self-rated health were assessed using single items, respectively. Baron and Kenny's causal steps and the Karlson/Holm/Breen method were adopted to test the mediating effects of the nurse-patient relationship and self-rated health in the association between emotional labour and turnover intention after adjusting for variations in sociodemographic and job characteristics.

RESULTS

Emotional labour was positively associated with turnover intention. Self-rated poor health and a disharmonious nurse-patient relationship partially mediated the positive effect of emotional labour on turnover intention.

CONCLUSIONS

Emotional labour significantly affects the turnover intention of nurses working in public tertiary hospitals in China, and this effect is partially mediated by self-rated health and the nurse-patient relationship.

IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY

Giving more attention to nurses' negative emotions and work attitudes is crucial. Developing comprehensive strategies for enhancing nurses' emotional management ability, promoting their physical and psychological well-being, and improving nurse-patient relationship to reduce nurses' turnover.

Medical staff's emotional exhaustion and its relationship with patient safety dimensions

PURPOSE

Medical staff's emotional exhaustion increases cynical attitudes and behaviors about work and patients and leads medical staff to become detached from work. This may decrease patients' trust and satisfaction and even endanger patients' lives. There is a need to examine the critical factors affecting the medical staff's emotional exhaustion by investigating its relationship with the patient-safety dimensions based on the safety attitudes questionnaire (SAQ).

DESIGN/METHODOLOGY/APPROACH

A case study is conducted from the viewpoints of physicians and nurses to examine the relationship between emotional exhaustion and six dimensions of the SAQ from 2016 to 2020 from a regional teaching hospital in Taiwan. Linear regression with forward selection is employed. Six dimensions of the SAQ are the independent variables, whereas emotional exhaustion is the dependent variable for each year.

FINDINGS

Stress recognition is the most important variable to influence emotional exhaustion negatively, while job satisfaction is the second important variable to affect emotional exhaustion positively from 2016 to 2020. On the contrary, working conditions do not influence emotional exhaustion in this hospital from medical staff's viewpoints.

ORIGINALITY/VALUE

This study uses longitudinal data to find that both stress recognition and job satisfaction consistently influence emotional exhaustion negatively and positively, respectively, in this five-year period. The third dimension to impact emotional exhaustion varies from time to time. Thus, the findings from a cross-sectional study might be limited. The authors' findings show that reducing stress recognition and enhancing job satisfaction can lead to the improvement of emotional exhaustion from medical staff's viewpoints, which should be monitored by hospital management.

[Concept of emotions in the nursing discipline, overview and benchmarks]

The following is how emotions are viewed within the nursing discipline. An exploration at the level of taxonomy, discipline, and nursing theories has been conducted. In addition, some articles are presented. It is also shown that emotions are part of the nursing discipline and that it would be relevant to explore the topic further.

'Staying strong': A constructivist grounded theory of how registered nurses deal with the impact of trauma-related events in rural acute care practice

AIMS AND OBJECTIVES

This study explored how Registered Nurses (RNs) in rural practice deal with psychologically traumatic events when living and working in the same rural community over time.

BACKGROUND

Rural RNs who are exposed to trauma may be at high risk for psychological distress (e.g. secondary traumatic stress, vicarious trauma and post-traumatic stress disorder), in the context of isolated practice and slower emergency response times.

DESIGN AND METHODS

Charmaz's constructivist grounded theory methodology was chosen for this qualitative study. Purposeful sampling was used to recruit 19 RNs from six rural acute care hospitals. A total of 33 interviews were conducted with 19 face-to-face initial interviews, 14 follow-up telephone interviews and 14 reflective journals. Adherence to the COREQ EQUATOR guidelines was maintained.

RESULTS

Participants were exposed to a multitude of trauma-related events, with their main concern of being intertwined with events for life. They dealt with this by staying strong, which included relying upon others, seeking inner strength, attempting to leave the past behind and experiencing transformational change over time. Being embedded in the community left them linked with these trauma-related events for life. Staying strong was a crucial element to their ability to cope and to face future events.

CONCLUSIONS

The psychological implications of trauma-related events when working and living in rural acute care practice settings are significant and complex. Findings highlight the need for organizational support and processes and may contribute to improved psychological services and management practices.

RELEVANCE TO CLINICAL PRACTICE

Key learnings were that rural nurses, who live and work in the same community, experience psychological changes over time from traumatic events that stay with them for life; employers fail to recognise the seriousness of this issue and trauma-informed policies with associated resources are lacking.

Is falling in love within the mental health system a problem? How to turn it into a chance for the care relationship

WHAT IS KNOWN ABOUT THE SUBJECT?: In the context of health and social care, situations at the limit or beyond the role of the professional, such as falling in love and physical attraction between a client and a nurse, are very common events. In residential contexts, the construction of the professional relationship is made more complex than in other care contexts since sharing daily life, routine, constant contact and isolation contribute to making relationships more intense from an emotional point of view. Moreover, the same elements that promote the therapeutic process (interpersonal closeness, self-disclosure, trust) are also sources of role ambivalence and possible emotional misunderstandings. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: In contrast to what is usually proposed in the literature for the management of similar situations, such as supervision by experts external to the team, this paper proposes a strategy of supervision between peers (called in literature "intervision") and of taking charge of the situation by the entire team and the group of service users. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: The story here presented offers a key example that may be of interest not only to residential centres for substance users but also to all residential mental health communities. It shows not only that one can fall in love, but that this event can generate new opportunities for the therapeutic pathway. The risks associated with not addressing these situations are discussed. These include the restriction of the feeling of falling in love within the canons of error; the attribution of what happened to personal characteristics and the assumption of guilt for such occurrences.

ABSTRACT

INTRODUCTION: The care pathway within a mental health service can create situations of strong emotional impact, including physical attraction and falling in love. This may evolve in moments of impasse for the staff and sometimes compromise the success of therapeutic treatment.

AIM/QUESTION

This article offers some evidence about how intervene in a situation such as a client falling in love with a nurse, avoiding transforming it into a problem. The fear of the nurse, maybe already inclined to blame themselves for what has happened, when he/she asks for supervision, is to feel judged also by the supervisor. This story teaches that to refer to figures from outside the team, as would usually be the case with supervision, may be replaced by enhancing the role composition already available in the residential community as a resource.

METHOD

The story was listened and enhanced thankyou to an exchange between M. and the community manager. From the analysis of the narratives co-produced by M., the former substance user, and the community manager, the elements that made it possible to transform a feeling of falling in love into an interaction of extended trust emerged.

RESULTS AND DISCUSSION

The non-judgmental and confidential context, but above all the training in interpersonal exchange, facilitated the client sharing very intimate and private experiences, which are usually hidden or denied. This made it possible to make the community responsible for the individual's experiences and to overcome the role impasse and the related identity dilemma.

IMPLICATIONS FOR PRACTICE

Neither nurses nor clients should be held accountable or blamed when these episodes occur. The strongest resource is sharing in the group and putting one's own experiences into play. Following the M. story, a targeted confrontation between team members and clients is an accessible and effective resource to respond to situations of strong emotional impact, falling in love being just one example; however, it can be effectively activated only through a collective taking charge of the individual's difficulties has already been implemented.

Cognitive Emotion Regulation Strategies Predict Burnout in Geriatric Nursing Staff

OBJECTIVES

Burnout contributes to high turnover rates, medical errors, and poor patient satisfaction in geriatric nursing staff. Nurses' cognitive emotion regulation (ER) strategies are emerging as an important personal resource related to burnout that are modifiable with intervention. This study examined the association between cognitive ER strategies and burnout among geriatric nursing staff.

METHODS

Participants were 54 nurses (RNs, LPNs, CNA/UWs) with a mean age of 43.1 years (SD = 12.2), majority female (96.3%), and racially diverse: Black (20.4%), White (63.0%), and Other (13.0%).

RESULTS

After controlling for CVs, cognitive ER strategies accounted for unique variance in depersonalization, but did not account for unique variance in emotional exhaustion or personal accomplishment. Rumination was associated with greater depersonalization, and greater refocus on planning was associated with lower depersonalization.

CONCLUSIONS

Findings suggest that depersonalization may be most impacted by ER; however, other ER strategies may be important that were not included in the current study (e.g., experiential avoidance, mindfulness). Future research is needed with additional ER strategies and larger samples.

CLINICAL IMPLICATIONS

Findings support the use of person-centered interventions, such as cognitive-behavioral and mindfulness-based techniques, to improve stress management and decrease depersonalization.

The link between task-focused care and care beyond technique: A meta-ethnography about the emotional labour in nursing care

OBJECTIVE

To synthesise the available body of qualitative work regarding the experiences of registered nurses and nursing students in managing emotional demands of care.

BACKGROUND

Care is the central part of nursing, and its provision is linked to interaction with patients. Comprehensive care allows emotions to be considered as an essential part of care. However, the emotional commitment that care demands poses a challenge for the nursing staff.

DESIGN

Noblit and Hare's interpretive meta-ethnography, which was written and reviewed for reporting clarity using the eMERGe.

METHODS

A comprehensive systematic search strategy was undertaken in PubMed, CINAHL, Scopus, Web of Science and PsycINFO in January 2020. The search included terms related to the sample population, phenomenon of interest, purpose of the study and type of research. Original or mixed qualitative articles in English, Spanish and Portuguese were included if they addressed the emotional labour experiences of nurses or nursing students.

RESULTS

A line-of-argument synthesis based on the metaphor The link between task-focused care and care beyond technique was developed. Three themes from analogous and refutational translations of findings in the included nine papers emerged: (1) forces to get involved in care; (2) the cost of caring and (3) need to vent.

CONCLUSION

Nursing staff and students managed the emotional demands by adjusting their involvement in care. Care beyond technique is provided by nurses who have strength and motivation in themselves and in the interaction with patients to become emotionally involved in care. Task-focused care avoids emotional exposure to patient suffering due to the personal cost involved. Venting and distancing are required to emotionally reconstruct themselves and to re-engage in care.

RELEVANCE TO CLINICAL PRACTICE

Increased knowledge about these experiences may raise awareness of the emotional demands as part of the care process, to prevent their impact and favour their support.

Emotional intelligence and perceived organizational support as predictors of emotional exhaustion among nurses and midwives

Purpose

Navigating the physical and emotional conditions of patients on daily basis can be emotionally exhaustive, requiring health professional to regulate their emotions in order to provide quality healthcare. The present study set out to examine the consequential effect of emotional intelligence and perceived organizational support (POS) on emotional exhaustion of nurses and midwives in the Ghanaian context. The study also examined the effects of age and cadres of nursing and midwifery on emotional exhaustion.

Design/methodology/approach

The study was quantitative in nature and employed the cross-sectional design in sampling respondents. The study was conducted in four public hospitals and two quasi-public hospitals in three main districts in the Greater Accra Region of Ghana. A sample of 342 nurses and midwives were proportionately sampled from various health facilities. The sample constituted of staff nurses and midwives.

Findings

The study revealed that while age, cadres of nursing and midwifery and POS had consequential effects on emotional exhaustion, emotional intelligence failed to predict emotional exhaustion.

Originality/value

Findings of the study draw the attention to the importance of organizational support in attenuating the emotional exhaustion associated with the nursing profession.

The Patient's Narrative Agenda as an assessment tool: the story of Robert, suffering from osteosarcoma

Background and aim of the work.

To activate the participation of the person in his/her care path, the literature highlights the impact of the professional’s ability to show a genuine interest in the problems brought by the patient and to recognize him/her as ‘competent’. In this sense the narrative patient’s agenda could be a useful relational tool, because is focused on the perception of patient experiences of his/her illness. Thus this study aims to analyze the usefulness of patient’s narrative agenda during the assessment phase.

Method.

A semi-structured interview has been adopted to explore the agenda of Robert, 21 years old, suffering from osteosarcoma. A first level analysis identified the four functional areas of the agenda: ideas and beliefs; expectations and desires and context in which he lives and interacts. A second level analysis assessed the main Robert’s problems.

Results.

The narrative agenda has highlighted many central problems of Robert (e.g. therapeutic adherence, quality of life, mood, body image, existential problems related to experiences, hopes and expectations). Of course these results could be integrated with other tools: qualitative, to Understand difficulties and to formulate hypotheses, and quantitative, to measure the level of severity of problems reported.

Discussion and conclusion.

The narrative agenda has not only proved to be a valid instrument of assessment, allowing an adequate insight on the patient’s problems, as we exemplified, but it can be also used for monitoring the dynamic situation of the person’s history, lending itself to the re-exploration of its functional areas over time.

What Makes a Social Robot Good at Interacting with Humans?

This paper discusses the nuances of a social robot, how and why social robots are becoming increasingly significant, and what they are currently being used for. This paper also reflects on the current design of social robots as a means of interaction with humans and also reports potential solutions about several important questions around the futuristic design of these robots. The specific questions explored in this paper are: “Do social robots need to look like living creatures that already exist in the world for humans to interact well with them?”; “Do social robots need to have animated faces for humans to interact well with them?”; “Do social robots need to have the ability to speak a coherent human language for humans to interact well with them?” and “Do social robots need to have the capability to make physical gestures for humans to interact well with them?”. This paper reviews both verbal as well as nonverbal social and conversational cues that could be incorporated into the design of social robots, and also briefly discusses the emotional bonds that may be built between humans and robots. Facets surrounding acceptance of social robots by humans and also ethical/moral concerns have also been discussed.

Nurses' emotions on care relationship: A qualitative study

AIMS

To describe nurses' experiences regarding the care relationship built with medical-surgical patients in acute hospitalization units and the association with their clinical practice.

BACKGROUND

Nurses' commitment to care and their relationships as well are the core of quality of care. Nurses consider that the emotional commitment is essential to the profession, thus accepting to be exposed to emotional distress.

METHODS

In-depth interviews were conducted to explore the experience of 23 nurses from seven Spanish hospitals. Taped interviews were transcribed verbatim and analysed according to inductive content analysis.

RESULTS

Six subcategories emerged from the data analysis: Fulfilling experiences, Feeling the pain of others, Emotional distress, Stepping back, Seeking professional support, and Evolution of emotions, which were combined in two main categories: Nurses' emotions and Nurses' coping strategies. Patient's suffering, work environment and interprofessional relations influence the care relationship.

CONCLUSIONS

Positive and negative emotions emerge spontaneously in professional relationships of experienced nurses. Lack of time and high workloads are factors that hinder the nurse-patient relationship. This care relationship is often the reason that fulfils them. Despite their level of expertise and having coping strategies, these are not always effective and, sometimes, nurses need professional help.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurses will continue performing their job with commitment; therefore, nursing managers should take care of their staff and pay attention to the emotional competence related to patients' relationships. Promoting self-care and a good working environment could improve their coping mechanisms.

Negative Mental States and Their Association to the Cognitive Function of Nurses

Abstract. Nurses’ inherently stressful occupation leaves them at a higher risk of developing negative mental states (stress, anxiety, and depression). However, research examining the effect of negative mental states on these health professionals’ cognitive performance is sparse. Thus, the present study aimed to assess the link between negative mental states and cognitive performance in nurses ( n = 53). Negative mental state data was obtained using the Depression Anxiety Stress Scale, brain activity was measured using electroencephalography, and finally, cognitive performance was assessed using the Cognistat and the Mini-Mental State Examination. Significant negative correlations ( p < .05) were observed between anxiety and attention, and all three negative mental states and memory performance. Electroencephalographic changes indicated that increases in anxiety were significantly associated ( p < .05) with decreases in gamma reactivity at fronto-central sites. The current study suggests that higher levels of negative mental states are associated with domain-specific cognitive impairments, and variations in gamma reactivity; possibly reflecting less optimal cortical functioning.

Emotional labour in palliative and end-of-life care communication: A qualitative study with generalist palliative care providers

OBJECTIVE

To explore generalist palliative care providers' experiences of emotional labour when undertaking conversations around palliative and end-of-life care with patients and families, to inform supportive strategies.

METHODS

Semi-structured interviews conducted with generalist staff (those providing 'primary' or 'general' palliative care, not palliative care specialists) who had attended a communication workshop. Sampling was purposive (by gender, profession, experience). Data were analysed using a framework approach; a sample of transcripts were double-coded for rigour. Data collection and analysis were informed by theories of emotional labour, coping, and communication.

RESULTS

Four ambulance staff, three nurses, two speech and language therapists, and one therapy assistant were interviewed. Five themes emerged: emotions experienced; emotion 'display rules'; emotion management; support needs; and perceived impact of emotional labour. Participants reported balancing 'human' and 'professional' expressions of emotion. Support needs included time for emotion management, workplace cultures that normalise emotional experiences, formal emotional support, and palliative and end-of-life care skills training.

CONCLUSION

Diverse strategies to support the emotional needs of generalist staff are crucial to ensure high-quality end-of-life care and communication, and to support staff well-being.

PRACTICE IMPLICATIONS

Both formal and informal support is required, alongside skills training, to enable a supportive workplace culture and individual development.