Burnout of Long-term Care Facility Employees: Relationship with Employees' Expressed Emotion Toward Patients

Ethical Leadership in LTC: From Caregivers' Customer Orientation to Senior's Satisfaction and Well-Being

Background

In response to the growth of the world's senior population, an investigation of ethical leadership on LTCs is needed, in particular in the impact it may have on customer orientation and on seniors' well-being.

Objective

We propose a model to identify the relationship between ethical leadership in LTCs and caregivers' customer orientation, and its influence on satisfaction with the service, satisfaction with life, and the quality of the interaction between caregivers and seniors.

Sampling

We present a matched sample of 277 caregivers and 277 elderly Brazilians, workers and seniors' in LTCs in Brazil. The minimum sample size was 222, determined using G-Power software version 3.1.9.2, based on the desired statistical power parameters and the number of predictors. Two structured questionnaires were developed, one for caregivers and the other for the elderly. 69 LTCs were contacted and 29 participated in the survey (10 nonprofit, 34.48%). Data were treated statistically using SEM modelling.

Results

We identified a positive influence of ethical leadership on caregivers' attitudes, favoring their orientation towards the seniors'. A positive relationship between customer-oriented caregivers and customer satisfaction, life satisfaction, and the quality of the senior's interaction. A customer-oriented caregiver exerts a mediating effect between ethical leadership and the seniors' related outcomes, making ethical leadership beneficial to seniors and their family members.

Conclusion

Ethical leadership favors successful management of LTCs, increasing customer orientation, and provides clues to establish a better causality and a chain of effects between leadership and senior-related outcomes. Therefore, LTCs may be the appropriate outlet for the role of ethics in leadership.

Practical Implications

This study provides managers with an understanding of the effects of ethical leadership in the context of LTCs, for both caregivers and seniors. The powerful effects of ethical leadership can be a stimulus to increase the role of ethics in LTCs, improving the quality of care, the well-being of the seniors, and, therefore, the human and financial performance of these institutions.

Fear of COVID-19, emotional exhaustion, and care quality experience in nursing home staff during the COVID-19 pandemic

BACKGROUND

Nursing home staff have been adversely impacted throughout the COVID-19 pandemic, facing difficulties in providing patient care. The aim of this study was to explore health workers' perception regarding their own care quality experience in nursing homes during the COVID-19 pandemic. Amidst the second wave of the pandemic, we investigated the relationships between fear of COVID-19 and care quality experiences in nursing homes with emotional exhaustion (EE) as a mediating role. We hypothesized that EE is associated with fear of COVID-19 and care quality experience among nursing home staff. Furthermore, we predicted that EE would mediate the relationships between fear of COVID-19 and care quality experience.

METHODS

During the second wave of COVID-19 (October to December 2020), we administered surveys to a large sample of 129 French nursing home staff with a mean age of 38.47 ± 10.31 who were directly and repeatedly exposed to COVID-19. We assessed their emotional exhaustion (EE) and care quality experience in the workplace via subjective indicators using self-reported scales.

RESULTS

In the context of COVID-19, low to severe emotional exhaustion levels were found among nursing home staff, and these levels were associated with care quality experience as well as fear of COVID-19. The groups with low and severe levels of EE reported the highest levels of fear of COVID-19. The groups with moderate and severe levels of EE reported the lowest levels of care quality experience. Lastly, the relationships between fear of COVID-19 and care quality experience were mediated by EE.

CONCLUSIONS

The findings made by the present study focused on the role of emotional coping responses to COVID-19. EE was associated positively with fear of COVID-19 and negatively with care quality experience. Furthermore, EE was found to mediate the relationship between fear of COVID-19 and care quality experience. We discuss these findings as they relate to palliative care issues in nursing homes and the manner in which emotional exhaustion ought to be addressed among nursing home staff.

The association between nurses' burnout and objective care quality indicators: a cross-sectional survey in long-term care wards

Background

Worldwide, rather few studies have examined the association between burnout and care quality using objectively measured quality indicators, with most of the studies have relied on perceived quality outcomes. This study aimed to examine the association between staff nurses’ burnout and selected objective quality metrics in long-term care wards in Japan.

Methods

This is a secondary analysis of a cross-sectional survey. Nurse managers and staff nurses working at randomly selected hospitals with long-term care wards—the equivalent of skilled nursing homes in Western countries— completed self-administered, anonymous questionnaires. The questionnaires collected data regarding care quality indicators, staff nurses’ burnout, and other confounders (e.g., ward size, participants’ years of experience, and patients’ conditions). All statistical analyses were conducted at the ward level. A multivariate regression analysis was used to examine associations between burnout and outcome indicators.

Results

Data from 196 wards in 196 hospitals (196 nurse managers and 2473 staff nurses) across Japan were analyzed. Multivariate regression analysis showed that higher emotional exhaustion was associated with higher rates of pneumonia and pressure ulcers (p-value = .036 and .032, respectively), and that reduced personal accomplishment was associated with higher rates of tube feeding (p-value = .018). A larger ward size was also associated with low rates of pneumonia (regression coefficient = −.001, p-value = .019).

Conclusions

Staff nurses’ burnout is a significant determinant of care quality in long-term care wards, implying that organizations that implement burnout reducing strategies may see greater benefits in patient outcomes. A large ward size was significantly associated with better care outcomes—specifically, low rates of pneumonia. Future research needs to determine feasible quality improvement measures in small-scale long-term care facilities, and to provide more comprehensive insights on ward-level variables that influence care quality in long-term care settings.

Burnout in UK care home staff and its effect on staff turnover: MARQUE English national care home longitudinal survey

BACKGROUND

staff burnout and turnover lead to care home residents receiving poorer quality care. Burnout is thought to cause turnover, but this has never been investigated. We know little about which care home staffs are burnt out.

AIMS

to explore burnout's relationship with staff turnover and prevalence and predictors of burnout.

METHOD

we calculated the relationship between Maslach Burnout Inventory scores and future staff turnover (12-month number of staff leaving/number employed). We explored staff, resident and care home predictors of burnout, measured as emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA).

RESULTS

two-thousand sixty-two care staff in 97 care home units participated. Median yearly staff turnover was 22.7%, interquartile range (IQR) 14.0-37.7%. Care staff recorded low median burnout (median EE: 14, IQR: 7-22; DP: 1, IQR: 0-5; PA 42, IQR: 36-45). We found no association between staff burnout and turnover rate. Younger staff age was associated with higher burnout (EE coefficient - 0.09; 95% confidence interval (CI): -0.13, -0.05; DP -0.02; 95% CI: -0.04, -0.01; PA 0.05; 95% CI: 0.02, 0.08). Speaking English as a second language predicted higher EE (1.59; 95% CI: 0.32, 2.85), males had higher DP (0.02; 95% CI: 0.01, 0.04) and staff working only night shifts lower PA (-2.08; 95% CI: -4.05, -1.30).

CONCLUSIONS

we found no association between care homes staff burnout level and staff turnover rates. It is a myth that burnout levels are high. Interventions for burnout could focus on at-risk groups. Future studies could consider turnover at an individual level.

A positive attitude towards provision of end-of-life care may protect against burnout: Burnout and religion in a super-aging society

Aim

The aim of our study was to investigate factors associated with burnout of nurses and care workers in nursing homes and geriatric hospitals in Japan. The use of Buddhist priests, the major religion in Japan, was also explored.

Methods

Questionnaires for nurses and care workers were sent to 10 care facilities. The survey questions included basic demographic information, the Japanese Burnout Index and the Japanese version of the Frommelt Attitude Toward Care Of Dying Scale Form B. They also asked questions about use of Buddhist priests for tasks such as helping to manage the anxiety or distress of patients, families, and staff, or providing sutra chanting.

Results

In total, 323 questionnaires were returned, of which 260 were used for analysis. Only 18 (6.9%) answered that they had any religious beliefs, which was relatively low compared to 27% from governmental survey data. In total, however, 71% expressed a need for Buddhist priests to help with anxiety or distress among patients. A positive attitude towards providing end-of-life care was a protective factor against depersonalization. It was, however, also related to lower feelings of personal accomplishment.

Conclusion

Care homes and geriatric hospitals may want to consider calling more on religious resources as a support for staff and patients.

A Bright Side to the Work-Family Interface: Husbands' Support as a Resource in Double-and-Triple-Duty Caregiving Wives' Work Lives

Purpose of the Study

This study examined how women who combine long-term care employment with unpaid, informal caregiving roles for children (double-duty-child caregivers), older adults (double-duty-elder caregivers), and both children and older adults (triple-duty caregivers) differed from their workplace-only caregiving counterparts on workplace factors related to job retention (i.e., job satisfaction and turnover intentions) and performance (i.e., perceived obligation to work while sick and emotional exhaustion). The moderating effects of perceived spouse support were also examined.

Design and Methods

Regression analyses were conducted on survey data from 546 married, heterosexual women employed in U.S.-based nursing homes.

Results

Compared to workplace-only caregivers, double-duty-elder and triple-duty caregivers reported more emotional exhaustion. Double-duty-child caregivers reported lower turnover intentions and both double-and-triple-duty caregivers felt less obligated to work while sick when perceiving greater support from husbands.

Implications

Results indicate that double-and-triple-duty caregiving women's job retention and obligation to work while sick may depend on perceived spouse support, highlighting the important role husbands play in their wives' professional lives. Findings also lend support to the emerging literature on marriage-to-work positive spillover, and suggest that long-term care organizations should target marital relationships in family-friendly initiatives to retain and engage double-and-triple-duty caregiving employees.