Burnout After Patient Death: Challenges for Direct Care Workers

Nurses' Experience With End-of-Life Care in Geriatric Centers: A Systematic Review

Background

Geriatric nurses provide end-of-life care based on the five pillars of aging. This systematic review assesses the emotions and feelings of geriatric nurses during end-of-life care. It considers the prevalence, triggers, and intensity of emotional responses among geriatric nurses. It also expounds on the strategies for overcoming the emotional challenges.

Methods

The study embarked on a systematic review of literature materials on nurses' emotions and feelings. The eligibility criteria involve literature materials published in the past 5 years, peer reviews, English language, geriatric nurses, and nurses in emergency department, primary care, and intensive care unit. Three databases (Cochrane Library, PubMed, and CINAHL) and Google Scholar were used.

Results

Using a PRISMA flow chart, the literature search led to the discovery of nine significant writings on the emotions and feelings of nurses attending to geriatric patients. Sample sizes in these studies varied from 6 to 126 nurses while three articles involved integrated, scoping, and literature review of published studies. The common emotions and feelings among nurses caring for elderly patients in the geriatric center are compassion fatigue, burnout, grief, and moral distress.

Conclusion

These emotions and feelings affect the performance of nurses. They also influence their physical and mental wellbeing. This situation calls for developing effective coping strategies to address this challenge.

Demystifying Death: Reflections on End-of-Life Doula Work

End-of-life doulas (EOLDs) represent a portion of a broader mobilization of end-of-life care practitioners to normalize discussions of death and assist dying persons and their caregivers in navigating the dying process. EOLDs primarily focus on creating a supportive environment for the dying and their loved ones. Research on the burgeoning care profession has documented the backgrounds and services of EOLD work; however, literature has overlooked EOLDs' personal reflections on their work. This study seeks to help fill this gap through interviews with 39 EOLDs registered with the International End-of-Life Doula Association (INELDA). Interviewees discussed the rewards, challenges, surprises, and motivations to continue their work, reinforcing previous studies' findings while expanding upon the perspectives of EOLDs in their own words. In sharing their experiences, EOLDs showcase how they facilitate death by respecting and advocating for the wishes of their clients while simultaneously navigating the hardships and joys of their profession.

How Do Home Care Workers Experience A Client's Death, Professionally and Personally? A Systematic Review and Meta-Synthesis

Background: Home care workers (HCWs) may frequently experience client death. This critical interpretive meta-synthesis aimed to identify the impacts of client death to offer preliminary recommendations with respect to support. Method: Five electronic databases, APA PsycINFO, CINAHL, MEDLINE, Web of Science, and Scopus, were searched systematically using keywords and subject headings. Results: Eight papers focusing on HCWs' experiences of client death were identified. Constructs were elicited and interpreted via Reciprocal Translation Analysis. The interpreted line of argument highlighted four interrelated themes: ''Personal grief: The impact of loss', 'Disenfranchised grief: no space for humanity and connection'', Inherent tension between self-care and organisational expectations: "You need a moment to hit the reset", and 'I wish someone was there to talk to: HCW support needs'. Conclusions: The findings demonstrate that HCWs are affected in multiple ways by client death, but these impacts are not consistently recognised or responded to by their organisations.

Changes Due to Patient Deaths: Medical Students' Expectations vs. Health Professionals' Experiences

CONTEXT

Preparing healthcare professionals for inevitable encounters with patient deaths is crucial to preventing maladaptive professional bereavement outcomes.

OBJECTIVES

This study aimed to explore the discrepancies between medical students' pre-patient death expectations and healthcare professionals' post-patient death experiences regarding accumulated global changes due to patient deaths (AGC), identify heterogeneous expectation patterns among students, and reveal risk factors for worthy-of-concern expectation patterns.

METHODS

Cross-sectional survey data from 231 professional caregivers and 405 medical and nursing students were used. Independent t tests and analyses of covariance were run for staff-student AGC comparisons. Latent profile analysis (LPA) among students was followed by logistic regression.

RESULTS

The students scored higher than did the staff in two AGC factors: more acceptance of limitations and more death-related anxiety. LPA identified four latent expectation patterns, with the "overoptimistic" (27.8%) group being worthy of concern, as students overestimated positive changes and underestimated negative changes. The overoptimistic pattern was predicted by students' motivations to study medicine, which were driven by "interests," "career opportunities," and "improving medical services in the hometown," rather than "by chance," and higher scores on the death attitude of "neutral acceptance."

CONCLUSION

In general, students tend to overestimate the long-term impacts of patient deaths. However, approximately 1/4 of students hold overly optimistic expectations, which are predicted by motivations to study medicine and death attitudes.

Unveiling the dynamics of older person care: a qualitative exploration of the intersection between formal and Informal Caregiving from the perspectives of registered nurses in Greece

In the evolving landscape of older person care, the imperative to explore holistic approaches persists, especially in regions with distinct societal norms around informal caregiving. The deeply ingrained tradition of familial caregiving, often led by female family members, has historically compensated for healthcare system gaps in less integrated systems. Hence, societal expectations may affect registered nurses' experiences and impact the quality of care for older persons. This study aims to describe the meaning of caring for older persons in care settings in Greece. Ten in-depth interviews with registered nurses in older person care settings underwent qualitative thematic analysis. Four themes emerged from the analysis: (i) Living and bonding with older people as a basis for caring, (ii) Caring as a double-faced fulfillment, (iii) A sense of insufficiency in the caring relationship, and (iv) The encounter of existential issues creating loneliness. This research provides insights into the meaning of caring for older persons, highlighting the experiences of the closest professional caregivers of older individuals. A specific capture of the entanglement of cultural norms, societal expectations, and their impact on professional caregivers' experiences may contribute to quality care provision in systems rooted in familial caregiving traditions.

A Comparative Study of Organizational Grief Support and Burnout Among Nursing Home Staff

BACKGROUND AND OBJECTIVES

The purpose of this study was to examine the relationship between dimensions of grief support (recognition of the relationship, acknowledgement of the loss, and inclusion of the griever) and aspects of burnout (emotional exhaustion, depersonalization, and personal accomplishment) among nursing home staff.

RESEARCH DESIGN AND METHODS

Data were collected from 553 nursing home workers from 37 nursing home facilities in 5 states during fall of 2022. Responses to the Maslach Burnout Inventory and Grief Support Health Care Scale were analyzed for this study.

RESULTS

The study found that recognizing the relationship with deceased patients led to a decrease in exhaustion and depersonalization among workers while simultaneously enhancing their sense of personal accomplishment. Including the griever in the support process lowered all burnout subscales for nursing home staff. Acknowledging the loss was associated with higher levels of personal accomplishment. Registered nurses, nurse practitioners, and physicians experienced higher levels of exhaustion and depersonalization compared to other nursing home staff. Behavioral health workers had the highest personal accomplishment, whereas direct support workers reported the lowest.

DISCUSSION AND IMPLICATIONS

These findings have important implications for improving the well-being of nursing home staff, emphasizing the importance of organizational grief support, and tailored interventions to address burnout among different healthcare provider roles in nursing homes.

Attitudes toward Death among Health Care Professionals in the Balkan Region

Background and Objectives: Death is an unavoidable experience in any person's life and affects not only the dying person but also their caregivers. The dying process has been displaced from homes to health care facilities in the majority of cases. Facing death and dying has become an everyday life of health care professionals (HCP), especially in palliative care (PC) settings. This study aimed to investigate the death attitudes among HCPs in Serbia. Materials and Methods: The Serbian version of the Death Attitude Profile-Revised (DAP-RSp) was used as a measurement instrument. Results: The average age of the 180 included participants was 42.2 ± 9.9 years; the majority were females (70.0%), with more than 10 years of working experience (73.0%), physicians (70.0%) and those working in a non-oncological (non-ONC) field (57.78%). The mean total score of DAP-RSp was 124.80 ± 22.44. The highest mean score was observed in the neutral acceptance dimension (NA) (5.82 ± 0.90) and lowest in the Escape acceptance (EA) (2.57 ± 1.21). Higher negative death attitudes were reported among nurses compared to physicians (p = 0.002). Statistically significant differences were observed in the fear of death (FD) and death avoidance (DA) domains, favoring PC specialists and oncologists (p = 0.004; p = 0.015). Physicians working in Oncology (ONC) showed lower FD values (p = 0.001) compared to non-ONC departments. Conclusions: Attitudes toward death among HCPs are of great importance for the well-being of both HCPs and patients. Negative attitudes can lead to deficient care. The fear of death is highly represented among Serbian HCPs working in non-ONC fields, including both nurses and physicians. This study emphasizes the need for further research to comprehensively explore and understand HCPs' attitudes toward death. This research highlights the need for the development of an educational curriculum across all levels of medical education, aimed at overcoming the fear of death and enhancing coping strategies, which will improve the care for patients diagnosed with terminal illnesses.

Awareness, Acceptance, Avoidance: Home Care Aides' Approaches to Death and End-of-Life Care

Death and dying are woven throughout the work of home care aides, and yet the care they provide at the end of life (EOL) remains poorly understood. This is due in part to the multiple circumstances under which aides provide EOL care. In this paper, we elucidate the EOL care experiences of aides working in home care agencies in New York City. We conducted in-depth interviews with 29 home care aides, and we analyzed these data using inductive, team-based methods. Our findings show that aides may not be aware of or accept a client's EOL status, and they may avoid EOL care. These conditions shape EOL care, and we detail the committed forms of care aides provide when they are aware and accepting. We recommend improved training, support systems, and policy change to enhance aides' contributions to EOL care, while protecting aides' health and well-being.

Practitioner Experiences of the Death of an Equine in an Equine-Assisted Services Program

Given the nature of horse-human interactions in equine-assisted services (EAS), death of a horse may have significant impacts. In this study, an online survey was distributed to EAS practitioners. The goal of the study was to explore the experiences of practitioners and identify the socioemotional processes that occur upon the death of an equine within an EAS program. Open-ended responses (N = 84) were analyzed qualitatively using a grounded theory and constant-comparative approach. Responses are situated into two themes (1) Processing the death of an equine and (2) Practical implications. Experiences processing the death of an equine can be situated within Worden's Four Tasks of Mourning, extending a grief model previously only considered in the context of human death to animal death. Practical implications found within responses highlight actions practitioners can take to prepare for and process through the death of an equine in their program.

Do-Not-Hospitalize Orders in Assisted Living Facilities: Direct Care Workers' Perspectives

PURPOSE

To gather sufficient qualitative data to create an intervention that would prevent direct care workers (DCWs) from sending residents with do-not-hospitalize (DNH) orders to the hospital.

METHOD

This was a qualitative study with eight participants that included a descriptive survey followed by semi-structured interviews.

RESULTS

DCWs were unfamiliar with DNH orders and their thinking on end-of-life care was binary (hospice or hospital) and protocol driven. However, supportive leaders were able to help DCWs problem-solve these complicated scenarios. Results were mixed on whether having a RN on site was helpful.

CONCLUSION

DCWs may benefit from having access to a nurse with palliative care experience when making decisions about residents with DNH orders. [Journal of Gerontological Nursing, 50(4), 11-15.].

Meaningful connections: An education program to enhance resident-certified nursing assistant relationships

Close relationships between nursing home residents and Certified Nursing Assistants (CNAs) result in positive outcomes for both residents and staff, including increased well-being for residents. However, many resident-CNA relationships remain superficial, are focused primarily on physical care, and interpersonal skill training for CNAs is sparse. The purpose of this study was to develop an education program to foster CNAs' interpersonal skills and relationship development. We conducted a literature review on CNA interpersonal skill training and disseminated a survey to CNAs to inform the education program. Literature review findings revealed that CNAs value their relationships with residents and desire more interpersonal training, but this training is often limited. The survey, which was disseminated via social media and facility contact referrals, asked responding CNAs (n = 73) to evaluate their perceptions of empowerment, interpersonal skill competency, and learning preferences. We found that most CNAs feel confident in their interpersonal skills, but they lack training in boundary-setting and bereavement support. About one-third of respondents did not feel that their work was valued or their strengths recognized by their supervisors. Most respondents reported that they valued visual (85%), experiential (91%) learning. The final program, Meaningful Connections, includes nine modules covering topics such as person-centered caregiving, empathy, emotional intelligence, and boundary-setting. One supplementary module provides potential adaptations to the curriculum to customize the needs of each participant group. The results of this project suggest a need for more CNA relationship training and support, especially in the areas of boundary-setting and bereavement.

"A Major Issue": The Impact of the COVID-19 Pandemic on How Home Care Leaders Perceive and Promote Aides' Mental Health and Well-Being

Home care aides play a critical role in the care of older adults, but they do this under difficult working conditions. The COVID-19 pandemic exacerbated aides' stress and worsened their mental health, raising the question of how agencies can better support aides. We explore how home care industry leaders in New York perceived and addressed home care aides' mental health and well-being prior to and during the pandemic through in-depth interviews conducted in 2019 (n = 8 agencies) and 2022 (n = 14 agencies). We found that these topics became more central in leaders' thinking, reflected in a range of new internally and externally funded agency actions, albeit limited by ongoing financial constraints. Maintaining a skilled and reliable aide workforce is critical to societal health but will remain challenging without continued investment in aide support of the kind described in the Surgeon General's Framework for Workplace Mental Health and Well-Being.

Stress and burnout in nursing home and égida workers during COVID-19

AIMS

Finding out whether there are differences in the levels of stress and burnout between workers providing care to dependent adults and those caring for independent older adults would provide comparative information about two different models of care. During the COVID-19 pandemic, workers caring for older adults were subjected to maladaptive situations that produced stress and burnout.

DESIGN

A cross-sectional survey design using the STROBE checklist.

METHODS

A total of 900 nursing home and égidas workers were assessed for stress and burnout. Data were collected online from October 2020 to February 2021, when Puerto Rico was experiencing the peak of the third wave of COVID-19. MANOVAs were performed to study the interactions between the workplace and having had COVID, the workplace and the size of institution and the workplace and position held.

DATA SOURCES

October 2020 to February 2021.

RESULTS

All interactions were significant. Nursing homes showed higher levels of stress and burnout when workers had undergone COVID, when the size of the institution was larger and for technical staff other services; in égidas, having undergone COVID did not influence stress or burnout, which increased when the institution was smaller and for executive staff.

CONCLUSIONS

This study showed that the effects of the COVID-19 pandemic affected nursing home workers more significantly than those working in other types of residential models with independent older adults.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Applying preventive interventions aimed at reducing stress and burnout would facilitate the adaptation of workers caring for older adults and help to improve the quality of care.

IMPACT

This study analysed the impact of COVID-19 on the stress and burnout of workers providing services to older adults. Nursing home workers who have had COVID-19 have higher stress and burnout. The size of the institution has a different effect depending on whether older adults are dependent or independent. Workers in institutions dedicated to the care of the older adults.

REPORTING METHOD

This study has adhered to the relevant EQUATOR guidelines: STROBE.

PATIENT OR PUBLIC CONTRIBUTION

During the different waves of the COVID-19 pandemic, it was difficult to establish direct contact with workers providing care to older adults; this reason made it necessary to apply online systems to obtain information. The workers appreciated the fact that the implications for stress and burnout of the situation experienced during this difficult process were investigated.

Factors associated with satisfaction and depressed mood among nursing home workers during the covid-19 pandemic

AIMS AND OBJECTIVES

This paper aims to examine the satisfaction and depressed mood experienced by nursing home workers during the COVID-19 pandemic and associated variables. Specifically, to analyse the factors that may contribute to nursing home workers developing adaptive behaviours that promote satisfaction or, on the contrary, show characteristics associated with a negative mood.

BACKGROUND

Nursing homes have faced unprecedented pressures to provide appropriately skills to meet the demands of the coronavirus outbreak.

DESIGN

A cross-sectional survey design using the STROBE checklist.

METHODS

Professionals working in nursing homes (n = 165) completed an online survey measuring sociodemographic and professional characteristics, burnout, resilience, experiential avoidance, satisfaction with life and depression. Data were collected online from April to July 2021, the time in which Spain was experiencing its fifth wave of COVID-19. Two multiple linear regression models were performed to identify salient variables associated with depressive mood and satisfaction.

RESULTS

Resilience, personal accomplishment and satisfaction had a significant and negative relationship with depression and emotional exhaustion, depersonalisation and experiential avoidance had a positive relationship with depression. However, emotional exhaustion, depersonalisation and experiential avoidance had a negative and significant relationship with satisfaction and personal accomplishment, and resilience had a positive and significant relationship with satisfaction. In addition, it was found that accepting thoughts and emotions when they occur is beneficial for developing positive outcomes such as satisfaction.

CONCLUSIONS

Experiential avoidance was an important predictor of the effects that the COVID-19 pandemic can have on nursing home workers.

RELEVANCE TO CLINICAL PRACTICE

Interventions focusing on resources that represent personal strengths, such as acceptance, resilience and personal accomplishment, should be developed.

NO PATIENT OR PUBLIC CONTRIBUTION

The complex and unpredictable circumstances of COVID's strict confinement in the nursing home prohibited access to the centres for external personnel and family members. Contact with the professionals involved could not be made in person but exclusively through online systems. However, professionals related to the work environment have subsequently valued this research positively as it analyses 'How they felt during this complicated process'.

An Integrative Review of "The Pause" After Patient Death

Background: Healthcare providers are engrossed in high-stakes, high-stress situations during their daily work with patient death being a potential negative outcome of work-related stress. Many interventions exist to combat work-related stress among nurses. The Pause, an intervention to offer a moment of silence for the healthcare team after a patient death, is one example. Objective: An integrative review of The Pause was conducted to investigate its use and how it impacts healthcare providers and their work environments. Methods: The integrative review methodology by Whittemore and Knafl was used to guide this study. Steps included were problem identification, literature search, data evaluation, data analysis, and presentation. Content analysis was used to identify themes. Results: Seven databases were searched in 2022 and seven studies were identified for inclusion in this review. Two themes were identified: personal benefits and professional benefits. Findings reveal benefits from self-care and grief processing to a better work environment. Conclusions: The Pause is a low-cost, low-risk intervention that can be implemented at an organizational level to help reduce burnout, unresolved grief, increase resilience, increase retention, and improve patient outcomes. Future research should include an examination of how The Pause may affect patient outcomes and workplace culture.

The Impact of Distress, Personal Meaning & Training on the Delivery of Support to Grieving Students by School Nurses

Supporting grieving students is part of a school nurse's role which can provide meaning or special purpose in their career. This was verified by an online survey completed by 648 school nurse members of the National Association of School Nurses (NASN). A majority of respondents felt personal distress as a result of their work with grieving students which was predicted by a lack of access to work/community resources available and a lower level of educational background of the school nurse. Training to support grieving students and a higher level of educational background of the school nurse, however, appeared to predict a greater level of personal meaning found in school nurses' support of grieving students. Level of support by school leadership provided to school nurses in their support of grieving students was also found to be related to both the personal distress experienced and the personal meaning derived by school nurses.

Influence of basic attributes and attitudes of nurses toward death on nurse turnover: A prospective study

BACKGROUND

Facing patient death is an unavoidable aspect of work for nurses working in healthcare settings. The attitudes of nurses toward death, however, can exert a negative psychological impact on themselves that can even cause them to quit this occupation.

AIM

The objective of this study was to explore the attitudes of nurses toward death, the factors influencing said attitudes, and whether nurses basic attributes and attitudes toward death were associated with their future turnover behavior.

METHOD

A prospective study design was adopted. The recruitment period ran from October 2017 to March 2018. A total of 323 nurses completed a basic attributes survey as well as the Death Attitude Profile-Revised questionnaire and were followed until May 30, 2021. The factors influencing turnover were then analyzed using the Cox proportional hazard model. The STROBE checklist was used for reporting in this study.

RESULTS

Age was found to be significantly associated with fear of death and death avoidance. Compared with nurses with no religion, nurses who were Buddhists/Taoists were more inclined toward neutral acceptance in their attitude toward death, whereas those who were Christians/Catholics were more inclined toward escape acceptance. Nurses with less than three years of work experience were more likely to resign earlier than those with more than 3 years of work experience. Fear of death and approach acceptance could be used to predict turnover.

CONCLUSIONS

Younger nurses were more likely to exhibit fear of death and escape behavior, and those with less work experience or a greater fear of death were more likely to resign. Nurses with religious beliefs could accept patient death more positively, whereas those who faced death with positive approach acceptance displayed reductions in turnover.

IMPLICATION FOR NURSING AND HEALTH POLICY

Younger nurses should receive more education regarding death early in their training. Hospitals should also offer more education from a religious aspect in order to reduce turnover.

Grief Support and Coping Mechanism Mediate the Effect of Grief on Burnout Among Intensive Care Unit Nurses: A Structural Equation Modeling Analysis

BACKGROUND

Patients' death caused the intensive care unit (ICU) nurses to grieve, which led to their burnout. Intensive care unit nurses use various coping mechanisms and need support to overcome grief.

OBJECTIVE

The aim of this study was to identify the mediation effects of coping mechanisms and grief support on the impact of grief on burnout.

METHOD

This cross-sectional study among 660 ICU nurses from 9 hospitals used 4 self-reported instruments to collect data, apart from the sociodemographic and employment-related variables. A final model was developed through structural equation modeling after establishing the construct validities of the measures through confirmatory factor analysis.

RESULTS

The representation of ICU nurses from each hospital was greater than 50%, with the majority being female (90.8%) with a mean age of 27.27 years. Most nurses perceived the absence of grief, low burnout, and moderate to low grief support. The nurses use various coping mechanisms. Grief support significantly mediated the relationship between grief and burnout using a bootstrapping method with a mediation strength using the variance counted for (VAF) of 34.95%. The final model fit indices with acceptable values validated the direct and indirect relationships of grief, grief support, and coping mechanisms on burnout.

DISCUSSION

The significant influence of grief support in mediating the effect of grief on burnout is an important finding. The nursing and hospital management can use this finding to provide grief support to ICU nurses, enhance the grief support resources, and promote future studies to test the model's validity and applicability to health care professionals who frequently face patients' death.

You clapped, you cheered, but did anybody hear? A mixed-methods systematic review of dementia homecare workers' training and psychosocial needs

The homecare sector's high turnover rate is linked to poor working conditions and a lack of person-centered practice. Limited research exists on the training and psychosocial needs of homecare workers caring for people living with dementia (PLWD). This systematic review explored these needs and identified 285 studies, of which seven studies met the inclusion criteria. A narrative synthesis identified four themes: "training and education challenges and facilitators;" "social isolation and the importance of peer support;" "emotional attachments and distress experienced by homecare workers;" and "working with families and its emotional impact on homecare workers." This review highlights the unmet educational and psychosocial needs of homecare workers and the negative impacts these unmet needs have. To improve person-centered practice in homecare, workers require dementia-specific training, and concurrent emotional and peer support, alongside support managing relationships with clients' families. Future research is required to implement an intervention to meet these needs.

Nursing assistants' perceptions and experiences with the emotional impact of providing palliative care: A qualitative interview study in nursing homes

AIM

To gain insight into the perceived emotional impact of providing palliative care among nursing assistants in Dutch nursing homes, their strategies in coping with this impact and associated needs.

DESIGN

Exploratory qualitative study.

METHODS

In 2022, 17 semistructured interviews with nursing assistants working in Dutch nursing homes were conducted. Participants were recruited via personal networks and social media. Interviews were open-coded by three independent researchers following the thematic analysis approach.

RESULTS

Three themes emerged regarding the elements that contribute to the emotional impact of providing palliative care in nursing homes: impactful situations (e.g. witnessing suffering and sudden deaths), interactions (e.g. close relationship and receiving gratitude) and reflection on provided care (e.g. feeling fulfilment or feeling inadequate in caring). Nursing assistants used different strategies to cope, including emotional processing activities, their attitude towards death and work and gaining experience. Participants experienced a need for more education in palliative care and organized peer group meetings.

CONCLUSION

Elements that play a role in how the emotional impact of providing palliative care is perceived by nursing assistants can have a positive or negative impact.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nursing assistants should be better supported in coping with the emotional impact of providing palliative care.

IMPACT

In nursing homes, nursing assistants are most involved in providing daily care to residents and have a signalling role in recognizing the deteriorating conditions of residents. Despite their prominent role, little is known about the emotional impact of providing palliative care among these professionals. This study shows that although nursing assistants already undertake various activities to reduce the emotional impact, employers should be aware of the unmet needs in this area and the responsibility they have in this regard.

REPORTING METHOD

The QOREQ checklist was used for reporting.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

BURNOUT PREVALENCE IN INTENSIVE CARE UNIT, GENERAL SURGERY UNIT AND EMERGENCY UNIT. A ROMANIAN STUDY

Objective

This study aims to investigate the effect of job characteristics and protective factors on burnout, one of the common medical staff issues. So far, little attention has been paid to testing protective factors' role on medical staff exhaustion.

Design

Using a correlation design, these constructs were tested on a sample of 221 participants, doctors, and nurses.

Main Outcome

The present study revealed protective factors power in predicting burnout, over job characteristics, and the moderation effect of role-playing in the medical care unit and clinical department.

Measures

For assessing burnout were used a Romanian translated version of the Maslach Burnout Inventory - General Survey (MBI).

Results

Protective factors like physical activities, vacation, and hours spent with family introduced an explanatory model and had a predictive validity over job characteristics in predicting medical staff's burnout. Finally, the effect of physical activities on burnout was moderated both by the role played in the medical care unit and clinical department, while the effect of time served in other medical institutions was moderated only by the role played in the medical care unit.

Conclusion

These results provide guidance for better burnout programs interventions, which are addressed to medical healthcare experts.

'That just doesn't feel right at times' - lone working practices, support and educational needs of newly employed Healthcare Assistants providing 24/7 palliative care in the community: A qualitative interview study

BACKGROUND

Healthcare assistants working in hospice at home settings have a pivotal role in supporting people dying at home and their family caregivers. Some healthcare assistants are working alone in patients' homes, which magnifies some of the issues reported for those working closely with other team members. There is a dearth of evidence in terms of education, training and support needs for healthcare assistants when working alone.

AIM

To explore the role of newly employed lone working healthcare assistants delivering palliative care in the community, and their support and educational needs.

DESIGN

Qualitative exploratory study using semi-structured interviews.

SETTING/PARTICIPANTS

Healthcare assistants (n = 16) employed less than 12 months by a national non-profit hospice and palliative care provider located across the UK.

RESULTS

Analysis of interviews identified three main themes: (1) Healthcare assistants have a unique and complex role catering for holistic needs of patients and their family caregivers in the home environment; (2) preparation for the complex role requires focus on experiential learning and specific training to support holistic care provision; (3) lone workers experience loneliness and isolation and identify peer support as a key intervention to support their wellbeing.

CONCLUSIONS

Given the complexities of their role within community palliative care teams, there are key learning points in relation to healthcare assistant preparation. Education and support networks should be prioritised to reduce isolation and support ongoing learning and development of newly employed healthcare assistants; all of which is vital to ensure safety and quality of care for the growing number of people they support in the community.

Influencing factors of nurses' short-term bereavement reactions after patient death

An online cross-sectional survey was performed among 181 nurses in mainland China who experienced their most recent patient death within the last month. Multivariate linear regressions were used following bivariate analysis to identify influencing factors for their short-term professional bereavement reactions. More intensive reactions were associated with the nurse's fewer experiences of patient death; the nurse's employment in the intensive care unit rather than the emergency, oncology, geriatrics, or internal medicine departments; and the patient experiencing more pain in the last few days. Higher reaction scores were also reported by nurses who lost the patient more than 1 week prior.

How client death impacts home care aides' workforce outcomes: an exploratory analysis of return to work and job retention

Home health aides face a range of stressors that may result in departing the workforce. One stressor that has emerged in multiple qualitative studies as potentially influencing retention is client death. Using 2019 data from a single agency in New York City employing approximately 1700 aides, we used logistic and linear regression to explore case and aide factors associated with workforce outcomes after client death. We found that longer case length (Beta = 0.01, p < .001) was associated with longer return to work for aides experiencing client death and longer job tenure (Beta = -0.002, p = .002) was associated with shorter return to work (n = 67). We found no difference in retention between aides who experienced client death and those who did not (n  216). This analysis suggests the importance of research on the period of time following client death and of offering support to aides after clients die, particularly after longer cases.

"We are Human too.": The Challenges of Being an End-of-Life Doula

End-of-life (EOL) doulas are emerging professionals who provide an intimate approach to the death process by focusing on the psychological, social, spiritual, and emotional needs of dying individuals. EOL doula work is stressful; it exposes individuals to recurring stressors such as suffering and grief. Trained professionals are needed to help advocate for the dying individual and their families. Despite the growing literature on EOL doulas, information regarding the challenges of being an EOL doula is underrepresented in the literature. This paper is one of the first to address this concept. Twelve in-depth, semi-structured interviews regarding the EOL doula experience were conducted as a part of a larger exploratory study. Three overarching themes emerged from the larger project: motivations to become an EOL doula, roles of an EOL doula, and challenges of an EOL doula. In this article, only challenges of EOL are discussed, along with subsequent subordinate themes.

Role of Home Health for Community-Dwelling Older Adults Near the End of Life: A Resource Beyond Hospice?

Background: Medicare home health could be leveraged to care for those near the end of life (EOL), especially for those who cannot access nor desire the Medicare hospice benefit. It is unknown what role home health currently has either preceding or as an alternative to hospice use. Objective: The aim of this study is to compare populations served and visit patterns of Medicare beneficiaries receiving home health/hospice/both near the EOL. Design: Nationally representative cohort study of National Health and Aging Trends Study (NHATS) respondents. Setting/Subjects: A total of 1,057 U.S. decedents in NHATS from 2012 to 2017 with linked Medicare claims were included in this study. Measurements: Measurements included the proportion of decedents who received home health/hospice/both/neither (yes/no) in the last six months of life (EOL) and mean number of visits by discipline (nurse/therapist [physical/occupational speech-language pathologist]/social worker/home health aide) per 30 eligible days at home for home health/hospice/both at the EOL. The primary independent variable was the clinician discipline providing services (nurse/therapist/social worker/aide). Results: In our sample, 19.9% received home health only, 25.8% hospice only, 18.8% both, and 35.6% neither at the EOL. These populations varied in their demographic, region, and clinical characteristics. Decedents who received home health only compared with hospice only were younger (44.1% over age 85 vs. 58.4%), members of a racially/ethnically diverse group (19.7% vs. 10.9%), and with less disability (37.2% required no assistance with activities of daily living vs. 22.7%), all p values <0.05. In adjusted models, those receiving home health versus hospice received similar numbers of visits per 30 days (average 5.4/30 vs. 6.6/30), while those receiving both received more visits (10.5/30). Home health provided more therapy visits, while hospice provided more social work and aide visits. Conclusions: More than one in three Medicare decedents nationwide received home health at the EOL. Home health has the potential to serve a population not reached by hospice and improve the quality of end-of-life care.

Randomized controlled trial of emotion-focused training for helping professionals

Introduction

The aim of this study was to examine the short- and long-term effectiveness of the novel Emotion-focused Training for Helping Professions on levels of compassion fatigue (secondary traumatic stress & burnout), self-criticism, self-compassion, and compassion for others.

Methods

A randomized controlled trial study was conducted. A total of 253 participants were recruited and randomly assigned to either the experimental group or the control group. The experimental group attended a 14-day online training. The control group did not perform any tasks.

Results

Results showed that after completing the intervention the experimental group participants reported significantly lower scores for secondary traumatic stress, burnout and self-criticism, and higher scores for self-compassion and that these lasted for two months after completion. Compared to the control group, the experimental group participants had significantly lower scores of secondary traumatic stress, burnout, self-criticism, and higher scores of self-compassion after the intervention. No significant changes were found for the control group, except a significant increase in time in the reported score for one dimension of burnout - exhaustion.

Discussion

The novel EFT-HP training was shown to be effective in reducing levels of compassion fatigue (secondary traumatic stress and burnout) and self-criticism and increasing self-compassion.

"You gotta have your cry": Administrator and direct care worker experiences of death in assisted living

Assisted living (AL) is increasingly a site of end-of-life care and a long-term care location where growing numbers of people are aging in place and dying. Despite these trends, limited research focuses on how death and grief impact the work environment in AL. This grounded theory analysis examined qualitative data collected from 27 administrators and 38 direct care workers (DCWs) in 7 diverse settings. As assisted living administrators and DCWs experienced resident death, they engaged in a dynamic and individualized process of "managing the normalization of death," which refers to the balance of self-identity and workplace identity. The process of reconciling these opposing contexts in AL involved several individual- and community-level conditions. Administrators and DCWs would benefit from additional resources and training around death. Increasing collaboration with hospice and clarifying policies about death communication would better prepare the workforce to acknowledge the end of life in assisted living.

COVID-19 and the Experiences and Needs of Staff and Management Working at the Front Lines of Long-Term Care in Central Canada

Across the globe, long-term care has been under increased pressure throughout the COVID-19 pandemic. This is the first study to examine the experiences and needs of long-term care staff and management during COVID-19, in the Canadian context. Our group conducted online survey research with 70 staff and management working at public long-term care facilities in central Canada, using validated quantitative measures to examine perceived stress and caregiver burden; and open-ended items to explore stressors, ways of coping, and barriers to accessing mental health supports. Findings indicate moderate levels of stress and caregiver burden, and highlight the significant stressors associated with working in long-term care during the COVID-19 pandemic (i.e., rapid changes in pandemic guidelines, increased workload, "meeting the needs of residents and families", fear of contracting COVID-19 and COVID-19 coming into long-term care facilities, and concern over a negative public view of long-term care staff and facilities). A small subset (13.2%) of our sample identified accessing mental health supports to cope with work-related stress, with most participants identifying barriers to seeking help. Novel findings of this research highlight the significant and unmet needs of this high-risk segment of the population.

An accumulation of distress: Grief, loss, and isolation among healthcare providers during the COVID-19 pandemic

This article draws on the journal entries of 62 healthcare professionals (HCP) in the United States and Canada who participated in the Pandemic Journaling Project (PJP) during 2020-2021. The HCP in this article represented healthcare fields including medicine, nursing, physical therapy, social work, and clinical psychology. In their journal entries, HCP provided accounts of witnessing the death and bereavement of their patients and loved ones; experiencing their own loss of loved ones and important milestones; facing isolation from their networks and places of meaning; and juggling increasing workloads and caregiving activities. I illustrate how these four areas were impacted by guilt, duty, ethical deliberations, and gender disparities. I argue that HCP face an accumulation of distress when they witness grief and face loss without space to process these experiences.

The implications of COVID-19 on health and social care personnel in long-term care facilities for older people: An international scoping review

This scoping review mapped out the existing literature pertaining to health and social care personnel experiences during the coronavirus disease-2019 (COVID-19) pandemic and their work in a long-term care setting for older people. This review identified the gaps in the implications of health and social care personnel's own health and well-being during the pandemic as well as the ethical dilemmas inherent in providing care during the COVID-19 pandemic. The authors utilised the PRISMA checklist for undertaking scoping reviews. The Databases Medline, PsychINFO, CINAHL, SCOPUS, Web of Science and Google Scholar were searched for relevant articles in English that were published between March 28, 2020 and June 1, 2022. This time period was selected to focus specifically on the COVID-19 pandemic. In the context of this review, long-term care facilities were defined to include institutions such as nursing homes, skilled nursing facilities, retirement homes and residential care homes. The gaps identified were a paucity of research on the experiences of health and social care personnel in long-term care facilities, the impact on their mental health, and the wider challenges experienced during the COVID-19 pandemic is discussed. The findings of this scoping review indicate a need for adequate preparedness during a pandemic within the health and social care sector to protect health and social care personnel and the individuals they care for.

A qualitative study of nursing practitioners' experiences with COVID-19 patients dying alone in Greece

Background

In Greece, there is still limited research on death in isolation due to COVID-19. This deserves attention because of the recent financial crisis, which profoundly impacted public health, and the high relevance of the Hippocratic tradition to the moral values of clinical practice.

Methods

A prospective qualitative study using in-depth interviews with 15 frontline nursing practitioners working in a COVID-19 ward or intensive care unit (ICU) was conducted from July 2021 to December 2021.

Results

The inability of family members to say a final goodbye before, during, or after death by performing proper mourning rituals is extremely inhuman and profoundly impacts the mental health status of patients, family members, and nursing practitioners. Patients and their family members strongly desire to see each other. Epidemiology, liability, and proper nursing performance emerged as reasons for the enforced strict visitation restrictions. Participants emphasized that visitations should be allowed on an individual basis and highlighted the need for the effective use of remote communication technology, which, however, does not substitute for in-person contact. Importantly, physicians allowed "clandestine" visits on an individual basis. Nursing practitioners had a strong empathic attitude toward both patients and their families, and a strong willingness to provide holistic care and pay respect to dead bodies. However, they also experienced moral distress. Witnessing heartbreaking scenes with patients and/or their families causes nursing practitioners to experience intense psychological distress, which affects their family life rather than nursing performance. Ultimately, there was a shift from a patient-centered care model to a population-centered care model. Furthermore, we identified a range of policy- and culture-related factors that exaggerate the negative consequences of dying alone of COVID-19.

Conclusion

These results reinforce the existing literature on several fronts. However, we identified some nuances related to political decisions and, most importantly, convictions that are deeply rooted in Greek culture. These findings are of great importance in planning tailored interventions to mitigate the problem of interest and have implications for other similar national contexts.

The Impact of Reflection on Death on the Self-Esteem of Health Care Workers

Background. The study was based on the Terror Management Theory. This theory assumes that self-preservation and awareness of imminent death create the potential to trigger fear. The “culture buffer” can protect people from fear, and it is composed of two factors: personal views on world issues and self-esteem. The aim of the study was to show that exposure to content that increases the availability of thoughts about death causes changes in medical personnel (doctors, nurses, and paramedics) in areas such as self-esteem, mood, sense of agency, and communion. Methods. The research was experimental. Standardized psychometric tests were used, including the Rosenberg self-esteem scale (RSE), the University of Wales Institution of Science and Technology) Mood Adjective Check List (UMACL), scales measuring agency and communion, and an additional questionnaire containing two types of text. Respondents were divided into two text groups: A (exposed to increased availability of thoughts of death) and B (neutral). Results. Reflection on death, triggered by the experimental manipulation of the independent variable (text version), did not modify mood (in groups of medical staff and students) or self-esteem of health care professionals but did modify scores on a single RSE item in the student’s group. Moreover, age, income level, religious attitude, and belonging to a professional group had an impact on self-esteem, mood components, and other parameters but did not interact with the text group. Reflection on death modified the sense of agency and communion. Conclusions. Exposure to content increasing the availability of thoughts of death led to observable effects possible to observe in all groups only after taking into account an additional factor, which turned out to be the religious attitude of the respondents in the experiment. Specific tools should be selected or developed for the needs of research on respondents working in health care.

Sense of coherence and burnout in nursing home workers during the COVID-19 pandemic in Spain

Care staff in nursing homes work in a challenging environment, and the COVID-19 pandemic has exacerbated those challenges in an unprecedented way. On the other hand, the sense of coherence (SOC) is a competence that could help these professionals perceive the situation as understandable, manageable and meaningful. This study aims to analyse the extent to which potential risk and protective factors against burnout have affected nursing home workers during the COVID-19 pandemic and to assess the contribution of these factors to their burnout. Three hundred forty professionals who worked in nursing homes in Spain completed a survey and reported on their sociodemographic characteristics and their organisational characteristics of the job related to COVID-19, SOC and burnout. Multiple linear regression analyses were performed. The results showed that the SOC is highly related to the dimensions of burnout and is a protective factor against this. In addition, the increase in hours has a negative effect, facilitating inadequate responses to stressful situations; and whereas perceived social support and availability of resources have a protective effect, the deterioration in mental and physical health is the most important risk factor. This study could help better understand the psychological consequences of the effort that nursing home workers and can also help design mental health prevention and care interventions for workers that provide them with resources and supports that foster their coping skills.

The Associations between Job Strain, Workplace PERMA Profiler, and Work Engagement

OBJECTIVE

Our purpose was to examine the relationship between job strain, work engagement, and the dimensions of well-being according to the Workplace PERMA (Positive Emotion, Engagement, Relationships, Meaning, Accomplishment) model.

METHODS

310 workers completed a web-based questionnaire, namely, the Brief Job Stress Questionnaire, Utrecht Work Engagement Scale, and the Workplace PERMA Profiler. Regression analyses were conducted on well-being and each scale of job strain, including job demands, job control, supervisor support and co-worker support.

RESULTS

Job control, supervisor support, and co-worker support were significantly correlated with the scores of five dimensions, and Happiness of the PERMA Profiler (except for between supervisor support and Accomplishment). Job demands was only significantly correlated with Engagement and Meaning.

CONCLUSIONS

All well-being dimensions were commonly influenced by job control and workplace support, while Engagement and Meaning were also facilitated by challenging job demands.

Grief and Loss During Care Transitions: Experiences of Direct Care Workers

Direct Care Workers (DCW) provide both personal care to patients and emotional support to patients and caregivers in hospice and palliative care. DCWs often develop close ties and are then expected to work with new clients immediately following a care transition, with little or no time to grieve. A qualitative pilot study (n = 24) was conducted to explore the experience of DCWs during care transitions. Data was collected via focus groups and individual interviews. Thematic analysis was used. Results suggest DCWs managed their experiences (n = 19), by anticipating and accepting grief and loss (n = 21), employing personal coping strategies (n = 19), and saying good-bye (n = 15). Relational factors impacted the experience of care transitions (n = 22), including building and maintaining the relationship (n = 14), and the strength of perceived connections (n = 15). Increased organizational support and training to help address grief and loss will better support DCWs and the direct care workforce.

Feelings and Emotions of Nurses Related to Dying and Death of Patients - A Pilot Study

Introduction

The aim of the study, conducted in selected inpatient units, was to evaluate and analyse the feelings and emotions which accompany nurses during their work when they face the death of patients.

Material and Methods

A total of 160 nurses were invited to participate in the study. The study group consisted of 40 nurses from each of the four departments of a municipal hospital: a surgery unit, an internal medicine unit, a hospital emergency department (ER) and an intensive care unit (ICU). A diagnostic survey method was used, including a questionnaire on sociodemographic data as well as questions designed by the author of the research related to the feelings of nurses provoked by the death of patients. To assess the level of anxiety and the ways of coping with stress related to contact with dying patients, Mini-COPE and PSS-10 questionnaires were used.

Results

Compassion, sadness and helplessness are the most common types of nurses’ emotions caused by the death of patients, regardless of the nurses’ length of service and the place of work. In the study group, 53.90% of participants experienced a high level of stress. The level of anxiety in nurses from the internal medicine ward was significantly higher than in the nurses from the intensive care unit and the emergency department. The way of coping with stress is related to the period of service and the workplace of nurses.

Conclusion

Nurses experience a high level of stress and strong emotions triggered by the observation of dying patients. Various styles of coping with stress can be noticed depending on job seniority and a place of employment. Due to the emotions evoked by the necessity to deal with death while performing professional duties, it is advisable to develop effective ways of coping in difficult situations.

Interventions to Reduce the Impact of Client Death on Home Care Aides: Employers' Perspectives

For home care agencies and aides, the death of clients has important, yet often unrecognized, workforce implications. While research demonstrates that client death can cause grief and job insecurity for aides, we currently lack home care agencies' perspectives on this issue and approaches to addressing it. This study uses key informant interviews with leaders from a diverse sample of eight New York City home care agencies to explore facilitators and barriers to agency action. We found that agencies engaged primarily in a range of informal, reactive practices related to client death, and relatively few targeted and proactive efforts to support aides around client death. While leaders generally acknowledged a need for greater aide support, they pointed to a lack of sustainable home care financing and policy resources to fund this. We recommend increased funding to support wages, paid time off, and supportive services, and discuss implications for future research.

Prevalence of burnout in healthcare professionals providing palliative care and the effect of interventions to reduce symptoms: A systematic literature review

BACKGROUND

In recent years there has been increasing attention for the prevalence and prevention of burnout among healthcare professionals. There is unclarity about prevalence of burnout in healthcare professionals providing palliative care and little is known about effective interventions in this area.

AIM

To investigate the prevalence of (symptoms of) burnout in healthcare professionals providing palliative care and what interventions may reduce symptoms of burnout in this population.

DESIGN

A systematic literature review based on criteria of the PRISMA statement was performed on prevalence of burnout in healthcare professionals providing palliative care and interventions aimed at preventing burnout.

DATA SOURCES

PubMed, PsycInfo and Cinahl were searched for studies published from 2008 to 2020. Quality of the studies was assessed using the method of Hawkers for systematically reviewing research.

RESULTS

In total 59 studies were included. Burnout among healthcare professionals providing palliative care ranged from 3% to 66%. No major differences in prevalence were found between nurses and physicians. Healthcare professionals providing palliative care in general settings experience more symptoms of burnout than those in specialised palliative care settings. Ten studies reported on the effects of interventions aimed at preventing burnout. Reduction of one or more symptoms of burnout after the intervention was reported in six studies which were aimed at learning meditation, improving communication skills, peer-coaching and art-therapy based supervision.

CONCLUSION

The range of burnout among healthcare professionals providing palliative care varies widely. Interventions based on meditation, communication training, peer-coaching and art-therapy based supervision have positive effects but long-term outcomes are not known yet.

How Leaders, Teams and Organisations can prevent Burnout and build Resilience: a thematic analysis'

CONTENT

Burnout occurs commonly in palliative care. Building resilience helps to mitigate the effects of burnout. Little is known about the importance of leaders, teams and organisations in preventing burnout and promoting resilience in palliative care.

OBJECTIVES

We studied palliative care clinicians with more than a decade's experience looking into their experiences on the role leaders, teams and organisations play in burnout and resilience.

PATIENTS AND METHODS

This is a thematic analysis focusing on how leaders, teams and organisations influence burnout and resilience. 18 palliative care clinicians-5 doctors, 10 nurses and 3 social workers-who worked in various palliative care settings (hospital, home hospice and inpatient hospice) were interviewed using semistructured questionnaires. The mean age of the interviewees was 52 years old, and the mean number of years practising palliative care was 15.7 years (ranging from 10 to 25 years). The interviews were recorded verbatim and were transcribed and analysed using a thematic analysis approach.

RESULTS

The following themes featured prominently in our study. For leaders: being supportive, caring and compassionate, being a good communicator and showing protective leadership. With teams: being like-minded, caring for the team, sharing the burden and growing together. For organisations: having a strong commitment to palliative care, supporting staff welfare and development, open communication, adequate staffing and organisational activities promoting staff well-being were described as protective against burnout and promoting resilience.

CONCLUSION

Leaders, teams and organisations play an important role in helping palliative care teams to reduce burnout and promote resilience.

The Experience to Implement Palliative Care in Long-term Care Facilities: A Grounded Theory Study of Caregivers

PURPOSE

The purpose of this study was to explore the experiences of caregivers in long-term care facilities as they implement palliative care. Although palliative care has been available in Taiwan for more than 30 years, it is often provided in hospitals, few models in the long-term care facilities.

METHODS

Semi-structured interviews using grounded theory methodology and purposive sampling. Two small long-term care facilities that had performed well in palliative care were selected from eastern Taiwan. A total of 12 caregivers participated in in-depth semi-structured face-to-face interviews.

RESULTS

Four major stages in the implementation of palliative care were identified: (1) feeling insecure, (2) clarifying challenges, (3) adapting to and overcoming the challenges, and (4) comprehending the meaning of palliative care. The core category of these caregivers as "the guardians at the end of life" reflects the spirit of palliative care.

CONCLUSION

This study demonstrates that successful palliative care implementation would benefit from three conditions. First, the institution requires a manager who is enthusiastic about nursing care and who sincerely promotes a palliative care model. Second, the institution should own caregivers who possess personality traits reflective of enthusiasm for excellence, unusual ambition, and a true sense of mission. Third, early in the implementation phase of the hospice program, the institution must have the consistent support of a high-quality hospice team.

Top Ten Tips Palliative Care Clinicians Should Know About Bereavement and Grief

Palliative care (PC) focuses on caring for the whole person, from birth to death, while managing symptoms and helping to navigate medical complexities. Care does not stop at the time of death, however, as assisting patients, families, and fellow clinicians through grief and bereavement is within PC's purview. Unfortunately, many clinicians feel unprepared to deal with these topics. In this article, PC and hospice clinicians define and explain bereavement, distinguish normative grief from pathological grief, offer psychometrically sound scales to screen and follow those suffering from grief, and discuss the interaction between grief and bereavement and the physical and mental health of those who are left behind after the death of a loved one.

A Cross-Sectional Survey on Burnout Prevalence and Profile in the Sicilian Population of Ambulance Driver-Rescuers

INTRODUCTION

Burnout is present at a high rate in emergency medicine. The ambulance driver-rescuers, who furnish first aid to the victims, are the non-medical part of the Italian 118-service staff. There is a lack of research on burnout risk in Italian Emergency Medical Services and, particularly, for this category of workers. The two Italian studies, including a little group of ambulance driver-rescuers, reported inconsistent findings.

HYPOTHESIS

This survey investigated for the first time the prevalence and exact profile of burnout in a large sample of Italian driver-rescuers. As a secondary aim, the study described how the items of the Italian version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) cluster in components in this sample.

METHODS

This cross-sectional census survey was conducted from June 2015 through May 2016 and involved all the driver-rescuers operating in Sicily, the biggest and most southern region of Italy. The subjects received a classification according to different profiles of burnout by using the Italian version of the MBI-HSS (burnout, engagement, disengagement, over-extension, and work-inefficacy). In order to explore the existence of independent factors, a Principal Component Analysis (PCA) was conducted on the survey to obtain eigenvalues >one for each component in the data.

RESULTS

The final sample comprised 2,361 responders (96.6% of the initial sample). Of them, 29.8% were in burnout (95% confidence interval [CI], 27.8% to 31.8%) and 1.7% presented a severe form (95% CI, 1.1% to 2.3%); 30.0% were engaged in their work (95% CI, 21.0% to 34.8%), 24.7% of responders were disengaged (95% CI, 22.9% to 26.5%), 1.2% presented an over-extension profile (95% CI, 0.8% to 1.7%), and 12.6% felt work-inefficacy (95% CI, 11.3% to 14.1%). The factors loaded into a five-factor solution at PCA, explaining 48.1% of the variance and partially replicating the three-factor structure. The Emotional Exhaustion (EE) component was confirmed. New dimensions from Personal Accomplishment (PA) and Depersonalization (DP) sub-scales described empathy and disengagement with patients, respectively, and were responsible for the increased risk of burnout.

CONCLUSIONS

These results endorse the importance of screening and psychological interventions for this population of emergency workers, where burnout could manifest itself more insidiously. It is also possible to speculate that sub-optimal empathy skills could be related to the disengagement and work-inefficacy feelings registered.

Burnout and Resilience After a Decade in Palliative Care: What Survivors Have to Teach Us. A Qualitative Study of Palliative Care Clinicians With More Than 10 Years of Experience

CONTEXT

Burnout is common among palliative care clinicians (PCCs). Resilience helps to reduce burnout, compassion fatigue, and is associated with longevity in palliative care.

OBJECTIVES

We aimed to study PCCs who have remained in the field for longer than 10 years to deepen our understanding on their views on burnout and resilience.

METHODS

We conducted a qualitative study using semistructured interviews and purposive sampling on 18 PCCs - five doctors, 10 nurses, and three social workers who worked in various palliative care settings (hospital palliative care team, home hospice, and inpatient hospice). The mean age of the interviewees was 52 years, and the mean number of years practicing palliative care was 15.7 years (range 10-25). The interviews were recorded verbatim, transcribed, and analyzed using a grounded theory approach.

RESULTS

Four major themes emerged from our analysis - struggling, changing mindset, adapting, and resilience. Intervening conditions, such as self-awareness, reflection, and evolution, were also important factors. The core phenomenon of our study was that of transformational growth - a process that PCCs have to go through before they achieve resilience. We also further classified resilience into both personal and collective resilience.

CONCLUSION

Our findings highlight the evolving process of transformational growth that PCCs must repeatedly undergo as they strive toward sustained resilience and longevity. It also stresses the importance of taking individual and collective responsibility toward building a culture of personal and team resilience.

The Role, Education, and Experience of Health Care Assistants in End-of-Life Care in Long-Term Care: A Scoping Review

The changing age profile of the human population globally means that the requirement for residential long-term care (LTC) for older adults is escalating, with an associated increase in deaths in these facilities. Health care assistants (HCAs), whose main role is provision of direct care to residents, comprise the largest staff cohort in residential care for older adults. The purpose of this scoping review was to explore three key areas related to HCAs: their role and responsibilities, end-of-life (EOL) education, and their views and experiences of caring for residents at EOL. The literature search included five databases and 32 studies were ultimately reviewed. Key issues were as follows: HCAs feel marginalized and undervalued, they need and desire EOL education, and resident deaths impact negatively on them. The changing care needs for older adults with complex comorbidities at EOL in LTC will place an increased onus on HCAs' skills, knowledge, and personal and professional development. [Journal of Gerontological Nursing, 46(1), 21-29.].

Home Care Workers' Experiences of Client Death and Disenfranchised Grief

While many types of health care workers experience patient death, home care workers do so under vastly different social and economic circumstances. When a client dies, home care workers often lose both a close relationship and a job. Though research suggests that health care workers' grief may frequently be disenfranchised, there is no in-depth study of the mechanisms that disenfranchise home care workers' grief specifically. To address this gap, our study used focus groups and peer interviews between home care workers in New York City. We describe four interrelated grief strategies they employ to navigate social and employer-based "grieving rules." Our findings suggest that home care workers' grief is disenfranchised via employer and societal underestimations of their relationships with clients and their losses when clients die, particularly job loss. Building on our findings, we suggest alterations to agency practices and home care systems to improve support for workers.