1
|
Shuai T, Xuan Y, Jiménez-Herrera MF, Yi L, Tian X. Moral distress and compassion fatigue among nursing interns: a cross-sectional study on the mediating roles of moral resilience and professional identity. BMC Nurs 2024; 23:638. [PMID: 39256782 PMCID: PMC11389509 DOI: 10.1186/s12912-024-02307-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/29/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Nursing interns often faced moral distress in clinical practice, similar to registered nurses, which can lead to compassion fatigue. The roles of moral resilience and professional identity in influencing the psychological well-being of nursing interns are recognized, but the interrelationships among moral distress, moral resilience, professional identity, and compassion fatigue in this group remain unclear. OBJECTIVES This study aimed to investigate the impact of moral distress on compassion fatigue among nursing interns and to explore the mediating role of moral resilience and professional identity. METHODS A quantitative cross-sectional study was conducted with 467 nursing interns. Data were collected using Compassion Fatigue Short Scale, Moral Distress Scale-revised, Rushton Moral Resilience Scale, and Professional Identity Scale. Data analyses were performed using SPSS 22.0 and Amos 21.0, adhering to the STROBE statement. RESULTS The mean scores for compassion fatigue, moral distress, moral resilience, and professional identity were 35.876, 44.887, 2.578, and 37.610, respectively. Moral distress was positively correlated with compassion fatigue. Structural equation modeling showed that moral resilience and professional identity partially mediated the relationship between moral distress and compassion fatigue (β = 0.448, P < 0.001). CONCLUSION The findings suggest that moral distress directly influences compassion fatigue among nursing interns and also exerts an indirect effect through moral resilience and professional identity. Interventions aimed at enhancing moral resilience and fostering a strong professional identity may help mitigate the adverse effects of moral distress on compassion fatigue among nursing interns.
Collapse
Affiliation(s)
- Ting Shuai
- Second Clinical Division, Peking University School and Hospital of Stomatology & National Clinical Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, China
| | - Yan Xuan
- Second Clinical Division, Peking University School and Hospital of Stomatology & National Clinical Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, China
| | | | - Lijuan Yi
- Nursing Department, Universitat Rovira i Virgili, Tarragona, 43002, Spain.
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou, 412000, China.
| | - Xu Tian
- Chongqing Center for Evidence-based Traditional Chinese Medicine, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400020, China.
| |
Collapse
|
2
|
Greene E, Austin G, Henneman A. Adverse childhood experiences among doctor of pharmacy students. CURRENTS IN PHARMACY TEACHING & LEARNING 2024; 16:327-334. [PMID: 38480066 DOI: 10.1016/j.cptl.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE Adverse Childhood Experiences (ACEs) have demonstrated negative impact on physical, emotional, and cognitive health outcomes. This study aimed to assess prevalence of ACEs among Doctor of Pharmacy (PharmD) students, and their associations with mental health, substance use, academic performance, and sleep patterns. METHODS A cross-sectional survey was conducted on PharmD students at a private University. ACE scores, mental health history, substance use, academic performance, and sleep habits were self-reported. Descriptive statistics and chi-square tests were used for analysis. RESULTS From 54 participants across all cohorts of students in the curriculum (response rate: 19%), 48% reported ≥4 ACEs. A majority of students reported having been diagnosed with or sought treatment for depression (56%) or anxiety (67%), while 42.9% reported a history of contemplating suicide. Participants with ACE scores of ≥4 were more likely to have sought treatment for depression, any mental health condition, contemplated suicide, or used alcohol for mental health purposes. No differences in academic performance based on ACE scores were found. CONCLUSION High numbers of ACEs were common and linked to mental illness, suicidality, and use of alcohol for mental health purposes. While no direct academic impact was found in this small sample size, adopting a trauma-informed approach is crucial to supporting student well-being. Further research in this area is needed to optimize interventions to support academic and professional success among students with ≥4 ACEs.
Collapse
Affiliation(s)
- Elisa Greene
- Belmont University College of Pharmacy and Health Sciences, 1900 Belmont Blvd, Nashville, TN 37212, United States of America.
| | - Gary Austin
- Belmont University College of Pharmacy and Health Sciences, 1900 Belmont Blvd, Nashville, TN 37212, United States of America.
| | - Amy Henneman
- Belmont University College of Pharmacy and Health Sciences, 1900 Belmont Blvd, Nashville, TN 37212, United States of America; Department of Integrated Medical Education, Belmont University Thomas F. Frist, Jr. College of Medicine, 1900 Belmont Blvd, Nashville, TN 37212, United States of America.
| |
Collapse
|
3
|
Bloemendaal AFT, Kamperman AM, Bonebakker AE, Kool N, Olff M, Mulder CL. Workplace trauma and professional quality of Life in clinical and forensic psychiatry: the CRITIC study. Front Psychiatry 2024; 15:1228335. [PMID: 38495910 PMCID: PMC10940400 DOI: 10.3389/fpsyt.2024.1228335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 02/12/2024] [Indexed: 03/19/2024] Open
Abstract
Background Frontline staff in psychiatry need to perform at a very high professional level in order to ensure patient and community safety. At the same time they are exposed to high levels of stress and workplace trauma. This may have severe consequences for their professional quality of life. In addition, health care workers in general have higher incidence levels of childhood adversity than the general population. The CRITIC (CRITical Incidents and aggression in Caregivers) Study aims to improve increased understanding of the interaction between personal life history (childhood adversity and benevolence), individual capabilities, exposure to trauma and violence at work and Professional Quality of Life (ProQOL). Method The Critic Study is a cross-sectional survey of these aspects in frontline, treatment and administrative staff in clinical and forensic psychiatry. We aim to include 360 participants. Participants will be asked to complete questionnaires on childhood adversity and childhood benevolence (assessing personal life history), professional quality of life, current trauma and violence exposure, current mental health (depression, anxiety and stress), coping, social support, work engagement and resilience. In this study we will examine the moderating role of adverse and benevolent childhood experiences in the association between workplace trauma exposure and professional quality of life. Finally, a theoretical model on the relationships between trauma, stress and coping in the context of professional functioning will be tested using structural equation modelling. Discussion The CRITIC study examines which factors influence the complex relationship between childhood adversity and benevolence, and ProQOL in healthcare workers. It also aims to provide insight into the complex relationship between personal life history, individual characteristics, exposure to trauma and violence at work and ProQOL. The results can be used for designing interventions to increase resilience to trauma and to improve professional quality of life among health care professionals. Trial registration The CRITIC study has been approved by the Medical Ethical Committee of the Erasmus Medical Centre, under trial registration number NL73417.078.20.
Collapse
Affiliation(s)
- Anthony F. T. Bloemendaal
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, Netherlands
- Dual Disorder Treatment Centre, Fivoor, The Hague, Netherlands
| | | | | | - N. Kool
- Dual Disorder Treatment Centre, Fivoor, The Hague, Netherlands
| | - M. Olff
- Amsterdam University Medical Centre (UMC), Department of Psychiatry, University of Amsterdam, Amsterdam Neuroscience and Amsterdam Public Health & ARQ National Psychotrauma Centre, Diemen, Netherlands
| | - C. L. Mulder
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, Netherlands
- Dual Disorder Treatment Centre, Fivoor, The Hague, Netherlands
- Antes Psychiatric Care, Parnassia Group, Rotterdam, Netherlands
| |
Collapse
|
4
|
Bouchard L, May JT, Dolan HR, Rainbow JG. A pilot resiliency course for Doctor of Nursing Practice (DNP) students: Lessons learned. J Prof Nurs 2024; 50:104-110. [PMID: 38369365 DOI: 10.1016/j.profnurs.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 11/30/2023] [Accepted: 12/10/2023] [Indexed: 02/20/2024]
Abstract
Graduate nursing students can face varied and significant stressors during their programs of study. The need for interventions to promote nursing student resiliency has been reported in the literature, by accrediting bodies, and in previous research conducted with students at the same university. Thus, the purpose of this project was to pilot a resilience course for Doctor of Nursing Practice (DNP) students. The theoretical frameworks guiding the design and implementation of the resiliency pilot program were andragogy (the science of adult learning) and rapid cycle quality improvement. The course included eleven monthly modules addressing resiliency content with written material, original videos, and online discussions and meetings. The first module overviewed the resiliency skills (Belief, Persistence, Trust, Strength, and Adaptability), five modules were dedicated to a specific resiliency skill, two modules addressed recent and anticipated challenges, two modules concentrated on the application (clinical and academic) of the resiliency skills, and the last module focused on reflection. Results of this pilot program indicate that DNP students can benefit from receiving resiliency content during their studies, especially from faculty involvement and increased peer support; however, future resiliency content may be more accepted and effective if embedded into nursing program curriculum and activities.
Collapse
Affiliation(s)
- Lindsay Bouchard
- University of Arizona College of Nursing, 2606 Patricia Ct., Ann Arbor, MI 48103, USA.
| | | | - Hanne R Dolan
- Arizona State University Edson College of Nursing and Health Innovation, USA
| | | |
Collapse
|
5
|
Yi LJ, Cai J, Ma L, Lin H, Yang J, Tian X, Jiménez-Herrera MF. Prevalence of Compassion Fatigue and Its Association with Professional Identity in Junior College Nursing Interns: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15206. [PMID: 36429923 PMCID: PMC9690934 DOI: 10.3390/ijerph192215206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Background: The issue of compassion fatigue among clinical nurses has received considerable attention, particularly during the COVID-19 pandemic. Yet, the current status of compassion fatigue among junior college nursing interns remains unclear. Additionally, professional identity can modulate the impact of compassion fatigue or burnout on psychological well-being; however, whether professional identity still works in this group is also unclear. This study aimed to reveal the current status of compassion fatigue among nursing interns in junior colleges and also investigate the association between compassion fatigue and professional identity. Methods: This cross-sectional survey evaluated the levels of participants' compassion fatigue (The Compassion Fatigue Short Scale) and professional identity (Professional Identity Scale) in 2256 nursing interns. Results: The mean score of compassion fatigue was 44.99, and 19.5% of the participants scored above The Compassion Fatigue Short Scale median scores for compassion fatigue. A moderate negative correlation was detected between compassion fatigue and professional identity. Conclusions: The level of compassion fatigue among nursing interns is low but nearly one in five nursing students is at risk of compassion fatigue. More attention should be paid to nursing interns with a high risk of compassion fatigue. Future studies are warranted to explore which pathways could mediate the relationship between professional identify and comparison fatigue.
Collapse
Affiliation(s)
- Li-Juan Yi
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou 412000, China
- Department of Nursing, Universitat Rovira i Virgili, 43002 Tarragona, Spain
| | - Jian Cai
- School of Nursing, Yongzhou Vocational Technical College, Yongzhou 425000, China
| | - Li Ma
- Department of Nursing, Guiyang Medical University, Guiyang 550025, China
| | - Hang Lin
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou 412000, China
| | - Juan Yang
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou 412000, China
| | - Xu Tian
- Department of Nursing, Universitat Rovira i Virgili, 43002 Tarragona, Spain
| | | |
Collapse
|
6
|
Qiu R, Zhu X. The Relationship Between Public Risk Familiarity and Mental Health During the COVID-19 Epidemic: A Moderated Mediation Model. Front Psychol 2022; 13:945928. [PMID: 35865701 PMCID: PMC9295708 DOI: 10.3389/fpsyg.2022.945928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
In order to explore, from the perspective of the social ecological model, the relationship and its mechanism linking public risk familiarity and mental health during the new coronary pneumonia epidemic, the new coronary pneumonia epidemic risk perception scale, psychological resilience scale, Chinese mental health scale, and SARS familiarity scale were used 741 members of the public were surveyed as research objects. The results show that: (1) When gender, age, and educational background are controlled, risk familiarity has a significant positive predictive effect on public mental health; (2) Risk familiarity predicts mental health through the mediating effect of mental toughness; (3) The mediating effect of mental toughness is moderated by the public's familiarity with SARS. Specifically, for members of the public with low SARS familiarity, the indirect effect of risk familiarity on mental health through mental toughness is smaller than that for those with high SARS familiarity. The results of this study integrate psychological resilience into the theory of risk cognition, which has implications for the improvement of public mental health.
Collapse
Affiliation(s)
| | - Xia Zhu
- Department of Military Medical Psychology, Air Force Medical University, Xi’an, China
| |
Collapse
|
7
|
Olson CM. Nurse practitioner programs: Selection factors and the student experience. J Prof Nurs 2022; 41:88-99. [DOI: 10.1016/j.profnurs.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
|
8
|
Abstract
Within health care, trauma-informed care has become an embedded approach in caring for patients; however, nurse leaders are not always prepared to lead nurses with a background of trauma. Nurses' past trauma, coupled with workplace stressors, may result in compassion fatigue, burnout, and secondary traumatic stress. Nurse leader engagement and trauma-informed leadership approaches are imperative to mitigate and mediate the effects of trauma in nurses as the COVID-19 pandemic recedes.
Collapse
|
9
|
Kendall-Tackett K, Beck CT. Secondary Traumatic Stress and Moral Injury in Maternity Care Providers: A Narrative and Exploratory Review. Front Glob Womens Health 2022; 3:835811. [PMID: 35602853 PMCID: PMC9114466 DOI: 10.3389/fgwh.2022.835811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/15/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction A significant percentage of maternity providers have experienced secondary traumatic stress following a traumatic birth. Previous studies identified it as an issue, but this literature review is 5–9 years old. In addition, the construct of moral injury has significantly increased our understanding of secondary trauma for military veterans. In the wake of COVID-19, this construct also applies to healthcare providers. Objectives The present article updates these reviews and compares findings for three groups: labor and delivery nurses, midwives, and obstetricians. The second portion of this review re-examines previously published qualitative research to determine whether moral injury might more accurately describe the experiences of maternity personnel. Methods A comprehensive review of PubMed, Scopus, Web of Science, PsychINFO, and CINAHL was conducted in June 2021 using search terms such as compassion fatigue, secondary trauma, moral injury, labor and delivery, nurses, midwives, and obstetricians. Forty articles were identified, but only 16 focused on secondary trauma or moral injury. Results Secondary trauma is a significant concern affecting at least 25% of maternity staff. However, some countries have very low rates, which correspond to low rates in childbirth-related trauma in mothers. Secondary trauma can lead to several symptoms, including re-experiencing, avoidance, negative changes in mood and cognitions, and hyperarousal, which can cause significant impairment. As a result, many providers decide to leave the field in the wake of a traumatic birth. The incidence of moral injury is unknown, but a re-examination of previously published qualitative data suggests that this construct, generally used to describe combat veterans, does describe some of what providers have reported. Acts of omission, i.e., failure to stop the harmful acts of others had long-term negative effects on labor and delivery nurses, consistent with data from military samples. Two possible mediators were proposed: hierarchical and gendered relationships in hospitals and agency of care. Conclusion The effects of traumatic birth on providers can be severe, including possible psychological sequelae, impaired job performance, and leaving the field. Moral injury expands upon the construct of secondary traumatic stress. This construct better describes the experiences of maternity staff in non-primary roles who witness traumatic births and are often haunted by events that they could not prevent, but often question whether they should have.
Collapse
Affiliation(s)
- Kathleen Kendall-Tackett
- School of Medicine, Texas Tech University Health Science Center Amarillo, Amarillo, TX, United States
- *Correspondence: Kathleen Kendall-Tackett
| | | |
Collapse
|
10
|
Completion and attrition of DNP students of the 2006-2015 matriculating cohorts. Nurs Outlook 2022; 70:487-495. [DOI: 10.1016/j.outlook.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/01/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022]
|