Enhancing meaning in palliative care practice: A meaning-centered intervention to promote job satisfaction

Effects of a Meaning-Centered Spiritual Care Training Program for Hospice Palliative Care Teams in South Korea: A Nonrandomized Controlled Trial

BACKGROUND

Spiritual care is an essential part and a core component of quality palliative care, as identified by the World Health Organization. However, spiritual care training for hospice palliative care teams (HPCTs) is infrequent.

OBJECTIVE

The aim of this study was to investigate the effects of a meaning-centered spiritual care training program for HPCTs (McSCTP-HPCT).

METHODS

This study used a nonrandomized controlled design. The McSCTP-HPCT comprised 5 modules. The participants were HPCTs working in 15 national hospice institutions and were allocated to either the experimental group (n = 33) or the control group (n = 27) based on the participating institutions' preference. Three outcome variables were tested: spiritual care competency, spiritual care therapeutics, and compassion fatigue. Data were analyzed using descriptive statistics, χ 2 test, 1-way analysis of variance, and repeated-measures analysis of variance.

RESULTS

There was a significant difference in the interaction between measurement time and group assignment in spiritual care competency ( P = .002) and spiritual care therapeutics ( P = .038), whereas no significant difference was found for compassion fatigue ( P = .716).

CONCLUSION

The McSCTP-HPCT conducted in this study shows effectiveness in increasing the spiritual care competency and spiritual care therapeutics of HPCTs and may support the importance of spiritual care training.

IMPLICATIONS FOR PRACTICE

The McSCTP-HPCTs adds to the scientific evidence on spiritual care and has the capacity to improve the quality of care for patients with a life-threatening illness.

Reflections on experiential training in meaning-centered psychotherapy: How MCP ended up facilitating professional wellbeing

OBJECTIVE

Meaning-centered psychotherapy (MCP) principles may provide a framework for engaging healthcare professionals in meaning-centered exploration as a novel approach to prevent burnout and enhance wellbeing in healthcare professionals through heightening personal meaning. This case study aimed to teach MCP to masters-trained social workers for use with medical patients. While the primary aim was to teach MCP to masters-trained social workers, this proof-of-concept project and this paper focus on a secondary aim of enhancing meaning and connection in the virtual workplace.

METHODS

A group of social workers participated in a 7-session MCP pilot from October 13th to November 24th, 2020. After each session, participants were asked to complete an anonymous continuing education evaluation with questions regarding clarity, organization, and relevance of the presentation related to use with their patient populations. Additional open-ended items queried participants for general comments about their experience using MCP to enhance professional fulfillment during COVID-19.

RESULTS

Nine social workers participated in the MCP pilot. Several qualitative themes emerged, including enhanced meaning, communication, connection, and agency in the virtual workplace.

SIGNIFICANCE OF THE RESULTS

This pilot demonstrated the feasibility and acceptability of using an adapted MCP instruction with hospital-based social workers during the COVID-19 pandemic to facilitate wellbeing. While MCP was originally created to intervene with patients with life-threatening illnesses, the brief, manualized experiential nature of the intervention lends itself to modification with staff for the purpose of enhancing meaning and community in their own lives.

A Cross-Sectional Study of Job Satisfaction and Intention to Leave Job in Palliative Care in Croatia

Purpose Stressful and demanding clinical situations may contribute to job dissatisfaction and may even contribute to an intention to leave the job among palliative care (PC) clinicians. Personal and organizational factors may influence the occupational well-being of PC clinicians as well. This study aimed to determine the predictive contribution of personal (communication skills, resilience, religiosity) and organizational (coworkers' social support, job control) factors in the explanation of PC clinicians job (dis)satisfaction and their intention to leave their job. Methods The study was conducted on a convenience sample of 122 PC clinicians of different disciplines (nurses/technicians, physicians, psychologists, spiritual counsellors/priests, social workers, physical therapists, etc). The sample mainly consisted of nurses (57%). Hierarchical and logistic regression analyses of the results obtained were applied. Results This study indicates that 53% of PC clinicians are satisfied with their daily job and 76% do not intend to leave the job. The results showed no differences in job satisfaction and intention to leave between nurses/technicians and other PC clinicians. A significant negative correlation was found between job satisfaction and intention to leave the job. Communication skills, religiosity and coworkers' social support, showed as significant predictors of job satisfaction. PC clinicians' perception of their own difficulties in communicating bad news contributed significantly to job satisfaction and intention to leave the job in palliative care. Conclusion This study suggests that job satisfaction in a palliative care setting is determined by a larger number of personal and organizational factors than the intention to leave the job. Communication skills showed indispensable for providing quality care for dying patients. Skills in communicating bad news to dying patients and their families have emerged as particularly important for PC clinicians' occupational well-being.

Influence of Psychological Nursing Intervention on Psychological State, Treatment Compliance, and Immune Function of Postoperative Patients with Rectal Cancer

In order to explore the clinical effect of psychological nursing intervention on postoperative chemotherapy for rectal cancer, 120 cases of rectal cancer patients were selected as the research subjects. The control group received conventional nursing treatment after operation, and the research group received comprehensive psychological nursing intervention on this basis. The self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, hope level scores, nursing satisfaction, mental state changes, treatment compliance, and immune function of two groups were analyzed and compared. There was no significant difference between the two groups of patients in the preoperative SAS, SDS, and hope level scale scores. After the intervention, postoperative SAS and SDS scores and CD8⁺ value of the research group were significantly lower than those of the control group. In contrast, the postoperative hope level score, treatment compliance, and postoperative CD4⁺/CD8⁺ of the research group were significantly higher, and the nursing satisfaction was better than that of the control group. The application of psychological nursing intervention in postoperative chemotherapy for patients with rectal cancer can effectively relieve anxiety and depression of patients, promote patients to establish a healthy and coordinated mental state, improve treatment compliance, improve immune function, and promote disease recovery.

Psychological resilience among palliative patients with advanced cancer: A systematic review of definitions and associated factors

OBJECTIVE

The palliative journey can be emotionally stressful for both patients with advanced cancer and their families. Psychological resilience is crucial in aiding with patients' adaptation and post-traumatic growth. The aim of this systematic review was to critically examine the definitions of psychological resilience and its associated factors in palliative patients with advanced cancer.

METHODS

Four databases were systematically searched from inception to August 2020. Both qualitative and quantitative studies that examined factors associated with psychological resilience in a sample of patients with advanced cancer undergoing palliative care were included.

RESULTS

A total of 15 studies met the criteria, of which 10 were qualitative and five were quantitative. Nine studies included a definition of psychological resilience, from which five common themes of buffering, adaptation, resources, recovery, and growth were derived. The quantitative studies found association between resilience and hope, independence, social support, fatigue, emotional distress, and coping strategies. The qualitative studies reported additional sources of resilience such as spirituality, social support, prior experience dealing with illness and life adversity, meaning-making, reconciling with life's finiteness, acceptance of illness, control, determination, positive attitude, dignity, engagement with palliative care and quality of life being supported by palliative care.

CONCLUSIONS

More research is needed for developing an overarching definition of psychological resilience in palliative advanced cancer patients that acknowledges and appreciates the contextual sensitivity of this concept among different cultural groups. Further studies are also needed to examine a holistic range of bio-psycho-socio-spiritual factors associated with psychological resilience among these patients and their families.

A meaning-centered spiritual care training program for hospice palliative care teams in South Korea: development and preliminary evaluation

BACKGROUND

Spirituality is a fundamental, intrinsic aspect of human beings and should be a core component of quality palliative care. There is an urgent need to train hospice palliative care teams (HPCTs) to enhance their ability to provide spiritual care. This study aimed to develop and evaluate a meaning-centered, spiritual care training program (McSCTP) for HPCTs (McSCTP-HPCTs).

METHODS

The modules' content was informed by Viktor Frankl's meaning-centered logotherapy with its emphasis on spiritual resources, as well as the spiritual care model of the Interprofessional Spiritual Care Education Curriculum (ISPEC). Following development, we conducted a pilot test with four nurses. We used the results to inform the final program, which we tested in an intervention involving 13 members of HPCTs. We took measurements using self-administered questionnaires at three points before and after the intervention. Using descriptive statistics, the Mann-Whitney U test, and the Kruskal-Wallis test, we analyzed the participants' demographic and career-related characteristics, as well as the degree of variance between three outcome variables: compassion fatigue (CF), spiritual care competencies (SCCs), and spiritual care therapeutics (SCT).

RESULTS

We divided the McSCTP-HPCTs into five modules. Module I: The HPCTs' SCC evaluation, understanding the major concepts of spiritual care and logotherapy; Modules II-IV: Meaning-centered interventions (MCIs) related to spiritual needs (existential, relational, and transcendental/religious); Module V: The process of meaning-centered spiritual care. The preliminary evaluation revealed significant differences in all three outcome variables at the posttest point (CF, p = 0.037; SCCs, p = 0.005; SCT, p = 0.002). At the four-week follow-up test point, we only found statistical significance with the SCCs (p = 0.006).

CONCLUSIONS

The McSCTP-HPCTs is suitable for use in clinical settings and provides evidence for assessing the SCCs of HPCTs.

Risk Perception of COVID-19, Meaning-Based Resources and Psychological Well-Being amongst Healthcare Personnel: The Mediating Role of Coping

The well-being of healthcare personnel during the COVID-19 pandemic depends on the ways in which they perceive the threat posed by the virus, personal resources, and coping abilities. The current study aims to examine the mediating role of coping strategies in the relationship between risk perception of COVID-19 and psychological well-being, as well as the relationship between meaning-based resources and psychological well-being amongst healthcare personnel in southern Poland. Two hundred and twenty-six healthcare personnel who worked in hospitals, outpatient clinics, and medical laboratories during the first few months of the coronavirus pandemic (March–May 2020) filled in questionnaires measuring risk perception of COVID-19, meaning-based resources, coping, and psychological well-being. The results demonstrate that risk perception was negatively related to psychological well-being, whereas meaning-based resources were positively associated with well-being. Two coping strategies—problem-focused and meaning-focused coping—mediated the relationship between risk perception and psychological well-being as well as the relationship between meaning-based resources and psychological well-being. This indicates that perception processes and personal factors do not directly influence healthcare personnel’s psychological well-being, but rather they do indirectly through coping processes.

Educating the Existential View to Nurses in Cancer Care: A Review

Background:

The aim of this study was to review the interventional studies about educating existential concepts to the nurses working in cancer care.

Materials and Methods:

In this systematic narrative review, the papers published in English and Farsi databases of PubMed, Elsevier, web of since, Scopus, ProQuest, ERIC, Google Scholar and Ovid, MagIran and SID, from 1990 to 2018 were reviewed. Methodological quality of the studies was independently assessed by, using checklists developed by Greenhalgh, and Cochrane Center. No statistical pooling of the outcomes was performed, due to heterogeneity of the outcomes.

Results:

After wide search, the 17 studies entered to this narrative study. The results showed that educating the existential concept to the nurses dealing with cancer patients can improve their self-competency in providing efficient care to these patients and their ability in decision making. It also enhances their quality of life and decreases the death anxiety and emotional exhaustion.

Conclusions:

There were limited and low quality interventional studies about the effects of educating existential concepts to the nurses dealing with cancer patients. These studies showed that knowing this philosophy can help nurses to address caring needs of cancer patients more efficiently. The specific method or content of education cannot be recommended because of the large differences in the methodologies between the studies.

Improving the wellbeing of staff who work in palliative care settings: A systematic review of psychosocial interventions

BACKGROUND

Staff in palliative care settings perform emotionally demanding roles which may lead to psychological distress including stress and burnout. Therefore, interventions have been designed to address these occupational risks.

AIM

To investigate quantitative studies exploring the effectiveness of psychosocial interventions that attempt to improve psychological wellbeing of palliative care staff.

DESIGN

A systematic review was conducted according to methodological guidance from UK Centre for Reviews and Dissemination.

DATA SOURCES

A search strategy was developed based on the initial scans of palliative care studies. Potentially eligible research articles were identified by searching the following databases: CINAHL, MEDLINE (Ovid), PsycINFO and Web of Science. Two reviewers independently screened studies against pre-set eligibility criteria. To assess quality, both researchers separately assessed the remaining studies using the Quality Assessment Tool for Quantitative Studies.

RESULTS

A total of 1786 potentially eligible articles were identified - nine remained following screening and quality assessment. Study types included two randomised controlled trials, two non-randomised controlled trial designs, four one-group pre-post evaluations and one process evaluation. Studies took place in the United States and Canada (5), Europe (3) and Hong Kong (1). Interventions comprised a mixture of relaxation, education, support and cognitive training and targeted stress, fatigue, burnout, depression and satisfaction. The randomised controlled trial evaluations did not improve psychological wellbeing of palliative care staff. Only two of the quasi-experimental studies appeared to show improved staff wellbeing although these studies were methodologically weak.

CONCLUSION

There is an urgent need to address the lack of intervention development work and high-quality research in this area.

Nurses' Practice Environment and Their Job Satisfaction: A Study on Nurses Caring for Older Adults in Shanghai

AIM

To examine the job satisfaction of nurses who are caring for older adults in healthcare settings in Shanghai, and to explore the underlying factors in order to explain and predict nurses' job satisfaction.

BACKGROUND

China has the largest elderly population in the world, and its population is aging rapidly. Studies on job satisfaction of nurses providing care for the elderly in China can help to identify problem areas and develop strategies for the improvement of nurses' working conditions. However, to date, this subject matter has not been thoroughly studied in the Chinese context. Previous studies in other countries show that many factors impact nurses' job satisfaction, with the practice environment being a critical factor. There is a serious nursing shortage in China, especially in the big cities such as Shanghai. Given the increasing care demand of the aging population, learning about the job satisfaction level among nurses who are caring for older adults can provide essential information to help attract and retain nurses in this specialty area.

METHODS

A cross-sectional survey was conducted among 444 nurses in 22 elderly care institutions in Shanghai. The Chinese version of the Index of Work Satisfaction (IWS) and the Nursing Practice Environment Scale were instruments used. Inferential statistical tests used to analyze the data included Spearman correlation analysis, one-way analysis of variance, and hierarchical regression tests.

RESULTS

The average overall IWS (part B) score was 135.21 ± 19.34. Personality, job and organizational characteristics were found to be the most influential factors, and the practice environment was identified as having the strongest impact on job satisfaction (Beta = 0.494).

CONCLUSION

Job satisfaction level among nurses who are caring for older adults in Shanghai is moderate, but the data suggest that this could be greatly increased if the nursing practice environment was improved.

A cognitive-existential intervention to improve existential and global quality of life in cancer patients: A pilot study

OBJECTIVE

We developed a specific cognitive-existential intervention to improve existential distress in nonmetastatic cancer patients. The present study reports the feasibility of implementing and evaluating this intervention, which involved 12 weekly sessions in both individual and group formats, and explores the efficacy of the intervention on existential and global quality of life (QoL) measures.

METHOD

Some 33 nonmetastatic cancer patients were randomized between the group intervention, the individual intervention, and the usual condition of care. Evaluation of the intervention on the existential and global QoL of patients was performed using the existential well-being subscale and the global scale of the McGill Quality of Life (MQoL) Questionnaire.

RESULTS

All participants agreed that their participation in the program helped them deal with their illness and their personal life. Some 88.9% of participants agreed that this program should be proposed for all cancer patients, and 94.5% agreed that this intervention helped them to reflect on the meaning of their life. At post-intervention, both existential and psychological QoL improved in the group intervention versus usual care (p = 0.086 and 0.077, respectively). At the three-month follow-up, global and psychological QoL improved in the individual intervention versus usual care (p = 0.056 and 0.047, respectively).

SIGNIFICANCE OF RESULTS

This pilot study confirms the relevance of the intervention and the feasibility of the recruitment and randomization processes. The data strongly suggest a potential efficacy of the intervention for existential and global quality of life, which will have to be confirmed in a larger study.

A Review of the Construct of Demoralization

Demoralization has been the subject of discussion in relation to end-of-life care. It is characterized by hopelessness and helplessness due to a loss of purpose and meaning. The purpose of this review was to consolidate the conceptual understanding of demoralization and argue for its existence as a psychiatric syndrome. The history of the construct is explored, including the nature of existential distress and related psychological conditions that precipitate demoralization. Recent definitions of demoralization are described and differentiated from similar constructs. Future directions are highlighted, specifically in relation to the assessment, diagnosis, and treatment of demoralization in palliative care. Overall, demoralization is a clinically useful construct for those facing existential threat, guiding the clinician toward efforts to restore morale, meaning, and purpose.

A comparison of burnout among oncology nurses working in adult and pediatric inpatient and outpatient settings

PURPOSE/OBJECTIVES

To investigate differences in burnout among oncology nurses by type of work setting, coping strategies, and job satisfaction.

DESIGN

Descriptive.

SETTING

A metropolitan cancer center.

SAMPLE

A convenience sample of 74 oncology nurses.

METHODS

Participants completed a demographic data form, the Nursing Satisfaction and Retention Survey, and the Maslach Burnout Inventory.

MAIN RESEARCH VARIABLES

Burnout, coping strategies, job satisfaction, and oncology work setting (inpatient versus outpatient and adult versus pediatric).

FINDINGS

The participants most often used spirituality and coworker support to cope. Emotional exhaustion was lowest for youngest nurses and highest for outpatient RNs. Personal accomplishment was highest in adult settings. Job satisfaction correlated inversely with emotional exhaustion and the desire to leave oncology nursing.

CONCLUSIONS

The findings support that the social context within the work environment may impact emotional exhaustion and depersonalization, and that demographics may be more significant in determining burnout than setting.

IMPLICATIONS FOR NURSING

The findings raise questions of whether demographics or setting plays a bigger role in burnout and supports organizational strategies that enhance coworker camaraderie, encourage nurses to discuss high-stress situations, and share ways to manage their emotions in oncology settings.

KNOWLEDGE TRANSLATION

Spirituality and coworker relationships were positive coping strategies among oncology nurses to prevent emotional exhaustion. Nurses who rely on supportive social networks as a coping mechanism have lower levels of depersonalization. Age was inversely related to emotional exhaustion.

Sentido de vida, dependência funcional e qualidade de vida em idosos

Este estudo objetivou avaliar os índices de sentido de vida (SV), qualidade de vida (QV) e dependência funcional (DF) de idosos, e observar se o SV poderia atuar como recurso protetor capaz de diminuir os efeitos da DF na QV. Caracteriza-se por ser transversal, de base domiciliar, com 210 participantes que possuem média de idade de 74 anos (dp= 7,70), a maioria do sexo feminino (68,4%) e com renda média de 868 reais (dp = 1,100). Os instrumentos utilizados foram: Mini-Exame do Estado Mental, medida de independência funcional, questionário de qualidade de vida para idosos, teste de propósito de vida e um questionário sociodemográfico. Os resultados indicaram que a maioria da amostra apresentou altos índices de QV, SV e baixos índices de DF, além disso, a relação entre DF e QV para os idosos com alto SV não foi significativa [β = -0,19; t(93) = -1,92; p > 0,05]. Portanto, a QV dos idosos que apresentaram níveis altos de SV se torna mais protegida contra as alterações dos níveis de DF. Sendo assim, o sentido de vida atuou como recurso psicológico protetor.

Meaning in bone marrow transplant nurses' work: experiences before and after a "meaning-centered" intervention

BACKGROUND

When a clinical culture emphasizes cure, as in bone marrow transplantation (BMT) services, BMT nurses commonly experience enormous stress when patients are suffering or dying. In this context, it is unclear what meanings BMT nurses experience in their work and how they find meaning and sustain hope, given conflicting responsibilities to patients.

OBJECTIVE

This study aimed to explore BMT nurses' experiences of meaning and hope and the effects of a meaning-centered intervention (MCI) on these experiences using qualitative methodology.

METHODS

Fourteen BMT nurses engaged in a 5-session MCI, with 7 members each participating in 2 groups. Semistructured qualitative interviews were conducted at 1 month before and after the intervention. Interpretive phenomenology guided data analysis.

RESULTS

The BMT nurses in the Princess Margaret Hospital experienced meaning in their involvement with their patients' suffering. The MCI seemed to inspire participants to engage more with patients and their suffering. Three subthemes reflected this influence: (a) greater awareness of boundaries between their personal and professional involvement, (b) enhanced empathy from an awareness of a shared mortality, and (c) elevated hope when nurses linked patients' suffering with meaning.

CONCLUSIONS

This study confirms that patients' suffering constitutes nurses' search for meaning and hope in their work. The MCI offers a way in which to actively support nurses in this process.

IMPLICATIONS FOR PRACTICE

Nurses can learn to be more responsive to patients' suffering beyond limits of cure. A minimal intervention, such as the MCI, supports BMT nurses in finding positive personal meaning and purpose in their otherwise highly stressful work culture.

Impact of a meaning-centered intervention on job satisfaction and on quality of life among palliative care nurses

OBJECTIVE

Palliative care (PC) nurses experience several recurrent organizational, professional, and individual challenges. To address existential and emotional demands, the meaning-centered intervention was recently developed. The intervention applied didactic and process-oriented strategies, including guided reflections, experiential exercises, and education based on themes of Viktor Frankl's logotherapy. The objective of this study was to test its efficiency to improve job satisfaction and quality of life in PC nurses from three regional districts in Quebec Province, Canada.

METHODS

A randomized waiting-list group design was conducted, intervention group (n=56) versus waiting-list group (n=53). Job satisfaction, perception of benefits of working in PC, and spiritual and emotional quality of life were measured at pre-, posttest, and 3-month follow-up.

RESULTS

The PC nurses in the experimental group reported more perceived benefits of working in PC after the intervention and at follow-up. Spiritual and emotional quality of life remained, however, unaffected by the intervention.

CONCLUSIONS

To explain null findings, theoretical and methodological challenges, related to existential interventions, such as choice of outcomes, and selection bias (participants recruited were healthy workers) are discussed. Future directions and strategies to deal with those issues are proposed.

A self-referral preventive intervention for burnout among Norwegian nurses: one-year follow-up study

OBJECTIVE

Burnout among nurses is an issue of concern, and preventive interventions are important to implement and evaluate. This study investigated levels and predictors of change in burnout dimensions after an intervention for help-seeking nurses.

METHODS

Nurses participating in a self-referral, counseling intervention, from 2004 to 2006 in Norway, were followed with self-reporting assessments. One-year follow-up was completed by 160/172 (93%, 155 women and 5 men).

RESULTS

Mean level of emotional exhaustion (one dimension of burnout, scale 1-5) was significantly reduced from 2.87 (SD 0.79) to 2.52 (SD 0.8), t=5.3, p<0.001, to the level found in a representative sample of Norwegian nurses. The proportion of nurses seeking psychotherapy increased after the intervention, from 17.0% (25/147) to 34% (50/147), p<0.001. Less reduction in emotional exhaustion was independently predicted by reporting a work-related conflict (beta -0.53 (SE 0.13), p<0.001) or by getting a period of sick leave (beta -0.28 (SE 0.12), p<0.05) after the intervention.

CONCLUSIONS

A short-term preventive intervention could contribute to reduction of emotional exhaustion in nurses. Work-related conflict and sick leave after the intervention were negatively associated with this reduction.

PRACTICE IMPLICATIONS

Preventive interventions to reduce burnout for nurses should be considered, as well as programs for preventing or handling conflicts at work.

"A rewarding conclusion of the relationship": staff members' perspectives on providing bereavement follow-up

GOALS OF WORK

Staff members in palliative home care play an important role in supporting bereaved family members. The aim of this study was to explore staff members' perspectives on providing such support.

MATERIAL AND METHODS

Staff members in six units responded (n=120; response rate 58%) to a postal questionnaire with Likert-type and open-ended questions. The responses were analyzed using statistics and manifest content analysis.

MAIN RESULTS

None of the respondents stated that bereavement follow-up was "most often difficult," 23% "most often rather difficult," 52.5% "most often rather easy," and 12.5% "most often easy." Apart from a tendency for age to be linked to perceived difficulty, there were no apparent patterns. Bereavement follow-up was a positive opportunity to support the family member's coping with their bereavement and to get feedback on the palliative care provided. Critical aspects concerned the question of whose needs actually were being met at bereavement follow-up, i.e., the staff members' needs for getting feedback on the care provided versus the risk of burdening the family members' by reminding them of the deceased's dying trajectory. Aspects that negatively influenced the staff members' experiences were complex and related, e.g., to the family member's dissatisfaction with the care provided, to the staff member's perceived lack of competence, and to the staff member's relationship to the family member.

CONCLUSIONS

Bereavement follow-up was perceived as a rewarding conclusion to the relationship with the family member. The findings suggest that meaning-based coping might be an appropriate framework when understanding staff members' experiences with providing bereavement follow-up.

Distress and burnout among genetic service providers

PURPOSE

To determine the nature, sources, prevalence, and consequences of distress and burnout among genetics professionals.

METHODS

Mailed survey of randomly selected clinical geneticists (MDs), genetic counselors, and genetic nurses.

RESULTS

Two hundred and fourteen providers completed the survey (55% response rate). Eight discrete sources of distress were identified forming a valid 28-item scale (alpha = 0.89). The greatest sources of distress were compassion stress, the burden of professional responsibility, negative patient regard, and concerns about informational bias. Genetic counselors were significantly more likely to experience personal values conflicts, burden of professional responsibility, and concerns about informational bias than MDs or nurses. Burnout scores were lower among those practicing more than 20 years and nurses. Distress scores were positively correlated with burnout and professional dissatisfaction (P < 0.0001). Eighteen percent of respondents think about leaving patient care, and burnout was the most significant predictor. Predictors of burnout included greater distress, fewer years in practice, working in university-based settings, being a genetic counselor or an MD, and deriving less meaning from patient care.

CONCLUSIONS

Genetic service providers experience various types of distress that may be risk factors for burnout and professional dissatisfaction. Interventions to reduce distress and burnout are needed for both trainees and practitioners.

Effect of music therapy on oncologic staff bystanders: A substantive grounded theory

Objective:

Oncologic work can be satisfying but also stressful, as staff support patients and families through harsh treatment effects, uncertain illness trajectories, and occasional death. Although formal support programs are available, no research on the effects of staff witnessing patients' supportive therapies exists. This research examines staff responses to witnessing patient-focused music therapy (MT) programs in two comprehensive cancer centers.

Method:

In Study 1, staff were invited to anonymously complete an open-ended questionnaire asking about the relevance of a music therapy program for patients and visitors (what it does; whether it helps). In Study 2, staff were theoretically sampled and interviewed regarding the personal effects of witnessing patient-centered music therapy. Data from each study were comparatively analyzed according to grounded theory procedures. Positive and negative cases were evident and data saturation arguably achieved.

Results:

In Study 1, 38 staff unexpectedly described personally helpful emotional, cognitive, and team effects and consequent improved patient care. In Study 2, 62 staff described 197 multiple personal benefits and elicited patient care improvements. Respondents were mostly nursing (57) and medical (13) staff. Only three intrusive effects were reported: audibility, initial suspicion, and relaxation causing slowing of work pace. A substantive grounded theory emerged applicable to the two cancer centers: Staff witnessing MT can experience personally helpful emotions, moods, self-awarenesses, and teamwork and thus perceive improved patient care. Intrusive effects are uncommon. Music therapy's benefits for staff are attributed to the presence of live music, the human presence of the music therapist, and the observed positive effects in patients and families.

Significance of results:

Patient-centered oncologic music therapy in two cancer centers is an incidental supportive care modality for staff, which can reduce their stress and improve work environments and perceived patient care. Further investigation of the incidental benefits for oncologic staff witnessing patient-centered MT, through interpretive and positivist measures, is warranted.

Meaninglessness in terminally ill cancer patients: a randomized controlled study

Although recent empirical studies reveal that fostering patients' perception of meaning in their lives is an essential task for palliative care clinicians, few studies have reported the effects of training programs for nurses specifically aimed at improving these skills. The primary aim of this randomized controlled trial was to determine the effects of an educational workshop focusing on patients' feelings of meaninglessness on nurses' confidence, self-reported practice, and attitudes toward caring for such patients, in addition to burnout and meaning of life. The study was designed as a single-institution, randomized controlled trial using a waiting list control. The intervention consisted of eight 180-minute training sessions over four months, including lectures and exercises using structured assessment. A total of 41 nurses were randomly allocated to three groups, which were separately trained, and all were evaluated four times at three-month intervals (before intervention, between each intervention, and after the last intervention). Assessments included validated Confidence and Self-Reported Practice scales, the Attitudes Toward Caring for Patients Feeling Meaningless Scale (including willingness to help, positive appraisal, and helplessness items), the Maslach Burnout Scale, job satisfaction, and the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp). One participant withdrew from the study before the baseline evaluation, and the remaining 40 nurses completed the study. The nurses were all female and had a mean age of 31+/-6.4, and mean clinical experience of 8.9+/-5.5 years. There were no significant differences in background among the groups. The intervention effects were statistically significant on the Confidence Scale, the Self-Reported Practice Scale, and the willingness to help, positive appraisal, and helplessness subscales, in addition to the overall levels of burnout, emotional exhaustion, personal accomplishment, job satisfaction, and the FACIT-Sp. The change ratio of each parameter ranged from 5.6% (willingness to help) to 37% for the helplessness score and 51% on the Confidence Scale. The percentages of nurses who evaluated this program as "useful" or "very useful" were 85% (to understand the conceptual framework in caring for terminally ill patients with meaninglessness), 80% (to foster nurses' personal values), and 88% (to know how to provide care for patients with meaninglessness). This educational intervention had a significant beneficial effect on nurse-perceived confidence, practice, and attitudes in providing care for patients feeling meaninglessness, in addition to the levels of burnout and spiritual well-being of nurses.

What do clinicians derive from partnering with their patients? A reliable and valid measure of "personal meaning in patient care"

OBJECTIVE

Burnout is high among clinicians and may relate to loss of "meaning" in patient care. We sought to develop and validate a measure of "personal meaning" that practitioners derive from patient care.

METHODS

As part of a larger study of well-being among genetics professionals, we conducted three focus groups of clinical genetics professionals: physicians, nurses and genetic counselors (N=29). Participants were asked: "What gives you meaning in patient care?" Eight themes were identified, converted into Likert items, and included in a questionnaire. Next, we mailed the questionnaire to clinical geneticists, genetic counselors and genetic nurses (N=480) randomly selected from mailing lists of their professional associations. Results were subjected to exploratory factor analysis. The survey also included validated scales of burnout and professional satisfaction, and a 1-item measure of gratitude, to assess predictive validity.

RESULTS

214 eligible providers completed the survey out of an estimated 348 eligible (61% response rate). Factor analysis resulted in a unidimensional scale consisting of 6-items with an alpha of 0.82 and an eigen value of 3.2. Factor loadings ranged from 0.69-0.77. The mean total score was 18.1 (S.D. 3.7) out of a possible high score of 24. Higher meaning scores were associated with being female (p=0.044), a nurse (p<0.001), and in practice longer (p=0.006). Meaning scores were inversely correlated with burnout (p<0.001), and positively correlated with gratitude (p<0.001) and professional satisfaction (p<0.022).

CONCLUSION

The 6-item "personal meaning in patient care" scale demonstrates high reliability and predictive validity in a select group of health professionals. Future research should validate this scale in a broader population of clinicians.

PRACTICE IMPLICATIONS

The scale could be useful in identifying providers at risk of burnout, and in evaluating interventions designed to counteract burnout, enhance meaning and improve communication and partnership between providers and patients.

Coping strategies, emotional outcomes and spiritual quality of life in palliative care nurses

It is in accompanying the dying that palliative care nurses say they find meaning in their work. To further explore this phenomenon, consideration of coping strategies is proposed. The main objective of this correlational study was to describe the association between coping strategies (using a revised version of the COPE scale (Carver et al, 1999)), emotional outcomes (distress and vigour; profile of mood states (POMS)), and spiritual quality of life (using the Functional Assessment of Chronic Illness Therapy - Spiritual Wellbeing Scale (FACIT-sp)). A sample of 120 nurses providing palliative care in acute care hospitals and the community in Quebec was included. Positive reinterpretation (beta=.27; p<.01) and turning to religion (beta=.33; p<.001), two strategies related to meaning-making coping and disengagement (beta=-.19; p<.05), were the best predictors, accounting for 22% of variance of spiritual quality of life. These findings are consistent with recent studies and highlight the importance of meaning-making strategies in psychological adjustment to bereavement for palliative care nurses.