Who cares? Offering emotion work as a 'gift' in the nursing labour process

"It's a Thing": What Nurse Elders Believe Novice Nurses Need to Know About Managing Emotional Labour

BACKGROUND

Emotional labour (EL) can take a significant toll on nurses' mental health and well-being and has serious implications for the retention of nurses in the workforce. Nurse educators have struggled to prepare novices to manage EL or find serviceable resources with which to do so within the body of nursing literature, which is dominated by essentially unhelpful narratives and is absent of the practical, real-world wisdom of elder nurses.

PURPOSE

This exploratory research study illuminated elder nurses' experiential knowledge and beliefs of what is important for novices to learn about EL.

METHODS

Conventional Content Analysis (CCA) of qualitative survey data from 688 nurses with 20+ years of experience.

RESULTS

CCA generated descriptive categories and sub-categories: What the elders themselves learned as student nurses, and their advice to novices in the individual realm, ("It's a Thing," healthy disengagement, supporting mental and physical well-being, reframing self-reproach), team realm (peer support, mentors), and institutional realm (structural barriers to mentors' support of novices, building novices' capacities for self-advocacy, resources to support health and well-being).

CONCLUSIONS

The elders' data confronted and reframed legacy individuated narratives in the literature by supporting and contextualizing nurses' emotional work. Elders advised novices that EL is a reality requiring concrete strategies to manage it throughout their practices. Elders extended their focus for management of EL beyond the individual to include peer support, mentorship, and the structural conditions in which nurses perform their EL, highlighting the need to empower nurses by building their capacity for self-advocacy of their workers' rights.

"If You Don't Have the Heart to Help, You Cannot Do This Job": The Multidimensional Wellbeing of Community Health Workers Serving Refugees During the COVID-19 Pandemic

Community health workers are members of two groups whose short- and long-term health has been uniquely shaped by the COVID-19 pandemic: health workers and the oft-marginalized populations that they serve. Yet, their wellbeing, particularly of those serving resettled refugees, before and during the pandemic has been largely overlooked. Drawing from a holistic conceptualization of wellness, this study examined the effects of the COVID-19 pandemic on a group of cultural health navigators (CHNs), who serve resettled refugees. We conducted semi-structured individual interviews with CHNs at a southwestern U.S. hospital system between July and August 2020, a critical time in the pandemic. Our analysis produced four themes that encapsulate the effects of the pandemic on CHN wellbeing: (1) "You fear for your life": Chronic risk of COVID-19 exposure takes a toll on physical, emotional, and environmental wellbeing; (2) "It is stressful because it is completely new": Uncertainty diminishes occupational, financial, and emotional wellbeing; (3) "If you don't have the heart to help, you cannot do this job": CHNs remain committed while facing challenges to their occupational wellbeing on multiple fronts; and (4) "Now, you cannot release your stress": Loss of and shifts in outlets integral to social and spiritual wellbeing. The findings deepen empirical understanding of how the pandemic affected the holistic wellbeing of CHNs, as they continued to serve their communities in a time of crisis. We discuss the implications for addressing the multidimensionality of community health worker wellbeing in research, policy, and practice.

Secondary emotional labor: How female nurses respond to the contradictions of caring

Prior research suggests that caring is in tension with a financially incentivized, technologically-driven healthcare system. Nevertheless, employers, the public, and nurses expect nurses to be caring when providing care to patients and families. This article focuses on nurses' emotional labor strategies when managing emotions related to organizationally imposed interference with caring. We analyzed 27 semi-structured interviews with nurses and found that the unsuccessful performance of emotional labor spills over into the women's relationships at and outside of work. We apply Di-Cicco-Bloom and DiCicco-Bloom's concept of secondary emotional labor to examine our findings and how secondary emotional labor further develops the alienation and exploitation concepts of Hochschild's emotional labor theory. We suggest a structural change in nurses' job design that remedies contradictory caring expectations and supports their emotional labor to prioritize a climate of caring for patients.

Frontstage nursing and backstage growth: The emotional labour of student nurses in Dutch nursing homes

The complex emotional work of nurses calls for more recognition of emotional labour and the incorporation of emotional labour in nursing education. Based on participant observation and semistructured interviews, we describe the experiences of student nurses in two nursing homes for elderly people with dementia in the Netherlands. We analyse their interactions using Goffman's dramaturgical view on the front and backstage behaviour and the distinction between surface acting and deep acting. The study reveals the complexity of emotional labour, as nurses swiftly adapt their communication styles and behavioural strategies between settings, patients, and even between moments within one interaction sequence, which shows that the theoretical binaries fail to fully capture their skills. Although student nurses take pride in their emotionally taxing work, the societal undervaluation of the nursing profession negatively impacts their self-image and ambitions. More explicit recognition of these complexities would enhance their self-appreciation. This calls for a professional 'backstage area' that allows nurses to articulate and strengthen their emotional labour skills. Educational institutions should provide this backstage for nurses-in-training to strengthen these skills as part of the professional skill set.

"Death is a sensitive topic when you are surrounded by life": Nurses experiences with pregnancy loss

OBJECTIVE

Although there is increasing evidence on the psychosocial adjustment and experiencing pregnancy loss from the patient's perspective, few studies have investigated the nurses' experience perceptions. This study aimed to understand the experience of nurses involved in pregnancy loss care based on the self-fulfillment model of communication.

METHODS

A qualitative approach was developed through semi-structured interviews to 16 nurses working in an Obstetrics and Maternal-Fetal Department of a local hospital. Based on grounded theory approach, data was analyzed with NVivo 12 software.

RESULTS

The analysis revealed three major themes and 11 sub-themes: i) stressful work conditions, comprising care management and institutional practices; ii) personal characteristics, including discomfort with loss, communication skills, work experience and empathy; and iii) the patient's journey, containing the partner's ambiguous role, timing, respect for the patient's individuality, viewing the fetus and facilitating grief rituals.

CONCLUSION

Nurses daily involved in providing care to patients suffering pregnancy loses have a demanding challenge in trying to assure that patients get the appropriate and better care and ensuring they keep their level of engagement in their profession. Interventions to improve communications skills with patients and with other health professionals are needed to enhance professional realization.

Worker Experiences of the Work Health and Safety Impacts of Exposure to Dying and Death in Clinical Settings: A Qualitative Scoping Review

Workers employed in clinical healthcare settings often encounter dying and death of patients as a part of their role. This scoping review aimed to explore the physical and psychosocial OHS impacts on health workers exposed to death within their occupational role and their inherent coping strategies. Six electronic databases PsycINFO (Ovid), Medline (Ovid), AMED (EBSCO), CINAHL (EBSCO), and Proquest Social Sciences were searched for peer reviewed research articles published between March 1971 and April 2022. PRISMA-ScR guidelines were followed. Three authors independently assessed articles for inclusion. Fifty-three studies with focus settings in hospitals, hospice, general practice and residential care were identified. Five main themes were developed and organized using and ergonomic systems approach: Cultural Environment, Workplace, Job Demands, Impacts and Coping. The findings demonstrate that caring for dying patients, the dead and their families in clinical settings impacts workers emotionally, physically, behaviorally and spiritually.

Occupational and Physical Therapists' Use of Intrapersonal and Interpersonal Emotion Regulation Strategies During Patient Interactions: A Qualitative Study

IMPORTANCE

Occupational and physical therapists' use of intrapersonal and interpersonal emotion regulation strategies may play an important role in building therapeutic relationships, but little is known about how they use these strategies during patient interactions.

OBJECTIVE

To understand how therapists use intrapersonal and interpersonal emotion regulation strategies during their patient interactions.

DESIGN

This qualitative study consisted of two stages of data collection. In Stage 1, therapists were interviewed regarding how they use emotion regulation strategies in their therapeutic relationships. In Stage 2, patient-therapist dyads were observed during treatment sessions and then interviewed at the end of the therapeutic relationship.

SETTING

Inpatient and outpatient rehabilitation hospitals and clinics in the United Kingdom.

PARTICIPANTS

In Stage 1, 13 occupational therapists and 9 physical therapists participated; in Stage 2, 14 patient-therapist dyads participated.

OUTCOME AND MEASURES

A semistructured interview guide was used to ask therapists how they use emotion regulation strategies during patient interactions.

RESULTS

Therapists used a wide range of interpersonal and intrapersonal emotion regulation strategies that can be categorized in prominent emotion regulation strategy taxonomies. They used these strategies both proactively, in anticipation of emotional events, and reactively, in response to emotional events. Their use helped them to build and maintain the therapeutic relationship and to protect themselves, feel better, and get their jobs done.

CONCLUSIONS AND RELEVANCE

The ability to regulate one's own and others' emotions is an essential part of therapists' work. In this study, therapists used a wide range of emotion regulation strategies to benefit themselves and their patients. What This Article Adds: This is the first study to identify the specific intrapersonal and interpersonal emotion regulation strategies used by occupational and physical therapists during patient-therapist interactions. This study makes an important contribution to understanding therapists' use of proactive and reactive emotion regulation strategies to build and maintain therapeutic relationships.

'You're on show all the time': Moderating emotional labour through space in the emergency department

AIMS

This is the second of two papers conceptualizing emotional labour in the emergency department (ED). This paper aims to understand the environmental 'moderators' of ED nurses' emotional labour.

DESIGN

Ethnography, through an interpretivist philosophy, enabled immersion in the ED setting, gathering the lived experiences and narratives of the ED nurses.

METHODS

Observation and semi-structured interviews over a 6-month period. Two hospital sites (one district general and one major trauma centre) based in the United Kingdom.

RESULTS

Over 200 h of observation plus 18 formal/semi-structured interviews were completed. Environmental, institutional and organizational dynamics of the emergency department instrumented the emotional labour undertaken by the nursing team. Time and space were found to be 'moderators' of ED nurses' emotional labour. This paper focusses on the relevance of space and in particular, 'excessive visibility' with little respite for the nurses from their intense emotional performance.

CONCLUSION

Emotional labour is critical to staff well-being and the way in which healthcare spaces are designed has an impact on emotional labour. Understanding how emotional labour is moderated in different clinical settings can inform organizational, environmental and workforce-related decision-making.

Relationship between emotional labor and sense of career success among community nurses in China, Beijing: A cross-sectional study based on latent class analysis

Background

This study investigated different patterns of emotional labor among community nurses in China and analyzed the relationships between the sense of career success and emotional labor.

Methods

A total of 385 community nurses from Beijing participated in this investigation. Latent class analysis was used to identify meaningful subgroups of participants, and analysis of variance was used to analyze relationships between emotional labor classes and the sense of career success.

Results

Emotional labor among community nursing staff in China was divided into three latent classes: active (n = 90, 25.6%), apathetic (n = 65, 18.5%), and moderate (n = 197, 55.9%). The active emotional labor classes had significantly higher career success (p<0.05). The “gaining recognition” dimension showed significant differences across the three classes.

Conclusion

Our findings suggested managers to implement a variety of measures to strengthen interventions for employees’ emotional labor that are targeted to incentive mechanisms, which will improve nurses’ sense of career success.

Your Presence Is Requested: Mindfulness Infusion in Workplace Interactions and Relationships

In an increasingly fast-paced work environment filled with distractions, an overabundance of information, and complex decision making, scholars and practitioners alike have begun to recognize the need to slow down and direct attention to the present moment. As such, the study and implementation of mindfulness in the workplace has received growing attention in recent years. This body of work, however, is preoccupied with the outcomes of individual- and collective-level mindfulness, largely ignoring mindfulness as brought into workplace interactions and relationships. In this study, we take a qualitative, grounded theory approach wherein we put forth and unpack a model of interpersonal mindfulness infusion: the process whereby individuals instill their mindfulness into their workplace interactions and relationships. We further distinguish between formal and informal and self- and other-focused mindfulness practices. We show how these practices underlie the mindfulness infusion process and can enhance workplace interactions and relationships. In doing so, we contribute to the organizational literature on mindfulness and positive relationships at work.

Nurses' Experiences of Care at Crisis Resolution Home Treatment Teams: A case study research

WHAT IS KNOWN ON THE SUBJECT?: There are many international studies on CRHTTs; however, there has been little research on nurses' experiences of working with CRHTTs. Earlier studies focused on the nurses' gatekeeping role but did not explore nurses' perception of care as a construct. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: This study provides information based on mental health nurses' experiences. It explains the home environment, the therapeutic relationship and the process of mental health nursing care during a crisis. Also, the study explains nurses' satisfaction with care provided at patients' home. Unlike other studies, this study focused on nurses' experiences while providing care, rather than on nurses' general responsibilities and the services they provide. This study is the first of its kind in Spain with such a focus. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Acknowledging nurses' experiences and their perspectives about the care they provide could help shift mental health nursing paradigms from those based on biomedical models to newer perspectives found in recovery models. Furthermore, this knowledge could improve the quality of care in mental health settings due to its potential to guide nursing practices. Raising mental health care providers' awareness of mental health nurses' personal and professional care constructs would help implement support systems to meet the professional's needs. Meeting the needs of nurses related to the care they provide is likely to impact patient care positively.

ABSTRACT

INTRODUCTION: Crisis resolution home treatment teams (CRHTTs) provide short-term, intensive home treatment to people experiencing mental health crises. There is limited research on nurses' experiences with CRHTTs. While earlier studies mainly focussed on mental health nurses' gatekeeping responsibilities, more investigation is needed in this field.

AIM

To explore nurses' perceptions and constructions about care in CRHTT services.

METHOD

A qualitative case study was employed. Ten semi-structured interviews were performed to nursing staff working in CRHTT services.

RESULTS

Three main categories emerged from the data analysis: nurses' perspectives of the care provided, nursing setting of care at home and nursing care plan at home.

DISCUSSIONS

Findings revealed that nurses experienced greater satisfaction providing care in the home settings, and therefore, it positively impacted the quality of care and reduced patient's stigma. This study also relates the value of developing care plans centred on patients' environments increasing Mental Health Nursing (MHN) work satisfaction.

IMPLICATIONS FOR PRACTICE

Knowledge of the intrinsic experiences of care provided by nurses in CRHTTs may help facilitate the development of the nursing role in CRHTT by improving understanding of care in mental health settings.

When Relationships Get in the Way: The emergence and persistence of care routines

Past research has shown that routines can be a vehicle for both stability and change in organizations. It is unclear however how this relationship alters and solidifies over time. In this paper, the changing behaviours of three newly formed teams within a domiciliary care organization are tracked over a period of two years. It was seen that self-reinforcing processes shaped the emergence and persistence of action patterns within these groups. The first process achieved coordination benefits which drove the emergence of routines, as ‘action patterns’ were first negotiated and then assigned to members of the care team. The second self-reinforcing process involved sets of expectations which deepened interpersonal relationships between the care worker and client. The impact of both these processes, altered the ostensive-performative duality, as routines emerged and persisted over time. This study therefore highlights the changing dynamics of stability and change within routines, and the key role played by social relations in this process.

Three types of emotional engagement: Caring for the older person with cancer in two ward settings

PURPOSE

The purpose of the study was to explore experiences of older people with cancer in the palliative care stages ascertaining the attributes of a person-centred approach in sustaining the management of emotions. This was a qualitative study comparing patients and professional experiences and perceptions of care across to ward settings.

METHODS

Methods involved 10 semi-structured interviews conducted with patients and focus groups (n = 6) and 10 semi-structured interviews with health professionals. Three dissemination focus groups (n = 14) were also carried out with professionals to allow further analysis of the data.

RESULTS

Findings highlight the way emotion work is conveyed and the emphasis' accorded to issues such as societal perceptions, knowledge, expectations of care, life stage, relationships, identity, and emotions when caring for people in the palliative stages. Professionals engaged with patients' emotions in three ways: superficial engagement, reflective engagement, and authentic engagement. Findings, also reinforce the importance of maintaining emotions through emotion work.

CONCLUSION

This study highlights how emotion work is facilitated through the interaction between patients and professionals and that the relational interactive stance. This current study establishes that emotion work seemed to be temporal, contextual and dynamic in nature, involving an ongoing process at the palliative care stages. Helping older people with cancer to understand their illness considering the situation of lives and experiences is essential to address their emotional needs at this stage of the cancer journey.

Latent profile analysis on Korean nurses: Emotional labour strategies and well-being

AIMS

To identify the unique profiles of emotional labour management strategies among Korean nurses in regards to the preferences of surface acting (affecting emotions required at the workplace) and deep acting (trying to genuinely experience emotions required at the workplace), a latent profile analysis (LPA) was conducted. In addition, differences in psychological and occupational well-being between the discovered profiles are examined.

DESIGN

An exploratory, cross-sectional LPA design was employed.

METHODS

Nurses (N = 204) working in university hospitals in South Korea responded to the survey during November 2019. Participants completed the Emotional Labour Questionnaire, a portion of the Maslach Burnout Inventory, the Minnesota Satisfaction Questionnaire short form and the Turnover Intentions Scale.

RESULTS

As a result of LPA on nurses' surface acting and deep acting, five profiles were discovered: non-actors, surface actors, moderators, regulators and high regulators. In addition, differences in emotional exhaustion, job satisfaction and turnover intentions between profiles were examined. Profiles that used high levels of surface acting had high levels of emotional exhaustion and turnover intentions.

CONCLUSION

Nurses with characteristics of surface actors, high regulators profiles in emotional labour context are more prone to emotional exhaustion and turnover possibilities, compared with other profiles (non-actors, moderators and regulators).

IMPACT

Insights from the current study are beneficial to hospitals in preventing potential emotional exhaustion and nurse turnover by responding to high-risk profiles and customizing emotional labour management policies with regards to the different profiles of nurses' emotional labour.

Essential Work in the U.S. during COVID-19: Navigating Vulnerability–Sustainability Tensions

The COVID-19 pandemic affected every functioning system in the United States. Workers deemed “essential” faced multiple threats to their well-being that quickly led to acute symptoms of anxiety, depression, burnout, and overall exhaustion, and organizations were challenged to devise employee protocols to maintain sustainability. This qualitative study takes a tension-centered approach to discern how “essential workers” in the United States navigated this tenuous work landscape, particularly with regard to emotional work and workplace dignity. We conducted 19 semi-structured in-depth interviews with essential workers during COVID-19. Our constant comparative analysis of the data identified a macro-tension between vulnerability and sustainability that was revealed through two micro-tensions: (a) essential work as instrumental and disposable, and (b) workplace dignity as recognized and transgressed. We unpack the emotional responses enmeshed in these micro-tensions and situate our findings at the intersection of organizational sustainability, emotional work and workplace dignity. We offer theoretical and practical implications for essential workers and organizations.

Practical ethical challenges and moral distress among staff in a hospital COVID-19 screening service

The COVID-19 pandemic has led to unprecedented disruptions to established models of healthcare and healthcare delivery, creating a host of new ethical challenges for healthcare institutions, their leadership and their staff. Hospitals and other large organisations have an obligation to understand and recognise the downstream effects that highly unusual situations and professionally demanding policy may have on workers tasked with its implementation, in order to institute risk-mitigation strategies and provide additional support where required. In our experience, targeted ethics-based forums that provide a non-confrontational platform to discuss and explore the ethical dilemmas that may have arisen have been well received, and can also serve as useful and immediate feedback mechanisms to managers and leadership. Using two case illustrations, this article examines some of the ethical challenges and dilemmas faced by these staff, based on discussions of shared experience during a clinical ethics forum for the Screening Clinic staff at Austin Health, Melbourne, Victoria.

Managing (im) patience of nurses and nurse's aides: Emotional labour and normalizing practices at geriatric facilities

Nurses and nurse's aides at geriatric facilities face demanding patients and challenging situations that trigger undesired emotions. The psychological implications of care workers' emotional labour have been extensively researched, but not so their emotional experiences and the regulation of these emotions aimed at normalizing the extraordinary situations that arise in the course of geriatric care. The present study is based on data collected in interviews with 36 nurses and nurse's aides, and nine health professionals and management-level employees, on participant observations, and on field notes collected over a period of 14 months at two geriatric institutions in Israel. The data reveal the construction of patience and impatience as the pivotal emotional experience that needs regulation to cope successfully with extraordinary situations. The findings suggest that strict patience-display rules were constructed as an occupational impetus that exacts a price by increasing emotional load. Patience was regulated continually by normalizing practices that were culturally embedded in the organizations, by reframing patients' abusive behaviours, and by diffusing undesired emotions using detachment and disengagement practices. The findings contribute to the scarce empirical research on emotional labour of nurse's aides, and to the conceptualization and empirical study of nurses' normalizing regulation practices as cultural-organizational artefacts.

What is nursing work? A meta-narrative review and integrated framework

BACKGROUND

There is ample evidence that modern nurses are under strain and that interventions to support the nursing workforce have not recognised the complexity inherent in nursing work. Creating a modern model of nursing work may assist nurses in developing workable solutions to professional problems. A new model may also foster cohesion among broad and diverse nursing roles.

AIM

The aim of this meta-narrative review was to investigate how researchers, using different methods and theoretical approaches, have contributed to the understanding of nursing work.

METHODS

A meta-narrative review was done to evaluate the trajectory of nursing work research, from 1953 to present. This review progressed through the stages of planning, searching, mapping, appraisal, and synthesis.

FINDINGS

A total of 121 articles were included in this meta-narrative review. These articles revealed five narratives of nursing work, where work is conceptualised as labour. These narratives were physical labour (n = 14), emotional (n = 53), cognitive (n = 24), and organisational (n = 1), and combinations of more than one type of labour (n = 29 articles). The paradigms identified in the meta-narrative were the positivist, interpretive, critical, and evidence-based paradigms. Each article in the review corresponded with a paradigm and a labour narrative, creating a comprehensive model.

CONCLUSIONS

Nursing work can be understood as a model of physical, emotional, cognitive, and organisational labour. These different types of labour may be hidden and taken for granted. Nurses can use this model to articulate what they do and how it supports patient safety. Nurses can also advocate for staffing allocations that consider all types of nursing labour. Tweetable abstract Nursing work is complex and includes physical, emotional, cognitive, and organisational labour. Staffing needs to take all nursing labour into account.

Insights into nurses' precarious emotional labour in the emergency department

BACKGROUND

Nurses in the emergency department (ED) work in emotionally charged situations and undertake extensive emotional labour. However, that labour is not visible to others, often overlooked and therefore undervalued. Furthermore, there is a lack of literature on the topic.

AIM

To explore ED nurses' experiences of emotional labour.

METHODS

In-depth semi-structured interviews were conducted with two staff nurses working in the ED of a large UK teaching hospital. Rigorous methods of data collection and analysis, including a strong reflexive stance, were adopted.

FINDINGS

Among three overarching themes that emerged from the data, two related more specifically to the ED: 'precarious emotional labour' and 'grieving etiquette'. Participants were found to perform sophisticated forms of emotional labour to manage the precariousness of their role, and to conceal or suppress their own feelings in order to maintain the grieving etiquette.

CONCLUSION

The ED is an environment that requires sophisticated but precarious forms of emotional labour. Recognising, valuing and supporting the emotional aspect of an ED nurse's role is essential if emergency services are to remain functional, efficient and humane.

Primary healthcare midwives' experiences of caring for parents who have suffered an involuntary pregnancy loss: a phenomenological hermeneutic study

OBJECTIVE

To illuminate the experiences of primary healthcare midwives who care for parents who have suffered an involuntary pregnancy loss.

DESIGN

The phenomenological hermeneutic approach developed by Lindseth and Norberg was used to carry out narrative interviews.

SETTING AND PARTICIPANTS

A purposive sample of 11 public primary healthcare midwives from a municipality in northern Spain, was selected. The participants' ages ranged between 26 and 62 years, and they were all women.

FINDINGS

Four main themes were identified: (1) handling adversity, (2) finding a motive to get involved, (3) providing care from the rear, and (4) avoiding emotional connections with the parents. For the midwives, caring for parents who had suffered an involuntary pregnancy loss meant leaving their own comfort zone and handling adversity. They described acting in different ways such as going beyond task-focused care, following their intuition or avoiding encounters with the parents.

CONCLUSIONS

More knowledge and preparation in terms of communication skills and bereavement is crucial for midwives in order to meet the needs of parents who have suffered an involuntary pregnancy loss. A caring organizational culture and supportive leadership will facilitate care continuity between specialized and primary healthcare and promote the welfare of midwives.

Perceptions of Clergy Regarding the Provision of Spiritual Care in Lithuanian Hospitals for Cancer Patients

This paper presents an analysis of narratives drawn from research that examined the views of clergy in regard to the provision of spiritual care in Lithuanian hospitals. The purpose of this research was to examine the shared responsibilities between what nurses do in the provision of holistic care and that of the clergy who are employed to provide spiritual care. A thematic analysis was undertaken, guided by questions related to how spirituality was perceived by the clergy; how spiritual care was defined; clergy's perceptions to nurses' provision of spiritual care, and whether there was a delineation between these two roles. Findings showed that although the clergy believed that their role was important in the provision of spiritual care, both nurses and clergy acknowledged that both played a role in spiritual support. However, scope of practice for each role was not yet defined. For nurses and clergy to understand their roles and the boundaries between them, clear standards of practice need to be developed.

Work Schedule Patching in Health Care: Exploring Implementation Approaches

The authors propose a typology of "work schedule patching," the ongoing adjustments made to plug scheduling holes after employers post schedules. Patching occurs due to changes in employer work demands, or employee nonwork demands necessitating scheduling adjustments, which are reactive or proactive. Using qualitative data from eight health-care facilities, the authors identified three narratives justifying schedule patching implementation approaches (share-the-pain, work-life-needs, and reverse-status-rotation) with variation in formalization and improvisation. Exploratory analysis showed a suggestive link between improvised work-life scheduling and lower pressure ulcers. This article advances theory on balancing the "service triangle" of scheduling in-service economies including health care.

Disempowered midwives and traumatised women: Exploring the parallel processes of care provider interaction that contribute to women developing Post Traumatic Stress Disorder (PTSD) post childbirth

BACKGROUND

Around 4% of women develop Post Traumatic Stress Disorder Post Childbirth (PTSD-PC). During childbirth a woman's perception of her care provider's interpersonal verbal and nonverbal relationship behaviours, termed 'Quality of Provider Interaction' are significantly associated with the development of PTSD-PC.

AIMS

To understand how women who develop PTSD-PC and midwives, experience their interactions during care provision. In particular, how they feel during their interactions and what this means to them.

METHODS

The qualitative method of Interpretative Phenomenological Analysis that incorporates a reflective approach, was used to gain deep understanding of the lived experience of care provider interaction. Six women who met full diagnostic criteria for PTSD-PC and six midwives who provided intrapartum care, participated in individual face-to-face interviews.

RESULTS

Two key findings were identified: 1) Failing to recognise and meet the human needs of both women and midwives, results in poor quality interactions from midwives and poor perception of care provider interaction by women; 2) The study groups of women and midwives both identified the quality of their relationship as central to positive interactions. RECOMMENDATIONS FOR PRACTICE: (1) Raise the status of psychological wellbeing for childbearing women and make it of equal importance to physical wellbeing, with clear focus upon care provider interaction; (2) Create a midwife centred system that enables midwives to provide optimal care provider interaction and improve relationship-based care; and (3) Challenge underlying toxic cultures that currently persist in the maternity services system, which undermine the work of midwives and consequently the experience of women.

CONCLUSION

Failure to recognise and meet the human and relationship needs of both childbearing women and midwives contributes to poor care provider interactions offered by midwives and negative perceptions of care provider interactions by women. In response, NHS maternity services need to highlight the importance of the quality of care provider interaction alongside perinatal psychological wellbeing. This requires improved working environments for midwives, so they can optimise their quality of interaction with childbearing women. This will in turn impact upon the incidence and levels of trauma and PTSD-PC experienced by women.

Application of Caring Theory to Nursing Care of Women Experiencing Stillbirth

PURPOSE

The purpose of this study was to determine the extent to which labor and delivery nurses used the tenets of Swanson's middle-range theory to care for women whose babies were stillborn.

STUDY DESIGN AND METHODS

A secondary analysis of qualitative in-depth interview data from 20 labor and delivery nurses obtained during a recent grounded theory study was conducted using the directed content analysis method. The five caring processes as described in Swanson's theory were used as a priori codes to conduct the analysis.

RESULTS

Nursing care of a woman experiencing a stillbirth included finding a way to connect with her and to understand what she was experiencing (knowing), spending extra time with her (being with), protecting her and preserving her dignity (doing for), providing information and explanations in a clear and methodical manner (enabling), and ensuring that she did not blame herself to facilitate the grieving/healing process (maintaining belief).

CLINICAL IMPLICATIONS

The caring processes outlined in Swanson's theory of caring provide a valuable guide that can be used when caring for women experiencing stillbirth.

Supporting the mental health needs of young people: the spatial practices of school nurses

Purpose

The purpose of this paper is to raise awareness of an understanding of how school nurses work in multiple spaces, supporting young people in relation to promoting and protecting their emotional and mental health and wellbeing. It is argued that young people’s emotional health needs are still as prevalent today as they were over 150 years ago, when Charles Dickens wrote about them in the novel Nicholas Nickleby.

Design/methodology/approach

Soja’s (1996) typology of spatial practice is applied to school nursing practice in an attempt to explore how different types of space influence how support is given to young people.

Findings

Examples are provided from previous research (Sherwin, 2016) of how Soja’s theory of Firstspace, Secondspace and Thirdspace can be identified within school nurses’ practice, thereby providing an understanding of how school nurses provide support to young people on an everyday basis. It is proposed that in an addition Fourthspace also exists and a new conceptual model of spatial practice is proposed.

Originality/value

School nurses have the potential to make a significant impact on preventing and protecting young people’s mental health. They provide valuable support to young people to enable them to cope with the complexities of their lives, yet relatively little is known about their everyday practice as this is an under-reported area of nursing. A new conceptual model is proposed to help provide an understanding of their practice.

Discursive practice - lean thinking, nurses' responsibilities and the cost to care

PURPOSE

The purpose of this paper is to explore the literature regarding work intensification that is being experienced by nurses, to examine the effects this is having on their capacity to complete care. The authors contend that nurses' inability to provide all the care patients require, has negative implications on their professional responsibility.

DESIGN/METHODOLOGY/APPROACH

The authors used institutional ethnography to review the discourse in the literature. This approach supports inquiry through the review of text in order to uncover activities that remain institutionally accepted but unquestioned and hidden.

FINDINGS

What the authors found was that the quality and risk management forms an important part of lean thinking, with the organisational culture influencing outcomes; however, the professional cost to nurses has not been fully explored.

RESEARCH LIMITATIONS/IMPLICATIONS

The text uncovered inconsistency between what organisations accepted as successful cost savings, and what nurses were experiencing in their attempts to achieve the care in the face of reduced time and human resources. Nurses' attempts at completing care were done at the risk of their own professional accountability.

PRACTICAL IMPLICATIONS

Nurses are working in lean and stressful environments and are struggling to complete care within reduced resource allocations. This leads to care rationing, which negatively impacts on nurses' professional practice, and quality of care provision.

ORIGINALITY/VALUE

This approach is a departure from the standard qualitative review because the focus is on the textual relationships between what is being advocated by organisations directing cost reduction and what is actioned by the nurses working at the coalface. The discordant standpoints between these two juxtapositions are identified.

Learning lessons from the analysis of patient complaints relating to staff attitudes, behaviour and communication, using the concept of emotional labour

AIMS AND OBJECTIVES

This article explores the content of letters of complaint by patients and carers about the behaviour, attitudes and communication of healthcare staff.

BACKGROUND

The most common focus of patient complaints in the UK and other high-income countries is staff attitudes, behaviour and communication. There is a move to learn lessons from patient complaints, which can be used to improve patient care and experience.

METHODS

Fifty letters of complaint made by patients and carers relating to the behaviour, attitudes and communication of healthcare staff were analysed.

RESULTS

Poor attitudes, behaviours and communication have significant negative impact on the emotional well-being of patients and carers. Many patients and carers have heightened sensitivities due to both health-related stresses and also other factors. The healthcare role is expected to include compassion and kindness. The concept of emotional labour is useful in explaining the skills and effort required of staff in this often invisible and undervalued aspect of health care.

CONCLUSIONS

Given the increasing focus on patient experience, it is important that the importance of good staff attitudes, behaviours and communication is understood and that the emotional labour associated with this is recognised.

RELEVANCE TO CLINICAL PRACTICE

An understanding of emotional intelligence can protect staff from burnout and other negative outcomes which those in a caring role can experience.

A mixed methods sequential explanatory study of the psychosocial factors that impact on midwives' confidence to provide bereavement support to parents who have experienced a perinatal loss

BACKGROUND

Perinatal bereavement is traumatic for many parents. Not only is the experience itself emotionally painful, the impact on their lives is made more difficult if midwives are unable to provide appropriate care to the parents.

AIM OF THE STUDY

To explore within an Irish context, the psychosocial factors that impact on midwives' confidence to provide bereavement support to parents who have experienced a perinatal loss.

DESIGN

A mixed methods sequential explanatory design was used to complete this two-phased study from August 2013 to July 2014. Ethical approval was granted from Ethics Committees of three maternity hospitals and a University in Ireland. The recruitment process for the survey occurred in August 2013 and July 2014 for the focus groups.

METHODS

A series of univariate and multivariate analysis were used to analyze the quantitative data using IBM Statistical Package for the Social Sciences (SPSS; version 20). The qualitative data were analyzed using qualitative content analysis. Steps were taken to ensure data validity and reliability.

RESULTS

The overall meta-inference of this study is that the majority of the midwives did not have adequate levels of confidence to provide bereavement support to grieving parents. The psychosocial factors that impact on midwives' confidence were identified as the midwives' awareness of the needs of bereaved parents, their own inner strength and the organizational support they received at their place of work.

CONCLUSION

Improving midwives' bereavement support knowledge and skills is essential for promoting their confidence. Midwives also need adequate emotional and practical support from their organizations.

Professionalised intimacy: how dementia care workers navigate between domestic intimacy and institutional detachment

This article reports an ethnographic study of the handover routines in Germany's first dementia village, with a central focus on how care is balanced between domestic intimacy and institutional detachment. The term 'professionalised intimacy' is used for the vivid interplay between comfort and intimacy that renders the interaction between care workers and residents far more complex than previous theories have articulated. Because of the intimacy involved in community building, however, the promise of personalised care must clash with the bureaucratic structures of an official institution, potentially depriving the care workers of their public, respected identity in the process. The study further suggests that most care workers, in fact, support this division between domestic intimacy and institutional detachment. Even if they subscribe to a dementia village's philosophy of personalised care, their medical training and enculturation has endowed them with a habitus compatible with the modern health profession, with incentives on achieving quantifiable health goals. The dementia village is thus illustrated as a pioneering health care experiment that negotiates rivalling discourses of intimacy, professionalisation, and medicalisation.

Understanding how nurses ration care

Purpose

The purpose of this paper is to explore how nurses make decisions to ration care or leave it undone within a clinical environment that is controlled by systems level cost containment. The authors wanted to find out what professional, personal and organisational factors contribute to that decision-making process. This work follows previous international research that explored missed nursing care using Kalisch and Williams’ MISSCARE survey.

Design/methodology/approach

The authors drew on the care elements used by Kalisch and Williams, asking nurses to tell us how they decided what care to leave out, the conduits for which could include delaying care during a shift, delegating care to another health professional on the same shift, handing care over to staff on the next shift or leaving care undone.

Findings

The findings suggest that nurses do not readily consider their accountability when deciding what care to leave or delay, instead their priorities focus on the patient and the organisation, the outcomes for which are frequently achieved by completing work after a shift.

Originality/value

The actions of nurses implicitly rationing care is largely hidden from view, the consequences for which potentially have far reaching effects to the nurses and the patients. This paper raised awareness to hidden issues facing nurses within a cycle of implicitly rationing care, caught between wanting to provide care to their patients, meeting the organisation’s directives and ensuring professional safety. Rethinking how care is measured to reflect its unpredictable nature is essential.

Students' Perceptions of Trigger Warnings in Medical Education

Phenomenon: Trigger warnings are verbal statements or written warnings that alert students in advance to potentially distressing material. Medical education includes numerous subjects frequently identified as triggers, such as abuse, rape, self-injurious behaviors, eating disorders, drug and alcohol addiction, and suicide. Thus, exploring medical students' perceptions of trigger warnings may provide a valuable perspective on the use of these warnings in higher education.

APPROACH

As part of a larger descriptive, cross-sectional survey study on medical education, we assessed 1st- and 2nd-year medical students' perceptions of trigger warnings in the preclinical curriculum. Five questions specific to trigger warnings explored students' knowledge, prior experience, and perceptions of trigger warnings in medical education. Frequencies of individual question responses were calculated, and qualitative data were analyzed via content and thematic analyses.

FINDINGS

Of the 424 medical students invited to participate, 259 completed the survey (M = 24.8 years, SD + 3.4, 51.4% female, 76.1% White, 53.7% 1st-year students). Few students (11.2%) were aware of the term trigger warning and its definition. However, after being presented with a formal definition on the online survey, 38.6% reported having had a professor use one. When asked whether they supported the use of trigger warnings in medical education, respondents were distributed fairly equally by response (yes = 31.0%, maybe = 39.2%, no = 29.7%). Qualitative analysis revealed three themes: (a) Trigger Warnings Allow Students to Know What is Coming and Prepare Themselves: Respondents believed that trigger warnings would benefit students with a history of trauma by providing them additional time to prepare for the material and, if appropriate, seek professional help; (b) Students Need to Learn How to Handle Distressing Information: Respondents agreed that they needed to learn and cope with highly sensitive material because they would be confronted with difficult and unexpected situations in clinical practice; and (c) Trigger Warnings Help Students Understand the Severity of the Material: Respondents felt that trigger warnings may help students understand the severity of the material being covered and increase awareness about trauma and its effects on health and well-being. Insights: Findings did not reach consensus for or against the use of trigger warnings in medical school; however, students emphasized the importance of learning how to cope with distressing material. Trigger warnings may represent a teaching tool to facilitate classroom discussions about the severity of trauma-related material and problem-focused coping strategies.

A mixed methods study of emotional exhaustion: Energizing and depleting work within an innovative healthcare team

This mixed methods study documents emotional exhaustion experiences among care team members during the development of an innovative team approach for caring for adults with serious illness. A mixed methods study design was employed to examine depleting work experiences that may produce emotional exhaustion, and energizing aspects of the work that may increase meaningfulness of work, thus reducing emotional exhaustion. The population studied included team members involved in care for adults with serious illness (n = 18). Team members were surveyed quarterly over an 18-month period using the Maslach Burnout Inventory (MBI). The MBI measures burnout, defined as the inability to continue work because of the interactional toll of the work. Analyses of MBI data show that although overall levels of burnout are low, 89% of team members reported moderate/high levels of emotional exhaustion during at least one survey period. In order to understand the kinds of work experiences that may produce or ameliorate emotional exhaustion, qualitative interviews were also conducted with team members at the end of the 18-month period. Major qualitative findings indicate that disputes within the team, environmental pressures, and standardisation of meaningful work leave team members feeling depleted. Having authentic relationships with patients, working as a team, believing in the care model, and practicing autonomy and creativity help team members to restore their emotional energy. Supports for team members' well-being are critical for continued innovation. We conclude with recommendations for improving team members' well-being.

Emotional Labor Within Teams: Outcomes of Individual and Peer Emotional Labor on Perceived Team Support, Extra-Role Behaviors, and Turnover Intentions

We investigated the relationship of emotional labor to perceived team support, extra-role behaviors, and turnover intentions. Our primary research question involved whether the relationships of individual deep acting with perceived team support and extra-role behaviors were conditional on the level of peer deep acting in the team. The possibilities were explored in two field studies. Study 1 sampled 195 students in 47 project teams multiple times over the course of a semester. Study 2 surveyed 202 nurses and their supervisors within 35 teams in a hospital. The multilevel results of both studies showed that the relationships between individual deep acting and outcome variables were dependent upon the level of peer deep acting in the team. As expected, individual and peer surface acting had only direct relationships with the same outcomes. These findings provided general support for our model and suggested that team-level effects are an important theoretical and practical consideration for understanding emotional labor within teams and organizations.

Measuring Emotional Labor among Young Workers

This analysis examines the applicability of the emotional labor scale from the Emotions at Work Scale (EWS) through the assessment of its psychometric properties in a sample of young workers. Factor analysis and test—retest reliability were conducted on a 13-item scale measuring emotional labor. The EWS 13-item emotional labor scale was refined to 9 items. Two subscales were delineated: 5 items measured surface acting and 4 items measured deep acting, each with a mean inter-item correlation of 0.33. Cronbach's alpha was .96 for the 9-item scale, and .71 and .67 for the surface acting and deep acting subscales, respectively. Test—retest reliability was 0.64 for surface acting and 0.51 for deep acting during a mean interval of 3 months. Emotional labor can be quantitatively measured among young workers using the derived 9-item scale, although additional studies further evaluating its use should be conducted.

Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review

Therapeutic interpersonal relationships are the primary component of all health care interactions that facilitate the development of positive clinician-patient experiences. Therapeutic interpersonal relationships have the capacity to transform and enrich the patients' experiences. Consequently, with an increasing necessity to focus on patient-centered care, it is imperative for health care professionals to therapeutically engage with patients to improve health-related outcomes. Studies were identified through an electronic search, using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases of peer-reviewed research, limited to the English language with search terms developed to reflect therapeutic interpersonal relationships between health care professionals and patients in the acute care setting. This study found that therapeutic listening, responding to patient emotions and unmet needs, and patient centeredness were key characteristics of strategies for improving therapeutic interpersonal relationships.

Observations of the experiences of people with dementia on general hospital wards

This paper is based on research that aimed to explore how people with dementia are cared for in general hospital wards in the United Kingdom (UK). The paper details findings from one phase of data collection, ward based observations. The observations elucidated the ways in which persons with dementia express and portray their ‘selves’, the interpretations made by nurses about the patients with dementia they cared for and the constructions of roles and care environments. The findings demonstrate how a variety of influences affect the way a person with dementia experiences a hospital admission. Nurses' positive or negative interpretations of a person with dementia can lead to the ‘constraint’ or ‘realisation’ of a person's portrayal of self. In an ageing global society, improving the care of older people is a priority. The findings illuminate the central importance of promoting two-way relationships in which the actions of people with dementia are recognised as portraying individuality and identity. The study highlights a need for practice development to enhance nursing care for medical and surgical patients with a coincidental diagnosis of dementia.