Caring about dying persons and their families: Interpretation, practice and emotional labour

"You close the door, wipe your sadness and put on a smiling face": a qualitative study of the emotional labour of healthcare professionals providing palliative care in nursing homes in France

BACKGROUND

Palliative care provided to frail and dying older persons in nursing homes results in intense emotions for residents and their relatives as well as for healthcare professionals. In France, scant attention has been given to how nursing home professionals manage their emotions when providing palliative care. This study analysed the emotional demands of providing palliative care in the nursing home context, the emotional strategies used by healthcare professionals to navigate such demands, and how these demands affect their emotional wellbeing.

METHODS

This qualitative study used a multiple case study approach. We purposively selected nine nursing homes from three geographical provinces in France with diverse ownership statuses (public, private, associative). Individual interviews and focus group discussions were held with 93 healthcare professionals from various occupational groups employed in the participating nursing homes. Data was collected from April 2021 to September 2022 and was analysed using thematic content analysis.

RESULTS

Data revealed that providing palliative care to dying residents within the nursing home context results in intertwined rewarding and exhausting emotional experiences for healthcare professionals. Professionals have to utilize multifaceted emotional strategies to navigate these experiences, including suppressing and modifying emotions and distancing themselves emotionally from residents to protect themselves from emotional suffering. Participants noted a lack of formal space to express emotions. Unrecognized emotional labour undermines the wellbeing of healthcare professionals in nursing homes, whereas acknowledging emotions enhances satisfaction and gives enhanced meaning to their crucial role in resident care.

CONCLUSION

Acknowledging emotional labour as an inevitable component of providing palliative care in nursing homes is critical to supporting healthcare professional wellbeing, resilience, and retention, which may ultimately improve the quality of care for dying residents. Ensuring quality care and supporting the emotional wellbeing of nursing home professionals requires an organisational culture that considers emotional expression a collective strength-building resource rather than an individual responsibility, in hopes of shaping a new culture that fully acknowledges their humanity alongside their professional skills.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT04708002; National registration: ID-RCB number: 2020-A01832-37, Registration date: 2020-12-03.

Prognostication As an Interactionally Delicate Matter: A Conversation Analytic Study of Hospice Multidisciplinary Team Meetings

Prognostication has been found to be a delicate matter in interactions between palliative care professionals and patients. Studies have investigated how these discussions are managed and how speakers orient to their delicate nature. However, the degree to which prognostication is a delicate matter in discussions between palliative care professionals themselves has yet to be investigated. This study explored how hospice multidisciplinary team (MDT) members oriented to the delicacy of prognostication during their meetings. Video-recordings of 24 hospice MDT meetings were transcribed and analyzed using Conversation Analysis. In-depth analysis of the interactions showed how prognostic discussions were oriented to as delicate. This was displayed through markers such as pauses and self-repair organization including cutting off words and restarts, and through accounts accompanying the prognosis. In this way, it was seen that prognostication was not necessarily straightforward. This was further evidenced when prognostic requests were problematic to respond to. It is noteworthy that prognostic discussions are delicate during hospice MDT meetings. Potential reasons may reach further than the taboo of death and lie within prognostic uncertainty and accountability. Research is warranted to explore what causes this delicacy and whether specific support is needed for hospice staff.

Homecare workers needs and experiences in end of life care: rapid review

BACKGROUND

Social homecare workers provide essential care to those living at home at the end of life. In the context of a service experiencing difficulties in attracting and retaining staff, we have limited knowledge about the training, support needs and experiences of this group.

AIM

To gain a timely understanding from the international literature of the experience, training and support needs of homecare workers providing end-of-life care.

METHODS

We conducted a rapid review and narrative synthesis using the recommendations of the Cochrane Rapid Reviews Methods Group. Building on a previous review, social homecare worker and end-of-life search terms were used to identify studies. Quality appraisal was conducted using a multimethods tool.

DATA SOURCES

CINAHL and Medline databases (2011-2023; English language).

RESULTS

19 papers were included representing 2510 participants (91% women) providing new and deeper insights. Four themes were generated: (1) emotional support; homecare workers need to manage complex and distressing situations, navigating their own, their clients' and clients' family, emotions; (2) interaction with other social and healthcare workers; homecare workers are isolated from, and undervalued and poorly understood by the wider healthcare team; (3) training and support; recognising the deteriorating client, symptom management, practicalities around death, communications skills and supervision; (4) recognising good practice; examples of good practice exist but data regarding effectiveness or implementation of interventions are scant.

CONCLUSIONS

Social homecare workers are essential for end-of-life care at home but are inadequately trained, often isolated and underappreciated. Our findings are important for policy-makers addressing this crucial challenge, and service providers in social and healthcare.

How palliative care professionals develop coping competence through their career: A grounded theory

BACKGROUND

Palliative care professionals face emotional challenges when caring for patients with serious advanced diseases. Coping skills are essential for working in palliative care. Several types of coping strategies are mentioned in the literature as protective. However, little is known about how coping skills are developed throughout a professional career.

AIM

To develop an explanatory model of coping for palliative care professionals throughout their professional career.

DESIGN

A grounded theory study. Two researchers conducted constant comparative analysis of interviews.

SETTING/PARTICIPANTS

Palliative care nurses and physicians across nine services from Spain and Portugal (n = 21). Theoretical sampling included professionals who had not continued working in palliative care.

RESULTS

Professionals develop their coping mechanisms in an iterative five-stage process. Although these are successive stages, each one can be revisited later. First: commencing with a very positive outlook and emotion, characterized by contention. Second: recognizing one's own vulnerability and experiencing the need to disconnect. Third: proactively managing emotions with the support of workmates. Fourth: cultivating an integrative approach to care and understanding one's own limitations. Fifth: grounding care on inner balance and a transcendent perspective. This is a transformative process in which clinical cases, teamwork, and selfcare are key factors. Through this process, the sensations of feeling overwhelmed sometimes can be reversed because the professional has come to understand how to care for themselves.

CONCLUSIONS

The explicative model presents a pathway for personal and professional growth, by accumulating strategies that modulate emotional responses and encourage an ongoing passion for work.

Development and Validation of a Scale to Measure Person-Centered Care in Fetal Care Centers

INTRODUCTION

Fetal care centers (FCCs) in the USA lack a standardized instrument to measure person-centered care. This study aimed to develop and validate the Person-Centered Care in Fetal Care Centers (PCC-FCC) Scale.

METHODS

Initial items were developed based on literature and input from clinicians and former patients. A Delphi study involving 16 experts was conducted to validate the content and construct. Through three rounds of online questionnaires using open-ended questions and Likert scales, consensus on item clarity and relevancy was established. The resulting items were then piloted with former fetal care center patients via a web-based survey. The instrument's reliability and validity were validated using Cronbach's α and exploratory factor analysis, respectively. Concurrent validity was assessed by comparing scores with the Revised Patient Perception of Patient-Centeredness (PPPC-R) Questionnaire.

RESULTS

258 participants completed the 48-item pilot PCC-FCC survey, categorized into six domains. Factor analysis yielded a 2-factor, 28-item scale. Internal consistency of the final scale had good reliability (α = 0.969). Data supported content, construct, and concurrent validity.

CONCLUSION

The PCC-FCC Scale is a reliable and valid measure of person-centered care in U.S. FCCs. It can be used to enhance services and begin connecting person-centered care to maternal-child health outcomes.

"I didn't know it was going to be like this.": unprepared for end-of-Life care, the experiences of care aides care in long-term care

BACKGROUND

Care aides provide up to 70-90% of the direct care for residents in long-term care (LTC) and thus hold great potential in improving residents' quality of life and end-of-life (EoL) care experiences. Although the scope and necessity of the care aide role is predicted to increase in the future, there is a lack of understanding around their perceptions and experiences of delivering EoL care in LTC settings. The aim of this study was to gain an understanding of the perspectives, experiences, and working conditions of care aides delivering end-of-life care in LTC in a rural setting, within a high-income country.

METHODS

Data were collected over ten months of fieldwork at one long-term care home in western Canada; semi-structured interviews (70 h) with 31 care aides; and observation (170 h). Data were analysed using Reflexive Thematic Analysis.

RESULTS

Two themes were identified: (i) the emotional toll that delivering this care takes on the care aids and; (ii) the need for healing and support among this workforce. Findings show that the vast majority of care aides reported feeling unprepared for the delivery of the complex care work required for good EoL care. Findings indicate that there are no adequate resources available for care aides' to support the mental and emotional aspects of their role in the delivery of EoL care in LTC. Participants shared unique stories of their own self-care traditions to support their grief, processing and emotional healing.

CONCLUSIONS

To facilitate the health and well-being of this essential workforce internationally, care aides need to have appropriate training and preparation for the complex care work required for good EoL care. It is essential that mechanisms in LTC become mandatory to support care aides' mental health and emotional well-being in this role. Implications for practice highlight the need for greater care and attention played on the part of the educational settings during their selection and acceptance process to train care aides to ensure they have previous experience and societal awareness of what care in LTC settings entails, especially regarding EoL experiences.

“I didn’t know it was going to be like this.”: End of Life Care Experiences of Care Aides Care in Long-term Care.. [DOI: 10.21203/rs.3.rs-1881436/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: Care aides provide upwards of 90% of the direct care for residents in long-term care (LTC) and thus hold great potential in improving residents’ quality of life and end-of-life (EoL) care experiences. Although the scope and necessity of the care aide role is predicted to increase in the future, there is a lack of understanding around their perceptions and experiences of delivering EoL care in LTC settings.Methods: Data were collected over ten months of fieldwork at one long-term care home in western Canada; semi-structured interviews (70 hours) with 31 care aides; and naturalistic observation (170 hours). Data were analysed using Reflexive Thematic Analysis.Results: Three themes were identified: (i) the lack of training and preparedness for the role of EoL care; (ii) the emotional toll that delivering this care takes on the care aids and; (iii) the need for healing and support among this workforce. Findings show that the vast majority of care aides reported feeling unprepared for the delivery of the complex care work required for good EoL care. Findings indicate that there are not adequate resources available for care aides’ to support the mental and emotional aspect of their role in the delivery of EoL care in LTC. Participants shared unique stories of their own self-care traditions to support their grief, processing and emotional healing. Conclusions: The care aides’ role in LTC is of increasing importance, especially in relation to the ageing population and the delivery of EoL care. To facilitate the health and wellbeing of this essential workforce, care aides need to have appropriate training and preparation for the complex care work required for good EoL care. It is essential that mechanisms in LTC become mandatory to support care aides' mental health and emotional wellbeing in this role.

"I tried to control my emotions": Nursing Home Care Workers' Experiences of Emotional Labor in China

Despite dramatic expansions in the Chinese nursing home sector in meeting the increasing care needs of a rapidly aging population, direct care work in China remains largely devalued and socially unrecognized. Consequently, scant attention has been given to the caregiving experiences of direct care workers (DCWs) in Chinese nursing homes. In particular, given the relational nature of care work, there is little knowledge as to how Chinese DCWs manage emotions and inner feelings through their emotional labor. This article examines the emotional labor of Chinese DCWs through ethnographic data collected with 20 DCWs in one nursing home located in an urban setting in central China. Data were analyzed using conventional content analysis and constant comparison. Participants’ accounts of sustaining a caring self, preserving professional identity, and hoping for reciprocity revealed implicit meanings about the often-conflicting nature of emotional labor and the nonreciprocal elements of care work under constrained working conditions. Importantly, the moral-cultural notion of bao (报 norm of reciprocity) was found to be central among DCWs in navigating strained resources and suggested their agency in meaning-construction. However, their constructed moral buffers may be insufficient if emotional labor continues to be made invisible by care organizations.

Clinician distress in seriously ill patient care: A dimensional analysis

BACKGROUND

Caring for patients with serious illness may severely strain clinicians causing distress and probable poor patient outcomes. Unfortunately, clinician distress and its impact historically has received little attention.

RESEARCH PURPOSE

The purpose of this article was to investigate the nature of clinician distress.

RESEARCH DESIGN

Qualitative inductive dimensional analysis.

PARTICIPANTS AND RESEARCH CONTEXT

After review of 577 articles from health sciences databases, a total of 33 articles were eligible for analysis.

ETHICAL CONSIDERATIONS

This study did not require ethical review and the authors adhered to appropriate academic standards in their analysis.

FINDINGS

A narrative of clinician distress in the hospital clinician in the United States emerged from the analysis. This included clinicians' perceptions and sense of should or the feeling that something is awry in the clinical situation. The explanatory matrix consequence of clinician distress occurred under conditions including: the recognition of conflict, the recognition of emotion, or the recognition of a mismatch; followed by a process of an inability to feel and act according to one's values due to a precipitating event.

DISCUSSION

This study adds three unique contributions to the concept of clinician distress by (1) including the emotional aspects of caring for seriously ill patients, (2) providing a new framework for understanding clinician distress within the clinician's own perceptions, and (3) looking at action outside of a purely moral lens by dimensionalizing data, thereby pulling apart what has been socially constructed.

CONCLUSION

For clinicians, learning to recognize one's perceptions and emotional reactions is the first step in mitigating distress. There is a critical need to understand the full scope of clinician distress and its impact on the quality of patient-centered care in serious illness.

End-Of-Life Care Communication in Long-Term Care Among Nurses, Residents, and Families: A Critical Review of Qualitative Research

RNs in long-term care (LTC) are a critical nexus for end-of-life (EOL) care communication with older adult residents and their families. A critical review of 17 qualitative research studies examined nurses' experience with EOL care in LTC. Findings indicate that time, preparation, advocacy, organizational resources, and a continuous, relational approach support EOL care communication. Regulatory burdens, understaffing, workflow demands, family and organizational dysfunction, anxiety, and depression impede EOL care communication. The current review revealed a gap in the literature describing LTC RNs' unique perspectives and knowledge regarding EOL care communication with residents and families. There is a current, pressing need to understand the facilitators LTC RNs use to overcome obstacles to effective EOL care communication. Future research could inform clinical practice guidelines and EOL care nursing education, enhancing LTC nurses' capacity to develop trust-based relationships and improving the efficacy of current EOL care communication interventions in LTC. [Journal of Gerontological Nursing, 47(7), 43-49.].

The relationships among alarm fatigue, compassion fatigue, burnout and compassion satisfaction in critical care and step-down nurses

AIMS AND OBJECTIVES

The study purpose was to investigate if compassion fatigue, burnout, compassion satisfaction and personal characteristics are associated with alarm fatigue and predict alarm fatigue in critical care nurses.

BACKGROUND

The phenomena of alarm fatigue, compassion fatigue and burnout place nurses, patients and the healthcare environment in potentially harmful situations and represent the opposite of the foundation of caring and compassion satisfaction in nursing. It has been noted that healthcare organisations should address alarm fatigue as mandated by the Joint Commission based on the higher number of alarms sounding in the critical care environment and based on factors influencing nurses to respond to the alarm.

DESIGN

This was a correlational and predictive quantitative study.

METHODS

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for research reporting of observational studies was followed in this study. Nurses working in the step-down and intensive care units from three hospitals in a selected healthcare network in Pennsylvania were recruited using convenience sampling (n = 52). Observation, the ProQOL and demographic surveys were used to collect data on alarm fatigue, compassion fatigue, burnout, compassion satisfaction and personal characteristics of critical care nurses. Methods of data analyses included descriptive statistics, chi-square, Spearman's ρ and binary logistic regression.

RESULTS

The study results revealed that the participating critical care nurses showed alarm fatigue, were at risk for compassion fatigue and were near risk for burnout.

CONCLUSIONS

This study illuminated the significant relationships among alarm fatigue and the characteristics of gender, nursing unit, nurse-to-patient ratio and age in critical care nurses.

RELEVANCE TO CLINICAL PRACTICE

The study results can help critical care nurses take the initiative to not only help themselves prevent or overcome alarm fatigue, compassion fatigue and burnout, but also help their coworkers in this area.

The relationship between emotional labour and job satisfaction in nursing

AIM

To investigate the relationship between emotional labour strategies and job satisfaction among nurses in Turkey.

BACKGROUND

Nursing is one of the professions in which emotional labour is heavily used. The relationship between emotional labour strategies and job satisfaction has many different consequences in nursing.

INTRODUCTION

Although studies have focused on the relationship between emotional labour and job satisfaction among nurses abroad, no studies on the subject have been found in Turkey.

METHODS

A cross-sectional descriptive design was employed. The study was conducted with 281 nurses working in a university hospital and three public hospitals in Manisa, Turkey. Research data were collected using the Personal Information Form, Emotional Labour Scale and Minnesota Satisfaction Questionnaire. Descriptive statistics and Pearson correlation analysis were used in data evaluation.

RESULTS

Analyses showed that the type of emotional labour strategy most frequently exhibited by nurses was surface acting. In surface acting, behaviours do not reflect employees' true feelings. Job satisfaction of nurses was higher than the medium level. A negative correlation was found between deep acting and job satisfaction. In deep acting, employees try to feel the emotions appropriate to the behaviour expected of them.

DISCUSSION

Nurses' emotional labour may cause some undesirable consequences.

CONCLUSION

Nurses' emotional labour strategies are related to their job satisfaction levels.

IMPLICATIONS FOR NURSING POLICY

Managers should be aware of the emotional labour of nurses and its possible negative consequences. Management strategies that target the negative consequences of emotional labour are important not only for the well-being of nurses but also for the quality of patient care.