Group-format clinical supervision for hospice nurses

In what ways might group clinical supervision affect the development of resilience in hospice nurses?

BACKGROUND

Resilience is important to sustain hospice nurses through a challenging career. Clinical supervision is a commonly cited support strategy, but there is limited evidence which focuses on its influence on the development of resilience in hospice nurses.

AIMS

To explore how group clinical supervision might affect the development of resilience in hospice nurses.

METHOD

A pragmatic approach and mixed methods research design was employed. Quantitative questionnaire data and qualitative focus group data were collected from community hospice nurses participating in group clinical supervision.

FINDINGS

The findings identified the importance of an effective group reflective process on the benefits to be gained from clinical supervision. Clinical supervision was found to affect the development of resilience by developing confidence at work, regulating emotions, offering a coping strategy, managing expectations, and developing self-awareness. This was dependent upon individual preference and experience, the local organisational context, and wider social and political factors.

CONCLUSION

This research contributes insight into group clinical supervision as an intervention to support resilience in hospice nurses. It offers recommendations for practice, to enhance the development of resilience through clinical supervision, and recommendations for future research.

Burnout, compassion fatigue and psychological capital: Findings from a survey of nurses delivering palliative care

BACKGROUND

Ageing populations worldwide and a concomitant increase in chronic conditions translates into an increased demand for the delivery of palliative and end of life care by nurses. This increasing demand for palliative care provision may produce stressors resulting in negative outcomes such as burnout and compassion fatigue.

AIM

The purpose of this study was to explore burnout and compassion fatigue, as well as potential protective factors, among nurses in New Zealand.

METHODS

An online survey was conducted with 256 registered nurses (between January 2016 and February 2017) recruited through nursing organisations and a large tertiary level hospital. Data analysis consisted of descriptive statistics, multivariate analysis of variance, Pearson correlations, and hierarchical multiple regression.

RESULTS

Psychological empowerment and the commitment and challenge components of psychological hardiness significantly predicted lower scores for the burnout while previous palliative care education and challenge predicted lower scores for the secondary traumatic stress component of compassion fatigue. Significant predictors of compassion satisfaction included previous palliative care education, psychological empowerment and both the commitment and challenge components of psychological hardiness.

CONCLUSION

Nurses draw upon unique combinations of "psychological capital" to deal with caring for patients with life-limiting illnesses. Any interventions to increase nurse palliative care education uptake must be tailored to develop and support these internal resources.

Including personal development in palliative care education to address death anxiety

BACKGROUND

Death anxiety may interfere with health care workers' (HCW) relationship with patients and their families.

AIMS

Evaluate an intervention to address death anxiety and improve HCW skills dealing with patients/families in palliative and end-of-life care.

DESIGN

Quasi-experimental mixed methods approach with a pre-test/post-test design.

PARTICIPANTS

208 HCWs receiving the intervention and working in end-of-life care, in and out of palliative care units, were invited to answer quantitative and qualitative questionnaires. In the end, 150 returned with quantitative answers and of these, 94 with qualitative answers as well. Additionally, out of the 150 participants, 26 were recruited for interview.

RESULTS

Pre-and post-test results revealed a significant reduction in levels of death anxiety, an increase in existential wellbeing, and a significant improvement in HCWs' perception of the quality of their helping relationship skills with patients/families. Content analysis provided an understanding of the difficulties experienced by the HCWs and the positive impact of the intervention.

CONCLUSION

An intervention to address death anxiety and help relationship skills can reduce the use of avoidance mechanisms and improve HCW self-perceived psycho-existential support to patients/families.

The Impact of a Novel Tool for Comprehensive Assessment of Palliative Care (MPCAT) on Assessment Outcome at 6- and 12-Month Follow-Up

CONTEXT

Assessment in palliative care settings should be focused, sensitive, specific, and effective to minimize discomfort to vulnerable and often highly morbid patients. This report describes the development of an admission assessment protocol for a Specialist Palliative Care Inpatient Unit and its implementation into clinical practice.

OBJECTIVES

The aim of this study was to develop and investigate the impact of the implementation of a Specialist Palliative Care admission assessment tool on documentation of key patient needs.

METHODS

The outcome of a systematic literature review was used to develop an admission assessment protocol (the intervention) in a Specialist Palliative Care Inpatient Unit. Mixed methods were used to facilitate a comprehensive evaluation pre- and post-intervention to test the effectiveness, feasibility, and acceptability of the intervention.

RESULTS

The documented evidence of pain assessment improved from a baseline rate of 71% to 100% post-intervention. This improvement was maintained 12 months post-introduction of the tool (P < 0.001). The documented evidence of screening for spiritual distress increased from a baseline rate of 23% to 70% at 6 months and to 82% at 12 months (P < 0.001). The number of referrals made in the first 24 hours after assessment increased post-intervention (physiotherapy, P = 0.001; occupational therapy, P = 0.001; social work, P = 0.005; pastoral care, P = 0.005); this was maintained at 12 months. Significantly, more clinicians (88%) agreed that palliative care domains were comprehensively assessed post-intervention in comparison with 59% pre-intervention (P = 0.01).

CONCLUSION

Introducing the Milford Palliative Care Assessment Tool was associated with significant improvement in assessment of multiple important aspects of patient need.

Examining clinical supervision as a mechanism for changes in practice: a research protocol

AIM

This paper describes the research protocol for a study exploring if and how clinical supervision facilitates change in practice relating to psychosocial aspects of care for Health Professionals, who have been trained to deliver a psychosocial intervention to adults with cancer.

BACKGROUND

There is a recognized need to implement care that is in line with clinical practice guidelines for the psychosocial care of adults with cancer. Clinical supervision is recommended as a means to support Health Professionals in providing the recommended psychosocial care.

DESIGN

A qualitative design embedded within an experimental, stepped wedge randomized control trial.

METHODS

The study will use discourse analysis to analyse audio-recorded data collected in clinical supervision sessions that are being delivered as one element of a large randomized control trial. The sessions will be attended primarily by nurses, but including physiotherapists, radiation therapists, occupational therapists. The Health Professionals are participants in a randomized control trial designed to reduce anxiety and depression of distressed adults with cancer. The sessions will be facilitated by psychiatrists experienced in psycho-oncology and the provision of clinical supervision.

DISCUSSION

The proposed research is designed specifically to facilitate exploration of the mechanisms by which clinical supervision enables Health Professionals to deliver a brief, tailored psychosocial intervention in the context of their everyday practice. This is the first study to use discourse analysis embedded within an experimental randomized control trial to explore the mechanisms of change generated within clinical supervision by analysing the discourse within the clinical supervision sessions.

Listening as a method of addressing psychological distress

AIMS

This paper discusses the values of therapeutic listening and ways that emotional difficulties can impact palliative nurses' abilities to provide psychological care.

BACKGROUND

Recent literature indicates that providing psychological care can burden some healthcare professionals including nurses; who may lack the necessary competencies or organizational resources to carry out their roles.

EVALUATION

References drawn from the databases: all EBM reviews, British Nursing INDEX, CINAHL, PSYCH INFO and MEDLINE and EMBASE are discussed.

KEY ISSUES

Psychological care is considered critical to providing holistic care. Yet the literature suggests engaging in such work makes emotional demands on the professionals attempting to carry it out and is associated with psychological difficulties including burnout.

CONCLUSION

Clinical supervision can help reduce the distress caused by emotionally charged situations. Thoughtful clinical supervision can also contribute to safe and effective health care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing would benefit from understanding more about the effects on healthcare professionals of repeated exposure to emotionally charged situations and benefits that clinical supervision can offer to health care.

Clinical supervision: what do we know and what do we need to know? A review and commentary

AIMS

This study is addressed to nurses but the issues are of equal concern to both midwives and health visitors. Clinical supervision ideally both challenges nurses as well as help their practice. There is need to identify critical elements that help professional practice and understand more clearly the changing nature of supervisory relationships.

BACKGROUND

Clinical supervision in nursing is over a decade old in the UK and yet emerging nursing literature suggests that many ideas remain unfamiliar to nursing practice. The resistance shown by nurse towards clinical supervising remains perplexing. Moreover, ideas concerning clinical supervision have been applied without a substantive evidence base.

METHODS

The discussion draws on varied ideas concerning supervision, including those outside of nursing, to ask what do we know and still need to know about clinical supervision. This study suggests that, a single approach to clinical supervision could be unhelpful to nursing.

FINDINGS AND CONCLUSION

Nursing knowledge concerning many aspects of clinical supervision is increasing because of research. Much of the literature suggests that clinical supervision is scholarly activity requiring much the same attention to relationships as the therapeutic activities it supports. This discussion concludes with the idea that clinical supervision might work at its best as a quiet activity allowing nurses to think about nursing work in ways that suit individual learning styles.