Clinical supervision and burnout: the influence of clinical supervision for community mental health nurses

Clinical supervision, a reflective intervention to support new graduate nurses and midwives enhance their person-centredness: qualitative evaluation

Person-centred care is an international healthcare priority. Strategies are needed to support nurses and midwives to understand the meaning of person-centredness and support them to embed this philosophy into practice. Clinical supervision has been proposed as a strategy to support this but requires more evidence.The aim of this research was to evaluate a newly developed model of clinical supervision, underpinned by person-centred practice theory, to enhance the person-centred practices of new graduate nurses and midwives.

DESIGN

Qualitative study (embedded within a mixed methods study) using focus groupsMethods: Group, online clinical supervision (named C.A.R.E.) underpinned by the Person-centred Practice Framework was provided to 103 new graduate nurses and midwives once per month for one hour, over six months. The researchers used [Braun, V., & Clarke, V. (2022). Thematic analysis; A practical guide. SAGE]. Thematic Analysis to analyse data.

RESULTS

Twenty one participated in the qualitative evaluation. Four themes were identified (1) Person-centredness in Action (person-centredness experienced and delivered by the new graduates) (2) Enhancing the Transitioning Toolkit (professional and personal growth as an outcome of reflection and learning together) (3) The Transitioning Environment (care environment and C.A.R.E. environment) and (4) Challenges to C.A.R.E. (team and organisation, and personal).

CONCLUSION

This supportive safe space allowed new graduates to explore their and other's practices, in relation to person-centred practice theory. Through sharing their experiences, they increased their knowledge and confidence to incorporate new learning into their own practice. This clinical supervision model underpinned by the Person-centred Practice Framework provides person-centred benefits to the new graduates, patients and families. However, without organisational support the benefits will not be realised.

An Interpretative Phenomenological Analysis on the Experience of Probation Officers in Managing People With Antisocial Personality Disorder

People who are managed by the National Probation Service and convicted of high risk offences will often meet criteria for antisocial personality disorder and have complex psychosocial needs; this group of people present with high risk behavior which may professionals have been reluctant to work with in the past who are associated with higher rates of recidivism. This study investigated the experiences of probation officers in managing people who meet the criteria for Anti Social Personality Disorder. Semi structured interviews were conducted with six participants to capture their experiences of working with this population, the challenges they faced, and coping mechanisms employed, through analysis using Interpretative Phenomenological Analysis (IPA). Three superordinate themes were identified which revealed participants internal feeling, strategies employed, and external challenges. They spoke about internal negative feelings, specifically feeling controlled, having mistrust, a lack of confidence, being overwhelmed with emotion, and experiencing a fear of risk behaviors. Other themes involved external pressures as well as different coping responses. Implications are discussed to help probation officers to understand this population, for the organization to support staff to work with challenging behaviors and prevent burn out, to enable positive outcomes, and for potentially reducing reoffending.

Learning Clinical Reasoning: The Experience of Postgraduate Psychiatry Trainee Doctors in Qatar

Phenomenon: As a core competency in medical education, clinical reasoning is a pillar for reducing medical errors and promoting patient safety. Clinical reasoning is a complex phenomenon studied through the lens of multiple theories. Although cognitive psychology theories transformed our understanding of clinical reasoning, the theories fell short of explaining the variations in clinical reasoning influenced by contextual factors. Social cognitive theories propose a dynamic relationship between learners' cognitive process and their social and physical environments. This dynamic relationship highlights the essential role of formal and informal learning environments for learning clinical reasoning. Approach: My research aimed to explore the personal experience of learning clinical reasoning in a sample of postgraduate psychiatry trainee doctors using cognitive psychology and social cognitive theories. A stratified convenience sample of seven psychiatry trainee doctors working in the Mental Health Services in Qatar completed semi-structured interviews in 2020. I analyzed the data manually using theoretical thematic analysis. Findings: I identified three overarching themes with multiple subthemes. The first theme was the hierarchical cultural impact on perceived learning opportunities and learning behavior. The first theme had two subthemes that explored the relationship with team members and the expected hierarchy roles. The second theme was the impact of emotions on the learning and execution of clinical reasoning.The second theme had three subthemes that explored the personal approach to managing emotions related to perceived self-efficacy and professional image. The third theme was characteristics of learning environments and their role in learning clinical reasoning. The last theme included three subthemes that explored stressful, autonomous, and interactive environments. Insights: The results accentuate the complexity of clinical reasoning. Trainees' experience of learning clinical reasoning was influenced by factors not controlled for in the curricula. These factors constitute a hidden curriculum with a significant influence on learning. Our local postgraduate training programmes will benefit from addressing the points raised in this study for effective and culturally sensitive clinical reasoning learning.

What accounts for turnover intention in the Australian public mental health workforce?

High staff turnover is common within the Australian public mental health workforce, contributing to workforce shortages and ultimately impacting the ability to provide stable efficient, effective, and ongoing optimal care to the community. In this study, we aimed to (a) establish the most pertinent factors associated with increased turnover intention in the public mental health workforce in Australia, and (b) establish whether such factors differ between metropolitan and rural services. We used a cross-sectional, correlational design using an online survey method. In total, 235 mental health service staff of various disciplines and levels, from four public hospitals in Victoria, Australia participated in the study. We used three feed-forward multiple regression analyses to assess the study aims. We found that job satisfaction, occupational burnout, and understaffing may be the most pertinent factors to consider regarding turnover intention. Job satisfaction and occupational burnout were factors endorsed across the entire sample, as well as specifically within both the metropolitan and rural services, while understaffing was a pertinent factor regarding turnover intention across the entire sample and for rural services, but not metropolitan services. Our findings regarding the pertinence of job satisfaction, occupational burnout, and understaffing in turnover intention provide key information that may be used to inform interventional targets aimed at reducing attrition from the public mental health workforce in Australia.

Job Satisfaction of Nurses in the Context of Clinical Supervision: A Systematic Review

The purpose of this systematic review is to gather and analyze data from existing research on the effects of clinical supervision (CS) intervention on nurses' job satisfaction and related outcomes such as stress levels, burnout, and care quality. Using the PRISMA (preferred reporting items for systematic reviews and meta-analysis) criteria, a systematic review of the research available in the databases PubMed, PsycInfo, Cochrane Library, and CINAHL, well as Google Scholar, between January 2010 and May 2023 was carried out. Out of the 760 studies assessed, only 8 met the criteria for inclusion in the review based on Hawker's assessment tool. The results indicate that CS has a positive impact on nurses' job satisfaction and related outcomes such as reduced burnout, stress levels, and the quality of care. The study also found that the effectiveness of CS in enhancing job satisfaction was most evident during the 6-month follow-up period. However, nurses who did not receive CS did not show any noticeable improvement in their knowledge or practice. Additionally, nurses who required more efficient clinical oversight reported little to no positive impact on their practice or training. The review also highlighted gaps in knowledge regarding the frequency and number of sessions required for the impact of CS on nurses' job satisfaction and other outcomes. Due to the limited number of studies included in this review, further research is recommended to evaluate the influence of CS on nurses' job satisfaction.

Burnout and secondary traumatic stress in staff working with people with intellectual disabilities: The role of adverse childhood experiences, resilience and trauma-informed organisational climate

BACKGROUND

There has been extensive research into adverse childhood experiences (ACEs), however, less consideration has been given to the prevalence and impact of ACEs for staff working with people with intellectual disabilities.

METHOD

Participants were staff employed by agencies that care for people with intellectual disabilities. An online survey collected demographic information and measures of ACEs, resilience, trauma-informed organisational climate, burnout and secondary traumatic stress. Correlation, regression, mediation and moderation analyses were used.

RESULTS

81.7% of 109 participants had experienced at least one ACE. Burnout, secondary traumatic stress and resilience were greater in the present study than in comparable samples. Trauma-informed organisational climate significantly predicted burnout and secondary traumatic stress. Resilience significantly predicted burnout.

CONCLUSIONS

Staff working with people with intellectual disabilities are likely to have experienced ACEs. Working in a trauma-informed organisational climate and resilience may be effective avenues for reducing burnout and secondary traumatic stress.

Health service improvement using positive patient feedback: Systematic scoping review

BACKGROUND

Healthcare services regularly receive patient feedback, most of which is positive. Empirical studies suggest that health services can use positive feedback to create patient benefit. Our aim was to map all available empirical evidence for how positive patient feedback creates change in healthcare settings.

METHODS

Empirical studies in English were systematically identified through database searches (ACM Digital Library, AMED, ASSIA, CINAHL, MEDLINE and PsycINFO), forwards and backwards citation, and expert consultation. We summarise the characteristics of included studies and the feedback they consider, present a thematic synthesis of qualitative findings, and provide narrative summaries of quantitative findings.

RESULTS

68 papers were included, describing research conducted across six continents, with qualitative (n = 51), quantitative (n = 10), and mixed (n = 7) methods. Only two studies were interventional. The most common settings were hospitals (n = 27) and community healthcare (n = 19). The most common recipients were nurses (n = 29). Most outcomes described were desirable. These were categorised as (a) short-term emotional change for healthcare workers (including feeling motivated and improved psychological wellbeing); (b) work-home interactional change for healthcare workers (such as improved home-life relationships); (c) work-related change for healthcare workers (such as improved performance and staff retention). Some undesirable outcomes were described, including envy when not receiving positive feedback. The impact of feedback may be moderated by characteristics of particular healthcare roles, such as night shift workers having less interaction time with patients. Some factors moderating the change created by feedback are modifiable.

CONCLUSION

Further interventional research is required to assess the effectiveness and cost-effectiveness of receiving positive feedback in creating specific forms of change such as increases in staff retention. Healthcare managers may wish to use positive feedback more regularly, and to address barriers to staff receiving feedback.

Nurse burnout before and during the COVID-19 pandemic: a systematic comparative review

Introduction

This review aimed to compare available evidence examining burnout using the Maslach Burnout Inventory (MBI) in nurses before and during the COVID-19 pandemic. The specific objective was to compare nurse burnout scores in terms of emotional exhaustion, depersonalization, and personal accomplishment.

Methods

A comprehensive search was conducted for studies on nurses' burnout using the MBI published between 1994 and 2022. In total, 19 studies conducted prior to the pandemic and 16 studies conducted during the pandemic were included and compared using the criteria from the Joanna Briggs Institute Critical Appraisal Tool.

Results

Surprisingly, the results indicated that nurses' burnout scores did not differ significantly before (N = 59,111) and during (N = 18,629) the pandemic. The difference observed was qualitative rather than quantitative.

Discussion

The outbreak of the COVID-19 pandemic exacerbated an already critical situation, and while COVID-19 may serve as an additional triggering factor for staff mental illness, it cannot solely explain the observed burnout levels. These findings underscore the need for long-term clinical and preventive psychological interventions, suggesting that psychological resources should not be limited to emergencies but extended to address the ongoing challenges faced by nurses.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=399628, identifier: CRD42023399628.

Burnout, mental health symptoms, and empathy in healthcare workers who care for children treated in a liver transplant center

OBJECTIVE

The healthcare workers in pediatric liver transplantation units are exposed to various stresses; however, their burnout has not been clarified yet. This study aimed to determine burnout, psychological symptoms and empathy levels in healthcare workers, to examine the relationship between these variables and to investigate the predictors of burnout.

METHOD

This cross-sectional study was conducted on healthcare workers in Turgut Özal Medical Center Pediatric Liver Transplant Institute. The participants filled out a questionnaire that investigating demographic and occupational characteristics, and including questions from Toronto Empathy Questionnaire, Maslach Burnout Inventory, and Brief Symptom Inventory.

RESULTS

Fifty healthcare workers participated in the study. Based on moderate and higher severity scores, 48% of the participants were emotionally exhausted, 22% of them were depersonalized. All of them had a high perception of personal accomplishment. There was a correlation between psychological symptoms level and emotional exhaustion and personal accomplishment as well as empathy and personal accomplishment. Not choosing the profession and the department willingly, age, education level, marital status, duration of profession, unit, not receiving in-service training, empathy, depressive symptoms and hostility scores predicted different aspects of burnout.

CONCLUSION

Considering that burnout and psychological stress lead to reduced professional abilities and the development of serious complications, the results obtained can guide managers on the measures to be taken.

Forensic Mental Health Nurses' Experiences of Clinical Supervision

BACKGROUND

Clinical supervision may support forensic mental health nurses with personal and professional growth in a work environment characterized by therapeutic, ethical, and practical challenges.

AIM

The aim of this study was to describe the experiences of forensic mental health nurses participating in a clinical supervision program.

METHODS

Seven forensic mental health nurses and two allied health professionals, working in a high-security forensic mental health hospital, were interviewed regarding their experiences of participating in a clinical supervision program.

FINDINGS

Participants expressed a need for clinical supervision and were motivated to participate in the program. Benefits of clinical supervision experienced by participants included improved communication with their colleagues, being supported in their career development, and developing habits and techniques to reflect on practice issues. Participants described being able to connect with their supervisor, enabled by both trust and confidence in the supervisor's expertise.

CONCLUSION

Staff showed engagement in the clinical supervision process and expressed experiencing positive outcomes related to personal and professional growth and development.

IMPLICATIONS FOR CLINICAL FORENSIC NURSING PRACTICE

To support nurses with the forensic mental health context-specific challenges they face, organizations should enable and promote access to clinical supervision. Considerations for forensic mental health organizations to increase uptake and effectiveness of clinical supervision include use of externally based clinical supervisors with adequate skills and experience with providing clinical supervision to clinical staff who work in a secure environment.

The Impact of COVID-19 on Burnout, Psychological Well-being, and Work Satisfaction in Psychiatry Trainees in Ireland

OBJECTIVE

Prior to the pandemic, trainee doctors were at higher risk of psychological ill health. There is limited evidence measuring the impact of COVID-19 on psychiatry trainees. This study evaluates levels of burnout, work satisfaction, and psychological well-being in psychiatry junior doctors in Ireland and identifies potential contributing factors.

METHODS

The authors carried out a cross-sectional online survey measuring demographic and work-related variables. Questions including exposure to COVID-19 and stress-related factors were included. We evaluated burnout, work satisfaction, and psychological well-being using the Abbreviated-Maslach Burnout Inventory, Basic Needs Satisfaction at Work Scale, and WHO-5 Well-being Index.

RESULTS

One hundred and five doctors responded (21%). The biggest stressor reported was reduced face-to-face contact with family and friends (73%). Forty one percent reported weekly supervision changes. Sixty five percent met the criteria for burnout, compared with 36.2% in 2018. Significant factors associated with burnout included staff shortages, longer hours, and less experience. Changes in supervision and working in non-European Working Time Directive compliant rotas were associated with lower scores across all subdomains of the BNSW Scale. The WHO-5 Well-being Index identified 48% scored low in personal well-being, indicating these trainees met the threshold for depression. Changes in regular supervision (p=0.010) were a significant predictor of low personal well-being.

CONCLUSIONS

High prevalence of burnout and low levels of well-being in this vulnerable cohort, particularly those who are inexperienced, have changes in supervision, and working longer hours is concerning. This study highlights the importance of regular supervision and support for this group.

A scoping review of the literature pertaining to burnout and leadership in mental health clinicians

PURPOSE

This paper aims to explore what is known in the literature about leadership and burnout within mental health clinicians (MHC).

DESIGN/METHODOLOGY/APPROACH

The Arksey and O'Malley (2005) framework was used to conduct a systematised scoping review of three databases: PsycInfo, PubMed and CINAHL. To ensure a broad scope of the literature, Google, Google Scholar and three sources of grey literature were also searched.

FINDINGS

In total 1,087 articles were identified and 36 were included in the final review, 23 of which were cross-sectional and correlational studies. There is a lack of experimental studies, longitudinal research and qualitative approaches. The literature repeatedly demonstrated an association between leadership and burnout; transformational-leadership style, good quality supervision, supportive relationships, positive communication and fostering autonomy are areas of interest.

RESEARCH LIMITATIONS/IMPLICATIONS

Future research activity should aim to follow the recommendations made in the literature; more experimental and longitudinal approaches are needed to support practical application of the findings.

ORIGINALITY/VALUE

To the best of the author's knowledge there is no other review which maps out the research pertaining to leadership and burnout among MHC. These findings can be used to guide future research to ensure that efforts are directed toward original, meaningful and practical ventures that will add to the evidence base and benefit clinical practice.

Adapting a Behavioral Intervention for Alcohol Use and HIV Medication Adherence for Lay Counselor Delivery in Cape Town, South Africa: A Case Series

Human immunodeficiency virus (HIV) and problematic alcohol use are two ongoing and interconnected epidemics in South Africa, with untreated problematic alcohol use associated with poorer HIV treatment outcomes and disease progression. A lack of trained mental health providers is a primary barrier to increasing access to evidence-based treatment in this setting. To address this gap, we integrated evidence-based intervention components for problematic alcohol use and antiretroviral therapy (ART) adherence, adapted for lay provider delivery in an HIV primary care setting in Cape Town, South Africa. The intervention, locally termed "Khanya" in isiXhosa, which means glow, direction, or light, comprises Life Steps adherence counseling, motivational interviewing, behavioral activation, and relapse prevention, including mindfulness-based relapse prevention components. In this case series, we present a detailed description of the intervention and provide three clinical cases of individuals who received the Khanya intervention to showcase necessary clinical adaptations and the supervision needed for optimal treatment delivery, flexibility in intervention delivery, and overall successes and challenges. We present descriptive data on alcohol use and ART adherence outcomes for the cases to supplement the narrative discussion. Successes of intervention delivery included participant uptake of mindfulness skills, reductions in alcohol use despite varying levels of motivation, and interventionist mastery over various clinical skills. Challenges included delivering the intervention within the allotted time and the strong influence of substance-using social networks. Overall, a pragmatic approach to intervention delivery was necessary, as was ongoing support for the interventionist to promote fidelity to both treatment components and therapeutic skills.

Trial registration

ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.

Scoping review with textual narrative synthesis of the literature reporting stress and burn-out in specialist nurses: making the case for inflammatory bowel disease nurse specialists

Objective

Inflammatory bowel disease clinical nurse specialists (IBD-CNSs) face increasing pressures due to rising clinical and patient demands, advanced complexity of work role, and minimal specialist management training and support. Stress and burn-out could undermine the stability of this workforce, disrupting clinical provision. We reviewed the literature on stress and burn-out to demonstrate the lack of evidence pertinent to IBD-CNSs and make the case for further research.

Design

Following Levac et al’s scoping review framework, relevant databases were searched for publications reporting work-related stress and burn-out among specialist nurses. Following screening and consensus on selection of the final articles for review, all authors contributed to data charting. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review extension guided reporting of the review.

Results

Of 194 retrieved articles, eight were eligible for review. None focused on IBD-CNSs, were qualitative, or UK-based. Three core themes were identified: Rates of Burn-out, Mitigating and Alleviating Factors, and Preventing and Resolving Burn-out. Risk of burn-out is greatest in novice and mid-career CNSs. Age and duration in role appear protective. Personal achievement is also protective and can mitigate earlier episodes of burn-out; opportunities for career progression are limited. Promoting personal well-being is beneficial. Senior managers have poor understanding of the role and provide inadequate support. Commitment to patients remains high.

Conclusion

Burn-out arises in CNSs across clinical specialisms in the international literature and has a significant negative effect on the workforce. Further research is needed to address the dearth of evidence on burn-out in IBD-CNSs in the UK.

Barriers and facilitators to accessing effective clinical supervision and the implementation of a clinical supervision exchange model in the Australian alcohol and other drugs sector

INTRODUCTION

Internationally, clinical/practice supervision is considered essential in the development and maintenance of professional proficiency across health disciplines. Among alcohol and other drug (AOD) workers, however, access to effective clinical supervision is limited. This study examined perceived barriers and facilitators to: (i) AOD workers accessing effective clinical supervision; and (ii) effective implementation of a clinical supervision exchange model in the AOD sector.

METHODS

Qualitative interviews with frontline workers (n = 10) and managers (n = 11) employed by eight government and non-government AOD treatment services in Brisbane, Australia were undertaken. Interviews were audio recorded, transcribed and data were thematically analysed.

RESULTS

Frontline workers and managers shared similar views. Reported barriers and facilitators to accessing effective clinical supervision included limited time, the high cost of providers, availability of skilled clinical supervisors, supervisor-supervisee matching and supervision modality. Participants considered the implementation of a clinical supervision exchange model to be a resource-effective strategy to increase access to external, individual clinical supervision while also exposing workers to a greater diversity of perspectives, increasing sector collaboration and improving the perceived value of clinical supervision among the workforce.

DISCUSSION AND CONCLUSIONS

The findings of this study suggest that limited time, cost and availability of skilled supervisors are primary barriers to AOD workers accessing high-quality clinical supervision. Implementation of a clinical supervision exchange model is perceived by frontline workers and service delivery managers to be a resource-effective strategy for increasing access to high-quality clinical supervision among workers.

Burnout in and Commission of Medical Errors by Secondary School Athletic Trainers

CONTEXT

Commission of medical errors by health care providers can be costly and potentially fatal for their patients. Previous researchers found a correlation between burnout and the commission of medical errors by physicians. The Smith Cognitive-Affective Model of Athletic Burnout suggests that emotional exhaustion and decreased personal accomplishment in athletic trainers (ATs) may be associated with behavioral outcomes such as commission of medical errors, but this association has not been examined.

OBJECTIVE

To explore the association between burnout in and commission of medical errors by ATs.

DESIGN

Cross-sectional study.

SETTING

Web-based survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 403 certified ATs working in the secondary school setting were recruited via multiple social media pages and the National Athletic Trainers' Association Research Survey Service.

MAIN OUTCOME MEASURE(S)

An online questionnaire that consisted of 97 items from previously used scales was distributed to participants. A logistic regression model with personal accomplishment and emotional exhaustion as independent variables and a dichotomous variable for commission of medical errors (yes or no) as a dependent variable was calculated. A Poisson regression model with personal accomplishment and emotional exhaustion as independent variables and number of medical errors committed as a dependent variable was also calculated.

RESULTS

Approximately 18.4% of our sample admitted to committing at least 1 medical error in the last 30 days. Both personal accomplishment (odds ratio = 1.06, P = .005) and emotional exhaustion (odds ratio = 1.02, P = .037) were significantly associated with commission of at least 1 medical error. Emotional exhaustion (B = .02, P = .002) was significantly associated with the number of medical errors committed.

CONCLUSIONS

Athletic trainers committed medical errors at a rate comparable with that of other health care professionals. Burnout was directly associated with both the likelihood of an AT committing a medical error and the number of errors an AT committed.

Pushing the bench: A mixed methods study of barriers to and facilitators of identification and referral into depression care by professional nurses in KwaZulu-Natal, South Africa

OBJECTIVE

Integration of mental health and chronic disease services in primary care could reduce the mental health treatment gap and improve associated health outcomes in low-resource settings. Low rates of nurse identification and referral of patients with depression limit the effectiveness of integrated mental health care; the barriers to and facilitators of identification and referral in South Africa and comparable settings remain undefined. This study explored barriers to and facilitators of nurse identification and referral of patients with depressive symptoms as part of integrated mental health service delivery in KwaZulu-Natal, South Africa.

DESIGN

Triangulation mixed methods study incorporating qualitative and quantitative data.

METHODS

Data collection, analysis, and interpretation were guided by the Consolidated Framework for Implementation Research (CFIR). Participants were professional nurses at ten primary health care facilities in Amajuba, KwaZulu-Natal, South Africa. Qualitative data collection involved semi-structured interviews targeting specific CFIR constructs with high- and low-referring nurses. Deductive and inductive coding were used to derive primary themes related to barriers and facilitators. Quantitative data collection involved a structured questionnaire assessing determinants explored in the interviews. Qualitative comparative analysis was used to identify the necessary or sufficient conditions for high and low nurse referral.

RESULTS

Twenty-two nurses were interviewed. Primary themes related to insufficient training, supervision, and competency; emotional burden; limited human and physical resources; perceived patient need for integrated services; and intervention acceptability. Sixty-eight nurses completed questionnaires. Quantitative results confirmed and expanded upon the qualitative findings. Low self-assessed competency was a consistent barrier to appropriate service delivery.

CONCLUSIONS

To promote the success of integrated care in a context of severe staff shortages and over-burdened providers, implementation strategies including direct training, structured supervision, and routine behavioral health screening tools are warranted. Interventions to improve mental health literacy of patients as well as emotional support for nurses are also needed.

Impact of clinical supervision on healthcare organisational outcomes: A mixed methods systematic review

OBJECTIVE

To review the impact of clinical supervision of post-registration/qualification healthcare professionals on healthcare organisational outcomes.

BACKGROUND

Clinical supervision is a professional support mechanism that benefits patients, healthcare professionals and healthcare organisations. Whilst evidence is growing on the impact of clinical supervision on patient and healthcare professional outcomes, the evidence base for the impact of clinical supervision on organisational outcomes remains weak.

METHODS

This review used a convergent segregated approach to synthesise and integrate quantitative and qualitative research findings, as per the Joanna Briggs Institute's recommendations for mixed methods systematic reviews. Databases searched included CINAHL, Embase, PubMed, PschINFO, and Scopus. Whilst a narrative synthesis was performed to present the findings of the quantitative and qualitative studies, the evidence from both quantitative and qualitative studies was subsequently integrated for a combined presentation. The review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

RESULTS

Thirty-two studies including 27 quantitative, two qualitative and three mixed methods studies, were included in the review. The results of the quantitative analysis showed that effective clinical supervision was associated with lower burnout and greater staff retention, and effective supervisor was associated with lower burnout and greater job satisfaction. Qualitative findings showed that healthcare professionals believed that adequate clinical supervision could mitigate the risk of burnout, facilitate staff retention, and improve the work environment, while inadequate clinical supervision can lead to stress and burnout. The evidence from quantitative and qualitative studies were complementary of each other.

CONCLUSION

Clinical supervision can have a variable effect on healthcare organisational outcomes. The direction of this effect appears to be influenced by the effectiveness of both the clinical supervision provided and that of the clinical supervisor. This highlights the need for organisations to invest in high quality supervision practices if maximal gains from clinical supervision are to be attained.

Telling a Complicated Grief: A Psychodynamic Study on Mental Health Nurses' Countertransference Reactions to Patients' Suicidal Behavior

A key element of suicide education, training and clinical supervision is enhancing emotional awareness about mental health professionals' countertransference reactions, as emotional responses to patients' suicidal behavior (SB) that may be unbeneficial to care. This study aimed to explore emotional responses to patients' SB in mental health nurses (MHNs) according to a psychodynamic perspective. Twenty-eight Italian MHNs (61% females, Mage = 52 years) were interviewed to examine their deep feelings about attempted suicides or deaths by suicide of patients with mental illness. Computer-aided thematic analysis was performed on the verbatim transcribed interviews, adopting Emotional Text Analysis (ETA) as a research framework to explore affective symbolizations underlying narratives, beyond intentional and explicitly reported contents. Some statistical multidimensional techniques were carried out, allowing th.e detection of shared symbolic domains (Cluster Analysis) and latent factors organizing the contraposition between them (Multiple Correspondence Analysis). Five symbolic domains emerged which were respectively referred to as: hyper-vigilance (21.97% of the overall textual corpus), resentment (17.86%), rationalization (34.50%), resignation (5.54%) and mourning (20.12%). Four latent factors explained the overall data variance: strive for reparation (F1), lack of control (F2), ambivalence toward care (F3) and complicated grief (F4). Some clinical recommendations were derived suggesting to balance issues of risk assessment/management and staff's reflective practice, to work on the subjective sense of hopelessness resulting from turning against oneself the hostility evoked by patients, to consider rationalization processes and implicit beliefs leading to risk underestimation and to address some basic conflicts contributing to a complicated grief in mourning suicidal events.

Burnout and quality of life among nurses working in selected mental health institutions in South West Nigeria

Background

Burnout remains a huge public health problem among nurses.

Methods

A cross-sectional descriptive study assessed 259 nurses from two Neuropsychiatric hospitals in Nigeria. Data was collected using a sociodemographic/ job related questionnaire, the Maslach Burnout Inventory (MBI), and the Short-Form health survey (SF-12). The associations between sociodemographic characteristic and burnout was anaysed using Chi square test, between burnout and quality of life using Spearman correlation statistics. Predictors of burnout were determined using binary regression analysis

Results

Prevalence of emotional exhaustion (EE) was 44.4%, depersonalization (DEP) 31.7% and reduced personal accomplishment was 98.8%. Predictors of EE were: poor funding from management, OR = 0.38 (95% CI 0.15–0.95) and role conflict, OR = 2.44 (95% CI 1.03–5.78), while the predictors of DEP, were age group, 31–40 years, OR = 0.37 (95% CI 0.18–0.77), male gender, OR = 2.55 (95% CI 1.40–4.65), role conflict, OR = 6.53 (95% CI 0.88–7.81) and working at more urban city, OR = 3.07 (95% CI 1.54–6.16). The mean total Quality of life (QOL) scores were significantly higher among respondents who had no EE and DEP p < 0.001.

Conclusion

Burnout is high among mental health nurses and is associated with poor quality of life.

A Grounded Theory Study: How Non-Treatment-Seeking Substance Users Make Sense of Their Behaviour “I Want To Be Me but I Don’t Know Who Me Is”

Despite the global impact of substance misuse, there are inadequate levels of specialist service provision and continued difficulties with treatment engagement. Within policy and research, there is substantial consideration of the importance of these factors. However, there is little empirical evidence of the views of non-treatment-seeking substance users, who make up the majority of the substance using population. The aim of this study was to understand how these individuals make sense of their behaviour and their reasons for not accessing treatment. A constructivist grounded theory approach was used to interview eight individuals who were currently using substances and not seeking help to stop. The analysis highlighted the importance of attachment to an identity associated with substance use, and relational variables such as connectedness to others, for treatment decisions for individuals who use substances. Understanding these influences, through trauma- and attachment-informed service provision, may reduce barriers to help-seeking and improve treatment uptake.

Task Sharing or Task Dumping: Counsellors Experiences of Delivering a Psychosocial Intervention for Mental Health Problems in South Africa

Given task-sharing mental health counselling to non-specialist providers is a recognised strategy to increase service capacity, ensuring that their training, supervision, and support needs are met is necessary to facilitate the sustainable delivery of a high-quality service. Using in-depth interviews, we qualitatively explored the experiences of 18 facility-based counsellors (FBCs) tasked with delivering a counselling intervention within chronic disease services offered within primary care facilities participating in the project MIND cluster randomised controlled trial. Findings show that project MIND training with a strong emphasis on role playing and skills rehearsal improved FBCs' confidence and competence, complemented by highly structured supervision and debriefing provided by a registered counsellor, were key strategies for supporting the implementation of task-shared mental health counselling. FBCs perceived many benefits to providing mental health counselling in primary healthcare but systemic interventions are needed for sustained implementation.

A personal and professional journey - experiences of being trained online to be a supervisor in professional supervision in nursing

Background

Nurses often work alone in complex environments with ambiguous responsibilities and need ensured access to supervision.Online supervision has become common and has potential to support supervision in rural areas.

Aim

To explore the experiences of registered nurses (RNs) learning online to be a supervisor in professional supervision in nursing.

Design

A longitudinal qualitative design was used.

Methods

A total of six focus group discussions, with 15 RNs divided in two groups, were conducted before, during, and after the training. Data underwent qualitative content analysis.

Results

Results showed that the participants experienced learning to be a supervisor online as a personal and professional journey, and learning online was an advantage rather than a disadvantage. Initially, they focused on themselves, then on themselves within the group, and finally on themselves and the group. Both the group and the internet environment were described as safe places. Online tutoring needs to include the creation of a social presence within the group.

Burnout, Work Satisfaction, and Well-being Among Non-consultant Psychiatrists in Ireland

OBJECTIVE

The aim of this study was to explore the areas of psychological well-being, satisfaction at work, and burnout among non-consultant psychiatrists in Ireland, and to assess for potential contributory factors.

METHODS

The College of Psychiatrists of Ireland distributed the survey online to 100 non-consultant psychiatry doctors working in Ireland. The survey contained questions relating to demographic and work-related variables, the Abbreviated-Maslach Burnout Inventory (a-MBI), Basic Needs Satisfaction at Work (BNSW) scale, and WHO-5 Well-being Index. Descriptive statistics were used by the authors to summarize the data and univariate associations were explored between baseline data and subscales.

RESULTS

Sixty-nine percent of our sample completed the survey. Thirty-six percent of the sample met the criteria for burnout, with lack of supervision the only variable significantly associated with this. Lack of regular supervision was associated with lower scores across all work satisfaction domains of the BNSW scale. The WHO-5 Well-being Index identified that 30% of respondents scored low in personal well-being, indicating that this proportion screened positive for depression, based on international diagnostic criteria. Lack of regular supervision was found to be significantly associated with low psychological well-being.

CONCLUSION

This study indicates that lack of supervision is significantly associated with burnout, lower satisfaction at work, and poorer psychological well-being. Close evaluation of these areas is important to identify vulnerable individuals and areas of training which can be improved upon, which may lead to relevant measures being implemented for the benefit of psychiatrists, patients, and the wider society.

Burnout and compassion fatigue among Exercise Physiologists in mental healthcare

BACKGROUND

Burnout and compassion fatigue (CF) are common among mental health practitioners. Accredited Exercise Physiologists (AEPs) provide clinical services to individuals experiencing mental illness, increasing their likelihood of experiencing burnout and CF.

AIMS

To examine the prevalence of burnout and CF among AEPs working with people experiencing mental illness.

METHODS

An anonymous online cross-sectional survey of AEPs working with people experiencing mental illness was distributed via the Exercise and Sports Science Australia Mental Health Special Interest Group Facebook page between July and November 2019. In addition to demographics and caseload data, respondents completed the Professional Quality of Life scale and Oldenburg Burnout Inventory (OLBI). Results are reported using descriptive statistics.

RESULTS

Sixty-two AEPs (68%, n = 42 female) completed the survey. Most (n = 53, 86%) reported delivering services to consumers with severe mental health conditions. Less than half (n = 27, 44%) reported working in a dedicated mental health facility. Moderate levels of burnout and CF were experienced by 60% and 30% of respondents, respectively.

CONCLUSIONS

The prevalence of moderate burnout and CF symptoms in AEPs is comparable with other mental health professionals. Strategies to preserve psychological well-being such as enhancing mental health training for undergraduates and formalized supervision structures discussed.

Factors influencing adequate and effective clinical supervision for inpatient mental health nurses' personal and professional development: An integrative review

WHAT IS KNOWN ON THE SUBJECT

CS was developed to give healthcare professionals a space to reflect, problem solve and recognise their own practice. It is different from managerial supervision as it is for the benefit of the individual staff member's personal and professional development firstly, but can potentially benefit the quality of care delivered by the organisation. There have been a range of problems associated with inpatient mental health nurses' engagement in CS and in experiencing the benefits of CS. This is concerning for the delivery of high quality care and the recruitment and retention of inpatient mental health nurses.

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE

This paper explores and identifies factors influencing adequate and effective CS for inpatient mental health nurses' personal and professional development. It identifies 6 themes incorporating enablers and barriers for inpatient mental health nurses' CS which lead to practice recommendations for improvement.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

This paper advocates a needs analysis to improve access to CS for inpatient mental health nurses. This review specifically adds further knowledge relating to inpatient mental health nurses' engagement with CS which the application of the needs analysis could influence.

ABSTRACT

Introduction Clinical supervision (CS) has been recognized as a reflective mechanism in inpatient mental health nursing practice; however, it remains unclear what adequate and effective supervision entails for inpatient mental health nurses. Aim To explore factors which influence adequate and effective clinical supervision for inpatient mental health nurses' personal and professional development. Method Whittemore and Knafl's model for ensuring rigour was utilized. This included stages to address problem identification, literature searching, data evaluation, data analysis and presentation. Seven electronic databases were searched with hand searching/Internet searching. Fourteen retrieved articles were selected and appraised using the Mixed Method Appraisal Tool (MMAT). The data extracted from the papers were analysed thematically. Results The review synthesis resulted in identifying six themes: (a) what makes CS effective; (b) reflection; (c) the facilitation of professional identity and knowledge through CS; (d) participation; (e) knowledge and understanding of CS; and (f) the facilitation of personal awareness and coping. Discussion This review adds further knowledge on the identification of effective CS for inpatient mental health nurses as a defined occupational healthcare group. Implications for practice A suggested needs analysis is presented to improve access to CS options with the aim of promoting effective CS and increased engagement.

Burnout and Substance Use in Collegiate Athletic Trainers

CONTEXT

The Smith Cognitive-Affective Model of Athletic Burnout suggests that athletic trainers (ATs) suffering from burnout may engage in substance use as a coping behavior. Increases in self-reported burnout symptoms are often associated with increases in heavy episodic drinking and tobacco use among various health care providers. However, this relationship has not been examined thoroughly.

OBJECTIVE

To investigate the prevalence of substance use in ATs and identify relationships between symptoms of burnout and substance use among ATs.

DESIGN

Cross-sectional study.

SETTING

Web-based survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 783 certified ATs working full time in the collegiate or university setting were sampled for this study. Graduate assistant and other part-time ATs were excluded. The survey was distributed via the National Athletic Trainers' Association membership directory e-mail broadcast service.

MAIN OUTCOME MEASURE(S)

A 100-item online questionnaire consisting of items from previously used scales was used for this study. The survey included the Maslach Burnout Inventory and questions on substance use from the Monitoring the Future study. Multiple regression analyses were performed to analyze the survey data. All independent (Maslach Burnout Inventory subscales) and dependent (use of alcohol, tobacco, and marijuana) variables were mapped to the Smith Cognitive-Affective Model of Athletic Burnout to determine which dimensions of burnout altered the odds of self-reported substance use.

RESULTS

Almost half (46.3%) of participants admitted to at least 1 binge-drinking episode. However, the use of cigarettes, smokeless tobacco, marijuana, and energy drinks during the previous month was less pronounced in the sample. Emotional exhaustion (B = 0.008, P = .023) and personal accomplishment (B = -0.016, P = .02) were significantly correlated with binge drinking. Emotional exhaustion (Exp[B] = 1.017, P < .001) was also significantly positively correlated with energy-drink consumption.

CONCLUSIONS

Some ATs engaged in heavy episodic drinking. Emotional exhaustion and a decreased sense of personal accomplishment were significantly correlated with this behavior.

Cairns Mental Health Co-Responder Project: Essential elements and challenges to programme implementation

In Australia and internationally, co-responder models are becoming an increasingly common intervention to respond to police callouts where there is an assumed mental health-related component or crisis. This type of model involves a collaborative approach where trained police officers team with mental health clinicians to provide specialized responses in order to improve outcomes for persons with mental illness. However, there is limited understanding as to major elements required for implementation of the model. This study aims to identify the essential elements and challenges in implementation of the Mental Health Co-Responder Project in Cairns, Australia, where the team consists of a mental health nurse with demonstrated competencies in crisis intervention and a specially trained police officer. In 2016, 39 participants completed semi-structured interviews regarding knowledge and experience of the Cairns co-responder model. The participants represented first responders and community-based service providers who work with and support persons living with mental illness. Using a thematic analysis approach, key elements identified as essential to successful project implementation were as follows: co-responder team characteristics, senior and project executive level support, collaborative project governance, and co-location of the team within a mental health setting. The main perceived challenges to project implementation included the following: initial concerns regarding client confidentiality, lack of an evaluation plan, and adequate project resourcing. Governance through a vigorous joint agency operation committee and adequate resourcing is imperative to the sustainability of this model.

Athletic Trainer Burnout: A Systematic Review of the Literature

OBJECTIVE

To identify the causes, effects, and prevalence of burnout in athletic trainers (ATs) identified in the literature.

DATA SOURCES

EBSCO: SPORTDiscus and OneSearch were accessed, using the search terms athletic trainer AND burnout.

STUDY SELECTION

Studies selected for inclusion were peer reviewed, published in a journal, and written in English and investigated prevalence, causes, effects, or alleviation of AT burnout.

DATA EXTRACTION

The initial search yielded 558 articles. Articles that did not specifically involve ATs were excluded from further inspection. The remaining 83 full-text articles were reviewed. Of these 83 articles, 48 examined prevalence, causes, effects, or alleviation of AT burnout. An evaluation of the bibliographies of those 48 articles revealed 3 additional articles that were not initially identified but met the inclusion criteria. In total, 51 articles were included in data collection.

DATA SYNTHESIS

Articles were categorized based on investigation of prevalence, causes, effects, or alleviation of burnout. Articles were also categorized based on which subset of the athletic training population they observed (ie, athletic training students, certified graduate assistants, high school or collegiate staff members, academic faculty).

CONCLUSIONS

Burnout was observed in all studied subsets of the population (ie, students, graduate assistants, staff, faculty), and multiple causes of burnout were reported. Suggested causes of burnout in ATs included work-life conflict and organizational factors such as poor salaries, long hours, and difficulties dealing with the "politics and bureaucracy" of athletics. Effects of burnout in ATs included physical, emotional, and behavioral concerns (eg, intention to leave the job or profession).

"You get exposed to a wider range of things and it can be challenging but very exciting at the same time": enablers of and barriers to transition to rural practice by allied health professionals in Australia

Background

There is consistent evidence highlighting the mal-distribution of the health workforce between urban and rural and remote regions. To date, addressing this mal-distribution has focused on medicine and nursing with limited initiatives targeted at allied health. Therefore, the aim of this research was to explore the enablers of and barriers to transition to rural practice by allied health professionals across South Australia in Australia.

Method

Qualitative descriptive methodology was used to underpin this research. Individual, in-depth semi-structured interviews were conducted with employers, managers and allied health professionals from rural regions of South Australia who were identified using purposive maximum variation sampling strategy.

Results

A total 22 participants shared their perspectives on the enablers of and barriers to transition to rural practice by allied health professionals across South Australia. Thematic analysis of the interview data resulted in a number of key issues impacting transition to rural-based practice. These findings could be broadly categorised into three stages during the transition: ‘before’; ‘during’ and ‘after’.

Discussion

This study identified a range of enablers of and barriers to transition to rural practice by allied health professionals. Five overarching themes – nature of rural practice, exposure to rural ‘taster’, social/lifestyle, job availability/characteristics, and mentor and support were identified. In particular, exposure to rural ‘taster’, social/lifestyle, and mentor and support were the key themes reported by the stakeholders. The multifactorial nature of the barriers and enablers highlight the complexity underpinning how AHPs transition to rural-based practice. These barriers/ enablers are often inter-linked and continually evolving which pose significant challenges for health care stakeholders to successfully addressing these.

Conclusion

This research sheds light on the complexities that confront and successful strategies that are required for health care stakeholders when considering how best to support allied health professional transition to rural practice.

Impact of clinical supervision of health professionals on organizational outcomes: a mixed methods systematic review protocol

OBJECTIVE

The objective of this review is to develop an aggregated synthesis of qualitative and quantitative reviews to derive recommendations for policy and practice relevant to clinical supervision (CS).

INTRODUCTION

Clinical supervision is a process where supervisors and supervisees engage in guided evaluation and reflection on current practice to enhance future practice. Recent studies have demonstrated the positive impact of CS on patient outcomes; however, the impact of CS on organizational outcomes is less clear. Therefore, this review will investigate organization outcomes and how health practitioners experience and view CS.

INCLUSION CRITERIA

This review will consider quantitative and qualitative studies on health professional supervisees in nutrition and dietetics, occupational therapy, physiotherapy, psychology, podiatry, social work, speech pathology and exercise physiology in hospitals and community settings. The quantitative component will include studies on the effects of CS based on staff retention and recruitment, intent to stay, intent to leave, job satisfaction and quality of work life, burnout and absenteeism. The qualitative component will consider studies that explore health professional supervisees' experiences on CS related to organizational outcomes.

METHODS

CINAHL, Embase, PubMed, PsycINFO, PEDro and Scopus will be searched for studies published in English, without a date limit. Both quantitative and qualitative studies will be screened for inclusion and critically appraised for methodological quality, and both types of data extracted using JBI tools for mixed methods systematic reviews. A convergent segregated approach to synthesis and integration will be used. The findings of each single method synthesis will be configured according to JBI methodology.

Effective nurse-patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance

Background

Therapeutic alliance is a core part of the nursing role and key to the attainment of positive outcomes for people utilising mental health care services. However, these relationships are sometimes difficult to develop and sustain, and nursing staff would arguably benefit from evidence-based support to foster more positive relationships.

Objectives

We aimed to collate and critique papers reporting on interventions targeted at improving the nurse–patient therapeutic alliance in mental health care settings.

Design

Systematic literature review.

Data sources

The online databases of Excerpta Medica database (Embase), PsycINFO, Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cumulative Index of Nursing and Allied Health Literature (CINAHL) were searched, eligible full text paper references lists reviewed for additional works and a forward citation search conducted.

Review methods

Original journal articles in English language were included where they reported on interventions targeting the nurse–patient therapeutic relationship and included a measure of alliance. Data were extracted using a pre-determined extraction form and inter-rater reliability evaluations were conducted. Information pertaining to design, participants, interventions and findings was collated. The papers were subject to quality assessment.

Results

Relatively few eligible papers (n = 8) were identified, highlighting the limitations of the evidence base in this area. A range of interventions were tested, drawing on diverse theoretical and procedural underpinnings. Only half of the studies reported statistically significant results and were largely weak in methodological quality.

Conclusions

The evidence base for methods to support nursing staff to develop and maintain good therapeutic relationships is poor, despite this being a key aspect of the nursing role and a major contributor to positive outcomes for service users. We reflect on why this might be and make specific recommendations for the development of a stronger evidence base, with the hope that this paper serves as a catalyst for a renewed research agenda into interventions that support good therapeutic relationships that serve both staff and patients.

Prevalence of burnout in mental health nurses and related factors: a systematic review and meta-analysis

The aim of this study was to determine the prevalence of burnout in mental health nurses and to identify its predictors. A systematic review was conducted of studies published in the following databases: CINAHL, Dialnet, LILACS, ProQuest, PsycINFO, PubMed, SciELO, and Scopus. The search equation used was "Nurs * AND Burnout AND mental health". Subsequently, three fixed-effects meta-analyses were performed, one for each dimension of burnout, to calculate its prevalence and the corresponding confidence intervals. The data were analysed using StatsDirect meta-analysis software. Eleven studies were finally included (n = 11). In most cases, the literature informs about moderate levels of emotional exhaustion, depersonalization, and personal accomplishment. The studies inform that variables such as work overload, work-related stress, professional seniority, male gender, being single, and aggression at work, among other factors, contribute to burnout development. The meta-analytic prevalence estimations of burnout with a sample of n = 868 mental health nurses are 25% for high emotional exhaustion, 15% for depersonalization, and 22% for low personal accomplishment. From a workforce development and safety perspective, it is important for managers to address the emotional exhaustion and low personal accomplishment aspects of burnout reported in the workplace by mental health nurses.

Burnout within forensic psychiatric nursing: Its relationship with ward environment and effective clinical supervision?

WHAT IS KNOWN ABOUT THIS SUBJECT?: Burnout is a prominent issue in psychiatric nursing and associated with significant adverse consequences for staff, service users and at an organizational level. Exploration of the extent and predictors of burnout in secure settings has received little research attention. It is not fully understood why prevalence rates of burnout in forensic settings are not elevated in comparison to other settings, despite the presence of known risk-related correlates. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: In contrast to previous research, findings suggest that clinical supervision may not be an effective, stand-alone intervention to support staff experiencing burnout. Thus, the current focus on clinical supervision to mitigate burnout may be insufficient in forensic services. The ward environment (specifically how safe staff feel, how therapeutic the ward feels and how well service users relate to one another) was found to be more important than clinical supervision in terms of burnout for forensic psychiatric nursing staff. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Policies regarding staff health and well-being should be developed with due consideration given to the association between burnout and the working environment. It should not be assumed that clinical supervision is sufficient to mitigate burnout in practice. Further research assessing all types of support and the ward environment is needed to gain a better understanding of its relationship to burnout. ABSTRACT: Introduction Despite extensive research examining burnout in psychiatric nursing staff, literature exploring key predictors of burnout in secure psychiatric settings has been relatively neglected. Research has yet to explore burnout in these settings by adopting previously identified predictors such as support or the ward environment. Aim The current study aimed to reduce this gap by exploring burnout, the perceived effectiveness of clinical supervision and ward environment. Method In 2014, nursing staff working in a medium secure forensic psychiatric unit in the United Kingdom (N = 137) provided demographic information and completed the measures assessing: Burnout, clinical supervision and the ward environment. Results Approximately 10% of nursing staff could be classed as "burnt-out". The main predictors of burnout were age and ward environment. Clinical supervision had minimal association with burnout. Discussion The current study sheds doubt on clinical supervision as a potential intervention for burnout and results appear comparable to research within other settings. The implications of the ward environment, supervision and burnout are discussed herein. Implication for Practice Interventions may need to focus on a positive ward environment (including patient cohesion, experienced safety and enhancing the therapeutic atmosphere). Organizations should support younger nursing staff as they appear particularly vulnerable to burnout.

Supervision training interventions in the health and human services: realist synthesis protocol

INTRODUCTION

Supervision training aims to develop workplace supervisory competencies. Despite extensive supervision literature, including literature reviews, the processes through which supervision training interventions produce their effects, for whom and under what circumstances is not clearly delineated. The purpose of this study is to explain the effect of contextual factors on the underpinning mechanisms of supervision training outcomes.

METHODS AND ANALYSIS

We propose to examine supervision training interventions across the health and human services workforce using realist methods. Pawson's five stages for undertaking a realist synthesis will be followed: (1) clarifying the scope of the review; (2) determining the search strategy; (3) study selection; (4) extracting data and (5) synthesising the evidence and drawing conclusions. Extracted data will include study characteristics, characteristics of participant cohort, intervention type, contextual factors, underlying mechanisms and supervision training outcomes. Patterns in context-mechanism-outcome configurations will be identified. Initial programme theories will be developed based on a comprehensive search of the literature, which will include key terms relating to supervision and training. The search strategy will involve: (1) electronic database searching using Medline, Cumulative Index to Nursing and Allied Health Literature, Social Services Abstracts, Educational Resources Information Center, PsycINFO and Australian Public Affairs Information Service and (2) hand and citation searching. We will also contact authors where necessary and discuss identified literature among the project team with extensive expertise in supervision training.

ETHICS AND DISSEMINATION

The realist synthesis will propose an evidence-informed theory of supervision training interventions (ie, what interventions work for whom and why). The findings will be disseminated in peer-reviewed journals and presentations and through discussions with relevant organisations and stakeholders. The research will be used by educators to develop evidenced-based supervision training interventions. It will also help workplace supervisors to better understand what types of supervision training might work most optimally for them and their colleagues. Other researchers could use the synthesis findings to guide future supervision research.

PROSPERO REGISTRATION NUMBER

CRD42018094186.

Person-job congruence, compassion and recovery attitude in Community Mental Health Teams

BACKGROUND

Community Mental Health Team (CMHT) staff are vulnerable to burnout and compassion fatigue, which has implications for service-user care and recovery outlook. Burnout itself is increased when professionals perceive there is low congruence between themselves and their job.

AIMS

The aim of this study is to identify how person-job congruence is associated with compassion fatigue and compassion satisfaction, and how these in turn relate to staff recovery attitudes.

METHOD

A cross-sectional survey of 132 CMHT staff, utilising the Areas of Worklife Scale, Professional Quality of Life Scale and Recovery Knowledge Inventory.

RESULTS

Multiple regression analysis revealed negative associations between "Workload" congruence and Secondary Traumatic Stress (p = 0.001). Low congruence in "Workload" (p = <0.001) "Reward" (p = 0.005) and "Values" (p = 0.005) were associated with increased Burnout. "Workload" congruence was positively associated with Compassion Satisfaction (p = 0.041). Compassion Satisfaction and Compassion Fatigue were not significantly associated with recovery attitude.

CONCLUSIONS

Interventions to address Compassion Fatigue are indicated to target: workloads, rewards, and aligning organisational and personal values. Further research is needed to explore predictors of compassion satisfaction and recovery attitude.

Factors that contribute to high-quality clinical supervision of the rural allied health workforce: lessons from the coalface

Objective The aim of this study was to identify the factors contributing to high-quality clinical supervision of the allied health workforce in rural and remote settings. Methods This quantitative study was part of a broader project that used a mixed-methods sequential explanatory design. Participants were 159 allied health professionals from two Australian states. Quantitative data were collected using an online customised survey and the Manchester Clinical Supervision Scale (MCSS-26). Data were analysed using regression analyses. Results Supervisee’s work setting and choice of supervisor were found to have a positive and significant influence on clinical supervision quality. Supervisee profession and time in work role were found to have a negative and significant influence on the quality of clinical supervision. Conclusions High-quality clinical supervision is essential to achieve quality and safety of health care, as well as to support the health workforce. Information on high-quality clinical supervision identified in this study can be applied to clinical supervision practices in rural and remote settings, and to professional support policies and training to enhance the quality of supervision. What is known about the topic? There is mounting evidence on the benefits of clinical supervision to health professionals, organisations and patients. Clinical supervision enhances recruitment and retention of the health workforce. However, there are still gaps regarding the factors that contribute to high-quality clinical supervision, especially for rural and remote health professionals. What does this paper add? This study, the first of its kind, recruited rural and remote health professionals from seven allied health disciplines across two Australian states. It investigated the factors that influence high-quality clinical supervision in this under-resourced group. This paper outlines specific factors that contribute to clinical supervision quality for rural and remote allied health professionals. What are the implications for practitioners? Effective and high-quality clinical supervision of the rural and remote allied health workforce can enhance recruitment and retention in those areas. Healthcare organisations can facilitate effective clinical supervision delivery by using the evidence gathered in this study in clinical supervision policy, training and practice.

A realist informed mixed-methods evaluation of Schwartz Center Rounds® in England

Background

Schwartz Center Rounds®(Rounds) were introduced into the UK in 2009 to support health-care staff to deliver compassionate care, something the Francis report (Francis R.Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office; 2013) identified as lacking. Rounds are organisation-wide forums that prompt reflection and discussion of the emotional, social and ethical challenges of health-care work, with the aim of improving staff well-being and patient care.

Objectives

How, in which contexts and for whom Rounds participation affects staff well-being at work, increases social support for staff and improves patient care.

Design

(1) A scoping review of Rounds literature and comparison with alternative interventions; (2) mapping Rounds providers via a survey, telephone interviews and secondary data; (3) a two-wave survey of (i) new attenders/non-attenders in 10 sites to determine the impact on staff engagement and well-being; and (ii) interviews with Rounds attenders, non-attenders, facilitators, clinical leads, steering group members, board members and observations in nine case study sites to (4) describe experiences and (5) test candidate programme theories by which Rounds ‘work’ (realist evaluation).

Setting

(1) International literature (English); (2) all Rounds providers (acute/community NHS trusts and hospices) at 1 September 2014 (survey/interview) and 15 July 2015 (secondary data); (3) 10 survey sites; and (4 and 5) nine organisational case study sites (six of which also took part in the survey).

Participants

(1) Ten papers were reviewed for Rounds and 146 were reviewed for alternative interventions. (2) Surveys were received from 41 out of 76 (54%) providers and interviews were conducted with 45 out of 76 (59%) providers. (3) Surveys were received from 1140 out of 3815 (30%) individuals at baseline and from 500 out of 1140 (44%) individuals at follow-up. (4 and 5) A total of 177 interviews were conducted, as were observations of 42 Rounds, 29 panel preparations and 28 steering group meetings.

Results

(1) The evidence base is limited; compared with 11 alternative interventions, Rounds offer a unique organisation-wide ‘all staff’ forum in which disclosure/contribution is not essential. (2) Implementation rapidly increased between 2013 and 2015; Rounds were implemented variably; challenges included ward staff attendance and the workload and resources required to sustain Rounds; and costs were widely variable. (3) There was no change in engagement, but poor psychological well-being (12-item General Health Questionnaire) reduced significantly (p < 0.05) in Rounds attenders (25% to 12%) compared with non-attenders (37% to 34%). (4 and 5) Rounds were described as interesting, engaging and supportive; four contextual layers explained the variation in Rounds implementation. We identified four stages of Rounds, ‘core’ and ‘adaptable’ components of Rounds fidelity, and nine context–mechanism–outcome configurations: (i) trust, emotional safety and containment and (ii) group interaction were prerequisites for creating (iii) a countercultural space in Rounds where staff could (iv) tell stories, (v) self-disclose their experiences to peers and (vi) role model vulnerability; (vii) provide important context for staff and patient behaviour; (viii) shining a spotlight on hidden staff and patient stories reduced isolation and enhanced support/teamwork; and (ix) staff learned through reflection resulting in ripple effects and outcomes. Reported outcomes included increased empathy and compassion for colleagues and patients, support for staff and reported changes in practice. The impact of Rounds is cumulative and we have identified the necessary conditions for Rounds to work.

Limitations

Rounds outcomes relied on self-report, fewer regular attenders were recruited than desired, and it was not possible to observe staff post Rounds.

Conclusion

Rounds offer unique support for staff and positively influence staff well-being, empathy and compassion for patients and colleagues.

Future work

The adaptation of Rounds to new contexts and to increase reach needs evaluation.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Burnout in mental health professionals: A systematic review and meta-analysis of prevalence and determinants

This study aimed to estimate the level of burnout in mental health professionals and to identify specific determinants of burnout in this population. A systematic search of MEDLINE/PubMed, PsychINFO/Ovid, Embase, CINAHL/EBSCO and Web of Science was conducted for original research published between 1997 and 2017. Sixty-two studies were identified as meeting the study criteria for the systematic review. Data on the means, standard deviations, and prevalence of the dimensions of burnout were extracted from 33 studies and included in the meta-analysis (n = 9409). The overall estimated pooled prevalence for emotional exhaustion was 40% (CI 31%-48%) for depersonalisation was 22% (CI 15%-29%) and for low levels of personal accomplishment was 19% (CI 13%-25%). The random effects estimate of the mean scores on the Maslach Burnout Inventory indicate that the average mental health professional has high levels of emotional exhaustion [mean 21.11 (95% CI 19.98, 22.24)], moderate levels of depersonalisation [mean 6.76 (95% CI 6.11, 7.42)] but retains reasonable levels of personal accomplishment [mean 34.60 (95% CI 32.99, 36.21)]. Increasing age was found to be associated with an increased risk of depersonalisation but also a heightened sense of personal accomplishment. Work-related factors such as workload and relationships at work, are key determinants for burnout, while role clarity, a sense of professional autonomy, a sense of being fairly treated, and access to regular clinical supervision appear to be protective. Staff working in community mental health teams may be more vulnerable to burnout than those working in some specialist community teams, e.g., assertive outreach, crisis teams.

The Role of the Registered Nurse Working in Substance Use Disorder Treatment: A Hermeneutic Study

Substance Use Disorders (SUDs) are a national public health crisis. However, there is minimal existing research literature on the role of the nurse working in SUD treatment. The purpose of this study was to describe the meaning of the professional role of the registered nurse working in the SUD setting. The study utilized a Heideggerian Phenomenological approach with a modified Colaizzi method for analysis and interpretation. The nine study participants, two males and seven females, aged 27-60 had worked in SUD treatment for 1-37 years. Three major themes, with sub-themes, emerged: Defining the Role for Self; Learning the Role; and Navigating with Ease in an Unchangeable Culture. Findings demonstrated that nurses in SUD treatment value their role and the care of patients with SUDs. Patient recovery or relapse influenced job satisfaction. Significantly, the findings highlighted an outdated role with rigid boundaries and no real contemporary identity. Findings can be used to address the need for a contemporary SUD nursing identity and to support ongoing involvement of nurses in health policy related to SUDs.

Compassion satisfaction and fatigue: A cross-sectional survey of Australian intensive care nurses

BACKGROUND

Compassion satisfaction and compassion fatigue influence nurses' intention to stay or leave nursing. Identification of compassion satisfaction or fatigue in critical care nurses is important in this high turnover workforce.

OBJECTIVES

The aim of this study was to examine factors predicting and contributing to compassion satisfaction and compassion fatigue experienced by critical care nurses in Australian intensive care units.

METHODS

A self-reported cross-sectional survey using an established tool collected data from critical care nurses of two adult Australian intensive care units.

RESULTS

Overall, these critical care nurses reported what Professional Quality of Life Scale guidelines designated as 'average' levels of compassion satisfaction and burnout, and 'low' levels of Secondary Traumatic Stress (STS). Compared to Site B, nurses at Site A had significantly higher compassion satisfaction (p=0.008) and lower STS scores (p=0.025), with site significantly predictive for compassion satisfaction (p<0.024) and STS (p<0.002). Nurses with postgraduate qualifications had significantly higher compassion satisfaction scores (p=0.027), and compassion satisfaction significantly increased with increasing duration of practice (p=0.042) as a nurse and in their current ICU (p=0.038). Burnout scores significantly reduced with increasing age, years of tenure and practice; burnout was predicted by lower years of tenure (p<0.016).

CONCLUSION

These critical care nurses revealed profiles that, whilst not in crisis, fell short of the ideal high compassion satisfaction and moderate/low fatigue. More recent tenure flags those potentially at higher risk of compassion fatigue, whilst the better scores associated with postgraduate education and from one site need further exploration. Further research should develop understanding and interventions to enhance compassion satisfaction and support retention of this crucial nursing workforce.

The therapeutic role of mental health nurses in psychiatric intensive care: A mixed-methods investigation in an inner-city mental health service

WHAT IS KNOWN ON THE SUBJECT?: Mental health services have been radically transformed since the 1990s, with an emphasis on care in the community. However, acute psychiatric wards remain an important component of service provision. Research shows that patients receive limited therapeutic interaction with nurses in such settings. A recent review showed that just 4%-12% of nurses' time was spent on activities that could be considered therapeutic. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE?: Whereas nurses wanted more time for individual therapeutic activity, patients were content with brief interactions. However, such contact was not always available, partly due to workload pressures. Both nurses and patients believed that a collaborative approach, involving the whole multidisciplinary team, was key to the success of therapeutic engagement. The meaning of therapeutic engagement remains nebulous. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurse education, ward management and clinical supervision should have greater emphasis on therapeutic engagement. Further research is needed to develop therapeutic engagement in acute psychiatric settings; such work should involve patients as active and equal partners.

ABSTRACT

Introduction Despite indications that therapeutic interaction is beneficial for patients and for nurses' job satisfaction in acute psychiatric care, research shows a small amount of nurses' time is spent on such activity. Aims This study investigated the actual and potential therapeutic role of the mental health nurse in psychiatric intensive care, where admission is due to violence or aggression. Methods In a mixed-methods concurrent triangulation design, clinician and patient activity was observed using a structured measurement tool, and qualitative interviews were conducted with four practitioners and six patients. Findings were generated using thematic analysis and descriptive statistics. Results Of the directly observed 234 clinician and 309 patient activities, 20.9% and 15.9%, respectively, were classified as therapeutic engagement. Interviews revealed that both clinicians and patients wanted more therapeutic contact, but whereas nurses wanted longer time to spend in individual sessions, patients preferred brief but more frequent interaction with nurses. Discussion This study shows disparity between actual and desirable levels of therapeutic interaction. Apart from organizational constraints, a fundamental problem is the lack of definition or established practices of therapeutic engagement. Implications for Practice There should be more emphasis on therapeutic engagement in nurse education, ward management and clinical supervision.

Prevalence of and factors associated with burnout among health care professionals in Arab countries: a systematic review

BACKGROUND

Burnout among healthcare professionals is one of the key challenges affecting health care practice and quality of care. This systematic review aims to (1) estimate the prevalence of burnout among health care professionals (HCP) in Arab countries; and (2) explore individual and work-related factors associated with burnout in this population.

METHODS

Multiple electronic databases were searched for studies published in English or Arabic from January 1980 to November 2014 assessing burnout (using the Maslach Burnout Inventory; MBI) amongst health care professionals (HCP) in Arab countries.

RESULTS

Nineteen studies (N = 4108; 49.3% females) conducted on HCP in Bahrain, Egypt, Jordan, Lebanon, Palestine, Saudi Arabia and Yemen were included in this review. There was a wide range of prevalence estimates for the three MBI subscales, high Emotional Exhaustion (20.0-81.0%), high Depersonalization (9.2-80.0%), and low Personal Accomplishment (13.3-85.8%). Gender, nationality, service duration, working hours, and shift patterns were all significantly associated with burnout.

CONCLUSIONS

Within the constraints of the study and the range of quality papers available, our review revealed moderate-to-high estimates of self-reported burnout among HCP in Arab countries that are similar to prevalence estimates in non-Arabic speaking westernized developed countries. In order to develop culturally appropriate interventions, further research using longitudinal designs is needed to confirm the risk factors for burnout in specific HCP settings and specialties in Arab countries.