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Nabirye AK, Munabi IG, Mubuuke AG, Kiguli S. Emotional and Psychological Experiences of Nursing students caring for Dying Patients: A phenomenology study at Mulago National Hospital, Uganda. RESEARCH SQUARE 2024:rs.3.rs-4323878. [PMID: 38766228 PMCID: PMC11100906 DOI: 10.21203/rs.3.rs-4323878/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Introduction Caring for dying patients is associated with psychological trauma, strong emotions and enormous stress for nursing staff and nursing students who are relied on by patients and relatives in such difficult situations. Although nurses have an ability of self-control and calm approach towards death, there are still some emotions they need to "work through". Research studies have documented limited exposure of nursing students to end-of-life care and inadequate understanding of the psychological and emotional experiences they encounter during clinical placements. This study explored the psychological and emotional experiences of Ugandan student nurses on caring for the dying patients at Mulago national referral hospital during clinical placement. Methods A qualitative phenomenological study was conducted among fifteen undergraduate nursing students of Makerere University in clinical placement at Mulago hospital. An In-depth interview guide was used to gather data on nursing students' emotional and psychological experiences and coping mechanisms. Data was audio recorded, verbatim transcribed and thematically analyzed using Atlas. ti version 6 software. Results The nursing students emotional and psychological experiences when caring for dying patients were emerged into two themes; (1) Psychological and emotional reactions, (2) Coping mechanisms. The sub themes were; anger, anxiety and depression which is triggered by a combination of issues of pressure from relatives, failure to save the dying patient, thoughts of wasted efforts to reverse the dying process, limited resources, limited technical and emotional support. The students cope by seeking help from peers, engagement in problem solving, distancing from patients, spirituality and engaging in personal stress reducing activities. Conclusion Insights from this study provide educators with a snapshot of student encounters, emotions, and coping strategies when facing dying patients and their families. Nursing students experience various negative emotional and psychological stressors triggered by a combination of issues that need to be addressed during care of dying patients. However, they devise different coping mechanisms to continue with provision of necessary end of life care as the clinical placement contributes to their learning, experience and builds confidence among student nurses.
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Bloomer MJ, Ranse K, Adams L, Brooks L, Coventry A. "Time and life is fragile": An integrative review of nurses' experiences after patient death in adult critical care. Aust Crit Care 2023; 36:872-888. [PMID: 36371292 DOI: 10.1016/j.aucc.2022.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Providing bereavement support and care to families is an aspect of critical care nursing practice that can be rewarding, yet emotionally and psychologically challenging. Whilst significant research has focused on end-of-life care in critical care, less is known about nurses' experiences after patient death. AIM The aim of this study was to synthesise research evidence on the experience of registered nurses after patient death in adult critical care. DESIGN A structured integrative review of the empirical literature was undertaken. A combination of keywords, synonyms, and Medical Subject Headings were used across the Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Ovid Medline, PsycInfo, Embase, and Emcare databases. Records were independently assessed against inclusion and exclusion criteria. A process of forward and backward chaining was used to identify additional papers. All papers were assessed for quality. Narrative synthesis was used to analyse and present the findings. RESULTS From the 4643 records eligible for screening, 36 papers reporting 35 studies were included in this review, representing the voices of 1687 nurses from more than 20 countries. Narrative synthesis revealed three themes: (i) postmortem care, which encompassed demonstrating respect and dignity for the deceased, preparation of the deceased, and the concurrent death rituals performed by nurses; (ii) critical care nurses' support of bereaved families, including families of potential organ donors and the system pressures that impeded family support; and (iii) nurses' emotional response to patient death including coping mechanisms. CONCLUSIONS Whilst a focus on the provision of high-quality end-of-life care should always remain a priority in critical care nursing, recognising the importance of after-death care for the patient, family and self is equally important. Acknowledging their experience, access to formal education and experiential learning and formal and informal supports to aid self-care are imperative.
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Affiliation(s)
- Melissa J Bloomer
- End of Life Advisory Panel, Australian College of Critical Care Nurses, Victoria, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Nursing & Midwifery, Griffith University, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Queensland Health, Queensland, Australia.
| | - Kristen Ranse
- End of Life Advisory Panel, Australian College of Critical Care Nurses, Victoria, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Nursing & Midwifery, Griffith University, Queensland, Australia
| | - Leah Adams
- End of Life Advisory Panel, Australian College of Critical Care Nurses, Victoria, Australia; Intensive Care Unit, Latrobe Regional Hospital, Victoria, Australia
| | - Laura Brooks
- End of Life Advisory Panel, Australian College of Critical Care Nurses, Victoria, Australia; School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Deakin University, Victoria, Australia
| | - Alysia Coventry
- End of Life Advisory Panel, Australian College of Critical Care Nurses, Victoria, Australia; St Vincent's Health Network Sydney, St Vincent's Hospital, Melbourne and Australian Catholic University, Australia
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Giménez-Espert MDC, Maldonado S, Prado-Gascó V. Influence of Emotional Skills on Attitudes towards Communication: Nursing Students vs. Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4798. [PMID: 36981707 PMCID: PMC10048995 DOI: 10.3390/ijerph20064798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/01/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
Communication in nursing is essential to the quality of care and patients' satisfaction, and personal variables such as empathy and emotional intelligence (EI) can improve it; however, no studies have to date analyzed these competencies and their relations among nursing students compared with nurses. The aims of this study are, therefore, to analyze the differences between nursing students and nurses in the means for empathy, EI and attitudes towards communication in order to assess the impact of empathy and EI on nurses' and nursing students' attitudes towards communication, and their influence on the behavioral dimension of attitude. A cross-sectional descriptive study was performed on a convenience sample of 961 nursing students and 460 nurses from the Valencian Community, Spain. T-test and hierarchical regression models (HRM) were used. The data was collected in the selected universities in the 2018/2019 academic year. The results showed high levels in all the variables analyzed (i.e., empathy, EI, and attitudes towards communication) in both samples. The HRM results suggested that empathy was a better predictor than EI of the attitudes towards patient communication among both the nursing students and nurses. In the behavioral dimension of the attitude, the cognitive and affective dimensions had greater weight than the emotional component (i.e., empathy and EI). Developing empathy and the cognitive dimension of the attitude in nursing students and nurses could, therefore, help improve EI and attitudes towards communication. These findings are important for developing intervention programs adjusted to real needs.
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Affiliation(s)
- María del Carmen Giménez-Espert
- Nursing Department, Faculty of Nursing and Chiropody, University of Valencia, Avd/ Menéndez Pelayo, s/n, 46010 Valencia, Spain
| | - Sandra Maldonado
- Nursing Department of the School of Health Sciences, Human Services and Nursing, Lehman College, CUNY, 250 Bedford Park West, New York, NY 10468, USA
| | - Vicente Prado-Gascó
- Social Psychology Department, Faculty of Psychology, University of Valencia, Av. Blasco Ibáñez, 21, 46010 Valencia, Spain
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Johnson E, Jack B. Grey area nursing: high-dependency nurses’ experiences of caring for patients approaching the transition from curative to palliative care. Int J Palliat Nurs 2022; 28:515-521. [DOI: 10.12968/ijpn.2022.28.11.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Nurses in high-dependency units frequently facilitate the withdrawal of life-sustaining treatments and provide end-of-life care. Providing this care has been shown to cause distress, burnout and cumulative grief. There remains a lack of understanding of high dependency nurses’ experiences of caring for patients approaching withdrawal of life-sustaining treatments. Aim: To explore experiences of high dependency nurses caring for patients approaching withdrawal of life-sustaining treatment and highlight any support or needs they may have. Methods: Interviews were conducted and analysed using qualitative thematic analysis. Findings: Nurses experienced conflict in decision making, which was reported to prolong patient distress and cause nurses moral anguish. Nurses need time to talk and further education to support them to provide withdrawal of life-sustaining treatment. Conclusion: High-dependency nurses need time to talk following caring for this patient group and more extensive education to support them to provide quality end-of-life care.
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Affiliation(s)
- Emily Johnson
- Palliative Care Nurse, Liverpool Foundation Trust, UK
| | - Barbara Jack
- Professor of Palliative and End-of-Life Care; Academic Programme Lead (MSc/PG Cert Integrated), Queenscourt Hospice, Edge Hill University, UK
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Wolf ZR, Bailey DN, Stubin CA. Bodywork and nursing practice: Development of a bodywork in nursing practice instrument. Nurs Forum 2022; 57:509-529. [PMID: 35133646 DOI: 10.1111/nuf.12703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 01/15/2022] [Accepted: 01/23/2022] [Indexed: 06/14/2023]
Abstract
Nursing's continued focus on caring for physical aspects of patients' bodies underscores the importance of bodywork and shows nursing's privileged, professional access to patients. This instrument development study presents the first phases of a new instrument. It established a conceptual definition of nursing's bodywork and initial psychometric properties of the Nursing Bodywork Instrument. Literature sources generated codes and clusters for item development. Literature-based and expert content validity were demonstrated. A pilot study tested nurses' (N = 53) agreement with draft items. The highest-ranked items confirmed nurses' bodywork and reliance on technological devices when giving direct patient care. Known groups validity testing by groups' years as a nurse did not differ statistically. Internal consistency reliability was 0.98 on the 128-item instrument, pointing to the need for future reduction. Inter-item correlations suggested that factor analysis with a large sample size might generate domains descriptive of nursing's bodywork. A total of 125 items resulted from item analysis and subsequent item revision. All items were matched with clusters; for example, technologic device management, physical comfort facilitation, skin/wound management, self-care facilitation, and respiratory management include some item clusters.
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Affiliation(s)
- Zane R Wolf
- Nursing Program, School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania, USA
| | - Denise N Bailey
- Nursing Program, School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania, USA
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Wendlandt B, Kime M, Carson S. The impact of family visitor restrictions on healthcare workers in the ICU during the COVID-19 pandemic. Intensive Crit Care Nurs 2022; 68:103123. [PMID: 34456111 PMCID: PMC8315942 DOI: 10.1016/j.iccn.2021.103123] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 07/05/2021] [Accepted: 07/17/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE To obtain information on how family visitor restriction during the COVID-19 pandemic has impacted the workplace experience of physicians and nurses in the medical intensive care unit, and to assess differences by profession. MATERIALS AND METHODS We developed a survey containing closed- and open-ended questions, applying both quantitative and qualitative analyses to our results. RESULTS Of the 74 respondents, 29 (38%) were nurses and 45 (62%) were physicians. Nurses reported positive changes to daily workflow and the ability to provide medical care, while physicians reported negative changes in these areas. Both groups reported decreased comprehension and increased distress among families, and decreased ability to provide end-of-life care. For the qualitative analysis, eight themes were identified: the patient's room as space, creation of a new space through virtual communication, time, increased complexity of care, challenges around the use of technology, adjustments to team roles and responsibilities, desire for families to return, and internal tension. CONCLUSION Intensive care physicians and nurses reported both positive and negative effects of family visitor restriction during the COVID-19 pandemic, with significant differences based on profession. Both groups expressed concern for an overall negative impact of visitor restriction on healthcare workers, patients, and their families.
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Affiliation(s)
- Blair Wendlandt
- Corresponding author at: 130 Mason Farm Road CB#7020, Chapel Hill, NC 27599, United States
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Thompson L, Bidwell S, Seaton P. The COVID-19 pandemic: Analysing nursing risk, care and careerscapes. Nurs Inq 2021; 29:e12468. [PMID: 34750928 PMCID: PMC8646573 DOI: 10.1111/nin.12468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 12/13/2022]
Abstract
This qualitative study explores how junior nurses, and some who were still in training, navigated the complexities and uncertainties engendered by the COVID-19 pandemic. Data are drawn from in-depth interviews with 18 students/nurses in Christchurch, New Zealand. Managing intertwining risk, care and careerscapes takes an intensified form as existing infection control rules, established norms of care, boundaries between home and work and expected career trajectories roil. 'Safe' and 'risky' spaces are porous but maintained using contextual, critical, clinical judgement. Carescapes are stretched, both within and beyond the walls of healthcare settings. Within the COVID-19 riskscape, careerscapes are open to both threat and opportunity. Countries demand much of their healthcare staff in times of heath crises, but have a limited appreciation of what it takes to translate seemingly tightly bounded protocols into effective practice. The labour required in this work of translation is navigated moment by moment. To surface some of this invisible work, those implementing pandemic plans may need to more carefully consider how to incorporate attention to the work/home/public boundary as well as overtly acknowledging the invisible emotional, physical and intellectual labour carried out in crisis risk, care and careerscapes.
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Affiliation(s)
- Lee Thompson
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Susan Bidwell
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Philippa Seaton
- Department of Postgraduate Nursing, University of Otago, Christchurch, New Zealand
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A national Position Statement on adult end-of-life care in critical care. Aust Crit Care 2021; 35:480-487. [PMID: 34384650 DOI: 10.1016/j.aucc.2021.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/27/2021] [Accepted: 06/06/2021] [Indexed: 11/24/2022] Open
Abstract
Patient death in critical care is not uncommon. Rather, the provision of end-of-life care is a core feature of critical care nursing, yet not all nurses feel adequately prepared for their role in the provision of end-of-life care. For this reason, the Australian College of Critical Care Nurses (ACCCN) supported the development of a Position Statement to provide nurses with clear practice recommendations to guide the provision of end-of-life care, which reflect the most relevant evidence and information associated with end-of-life care for adult patients in Australian critical care settings. A systematic literature search was conducted between June and July, 2020 in CINAHL Complete, Medline, and EMBASE databases to locate research evidence related to key elements of end-of-life care in critical care. Preference was given to the most recent Australian or Australasian research evidence, where available. Once the practice recommendations were drafted in accordance with the research evidence, a clinical expert review panel was established. The panel comprised clinically active ACCCN members with at least 12 months of clinical experience. The clinical expert review panel participated in an eDelphi process to provide face validity for practice recommendations and a subsequent online meeting to suggest additional refinements and ensure the final practice recommendations were meaningful and practical for critical care nursing practice in Australia. ACCCN Board members also provided independent review of the Position Statement. This Position Statement is intended to provide practical guidance to critical care nurses in the provision of adult end-of-life care in Australian critical care settings.
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Jackson J, Anderson JE, Maben J. What is nursing work? A meta-narrative review and integrated framework. Int J Nurs Stud 2021; 122:103944. [PMID: 34325358 DOI: 10.1016/j.ijnurstu.2021.103944] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND There is ample evidence that modern nurses are under strain and that interventions to support the nursing workforce have not recognised the complexity inherent in nursing work. Creating a modern model of nursing work may assist nurses in developing workable solutions to professional problems. A new model may also foster cohesion among broad and diverse nursing roles. AIM The aim of this meta-narrative review was to investigate how researchers, using different methods and theoretical approaches, have contributed to the understanding of nursing work. METHODS A meta-narrative review was done to evaluate the trajectory of nursing work research, from 1953 to present. This review progressed through the stages of planning, searching, mapping, appraisal, and synthesis. FINDINGS A total of 121 articles were included in this meta-narrative review. These articles revealed five narratives of nursing work, where work is conceptualised as labour. These narratives were physical labour (n = 14), emotional (n = 53), cognitive (n = 24), and organisational (n = 1), and combinations of more than one type of labour (n = 29 articles). The paradigms identified in the meta-narrative were the positivist, interpretive, critical, and evidence-based paradigms. Each article in the review corresponded with a paradigm and a labour narrative, creating a comprehensive model. CONCLUSIONS Nursing work can be understood as a model of physical, emotional, cognitive, and organisational labour. These different types of labour may be hidden and taken for granted. Nurses can use this model to articulate what they do and how it supports patient safety. Nurses can also advocate for staffing allocations that consider all types of nursing labour. Tweetable abstract Nursing work is complex and includes physical, emotional, cognitive, and organisational labour. Staffing needs to take all nursing labour into account.
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Affiliation(s)
- Jennifer Jackson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK.
| | - Janet E Anderson
- Professor of Quality of Care for Older People, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB UK.
| | - Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Duke of Kent Building, Guildford, GU2 7XH UK.
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Kirk K, Cohen L, Edgley A, Timmons S. "I don't have any emotions": An ethnography of emotional labour and feeling rules in the emergency department. J Adv Nurs 2021; 77:1956-1967. [PMID: 33576110 DOI: 10.1111/jan.14765] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/18/2020] [Accepted: 01/10/2021] [Indexed: 11/28/2022]
Abstract
AIMS This study aims to apply Hochschild's theory of emotional labour to emergency care, and uncover the 'specialty-specific' feeling rules driving this labour. Despite the importance of positive nurse well-being, the emotional labour of nursing (a great influencer in wellbeing) remains neglected. DESIGN AND METHODS Ethnography enabled immersion in the ED setting, gathering the lived experiences and narratives of the ED nursing team. We undertook first-hand observations at one major trauma centre ED and one district general ED including semi-structured interviews (18). A reflexive and interpretive approach towards thematic analysis was used. RESULTS We unearthed and conceptualized four feeling rules born from this context and offer extensive insights into the emotional labour of emergency nurses. CONCLUSION Understanding the emotional labour and feeling rules of various nursing specialties offers critical insight into the challenges facing staff - fundamental for nursing well-being and associated retention programs. IMPACT What problem did the study address? What were the main findings? Where and on whom will the research have impact? Academically, this research expands our understanding - we know little of nurses' feeling rules and how specialties influence them. Clinically, (including service managers and policy makers) there are practical implications for nurse well-being.
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Affiliation(s)
- Kate Kirk
- School of Health Sciences, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - Laurie Cohen
- Nottingham University Business School, Nottingham, UK
| | - Alison Edgley
- School of Health Sciences, University of Nottingham, Queens Medical Centre, Nottingham, UK
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Kirk K, Edgley A. Insights into nurses' precarious emotional labour in the emergency department. Emerg Nurse 2021; 29:22-26. [PMID: 33125201 DOI: 10.7748/en.2020.e2039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nurses in the emergency department (ED) work in emotionally charged situations and undertake extensive emotional labour. However, that labour is not visible to others, often overlooked and therefore undervalued. Furthermore, there is a lack of literature on the topic. AIM To explore ED nurses' experiences of emotional labour. METHODS In-depth semi-structured interviews were conducted with two staff nurses working in the ED of a large UK teaching hospital. Rigorous methods of data collection and analysis, including a strong reflexive stance, were adopted. FINDINGS Among three overarching themes that emerged from the data, two related more specifically to the ED: 'precarious emotional labour' and 'grieving etiquette'. Participants were found to perform sophisticated forms of emotional labour to manage the precariousness of their role, and to conceal or suppress their own feelings in order to maintain the grieving etiquette. CONCLUSION The ED is an environment that requires sophisticated but precarious forms of emotional labour. Recognising, valuing and supporting the emotional aspect of an ED nurse's role is essential if emergency services are to remain functional, efficient and humane.
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Affiliation(s)
- Kate Kirk
- School of Health Sciences, University of Nottingham and Nottingham University Hospitals Trust, Nottingham, England
| | - Alison Edgley
- School of Health Sciences, University of Nottingham, Nottingham, England
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12
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The process of giving information to families in intensive care units: A narrative review. ENFERMERIA INTENSIVA 2020; 32:18-36. [PMID: 32763104 DOI: 10.1016/j.enfi.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 09/26/2019] [Accepted: 11/24/2019] [Indexed: 11/23/2022]
Abstract
AIM Information is one of the most important needs of families of critical patients. Healthcare professionals also identify the great value of communication with families to reduce their anxiety and stress. Despite this, families may feel inadequately informed, causing added suffering. The purpose of this study is to provide an understanding of both families' and healthcare professionals' perspectives on information giving within intensive care units (ICU). METHOD A narrative review was conducted using MEDLINE, CINAHL, PsycINFO databases and the Cochrane Library to identify studies published in either English or Spanish from 2002 to 2018. RESULTS 47 studies were included, and five categories were identified: 1)"the need to know"; 2)family satisfaction with the information received; 3)impact of information on families' experiences in the ICU; 4)nurses and physicians' perceptions of information transmission, and 5)information process in the ICU. CONCLUSIONS Providing honest and truthful information to the families of critical patients is essential to reduce family anxiety and increase family control, although this often appears to be inadequately accomplished by staff. Interdisciplinary involvement in information giving may be beneficial for both families and ICU professionals. This review brings new understanding about the process of information to families of ICU patients and it can be used to improve the quality and humanization of care in the ICUs.
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Kalocsai C, des Ordons AR, Sinuff T, Koo E, Smith O, Cook D, Golan E, Hales S, Tomlinson G, Strachan D, MacKinnon CJ, Downar J. Critical care providers' support of families in bereavement: a mixed-methods study. Can J Anaesth 2020; 67:857-865. [PMID: 32240521 DOI: 10.1007/s12630-020-01645-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/13/2020] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE When people die in intensive care units (ICUs), as many as half of their family members may experience a severe grief reaction. While families report a need for bereavement support, most ICUs do not routinely follow-up with family members. Clinicians are typically involved in supporting families during death and dying, yet little is known about how they work with families in bereavement. Our goal was to explore how clinicians support bereaved families, identify factors that facilitate and hinder support, and understand their interest and needs for follow-up. METHODS Mixed-methods study of nurses and physicians working in one of nine adult medical-surgical ICUs in academic hospitals across Canada. Qualitative interviews followed quantitative surveys to reflect, expand, and explain the quantitative results. RESULTS Both physicians and nurses perceived that they provided empathetic support to bereaved families. Emotional engagement was a crucial element of support, but clinicians were not always able to engage with families because of their roles, responsibilities, experiences, or unit resources. Another important factor that could facilitate or challenge engagement was the degree to which families accepted death. Clinicians were interested in participating in a follow-up bereavement program, but their participation was contingent on time, training, and the ability to manage their own emotions related to death and bereavement in the ICU. CONCLUSIONS Multiple opportunities were identified to enhance current bereavement support for families, including the desire of ICU clinicians for formal follow-up programs. Many psychological, sociocultural, and structural factors would need to be considered in program design.
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Affiliation(s)
- Csilla Kalocsai
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Centre for Addiction and Mental Health, CAMH Education, 33 Russell Street, Rm. 2054, Toronto, ON, M5S 2S1, Canada.
| | - Amanda Roze des Ordons
- Division of Palliative Medicine, Department of Critical Care Medicine, Department of Oncology, Department of Anesthesiology, University of Calgary, Calgary, AB, Canada
| | - Tasnim Sinuff
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Ellen Koo
- University Health Network, Toronto, ON, Canada
| | - Orla Smith
- St. Michael's Hospital, Toronto, ON, Canada
| | - Deborah Cook
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Eyal Golan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Hales
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - George Tomlinson
- University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - James Downar
- Division of Palliative Care, University of Ottawa, Ottawa, ON, Canada
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14
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Moran RJ, Asquith NL. Understanding the vicarious trauma and emotional labour of criminological research. METHODOLOGICAL INNOVATIONS 2020. [DOI: 10.1177/2059799120926085] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The psychological cost of exposure to traumatic events is receiving greater recognition in recent years, especially in terms of its impact in helping professions and emergency services. However, the costs to researchers remain relatively unexplored. In this article, we will discuss the nature and impact of vicarious trauma using two criminological research projects as case studies: one a qualitative project engaging with survivors of childhood sexual abuse, and the other, a quantitative analysis of police hate crime reports. In addition to considering the trauma elicited in fieldwork such as interviews, we interrogate the costs imposed on researchers during the coding and analysing processes. We suggest that the cost is potentially greater when the researcher has a personal connection with the issues being researched, but that this personal experience also provides the researcher with important skills for responding to new or compounded trauma. The costs of engagement with trauma may be compensated by the productive outputs and impact on policy and practice that this type of research may elicit. Understanding the impact and costs of engaging with close analyses of trauma is critical in developing more robust and ethical research processes to ensure that this trauma is appropriately managed so as to avert the long-term damage this work can inflict on researchers and participants.
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Affiliation(s)
- Rebecca J Moran
- University of New South Wales, Sydney, NSW, Australia
- Curtin University, Bentley, WA, Australia
| | - Nicole L Asquith
- Western Sydney University, Penrith, NSW, Australia
- Tasmanian Institute of Law Enforcement Studies, University of Tasmania, Hobart, TAS, Australia
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Gullick J, West S. Heideggerian hermeneutic phenomenology as method: modelling analysis through a meta-synthesis of articles on Being-towards-death. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:87-105. [PMID: 31264089 DOI: 10.1007/s11019-019-09911-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
While the richness of Heideggerian philosophy is attractive as a healthcare research framework, its density means authors rarely utilise its fullest possibilities as an hermeneutic analytic structure. This article aims to clarify Heideggerian hermeneutic analysis by taking one discrete element of Heideggerian philosophy (Being-towards-death), and using it's clearly defined structure to conduct a meta-synthesis of Heideggerian phenomenological studies on the experience of living with a potentially life-limiting illness. The findings richly illustrate Heidegger's philosophy that there is either an inauthentic positioning towards death, or an authentic positioning towards death with a proposition that (1) death is certain; (2) death is indefinite; (3) death is non-relational; and (4) death is not-to-be-outstripped. None of the 29 included studies on the experience of a confrontation with death fully utilised this framework, despite claiming a grounding in Heideggerian thought. This demonstrates the value in modelling how Heideggerian existential structures can be used proactively as analytical 'hooks' for data in research claiming a basis in this philosophy and/or method. By modelling the potential application of an important Heideggerian philosophical construct to published qualitative data, this meta-synthesis has revealed new domains and more nuanced understandings of the temporal structure of Being-towards-death. Such an approach helps to more fully unveil the existential concerns of people at the core of interpretative phenomenological enquiry and may provide a blueprint to map either primary or synthesised data to other key ontological existentials.
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Affiliation(s)
- Janice Gullick
- A4:32, MO2, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- International Institute of Qualitative Methods, University of Alberta, Edmonton, AB, Canada.
| | - Sandra West
- A5:11, MO2, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Ghaedi F, Ashouri E, Soheili M, Sahragerd M. Nurses' Empathy in Different Wards: A Cross-Sectional Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:117-121. [PMID: 32195156 PMCID: PMC7055183 DOI: 10.4103/ijnmr.ijnmr_84_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/23/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022]
Abstract
Background: Empathy is an important component of the nurse-client relationship and nursing care. The current study aimed to compare nurses' level of empathy with patients in critical care units, psychiatric, and emergency wards. Materials and Methods: The present cross-sectional study was conducted on 112 nurses selected by convenience sampling in three educational hospitals affiliated with Isfahan University of Medical Sciences, Iran from June to September 2017. Data collection tool was a two-part questionnaire consisting of sociodemographic data (such as age, gender, and work experience) and Jefferson Scale of Empathy (JSE) containing 20 items, scored according to Likert scale from totally agree (7 points) to totally disagree (1 point). In total, the maximum score was 140 and the minimum score was 20. Data were analyzed using SPSS version 16 as well as descriptive and analytical statistical tests (multiple regression). Results: The mean (SD) empathy score of nurses working in critical care units, emergency, and psychiatric wards was 87.51 (6.65), 87.59 (4.90), and 90.71 (7.12), respectively. Regarding the regression models, it was observed that only the work experience was a significant predictor for empathy (β = 0.19, p = 0.04). This model predicted 3.50% of variances in the nurses' empathy. Conclusions: Nurses' level of empathy in this study was above average with equal scores in different wards. Therefore, increasing the nurses' level of empathy is essential in interventional studies.
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Affiliation(s)
- Fatemeh Ghaedi
- Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elaheh Ashouri
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mozhgan Soheili
- PhD Student of Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Sahragerd
- Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Lamiani G, Dordoni P, Vegni E, Barajon I. Caring for Critically Ill Patients: Clinicians' Empathy Promotes Job Satisfaction and Does Not Predict Moral Distress. Front Psychol 2020; 10:2902. [PMID: 31969851 PMCID: PMC6960200 DOI: 10.3389/fpsyg.2019.02902] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 12/06/2019] [Indexed: 12/30/2022] Open
Abstract
Background Several studies have highlighted the benefits of empathy in healthcare settings. A correlation between clinicians' empathy and patients' adherence and satisfaction, as well as the ability for the clinician to accurately assess family members' needs, has been found. However, empathy is often seen by clinicians as a risk factor for their wellbeing. This study aims to assess whether the level of empathy of clinicians working in critical care settings may expose them to moral distress, poor job satisfaction, and intention to quit their job. Methods Italian clinicians who attended the 2016 "Smart Meeting Anesthesia Resuscitation in Intensive Care" completed the Empathy Quotient questionnaire, the Moral Distress Scale-Revised, and two questions assessing job satisfaction and intention to quit the job. Multiple linear and logistic regressions were performed to determine if clinicians' empathy influences moral distress, job satisfaction, and intention to quit. Age, gender, and profession were used as control variables. Results Out of 927 questionnaires distributed, 216 were returned (23% response rate) and 210 were used in the analyses. Respondents were 56% physicians, 24% nurses, and 20% residents. Over half of the clinicians (58%) were female. Empathy resulted the only significant predictor of job satisfaction (β = 0.193; p < 0.05). None of the variables included in the model predicted moral distress. Conclusion Empathy determined neither moral distress nor intention to quit. Findings suggest that empathy is not a risk factor for critical care clinicians in developing moral distress and the intention to quit their job. On the contrary, empathy was found to enhance clinicians' job satisfaction.
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Affiliation(s)
- Giulia Lamiani
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Paola Dordoni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Elena Vegni
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Isabella Barajon
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Barnett MD, Hays KN, Cantu C. Compassion fatigue, emotional labor, and emotional display among hospice nurses. DEATH STUDIES 2019; 46:290-296. [PMID: 31814533 DOI: 10.1080/07481187.2019.1699201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to investigate relationships between compassion fatigue, emotional labor, and emotional display among hospice nurses (N = 90; 94.4% women). The hospice nurses indicated the emotional labor they utilize is primarily suppressing both positive and negative affect. Compassion fatigue was positively associated with expressing negative emotions, faking negative emotions, negative display rule perceptions, and surface acting, and negatively associated with suppressing negative emotions. Interventions and policies that foster greater authenticity and support emotional regulation may help reduce compassion fatigue among hospice nurses.
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Affiliation(s)
- Michael D Barnett
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, Texas, USA
| | - Kathryn N Hays
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Christina Cantu
- Department of Psychology & Behavioral Sciences, Louisiana Tech University, Ruston, Louisiana, USA
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Abstract
RATIONALE Caring for patients at the end of life is emotionally taxing and may contribute to burnout. Nevertheless, little is known about the factors associated with emotional distress in intensive care unit (ICU) nurses. OBJECTIVES To identify patient and family factors associated with nurses' emotional distress in caring for dying patients in the ICU. METHODS One hundred nurses who cared for 200 deceased ICU patients at two large academic medical centers in the Northeast United States were interviewed about patients' psychological and physical symptoms, their reactions to those patient experiences (e.g., emotional distress), and perceived factors contributing to their emotional distress. Logistic regression analyses modeled nurses' emotional distress as a function of patient symptoms and care. RESULTS Patients' overall quality of death (odds ratio [OR], 3.08; 95% confidence interval [CI], 1.31-7.25), suffering (OR, 2.34; CI, 1.03-5.29), and loss of dignity (OR, 2.95; CI, 1.19-7.29) were significantly associated with nurse emotional distress. Some 40.5% (79 of 195) of nurses identified families' fears of patient death, and 34.4% (67 of 195) identified families' unrealistic expectations as contributing to their own emotional distress. CONCLUSIONS Patients' emotional distress, physical distress, and perceived quality of death are associated with nurse emotional distress. Unrealistic family expectations for the patient may be a source of nurse emotional distress. Improving patients' quality of death, including enhancing their dignity, reducing their suffering, and promoting acceptance of an impending death among family members may improve the emotional health of nurses.
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Rodríguez-Huerta MD, Álvarez-Pol M, Fernández-Catalán ML, Fernández-Vadillo R, Martín-Rodríguez M, Quicios-Dorado B, Díez-Fernández A. An informative nursing intervention for families of patients admitted to the intensive care unit regarding the satisfaction of their needs: The INFOUCI study. Intensive Crit Care Nurs 2019; 55:102755. [PMID: 31515006 DOI: 10.1016/j.iccn.2019.102755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 11/26/2022]
Abstract
AIM To evaluate whether an informative intervention by nursing professionals through Short Message Service (SMS) improved patients' family members' satisfaction with the intensive care experience. METHODS/DESIGN This was an exploratory, two-armed, randomised, non-pharmacological, prospective study. The intervention consisted of providing information to the contact persons of patients admitted to the ICU of the University Hospital La Princesa (Madrid, Spain) through SMS based on the patient's nursing assessment. Nursing diagnoses established by NANDA and based on the Virginia Henderson model were used as a reference. The main result was the satisfaction levels of the contacts of patients admitted to the intensive care unit, which was evaluated with the Critical Care Family Needs Inventory. RESULTS The total score on the Critical Care Family Needs Inventory was significantly better in the intervention group (16.6 ± 3.3 vs. 19.1 ± 4.7; p = 0.012) compared with the control group. All participants included in the intervention considered it useful to some degree. Even when the contact person received negative information, there was no demand for information outside established hours, which was included as a possible adverse effect of the intervention. CONCLUSION Support in the form of additional nursing information implied an increase in the satisfaction of the needs perceived by the contact persons of patients admitted to the intensive care unit, together with a better perception of the quality of intensive care unit care and a reassuring and beneficial effect.
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Affiliation(s)
| | | | | | | | | | | | - Ana Díez-Fernández
- Universidad de Castilla-La Mancha, Faculty of Nursing, Cuenca, Spain; Universidad de Castilla-La Mancha, Social and Health Care Research Center, Cuenca, Spain.
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21
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Krawczyk M. Organizing end of life in hospital palliative care: A Canadian example. Soc Sci Med 2019; 291:112493. [DOI: 10.1016/j.socscimed.2019.112493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 08/04/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
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Page P, Simpson A, Reynolds L. Bearing witness and being bounded: The experiences of nurses in adult critical care in relation to the survivorship needs of patients and families. J Clin Nurs 2019; 28:3210-3221. [PMID: 31017337 DOI: 10.1111/jocn.14887] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/08/2019] [Accepted: 03/21/2019] [Indexed: 11/27/2022]
Abstract
AIM To discern and understand the responses of nurses to the survivorship needs of patients and family members in adult critical care units. BACKGROUND The critical care environment is a demanding place of work which may limit nurses to immediacy of care, such as the proximity to death and the pressure of work. DESIGN A constructivist grounded theory approach with constant comparative analysis. METHODS As part of a wider study and following ethical approval, eleven critical care nurses working within a general adult critical care unit were interviewed with respect to their experiences in meeting the psychosocial needs of patients and family members. Through the process of constant comparative analysis, an overarching selective code was constructed. EQUATOR guidelines for qualitative research (COREQ) were applied. RESULTS The data illuminated a path of developing expertise permitting integration of physical, psychological and family care with technology and humanity. Gaining such proficiency is demanding, and the data presented reveal the challenges that nurses experience along the way. CONCLUSION The study confirms that working within a critical care environment is an emotionally charged challenge and may incur an emotional cost. Nurses can find themselves bounded by the walls of the critical care unit and experience personal and professional conflicts in their role. Nurses bear witness to the early stages of the survivorship trajectory but are limited in their support of ongoing needs. RELEVANCE TO CLINICAL PRACTICE Critical care nurses can experience personal and professional conflicts when caring for both patients and families. This can lead to moral distress and may contribute to compassion fatigue. Critical care nurses appear bounded to the delivery of physiological and technical care, in the moment, as demanded by the patient's acuity. Consequentially, this limits nurses' ability to support the onward survivorship trajectory. Increased pressure and demands on critical care beds have contributed further to occupational stress in this care setting.
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Affiliation(s)
- Pamela Page
- Faculty of Health Social Care & Education, School of Nursing & Midwifery, Anglia Ruskin University, Chelmsford, UK
| | - Alan Simpson
- School of Health Sciences, Centre for Mental Health Research, City, University of London, London, UK
| | - Lisa Reynolds
- Nursing Division, School of Health Sciences, City, University of London, London, UK
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23
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Cluley V. Becoming-care: reframing care work as flesh work not body work. CULTURE AND ORGANIZATION 2019. [DOI: 10.1080/14759551.2019.1601724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Alshahrani S, Magarey J, Kitson A. Relatives' involvement in the care of patients in acute medical wards in two different countries-An ethnographic study. J Clin Nurs 2018. [PMID: 29514398 DOI: 10.1111/jocn.14337] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore the nature of relatives' involvement in the care of patients in acute medical settings in Australia and Saudi Arabia and to explore the perceptions, attitudes and experiences of nurses. BACKGROUND There is little known about how relatives respond to being involved in patient care and the impact this has on the quality of care. Equally, little is known about how nurses enable such involvement. Previous studies have focused on settings such as critical care and paediatrics where relatives' involvement as advocates is mostly acknowledged and accepted. DESIGN The study used a qualitative ethnographic approach based on an interpretive paradigm. METHODS Data collection was carried out in medical settings in two major hospitals: one in Australia and another in Saudi Arabia. Data were collected by observations and interviews over a 6-month period, with 3 months spent in each setting. RESULTS In both fields, relatives and nurses faced ongoing ambiguity about the role relatives should play in the hospital environment. Nurses were challenged by the unpredictability of relatives' participation in patient care. The nurses' fear of taking responsibility and uncertainty about the relatives' role led them to take varied and individualised approaches to the involvement of relatives in patient care. Relatives were unclear about how to behave in the role; what the needs of patients were; and whether they were contributing positively to care and this resulted in frustration. CONCLUSION The results show that ambiguity regarding the role of relatives led to problems in patient care such as safety concerns and conflict with nurses. RELEVANCE TO CLINICAL PRACTICE This study identified the need for patients' relatives and nursing staff to more actively engage in negotiating and managing their respective roles in acute medical areas. This could be supported by the development and use of a set of principles or guidelines for nurses, relatives and patients regarding relatives' involvement in hospital care settings to reduce ambiguity for all involved.
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Affiliation(s)
| | - Judy Magarey
- Adelaide Nursing School, The University of Adelaide, Adelaide, SA, Australia
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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25
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Giménez‐Espert MDC, Prado‐Gascó VJ. The role of empathy and emotional intelligence in nurses’ communication attitudes using regression models and fuzzy‐set qualitative comparative analysis models. J Clin Nurs 2018; 27:2661-2672. [DOI: 10.1111/jocn.14325] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2018] [Indexed: 01/17/2023]
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26
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Listening to How Experienced Nurses Care for the Dying Husband and His Spouse. Dimens Crit Care Nurs 2018; 36:193-201. [PMID: 28375996 DOI: 10.1097/dcc.0000000000000246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although most nurses in critical care settings provide nursing care for marital couples when 1 of the partners is dying, this is a relatively new area of research. OBJECTIVE The aim of this study is to describe the nature of nursing care provided for marital couples in the critical care unit when the husbands were dying. METHOD A qualitative interpretive description was used to construct this study. Data were collected by conducting semistructured individual interviews with 15 experienced critical care nurses in quiet conference rooms. The initial sample was recruited by invitation, and then followed by the snowball method. Institutional review board approval was obtained at the supporting institution. Interviews were recorded and transcribed to facilitate analysis. Data were analyzed line by line with constant comparison to formulate key ideas and then organized into themes. RESULTS Three themes were identified: (a) experienced nurses support the wife and husband, (b) experienced nurses connect spiritually with the wife and husband, and (c) experienced nurses provide skillful care for the wife and her husband who is dying. These themes form a description of the nature of nursing care needed by novice nurses. Emphasis for novice nurses includes focusing on the uniqueness of the marital couple as the patient, being less task oriented, and being more emotionally sensitive to the needs of the marital dyad. In this study, experienced nurses relay the importance of engaging self with these couples and being present at the end of life. DISCUSSION Future research directions are to explore innovative ways nurses may provide spiritual and emotional support to these marital couples and to measure what care activities the wife deems most beneficial for her and her husband at his end of life.
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Funk LM, Peters S, Roger KS. The Emotional Labor of Personal Grief in Palliative Care: Balancing Caring and Professional Identities. QUALITATIVE HEALTH RESEARCH 2017; 27:2211-2221. [PMID: 28891373 DOI: 10.1177/1049732317729139] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The paid provision of care for dying persons and their families blends commodified emotion work and attachments to two often-conflicting role identities: the caring person and the professional. We explore how health care employees interpret personal grief related to patient death, drawing on interviews with 12 health care aides and 13 nurses. Data were analyzed collaboratively using an interpretively embedded thematic coding approach and constant comparison. Participant accounts of preventing, postponing, suppressing, and coping with grief revealed implicit meanings about the nature of grief and the appropriateness of grief display. Employees often struggled to find the time and space to deal with grief, and faced normative constraints on grief expression at work. Findings illustrate the complex ways health care employees negotiate and maintain both caring and professional identities in the context of cultural and material constraints. Implications of emotional labor for discourse and practice in health care settings are discussed.
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Affiliation(s)
- Laura M Funk
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheryl Peters
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
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28
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Ong KK, Ting KC, Chow YL. The trajectory of experience of critical care nurses in providing end-of-life care: A qualitative descriptive study. J Clin Nurs 2017; 27:257-268. [DOI: 10.1111/jocn.13882] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Keh Kiong Ong
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | | | - Yeow Leng Chow
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
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Wong P, Liamputtong P, Koch S, Rawson H. Barriers to families' regaining control in ICU: Disconnectedness. Nurs Crit Care 2017; 23:95-101. [PMID: 28849608 DOI: 10.1111/nicc.12310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The nature of interactions between health care professionals and families may have a significant impact on families' experience and outcomes of critical illness. The value of encouraging positive relationships with families is well documented; however, it is argued that the lack of theoretical frameworks to guide practice in this area may be a barrier to improving patient- and family-centred care. AIMS The study on which this paper is based aimed to understand families' experiences of their interactions when a relative is admitted unexpectedly to an Australian intensive care unit and to generate a substantive theory that represents families' interactions that can be used to guide critical care nursing practice when caring for patients' families in this context. DESIGN AND METHODS A grounded theory methodology was adopted for the study. Data were collected between 2009 and 2013 using in-depth interviews with 25 family members of 21 critically ill patients admitted to a metropolitan, tertiary-level intensive care unit (ICU) in Australia. FINDINGS A core category of regaining control has been generated from our study. This paper focuses on Disconnectedness, which leads to increased emotional vulnerability and is also a barrier to families' regaining control. Families feel disconnected when staff emotionally and physically disengage from them, when staff interact insensitively and in a manner that offers families limited hope. CONCLUSION Our findings offer an in-depth understanding of staff engagement with families and its impact on the families' ability to regain control. Although some themes have been previously identified in the literature in isolation, the interrelationships of the categories within a theoretical framework to represent family resilience in the context of an ICU situated in the Australian health care system are a novel finding. RELEVANCE TO CLINICAL PRACTICE The findings can be used to support patient- and family-centred care interventions in the ICU.
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Affiliation(s)
- Pauline Wong
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
| | - Pranee Liamputtong
- School of Science and Health, Western Sydney University, Campbelltown Campus, Penrith, Australia
| | - Susan Koch
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,University of Sydney Medical School, Hornsby Ku-ring-gai Hospital, Hornsby, Australia
| | - Helen Rawson
- School of Nursing & Midwifery, Faculty of Health, Deakin University, Geelong, Australia
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30
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Hunt PA, Denieffe S, Gooney M. Burnout and its relationship to empathy in nursing: a review of the literature. J Res Nurs 2017. [DOI: 10.1177/1744987116678902] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Compassion and empathy are viewed as important by both nurses and patients. The positive emotions that nurses feel as a result of compassionate and empathic practice are known as compassion satisfaction, whilst the negative consequences are known as burnout and compassion fatigue. Empathy has two distinct components: emotional empathy, which involves feeling the emotions of another, and cognitive empathy, which relates to self-regulation of the emotion felt. The purpose of this literature review is to examine the relationship between burnout and empathy in the nursing literature. The results suggest that the relationship between these constructs is complex, and an ability to self-regulate emotions during empathic engagement may reduce the risk of burnout. The implications for nurses, health care organisations, educators and health care policy makers are discussed. This review provides insight into how adaptive empathic engagement may reduce the risk of burnout.
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Affiliation(s)
- Patricia A Hunt
- Assistant Lecturer, Department of Nursing and Health Care, Waterford Institute of Technology, Ireland
| | - Suzanne Denieffe
- Head of Department of Nursing and Health Care, Department of Nursing and Health Care, Waterford Institute of Technology, Ireland
| | - Martina Gooney
- Lecturer in Physiology, Department of Nursing and Health Care, Waterford Institute of Technology, Ireland
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McMeekin DE, Hickman RL, Douglas SL, Kelley CG. Stress and Coping of Critical Care Nurses After Unsuccessful Cardiopulmonary Resuscitation. Am J Crit Care 2017; 26:128-135. [PMID: 28249865 DOI: 10.4037/ajcc2017916] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Participation by a critical care nurse in an unsuccessful resuscitation can create a unique heightened level of psychological stress referred to as postcode stress, activation of coping behaviors, and symptoms of posttraumatic stress disorder (PTSD). OBJECTIVES To explore the relationships among postcode stress, coping behaviors, and PTSD symptom severity in critical care nurses after experiencing unsuccessful cardiopulmonary resuscitations and to see whether institutional support attenuates these repeated psychological traumas. METHODS A national sample of 490 critical care nurses was recruited from the American Association of Critical-Care Nurses' eNewsline and social media. Participants completed the Post-Code Stress Scale, the Brief COPE (abbreviated), and the Impact of Event Scale-Revised, which were administered through an online survey. RESULTS Postcode stress and PTSD symptom severity were weakly associated (r = 0.20, P = .01). No significant associations between coping behaviors and postcode stress were found. Four coping behaviors (denial, self-distraction, self-blame, and behavioral disengagement) were significant predictors of PTSD symptom severity. Severity of postcode stress and PTSD symptoms varied with the availability of institutional support. CONCLUSIONS Critical care nurses show moderate levels of postcode stress and PTSD symptoms when asked to recall an unsuccessful resuscitation and the coping behaviors used. Identifying the critical care nurses most at risk for PTSD will inform the development of interventional research to promote critical care nurses' psychological well-being and reduce their attrition from the profession.
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Affiliation(s)
- Dawn E. McMeekin
- Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University
| | - Ronald L. Hickman
- Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University
| | - Sara L. Douglas
- Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University
| | - Carol G. Kelley
- Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University
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32
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Delgado C, Upton D, Ranse K, Furness T, Foster K. Nurses' resilience and the emotional labour of nursing work: An integrative review of empirical literature. Int J Nurs Stud 2017; 70:71-88. [PMID: 28235694 DOI: 10.1016/j.ijnurstu.2017.02.008] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/05/2017] [Accepted: 02/07/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND The emotional labour of nursing work involves managing the emotional demands of relating with patients, families and colleagues. Building nurses' resilience is an important strategy in mitigating the stress and burnout that may be caused by ongoing exposure to these demands. Understandings of resilience in the context of emotional labour in nursing, however, are limited. OBJECTIVES To investigate the state of knowledge on resilience in the context of emotional labour in nursing. DESIGN Integrative literature review. DATA SOURCES CINAHL, Medline, Scopus, and PsycINFO electronic databases were searched for abstracts published between 2005 and 2015 and written in English. Reference lists were hand searched. REVIEW METHODS Whittemore and Knafl's integrative review method was used to guide this review. The constant comparative method was used to analyze and synthesize data from 27 peer-reviewed quantitative and qualitative articles. Methodological quality of included studies was assessed using the Mixed Methods Assessment Tool. RESULTS Emotional labour is a facet of all aspects of nursing work and nurse-patient/family/collegial interactions. Emotional dissonance arising from surface acting in emotional labour can lead to stress and burnout. Resilience can be a protective process for the negative effects of emotional labour. Several resilience interventions have been designed to strengthen nurses' individual resources and reduce the negative effects of workplace stress; however they do not specifically address emotional labour. Inclusion of emotional labour-mitigating strategies is recommended for future resilience interventions. CONCLUSION Resilience is a significant intervention that can build nurses' resources and address the effects of emotional dissonance in nursing work. There is a need for further investigation of the relationship between resilience and emotional labour in nursing, and robust evaluation of the impact of resilience interventions that address emotional labour.
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Affiliation(s)
- Cynthia Delgado
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Fitzroy VIC 3065, Australia; Sydney Nursing School, The University of Sydney, Camperdown NSW 2050, Australia; Consultation Liaison Mental Health, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown NSW 2050, Australia.
| | - Dominic Upton
- Faculty of Health, University of Canberra, Bruce ACT 2617, Australia.
| | - Kristen Ranse
- Faculty of Health, University of Canberra, Bruce ACT 2617, Australia.
| | - Trentham Furness
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Fitzroy VIC 3065, Australia; The Royal Melbourne Hospital & Northwestern Mental Health, Melbourne Health, Parkville VIC 3050, Australia.
| | - Kim Foster
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Fitzroy VIC 3065, Australia; The Royal Melbourne Hospital & Northwestern Mental Health, Melbourne Health, Parkville VIC 3050, Australia.
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[End of life care difficulties in intensive care units. The nurses' perspective]. GACETA SANITARIA 2017; 31:299-304. [PMID: 28188012 DOI: 10.1016/j.gaceta.2016.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the difficulties perceived by nursing staff in the delivery of end-of-life care to critically ill patients within intensive care units (ICU). METHOD A descriptive phenomenological qualitative study was performed. A purposeful and snowball sampling of nursing staff with at least 1 year's previous experience working in an ICU was conducted. Twenty-two participants were enrolled. Data collection strategies included in-depth unstructured and semi-structured interviews and researcher's field notes. Data were analysed using the Giorgi proposal. RESULTS Three themes were identified: academic-cultural barriers, related to the care orientation of the ICU and lack of training in end of life care; architectural-structural barriers, related to the lack of space and privacy for the patient and family in the last moments of life; and psycho-emotional barriers, related to the use of emotional detachment as a strategy applied by nursing staff. CONCLUSIONS Nursing staff need proper training on end-of-life care through the use of guidelines or protocols and the development of coping strategies, in addition to a change in the organisation of the ICU dedicated to the terminal care of critically ill patients and family support.
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Hopeck P, Harrison TR. Reframing, Refocusing, Referring, Reconciling, and Reflecting: Exploring Conflict Resolution Strategies in End-of-Life Situations. HEALTH COMMUNICATION 2017; 32:240-246. [PMID: 27177189 DOI: 10.1080/10410236.2015.1099509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Many problems can occur between family members at the end of a patient's life, resulting in conflict that others-the nurses, patient advocates, clergy, and social workers involved in the case-must resolve. This article explores the strategies used by those individuals to resolve conflict. Using grounded practical theory as a theoretical and methodological framework, qualitative interviews (n = 71) revealed how they manage family conflict at the end of life. The management styles include reframing, refocusing, referring, reconciling, and reflecting (the "5 Rs"). These strategies provide a conflict management typology for those who work with families during end-of-life situations.
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Affiliation(s)
- Paula Hopeck
- a Department of Languages, Cultures, and Communication , Stephen F. Austin State University
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Becker CA, Wright G, Schmit K. Perceptions of dying well and distressing death by acute care nurses. Appl Nurs Res 2017; 33:149-154. [DOI: 10.1016/j.apnr.2016.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 09/15/2016] [Accepted: 11/10/2016] [Indexed: 11/25/2022]
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Badolamenti S, Sili A, Caruso R, FidaFida R. What do we know about emotional labour in nursing? A narrative review. ACTA ACUST UNITED AC 2017; 26:48-55. [DOI: 10.12968/bjon.2017.26.1.48] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sondra Badolamenti
- PhD Candidate, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Rosario Caruso
- Head of Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Roberta FidaFida
- Lecturer in Organizational Behaviour, Norwich Business School, University of East Anglia
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Nagel Y, Towell A, Nel E, Foxall F. The emotional intelligence of registered nurses commencing critical care nursing. Curationis 2016; 39:e1-e7. [PMID: 28155300 PMCID: PMC6091746 DOI: 10.4102/curationis.v39i1.1606] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 08/30/2016] [Accepted: 08/01/2016] [Indexed: 12/01/2022] Open
Abstract
Background Critical care is described as complex, detailed healthcare in a unique, technologically rich environment. Critical care nursing requires a strong knowledge base and exceptional clinical and technological skills to cope in this demanding environment. Many registered nurses (RNs) commencing work in these areas may lack resilience, and because of the stress of the critical care environment, coping mechanisms need to be developed. To prevent burnout and to enable critical care nurses to function holistically, emotional intelligence (EI) is essential in the development of such coping mechanisms. Objective The aim of this study was to describe the EI of RNs commencing work in critical care units in a private hospital group in Gauteng, South Africa. Method The design used for this study was a quantitative descriptive survey. The target population were RNs commencing work in critical care units. Data were collected from RNs using the Trait Emotional Intelligence Questionnaire – Short Form and analysed using the Statistical Package for the Social Sciences software. Results The sample (n = 30) had a mean age of 32 years. Most of the participants (63%) qualified through the completion of a bridging course between 2010 and 2012. The majority (62%) of the sample had less than 2 years’ experience as RNs. Conclusion The EI of RNs commencing work in a critical care environment was indicative of a higher range of Global EI, with the well-being factor scoring the highest, followed by the emotionality factor, then self-control, with the sociability factor scoring the lowest.
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Affiliation(s)
| | - Amanda Towell
- School of Nursing and Midwifery, Edith Cowan University, Western Australia.
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Walker W, Deacon K. Nurses’ experiences of caring for the suddenly bereaved in adult acute and critical care settings, and the provision of person-centred care: A qualitative study. Intensive Crit Care Nurs 2016; 33:39-47. [DOI: 10.1016/j.iccn.2015.12.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 11/05/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
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Santiago de Castro E. Experiencia de estar hospitalizado en una unidad de cuidado intensivo coronario de Barranquilla. AVANCES EN ENFERMERÍA 2016. [DOI: 10.15446/av.enferm.v33n3.41841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p>La experiencia de estar hospitalizado en una unidad de cuidado intensivo genera ansiedad, angustia y estrés en la persona. Los pacientes con enfermedad coronaria requieren de cuidados especiales en este tipo de unidades, por lo que las percepciones, sentimientos y vivencias del paciente durante su estancia en la unidad se constituyen en elementos significativos de su experiencia. Objetivos: Conocer el significado de las experiencias vividas en una unidad de cuidado intensivo coronario de una clínica de Barranquilla. Metodología: Estudio cualitativo, descriptivo, con enfoque fenomenológico, en el que se entrevistaron nueve pacientes entre 59 y 74 años que estuvieron hospitalizados en una unidad de cuidado intensivo coronario con diagnóstico de infarto agudo de miocardio. Como estrategia de investigación, se utilizó el método de Colaizzi, siguiendo cada uno de los pasos sugeridos y guardando el rigor ético correspondiente. Resultados: Se identificaron cuatro categorías que reflejan de forma exhaustiva el fenómeno estudiado: 1) El primer contacto con la unidad 2) Lo malo de estar hospitalizado en la unidad 3) Confianza en Dios y 4) Pérdida de la percepción del tiempo. Conclusiones: Las vivencias expresadas por los participantes corroboran lo hallado en estudios similares, los cuales convergen al afirmar que el ingreso a la unidad de cuidado intensivo genera una serie de sentimientos negativos en la persona, que marcan de manera significativa su experiencia de vida. Pero también influyen aspectos positivos derivados de la atención humanizada del personal de enfermería.</p>
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Northam HL, Hercelinskyj G, Grealish L, Mak AS. Developing graduate student competency in providing culturally sensitive end of life care in critical care environments – A pilot study of a teaching innovation. Aust Crit Care 2015; 28:189-95. [DOI: 10.1016/j.aucc.2014.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 10/24/2022] Open
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ICU family communication and health care professionals: A qualitative analysis of perspectives. Intensive Crit Care Nurs 2015; 31:315-21. [DOI: 10.1016/j.iccn.2015.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/09/2015] [Accepted: 02/24/2015] [Indexed: 11/19/2022]
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Andrews T. To cure sometimes, to relieve often and to comfort always: nurses' role in end-of-life decision-making. Nurs Crit Care 2015; 20:227-8. [PMID: 26268198 DOI: 10.1111/nicc.12203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tom Andrews
- School of Nursing and Midwifery, University College Cork, Ireland.
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Rippin AS, Zimring C, Samuels O, Denham ME. Finding a Middle Ground: Exploring the Impact of Patient- and Family-Centered Design on Nurse-Family Interactions in the Neuro ICU. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2015; 9:80-98. [PMID: 26187793 DOI: 10.1177/1937586715593551] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This comparative study of two adult neuro critical care units examined the impact of patient- and family-centered design on nurse-family interactions in a unit designed to increase family involvement. BACKGROUND A growing evidence base suggests that the built environment can facilitate the delivery of patient- and family-centered care (PFCC). However, few studies examine how the PFCC model impacts the delivery of care, specifically the role of design in nurse-family interactions in the adult intensive care unit (ICU) from the perspective of the bedside nurse. METHODS Two neuro ICUs with the same patient population and staff, but with different layouts, were compared. Structured observations were conducted to assess changes in the frequency, location, and content of interactions between the two units. Discussions with staff provided additional insights into nurse attitudes, perceptions, and experiences caring for families. RESULTS Nurses reported challenges balancing the needs of many stakeholders in a complex clinical environment, regardless of unit layout. However, differences in communication patterns between the clinician- and family-centered units were observed. More interactions were observed in nurse workstations in the PFCC unit, with most initiated by family. While the new unit was seen as more conducive to the delivery of PFCC, some nurses reported a loss of workspace control. CONCLUSIONS Patient- and family-centered design created new spatial and temporal opportunities for nurse-family interactions in the adult ICU, thus supporting PFCC goals. However, greater exposure to unplanned family encounters may increase nurse stress without adequate spatial and organizational support.
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Affiliation(s)
| | | | - Owen Samuels
- Neuroscience Critical Care, Emory Healthcare, Atlanta, GA, USA
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Gallagher A, Bousso RS, McCarthy J, Kohlen H, Andrews T, Paganini MC, Abu-El-Noor NI, Cox A, Haas M, Arber A, Abu-El-Noor MK, Baliza MF, Padilha KG. Negotiated reorienting: A grounded theory of nurses’ end-of-life decision-making in the intensive care unit. Int J Nurs Stud 2015; 52:794-803. [DOI: 10.1016/j.ijnurstu.2014.12.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 09/12/2014] [Accepted: 12/11/2014] [Indexed: 10/24/2022]
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Adams AMN, Mannix T, Harrington A. Nurses' communication with families in the intensive care unit - a literature review. Nurs Crit Care 2015; 22:70-80. [DOI: 10.1111/nicc.12141] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 08/13/2014] [Accepted: 09/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- AMN Adams
- MNg; University Hospital of Northern Norway, Intensiv avdeling; 9038 Tromsø Norway
| | - T Mannix
- School of Nursing and Midwifery; Flinders University, Adelaide; GPO Box 2100 Adelaide South Australia Australia
| | - A Harrington
- School of Nursing and Midwifery; Flinders University, Adelaide; GPO Box 2100 Adelaide South Australia Australia
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For an open-door, more comfortable and humane intensive care unit. It is time for change. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.medine.2014.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Escudero D, Viña L, Calleja C. Por una UCI de puertas abiertas, más confortable y humana. Es tiempo de cambio. Med Intensiva 2014; 38:371-5. [DOI: 10.1016/j.medin.2014.01.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/14/2014] [Accepted: 01/20/2014] [Indexed: 11/25/2022]
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Cricco-Lizza R. The need to nurse the nurse: emotional labor in neonatal intensive care. QUALITATIVE HEALTH RESEARCH 2014; 24:615-628. [PMID: 24675967 DOI: 10.1177/1049732314528810] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this 14-month ethnographic study, I examined the emotional labor and coping strategies of 114, level-4, neonatal intensive care unit (NICU) nurses. Emotional labor was an underrecognized component in the care of vulnerable infants and families. The nature of this labor was contextualized within complex personal, professional, and organizational layers of demand on the emotions of NICU nurses. Coping strategies included talking with the sisterhood of nurses, being a super nurse, using social talk and humor, taking breaks, offering flexible aid, withdrawing from emotional pain, transferring out of the NICU, attending memorial services, and reframing loss to find meaning in work. The organization had strong staffing, but emotional labor was not recognized, supported, or rewarded. The findings can contribute to the development of interventions to nurse the nurse, and to ultimately facilitate NICU nurses' nurturance of stressed families. These have implications for staff retention, job satisfaction, and delivery of care.
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Olausson S, Ekebergh M, Osterberg SA. Nurses' lived experiences of intensive care unit bed spaces as a place of care: a phenomenological study. Nurs Crit Care 2014; 19:126-34. [PMID: 24646033 DOI: 10.1111/nicc.12082] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/06/2013] [Accepted: 12/15/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The environment of an intensive care unit (ICU) is, in general, stressful and has an impact on quality of care in terms of patient outcomes and safety. Little is known about nurses' experiences, however, from a phenomenological perspective with regard to the critical care settings as a place for the provision of care for the most critically ill patients and their families. AIM The aim of this study was to explore nurses' lived experiences of ICU bed spaces as a place of care for the critically ill. DESIGN AND METHODS A combination of qualitative lifeworld interviews and photos --photovoice methodology --was used when collecting data. Fourteen nurses from three different ICUs participated. Data were analysed using a phenomenological reflective lifeworld approach. FINDINGS An outer spatial dimension and an inner existential dimension constitute ICU bed spaces. Caring here means being uncompromisingly on call and a commitment to promoting recovery and well-being. The meanings of ICU bed spaces as a place of care comprise observing and being observed, a broken promise, cherishing life, ethical predicament and creating a caring atmosphere. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE The architectural design of the ICU has a great impact on nurses' well-being, work satisfaction and the provision of humanistic care. Nurses need to be involved in the process of planning and building new ICU settings. There is a need for further research to highlight the quality of physical environment and its impact on caring practice.
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Affiliation(s)
- Sepideh Olausson
- S Olausson, PhD candidate, RN, CCRN, MSn, Department of Health Sciences, University of Borås, Borås, Sweden; Linnaeus University, Växjö, Sweden
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