WHY RENAL NURSES COPE SO WELL WITH THEIR WORKPLACE STRESSORS

Exploring compassion satisfaction and compassion fatigue in emergency nurses: a mixed-methods study

BACKGROUND

Compassion fatigue can have detrimental effects on emergency nurses and the quality of patient care they deliver. Ongoing challenges such as operational pressures and the coronavirus disease 2019 (COVID-19) pandemic may have increased nurses' risk of experiencing compassion fatigue.

AIM

To explore and understand emergency nurses' experiences and perceptions of compassion satisfaction and compassion fatigue.

METHOD

This study used an explanatory sequential mixed-methods design comprising two phases. In phase one, the Professional Quality of Life (ProQOL-5) scale was used to obtain information on the prevalence and severity of compassion satisfaction and compassion fatigue among emergency nurses. In phase two, six participants' experiences and perceptions were explored via semi-structured interviews.

FINDINGS

A total of 44 emergency nurses completed the ProQOL-5 questionnaires. Six respondents had a high compassion satisfaction score, 38 had a moderate score and none had a low score. In the interviews, participants revealed different explanations regarding their compassion satisfaction levels. Three main themes were identified: personal reflections; factors identified as maintaining stability; and external factors affecting compassion.

CONCLUSION

Compassion fatigue needs to be prevented and addressed systemically to avoid detrimental effects on ED staff morale and well-being, staff retention, patients and care delivery.

Exploring Resilience in Care Home Nurses: An Online Survey

Resilience is considered a core capability for nurses in managing workplace challenges and adversity. The COVID-19 pandemic has brought care homes into the public consciousness; yet, little is known about the resilience of care home nurses and the attributes required to positively adapt in a job where pressure lies with individuals to affect whole systems. To address this gap, an online survey was undertaken to explore the levels of resilience and potential influencing factors in a sample of care home nurses in Northern Ireland between January and April 2022. The survey included the Connor-Davidson Resilience Scale, demographic questions and items relating to nursing practice and care home characteristics. Mean differences and key predictors of higher resilience were explored through statistical analysis. A moderate level of resilience was reported among the participants (n = 56). The key predictors of increased resilience were older age and higher levels of education. The pandemic has exposed systemic weakness but also the strengths and untapped potential of the care home sector. By linking the individual, family, community and organisation, care home nurses may have developed unique attributes, which could be explored and nurtured. With tailored support, which capitalises on assets, they can influence a much needed culture change, which ensures the contribution of this sector to society is recognised and valued.

Health status, resources, and job demands in geriatric nursing staff: A cross-sectional study on determinants and relationships

BACKGROUND

According to current estimates, the number of people needing care will double in the next 40 years. It is expected that between 130,000 and 190,000 additional nurses will be needed by 2030 in Germany. Physical and psychological burdens associated with nursing in long-term care facilities can develop into serious health risk factors and significantly impact occupational factors such as absenteeism, especially when linked to difficult working conditions. However, demands and resources specific to the nursing profession have not been analyzed extensively to preserve and promote nurses' workability and health adequately.

OBJECTIVE

Our study aimed to examine the extent to which perceived health among geriatric nursing staff in Germany is predicted by personal resources, job demands, and job resources. In addition, we analyzed the impact of different behavior and experience patterns on these relationships.

DESIGN, SETTING, AND PARTICIPANTS

An observational study was conducted between August 2018 and February 2020 in 48 nursing home facilities with 854 staff members in Germany as part of the project 'PROCARE - Prevention and occupational health in long-term care'.

METHODS

The survey contained instruments that measure workplace exposure, musculoskeletal complaints, physical and mental well-being, chronic stress, and work-related behavior and experience patterns. In addition, health-related information on physical activity and nutrition was collected. Data were analyzed using structural equation modeling.

RESULTS

The combined physical and mental workload for geriatric nurses is very high, with 75 % showing chronic stress. In the overall model, job and personal resources have a stronger association with mental health than physical health, while job demands have an equal impact on mental and physical health. Coping behavior also plays an important key role that should be assessed and considered. A behavior and experience risk pattern (health-endangering) is more strongly associated with a lower health status than a health-promoting behavior pattern. Results of the multigroup test showed that work-related behavior and experience patterns significantly moderate the relationship between physical health and mental health (χ2 = 392/p ≤ .001/df = 256/RMSEA = 0.028/CFI = 0.958/TLI = 0.931). Only 43 % show a health-friendly coping pattern.

CONCLUSIONS

Our findings underline the importance of holistic health promotion, which not only aims at changes at the behavioral level and the development of coping strategies but also takes on the task of reducing the workload and including measures to improve the working climate.

TRIAL REGISTRATION NUMBER

DRKS.de (DRKS00015241); August 9, 2018.

TWEETABLE ABSTRACT

Healthier coping patterns can benefit geriatric nurses' health. However, this is not a substitute for improving working conditions.

[Personal Resources of Geriatric Nursing Staff - Results of a Cross-Sectional Study]

OBJECTIVES

Geriatric nursing staff are exposed to high workloads, which often lead to stress, incapacity to work and early retirement. Personal resources can help deal with work demands and can have a positive effect on health. To design tailored interventions, this study aims to identify personal resources of staff and its impact on stress levels.

MEASURES

Data on 195 geriatric nurses (87.4% female, 40.1±12.2 years) were collected using a set of validated questionnaires consisting of Slesina questionnaire, Nordic Questionnaire, SF-12, personal resources (according to WHO criteria), AVEM questionnaire and the SSCS scale of the TICS questionnaire. According to the SSCS scale, nursing staff were divided into stressed and non-stressed. To further investigate potential factors influencing the development of stress, a four-step regression analysis was carried out.

RESULTS

Non-stressed geriatric nursing staff felt less burdened by work-related stress factors, had fewer physical complaints, had higher physical (p<0.001) and mental well-being (p <0.001), better personal resources and healthier work-related behavior and experience. The regression analysis showed that personal resources such as satisfaction with health status, nutritional behavior, frequency of being calm and relaxed, frequency of being full of energy as well as the stress level can improve physical and mental well-being, but cannot decrease the emergence of stress in case of unhealthy work coping behavior (R²=0.760).

CONCLUSION

When developing stress prevention interventions, the focus should be on strengthening personal resources. In addition, individual work-related behavior and experience patterns should be taken into account.

The work environment of haemodialysis nurses and its mediating role in burnout

BACKGROUND

The work environment can contribute to the occurrence of nurses' burnout.

OBJECTIVES

This study assessed the work environment of haemodialysis nurses and the extent of burnout they have suffered, and it explored the connection between work environment and burnout.

DESIGN

A multicentre cross-sectional study was conducted in 53 public, hospital-based haemodialysis units in Greece.

PARTICIPANTS

A total of 537 haemodialysis nurses participated. The majority consisted of females (90.8%) who possessed a university degree or a degree from a technological institute (72.6%). They had an average of 15 years of experience in dialysis.

MEASUREMENTS

The Practice Environment Scale of the Nursing Work Index and the Copenhagen Burnout Inventory (CBI) were used. The demographic characteristics of the participants were also collected.

RESULTS

Although the nurses rated their work environment as healthy, they were experiencing a moderate degree of burnout. The multivariate linear regression analysis with the CBI scales as dependent variables was applied. The increased nurses' participation in hospital affairs was associated with decreased personal (coefficient β = -9.4, 95% confidence interval [CI] = -17.4 to -1.3, p = 0.023), work-related (coefficient β = -12.9, 95% CI = -22.5 to -3.5, p = 0.008) and patient-related burnout (coefficient β = -15.9, 95% CI = -24.5 to -7.4, p = < 0.001). The better collegial nurse-physician relationships were associated with decreased personal (coefficient β = -10.7, 95% CI = -18.3 to -3.0, p = .007) and work-related burnout (coefficient β = -15.1, 95% CI = -23.3 to -7.0, p =  < 0.001).

CONCLUSIONS

The work environment of haemodialysis nurses was associated with burnout. Its improvement is an important tool in administrations' effort to ensure the nursing staff's well-being.

Nurse resilience: A concept analysis

Nurse resilience is attracting increasing attention in research and practice. Possession of a high level of resilience is cited as being crucial for nurses to succeed professionally and manage workplace stressors. There is no agreed definition of nurse resilience. A concept analysis was undertaken to examine nurse resilience using a priori selected analysis framework. This concept analysis aims to systematically analyse resilience as it relates to nurses and establish a working definition of nurse resilience. Sixty-nine papers met the search criteria for inclusion. Key attributes of nurse resilience were social support, self-efficacy, work-life balance/self-care, humour, optimism, and being realistic. Resilience enables nurses to positively adapt to stressors and adversity. It is a complex and dynamic process which varies over time and context and embodies both individual attributes and external resources. Sustaining nurse resilience requires action and engagement from both individuals and organizations.

Professional relationships between nephrology clinicians and patients: a systematic review

BACKGROUND

Nephrology nurses and patients expressed that the clinician-patient relationship in a haemodialysis (HD) unit might be best described as being part of an extended family. However, there is a risk that professional boundaries may become blurred due to the perceived closeness of this relationship.

OBJECTIVE

This systematic review sought to explore the experiences of nephrology clinicians in establishing and maintaining a professional relationship with people experiencing end-stage kidney disease who are receiving HD treatment.

METHOD

A search strategy was created using JBI systematic review guidelines for six databases (PubMed, CINAHL, EMBASE, PsycINFO, Cochrane Library and JBI library). Qualitative studies were eligible for inclusion when the participants were nephrology clinicians who provided HD treatment or management of patients in a hospital outpatient HD unit or a community HD centre.

RESULTS

Three studies met the inclusion criteria and the findings were synthesised into two themes (1) establishing a professional relationship and (2) coping mechanisms. All three studies focused on nephrology clinicians realising the importance of treating patients as individuals. Nephrology clinicians demonstrated advanced communication skills, empathy and compassion when interacting with patients, which seemed to contribute to patient satisfaction. This systematic review found some qualitative evidence to explain how nephrology clinicians establish and maintain a professional clinician-patient relationship with patients in the HD unit.

CONCLUSION

This review highlighted a significant gap in research concerning the trajectory of the clinician-patient relationship across all members of the renal multidisciplinary health care team.

Workplace stress and resilience in the Australian nursing workforce: A comprehensive integrative review

This integrative review aimed to identify and synthesize evidence on workplace stress and resilience in the Australian nursing workforce. A search of the published literature was conducted using EMBASE, MEDLINE, CINAHL (EBSCO), PsycINFO, Web of Science, and Scopus. The search was limited to papers published in English from January 2008 to December 2018. The review integrated both qualitative and quantitative data into a single synthesis. Of the 41 papers that met the inclusion criteria, 65.85% (27/41) used quantitative data, 29.26% (12/41) used qualitative data, and 4.87% (2/41) used mixed methods. About 48.78% (20/41) of the papers addressed resilience issues, 46.34% (19/41) addressed workplace stress, and 4.87% (2/41) addressed both workplace stress and resilience. The synthesis indicated that nurses experience moderate to high levels of stress. Several individual attributes and organizational resources are employed by nurses to manage workplace adversity. The individual attributes include the use of work-life balance and organizing work as a mindful strategy, as well as self-reliance, passion and interest, positive thinking, and emotional intelligence as self-efficacy mechanisms. The organizational resources used to build resilience are support services (both formal and informal), leadership, and role modelling. The empirical studies on resilience largely address individual attributes and organizational resources used to build resilience, with relatively few studies focusing on workplace interventions. Our review recommends that research attention be devoted to educational interventions to achieve sustainable improvements in the mental health and wellbeing of nurses.

Nursing care for renal patients on hemodialysis: challenges, dilemmas and satisfactions

OBJECTIVE

To identify the challenges, dilemmas and satisfactions presented by nursing professionals in hemodialysis services during the care of renal patients.

METHOD

Institutional ethnography was used, and 18 semi-structured interviews were conducted with nine members of the nursing staff. Conventional content analysis was performed.

RESULTS

For the nursing staff, care presents challenges such as the complex physical and emotional condition of patients, the management of technology for care, and coping with the suffering and death of patients with whom they have established a close relationship. The dilemmas are related to providing care for patients who refuse to receive it, and the personal and family costs involved in treatment in contrast to the limited quality of life of some patients. The main satisfactions are collaborative work, the sufficiency of resources and the confidence and recognition for performing independent work.

CONCLUSION

The findings of the study are associated with the presence of professional burnout and interference in the ability to build satisfactory interpersonal relationships, lower job satisfaction and quality of care.

Challenges facing oncology nurses in Jordan: A qualitative study

BACKGROUND

The literature shows that oncology nurses have more stressors than nurses in other units. They face many challenges both within and outside the work environment that affect them negatively. Most of the reviewed studies concerning these challenges were conducted in developed countries.

AIM

The purpose of this study was to explore the challenges experienced by oncology nurses in Jordan during their daily practice.

METHOD

A qualitative descriptive approach was adopted. Semistructured individual face-to-face interviews were conducted with 24 nurses. Participants were selected from oncology departments in one of the biggest governmental hospitals in Jordan.

RESULTS

Two main themes were drawn from the data analysis. The first discussed the personal challenges that oncology nurses encountered. These included emotional attachment to patients and difficulties in separating work and personal life. The second related to organizational challenges in the work environment, which included the nurses' lack of authority to inform patients about their diseases, nursing staff and supply shortages, and a lack of orientation programs. All of these factors affected the psychological status of the nurses.

CONCLUSIONS

The results of this study indicated that the working environment for oncology nurses is highly stressful and demanding and these nurses face many challenges in their work. The understanding and consideration of these challenges by stakeholders, managers, and organizational leaders would lead to improvements in the nurses' psychological state, thereby enhancing the quality of care in these units and helping with staff retention.

Strategies used by nursing staff in situations of workplace violence in a haemodialysis unit

Objective

To identify strategies that nursing staff use at a haemodialysis unit in situations of violence by patients during care.

Method

Qualitative descriptive and exploratory research with focus groups and the participation of eight workers of the nursing staff of a private haemodialysis unit in southern Brazil. The data were subjected to thematic content analysis.

Results

The adopted strategies are described in the following categories: Tolerating violence due to the patient's health condition; Working around conflicting situations and giving in to patient's requests; Adopting a position of rejection to violence; and Staying away from the aggressor patient.

Final considerations

Workers and, above all, the institution in the role of mediator, must work together to prevent and discourage violence in the workplace.

The use of grounded theory in studies of nurses and midwives' coping processes: a systematic literature search

BACKGROUND

Researchers are increasingly using grounded theory methodologies to study the professional experience of nurses and midwives.

AIM

To review common grounded theory characteristics and research design quality as described in grounded theory studies of coping strategies used by nurses and midwives.

METHODS

A systematic database search for 2005-2015 identified and assessed grounded theory characteristics from 16 studies. Study quality was assessed using a modified Critical Appraisal Skills Programme tool.

FINDINGS

Grounded theory was considered a methodology or a set of methods, able to be used within different nursing and midwifery contexts. Specific research requirements determined the common grounded theory characteristics used in different studies. Most researchers did not clarify their epistemological and theoretical perspectives.

CONCLUSION

To improve research design and trustworthiness of grounded theory studies in nursing and midwifery, researchers need to state their theoretical stance and clearly articulate their use of grounded theory methodology and characteristics in research reporting.

Haemodialysis work environment contributors to job satisfaction and stress: a sequential mixed methods study

Background

Haemodialysis nurses form long term relationships with patients in a technologically complex work environment. Previous studies have highlighted that haemodialysis nurses face stressors related to the nature of their work and also their work environments leading to reported high levels of burnout. Using Kanters (1997) Structural Empowerment Theory as a guiding framework, the aim of this study was to explore the factors contributing to satisfaction with the work environment, job satisfaction, job stress and burnout in haemodialysis nurses.

Methods

Using a sequential mixed-methods design, the first phase involved an on-line survey comprising demographic and work characteristics, Brisbane Practice Environment Measure (B-PEM), Index of Work Satisfaction (IWS), Nursing Stress Scale (NSS) and the Maslach Burnout Inventory (MBI). The second phase involved conducting eight semi-structured interviews with data thematically analyzed.

Results

From the 417 nurses surveyed the majority were female (90.9 %), aged over 41 years of age (74.3 %), and 47.4 % had worked in haemodialysis for more than 10 years. Overall the work environment was perceived positively and there was a moderate level of job satisfaction. However levels of stress and emotional exhaustion (burnout) were high. Two themes, ability to care and feeling successful as a nurse, provided clarity to the level of job satisfaction found in phase 1. While two further themes, patients as quasi-family and intense working teams, explained why working as a haemodialysis nurse was both satisfying and stressful.

Conclusions

Nurse managers can use these results to identify issues being experienced by haemodialysis nurses working in the unit they are supervising.

Estratégias de enfrentamento dos enfermeiros em serviço hospitalar de emergência

Resumo Objetivo: Identificar as estratégias de enfrentamento dos enfermeiros em serviço hospitalar de emergência e relacioná-las às variáveis sociodemográficas e profissionais. Métodos: Estudo transversal com 89 enfermeiros. Os instrumentos de pesquisa foram: formulário para caracterização dos sujeitos e o Inventário de Estratégias de Enfrentamento de Folkman e Lazarus. Resultados: As estratégias de enfrentamento mais utilizadas foram: resolução de problemas e reavaliação positiva; a menos utilizada, foi o confronto. As estratégias confronto, reavaliação positiva, e fuga e esquiva foram associadas ao sexo masculino, não ter um companheiro e trabalhar em período noturno, respectivamente. Conclusão: As estratégias de enfrentamento podem ser auxiliadas por acompanhamento escuta, programas educacionais e um espaço para discussão das dificuldades relacionadas ao trabalho.

Qualitative research methods in renal medicine: an introduction

Qualitative methodologies are becoming increasingly widely used in health research. However, within some specialties, including renal medicine, qualitative approaches remain under-represented in the high-impact factor journals. Qualitative research can be undertaken: (i) as a stand-alone research method, addressing specific research questions; (ii) as part of a mixed methods approach alongside quantitative approaches or (iii) embedded in clinical trials, or during the development of complex interventions. The aim of this paper is to introduce qualitative research, including the rationale for choosing qualitative approaches, and guidance for ensuring quality when undertaking and reporting qualitative research. In addition, we introduce types of qualitative data (observation, interviews and focus groups) as well as some of the most commonly encountered methodological approaches (case studies, ethnography, phenomenology, grounded theory, thematic analysis, framework analysis and content analysis).

Mental health nursing in Australia: resilience as a means of sustaining the specialty

As a concept, resilience is continuing to attract considerable attention and its importance across various life domains is increasingly recognised. Few studies, however, have defined or considered the notion of the group or collective resilience of a profession, including the capacity of that profession to withstand adversity and continue to develop positively in the face of change. This article considers the notion of resilience from the perspective of the specialty of mental health nursing, including the ways the specialty has adapted--and continues to develop--to changes experienced since deinstitutionalisation. Insights are drawn from a national Delphi study undertaken in Australia to develop a Scope of Practice for Mental Health Nurses, with responses used as a springboard to consider the impact of the perceived loss of professional identity on the collective resilience of the profession. Recommendations for a way forward for the profession are considered, including the ways in which a collective professional resilience could be developed to sustain and strengthen the professional identity of mental health nursing in Australia and across the globe.

Relationships among work stress, job satisfaction, mental health, and healthy lifestyle behaviors in new graduate nurses attending the nurse athlete program: a call to action for nursing leaders

BACKGROUND

Although nurses are educated to take outstanding care of others, they themselves often have poor health outcomes, including high rates of depression and obesity, which are associated with stressful work environments. Furthermore, a high percentage of new graduate nurses leave their positions in the first year of employment, resulting in exorbitant costs to health care systems.

PURPOSE

The aim of this study was to determine the relationships among key variables that influence job satisfaction and healthy lifestyle behaviors of new graduate nurses, including workplace stress, work environment, lifestyle beliefs, and mental health.

DESIGN

A descriptive correlational design was used with baseline data from 61 new graduate nurses attending the 2-day Nurse Athlete program, a workshop that focuses on nutrition, energy management, and physical activity.

RESULTS

Higher levels of workplace stress were associated with higher levels of depression and anxiety as well as lower levels of resiliency, job satisfaction, and healthy lifestyle beliefs.

IMPLICATIONS

Nurse leaders and managers must invest in creating healthy work environments for new and experienced nurses as well as provide mental health screening, resources, and intervention programs that focus on education and skills-building in health promoting behaviors, including emotional regulation of stress, anxiety, and depression.