Predicting emotional exhaustion among haemodialysis nurses: a structural equation model using Kanter's structural empowerment theory

The role of empowering leadership and psychological empowerment on nurses’ work engagement and affective commitment

Purpose

This study aims to investigate to role of empowering leadership and psychological empowerment on nurses' work engagement and affective commitment.

Design/methodology/approach

Self-administered questionnaire data from 231 nurses working in a university hospital in Saudi Arabia were analysed using a cross-sectional research design using structural equation modelling (SEM) to assess the relationship between empowering leadership (EL), affective commitment (AC) and work engagement (WE) while testing for the mediating role of psychological empowerment (PE).

Findings

SEM analysis demonstrated that EL significantly relates to AC. AC similarly significantly relates to WE. Further, the results showed that PE substantially mediates the relationship between EL and WE. There is no significant direct relationship found between EL and WE.

Practical implications

The study findings are essential for nursing managers. They illustrate that nurses become more committed to their organisation and, in return, more engaged with their work when they receive EL. Therefore, nursing managers could train their leaders to practice EL as increased WE has been found to result in other positive work attitudes such as reduced turnover intention.

Originality/value

This study corroborates the relationships between EL, AC and WE, as well as the mediating role of PE. However, this research is unique as the long-established relationship between EL and WE was not supported. It shows that the propositions of leader-member exchange theory may not hold for unique non-Western contexts, in this case, Saudi Arabia.

Nurses' experience in improving adherence to fluid intake and diet in hemodialysis patients

The objective of study is to explore nurses' experiences in their role as educators in improving adherence to fluid and dietary restrictions in hemodialysis patients. This study used a qualitative phenomenological method with a purposive sampling method. Eight nurses were selected for in-depth interviews. Data analysis was conducted using the Colaizzi method. The study found five themes. (1) Intensive interaction with patients to optimize the role of nurses. (2) Various methods are used in delivering education. (3) Various obstacles are experienced in delivering education. (4) Nurses are required to improve their abilities and (5) Benefits for nurses. It is important for nurses to improve their role continuously. Hospitals and health facilities need to encourage nurses in their efforts to develop themselves and their clinical roles, so the quality of nursing care can be improved.

Burnout syndrome among nephrologists - a burning issue - results of the countrywide survey by the Polish Society of Nephrology

Background

Burnout syndrome in physicians is associated with adverse patient safety events, poorer quality of care and reduced patients’ satisfaction. There has been scarce information on the risk factors of burnout affecting professionals working in the renal care settings. As yet the phenomenon has not been studied in the population of Polish nephrologists therefore a nationwide cross-sectional study was established by the Polish Society of Nephrology to assess the prevalence of the syndrome.

Methods

The survey, that consisted of the abbreviated Maslach Burnout Inventory, questions about strategies for dealing with burnout symptoms and demographic data, was distributed during two main national meetings that gather nephrologists in Poland. 177 participants filled out the survey – 64% of participants were women, 88% were specialists and 12% - doctors in training.

Results

52% of participants demonstrated a high level of depersonalization and almost half of the study group showed high level of emotional exhaustion. Reduced personal accomplishment was more pronounced in doctors working mostly in dialysis units compared to other nephrologists (p = 0.017). 37% of participants reported that they treat some patients as they were impersonal objects and 48% felt emotionally drained from their work. 59% of participants would like to take part in the remedy program.

Conclusions

Burnout syndrome seems to be an important problem in the population of Polish nephrologists. Doctors working mostly in dialysis settings might be at increased risk of reduced personal accomplishment. The results of the survey may be useful to prepare burnout remedy program.

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.

Improving Structural Empowerment and Job Satisfaction Among State Health Facility Surveyors

BACKGROUND

State survey agencies are experiencing an increase in work requirements and surveyor staffing instability thereby compromising organizational performance. No information has been published about surveyor perceptions of the work environment and job satisfaction to inform management interventions for improvement.

OBJECTIVE

The purposes of this study were to evaluate state health facility surveyor perceptions of the work environment and to formulate management recommendations for improving recruitment and retention.

METHODS

The Theory of Structural Empowerment (SE) served as the framework for this study which employed a nonexperimental descriptive survey design. Data were obtained using the Conditions of Work Effectiveness Questionnaire-II, the Job Satisfaction Survey, and open-ended questions. Participants were surveyors employed by a state survey agency in northeast United States (N = 52).

RESULTS

Surveyors reported moderate and ambivalent overall SE and job satisfaction, respectively. Significant differences among bureaus, divisions, disciplines/backgrounds, and level of nursing education were identified.

CONCLUSIONS

Surveyor perceptions of SE and job satisfaction are suboptimal and could be improved with modifications to the work environment.

IMPLICATIONS FOR NURSING

Managers should assess how staff perceive the work environment and implement data-driven, evidence-based interventions that can reduce attrition and improve organizational efficiency and effectiveness.

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.

Empowerment and performance of managers and subordinates in elderly care: A longitudinal and multilevel study

AIM

To investigate relationships between first-line managers' ratings of structural and psychological empowerment, and the subordinates' ratings of structural empowerment, as well as their ratings of the managers' leadership-management performance.

BACKGROUND

Work situations in elderly care are complex. To date, few studies have used a longitudinal, correlational and multilevel design to study the working life of subordinates and managers.

METHOD

In five Swedish municipalities, questionnaires were answered twice during 2010-12 by 56 first-line managers and 769 subordinates working in nursing homes or home-help services.

RESULTS

First-line managers' empowerment at Time 1 partially predicted subordinate's structural empowerment and ratings of their managers' leadership-management performance at Time 2. Changes over time partially revealed that the more access managers had to structural empowerment, i.e. increase over time, the higher the ratings were for structural empowerment and managerial leadership-management performance among subordinates.

CONCLUSIONS

Findings strengthen research and theoretical suggestions linking first-line managers' structural empowerment to their subordinates' structural empowerment and ratings of their manager's leadership-management performance.

IMPLICATIONS FOR NURSING MANAGEMENT

Managers with high access to structural empowerment are more likely to provide subordinates access to structural empowerment.

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.