An attribution theory perspective on emotional labour in nurse-patient encounters: a nested cross-sectional study in paediatric settings

Emotional labour and turnover intention among nurses in China: Mediating effects of nurse-patient relationship and self-rated health

AIM

This study tested the mediating role of the nurse-patient relationship and self-rated health in the effect of emotional labour on turnover intention among nurses in China.

BACKGROUND

The underlying mechanism behind the effect of emotional labour on turnover intention remains inadequately understood.

INTRODUCTION

Nurses with a high level of emotional labour are predisposed to experiencing poor health and tension in their relationships with patients, which may increase turnover intention.

METHODS

A cross-sectional survey of 527 nurses in a public tertiary hospital in Qiqihar, located in China's Heilongjiang province, was conducted. Emotional labour and turnover intention were assessed using existing validated scales containing multiple items, while the nurse-patient relationship and self-rated health were assessed using single items, respectively. Baron and Kenny's causal steps and the Karlson/Holm/Breen method were adopted to test the mediating effects of the nurse-patient relationship and self-rated health in the association between emotional labour and turnover intention after adjusting for variations in sociodemographic and job characteristics.

RESULTS

Emotional labour was positively associated with turnover intention. Self-rated poor health and a disharmonious nurse-patient relationship partially mediated the positive effect of emotional labour on turnover intention.

CONCLUSIONS

Emotional labour significantly affects the turnover intention of nurses working in public tertiary hospitals in China, and this effect is partially mediated by self-rated health and the nurse-patient relationship.

IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY

Giving more attention to nurses' negative emotions and work attitudes is crucial. Developing comprehensive strategies for enhancing nurses' emotional management ability, promoting their physical and psychological well-being, and improving nurse-patient relationship to reduce nurses' turnover.

The moderating role of age and seniority on nurses' emotional dissonance and perceived health

This study aims to investigate the weight of surface acting (a condition in which subjects must display an emotional state that does not correspond to their real feelings) in the relationship between the emotional load of nursing work and the perception of health, and to evaluate the moderating effect of age and length of service. A moderated mediation analysis was conducted on a sample of 359 Italian nurses. The results confirmed the mediation role of surface acting and showed that both age and seniority have moderating effects so that in conditions of high emotional load, older and more experienced nurses show higher levels of surface acting, and in conditions of high surface acting, younger and less experienced nurses show lower levels of perceived health. In conclusion, surface acting seems a stressor for younger nurses, not yet used to the weight of faking emotions, while the perceived emotional load seems a stressor for older and more experienced nurses. Each result highlights the importance of providing emotional regulation skills training and support to reduce the psychological impact of emotional demands on nurses.

Challenging encounters in clinical dentistry: a qualitative study investigating online reviews of patient satisfaction with Norwegian dentists

OBJECTIVE

Mapping key themes that characterize challenging and positive encounters in dental practice using online reviews of patient satisfaction.

MATERIALS AND METHODS

11,764 online patient reviews of dental encounters, consisting of an overall satisfaction rating (1-5 stars) and a free-text response, were collected from the web-site Legelisten.no. The reviews were split into two sets: reviews from patients with low satisfaction (1-2 stars) representing challenging encounters vs. patients with high satisfaction (4-5 stars) representing positive encounters. A qualitative thematic analysis was used to analyse the text materials in the datasets.

RESULTS

Five key themes to both challenging and positive patient encounters were identified: (1) Interpersonal factors, (2) Patient factors, (3) Dentist factors, (4) Situational factors, and (5) Consequences. These themes are discussed in light of their role in challenging and positive patient encounters, as well as previous studies of online reviews and patient satisfaction.

CONCLUSIONS

Based on the patients' experiences with dental encounters, challenging encounters seem to arise when dentists' personality traits and communication skills fail to match the patients' expectations or preferences. It appears central to patient satisfaction that dentists are able to shift between different communication styles in order to adapt to the personality and preferences of the patients.

Emotion management and stereotypes about emotions among male nurses: a qualitative study

BACKGROUND

Nursing requires a high load of emotional labour. The link between nursing, emotional labour and the female sex, complicates the figure of the male nurse, because masculinity is associated with physical or technical (rather than emotional) and moreover is defined in contrast to femininity. Our objective was to understand how emotion management is described by male nurses who work in the paediatrics department of a Spanish tertiary hospital.

METHODS

Qualitative descriptive study. The participants were selected through intentional sampling in the paediatrics department of a Spanish tertiary hospital. We conducted semi-structured interviews until reaching data saturation. We carried out a content analysis, using Lincoln and Guba's definition of scientific rigour.

RESULTS

We identified two key themes in the data: 1) Stereotypes related to the emotional aspects of care: Participants took for granted some gender stereotypes while questioning others and defended alternative ways of managing emotions related to care. 2) Emotion management strategies: Participants described keeping an emotional distance, setting boundaries, relativising problems and using distraction and humour.

DISCUSSION

Nursing care is conditioned by gender roles and stereotypes that present men as less capable than women of feeling and managing emotions. However, emotion management is necessary in nursing care-especially in paediatrics-and our participants reported using strategies for it. Although participants continued to interpret care in terms of traditional roles, they contradicted them in adapting to the emotional labour that their job requires.

CONCLUSIONS

New behaviours are emerging among male nurses, in which care and emotion management are not exclusively the purview of women. Our participants reproduced some gender stereotypes while disrupting others, and they tended to cling to the stereotypes that were favourable to them as male nurses. As we work towards a gender-neutral profession, these results represent a first step: male participants reported that they provide care and manage their emotions as well as (or better than) women. However, because they substantiated their claims by drawing on negative stereotypes of women, further progress must be made.

Emotion work and resilience of nurses and physicians towards Palestinian Authority patients

AIM

The purpose of this study was to explore the emotion work and resilience of Israeli healthcare personnel who treat paediatric patients from the Palestinian Authority in Israel.

BACKGROUND

Healthcare personnel deal with internalized emotional conflict deriving from the ethos of health care and the ethos of conflict. Emotion work may be used to overcome emotional conflict, while resilience serves as a protective process against emotional conflict.

METHODS

A mixed methods study among 101 healthcare workers: 84 nurses and 17 physicians. Quantitative data were analysed using IBM SPSS 24.0, and qualitative data were analysed using the constant comparative analysis method.

FINDINGS

Empathy was the highest ranking emotion and contempt was the lowest, for experienced and expected emotions. Positive correlations were found between identification with the ethos of health care and resilience, emotional gap and emotion work, and between the level of Arabic language and emotion work. A negative correlation was found between emotional gap and resilience. The qualitative data yielded three themes: Knowledge of the Arabic language, familiarity with the Arab culture and equitable treatment.

DISCUSSION

The language proficiency of patients belonging to a minority group increases nurses' and physicians' emotion work. Identification with the ethos of health care increases resilience, as both are linked to a sense of vocation and an intrinsic willingness to care for paediatric patients.

CONCLUSION

The study supports the theory of emotion work and refines the role of the ethos of health care in building resilience. Language and cultural capability have a significant role in providing healthcare personnel with methods to treat minorities equitably.

IMPLICATIONS FOR HEALTH POLICY

Hospital managements may supply tailor-made interventions to enhance healthcare personnel's transcultural communication skills, build resilience and cultivate emotion work capabilities. Nursing practice could encourage the use of nursing care plans specific to the individual paediatric patient that can be used by nursing staff to keep care current and applicable.

Development of the Attributional Style of Doctor Questionnaire

Background

The attributional style of clinical workers will affect their emotion and behavior and affect how they deal with the relationship with patients. Current tools lack clinical events and are not suitable for measuring the attributional style of doctor. In this study, the development of the Doctor’s Attributional Style Questionnaire (DASQ) is presented.

Methods

In study 1, based on the previous literature and the open-ended questionnaire, the theoretical structure of DASQ was constructed. In study 2, items analysis and exploratory factor analysis (EFA) were conducted in the sample (n=559) to select the best items for the DASQ. In study 3, the internal structure of the DASQ was tested in the sample (n=740) via confirmatory factor analysis (CFA) and 218 doctors were retested four weeks later.

Results

There are 24 items in the scale, including positive events questionnaire and negative events questionnaire, all of which are composed of four dimensions: controllability, globality, stability, and internality. The fitting degree of each questionnaire model is good, and all indexes are above 0.9. The internal consistency coefficient and retest coefficient of both the positive events questionnaire and the negative events questionnaire were above 0.75.

Conclusion

The DASQ meets the requirements of measurement and can be used to measure the attributional style of doctors.

Resilience Scale Psychometric Study. Adaptation to the Spanish Population in Nursing Students

Nursing students and professionals are exposed to highly stressful clinical situations. However, when confronted with stress, which is exacerbated by academic and professional situations, there is a great disparity between those who do not know how to respond suitably to the demands from patients or teachers due to a lack of competence and personal resistance, and those who are more resilient and develop a greater range of strengths. This research aims to analyse the validity and psychometric characteristics of a questionnaire on resilience adapted to Spanish nursing bachelor’s degree students. The participants were 434 undergraduate nursing students from the province of Valencia (Spain) between 17 and 54 years of age (Mean, M = 21; Standard Deviation, SD = 0.320), 104 of whom were men (24%) and 330 women (76%). A cross-sectional group evaluation was carried out in the university itself, adhering to the ethical standards of the Declaration of Helsinki. Based on the descriptive, factorial, exploratory and confirmatory analyses, it was possible to confirm the suitability of the questionnaire and its adaptation to nursing students. The model is thus suitable for evaluating the population under study. Furthermore, there are statistically significant differences depending on age and gender. The results show that the questionnaire analysed is suited to evaluating resilience among Spanish nursing students, thereby justifying the adaptation of a scale of this nature to foster resilience among nursing students and nurses in professional life, who are exposed to critical situations with patients’ suffering, deterioration or death. Our study highlights important practical implications: Spanish nursing studies involve theory and practice, but students and nurses in professional life have to confront critical situations of patients’ suffering, deterioration, or death. These situations cause stress and feelings of impotence that may lead to chronic stress and even suicidal thoughts.

Emotional Labor Strategies, Stress, and Burnout Among Hospital Nurses: A Path Analysis

PURPOSE

This study aimed to examine the associations among emotional labor strategies, stress from emotional labor, and burnout in nurses.

DESIGN

We employed a descriptive cross-sectional design. Data were collected from May to November 2018 in South Korea using structured questionnaires. Participants were 303 nurses from 27 hospitals, who were recruited by convenience sampling.

METHODS

Emotional labor strategies (surface acting, deep acting, and expression of naturally felt emotions), stress, and burnout were self-reported. A path analysis using structural equation modeling was performed to examine the associations among the study variables.

FINDINGS

Bivariate analyses revealed that surface acting was positively correlated with stress and burnout, deep acting was negatively correlated with burnout, and naturally felt emotions were negatively correlated with stress and burnout. The path analysis revealed that surface acting was positively associated with stress, naturally felt emotions were negatively associated with burnout, and the stress from emotional labor was positively associated with burnout. Although surface acting was not directly associated with burnout, it was indirectly associated through stress.

CONCLUSIONS

Surface acting involves regulation and suppression of one's felt emotions. The findings of this study suggest that hospitals need to reduce expectations for surface acting to reduce nurses' stress and burnout. Organizational efforts to provide interventions that improve nurses' ability to manage their emotions in interactions with patients might effectively foster nurses' well-being.

CLINICAL RELEVANCE

Surface acting might contribute to nurses' burnout, and naturally felt emotions might reduce nurses' burnout. Nurse managers should thus provide opportunities to discuss the utilized emotional labor strategies and encourage appropriate responses depending on the patient context. Programs that promote emotional competence may reduce the adverse effects associated with nurses' emotional labor and foster effective coping strategies.

The relationship between emotional labour and job satisfaction in nursing

AIM

To investigate the relationship between emotional labour strategies and job satisfaction among nurses in Turkey.

BACKGROUND

Nursing is one of the professions in which emotional labour is heavily used. The relationship between emotional labour strategies and job satisfaction has many different consequences in nursing.

INTRODUCTION

Although studies have focused on the relationship between emotional labour and job satisfaction among nurses abroad, no studies on the subject have been found in Turkey.

METHODS

A cross-sectional descriptive design was employed. The study was conducted with 281 nurses working in a university hospital and three public hospitals in Manisa, Turkey. Research data were collected using the Personal Information Form, Emotional Labour Scale and Minnesota Satisfaction Questionnaire. Descriptive statistics and Pearson correlation analysis were used in data evaluation.

RESULTS

Analyses showed that the type of emotional labour strategy most frequently exhibited by nurses was surface acting. In surface acting, behaviours do not reflect employees' true feelings. Job satisfaction of nurses was higher than the medium level. A negative correlation was found between deep acting and job satisfaction. In deep acting, employees try to feel the emotions appropriate to the behaviour expected of them.

DISCUSSION

Nurses' emotional labour may cause some undesirable consequences.

CONCLUSION

Nurses' emotional labour strategies are related to their job satisfaction levels.

IMPLICATIONS FOR NURSING POLICY

Managers should be aware of the emotional labour of nurses and its possible negative consequences. Management strategies that target the negative consequences of emotional labour are important not only for the well-being of nurses but also for the quality of patient care.

Nurses' response to parents' 'speaking-up' efforts to ensure their hospitalized child's safety: an attribution theory perspective

AIM

To understand how attribution processes (control and stability), which the nurse attributes to parental involvement in maintaining child safety, determine the nurse's response to a safety alert.

BACKGROUND

Participation of parents in maintaining their child's safety is shown to reduce the incidence of and risk of clinical errors. Unless nurses respond appropriately to parents' safety alerts, this potential source of support could diminish.

DESIGN

A 2 (controllability: high vs. low) × 2 (consistency: high vs. low) factorial design.

METHODS

Data were collected during the period 2013-2014 in paediatric wards. Four variants of scenarios were created corresponding to the different combinations of these variables. A total of 126 nurses read a scenario and completed self-report questionnaires measuring their response to the parent's safety alert. Additional data were collected about the manipulation check, safety norms in the ward and demographic variables. Data were analysed using analysis of variance.

FINDINGS

Results showed a main effect of stability and a significant two-way interaction effect of stability and controllability, on a nurse's tendency to help the parent and fix the safety problem. Furthermore, safety norms were significantly related to nurses' response.

CONCLUSION

These findings contribute to the understanding of antecedents that affect nurses' responses to parents' speaking-up initiatives: whether nurses will reject or heed the alert. Theoretical and practical implications for promoting parents' engagement in their safety are discussed.

Nurses' resilience and the emotional labour of nursing work: An integrative review of empirical literature

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.