Mental health nurses' experiences of managing work-related emotions through supervision

Organizational factors to optimize mental health nurses' wellbeing in the workplace: An integrative literature review

Mental health nursing is a privilege and a rewarding profession. There has been a call for transformational change in mental health services to improve outcomes for the people of New Zealand, with mental health nurses integral to this. However, with predicted nursing shortages, high levels of burnout, and increasing demands in the workplace, an organizational focus on wellbeing for mental health nurses is needed to sustain the workforce, implement change and improve outcomes for people using mental health services. An integrative review of the literature was undertaken to explore how organizations can optimize mental health nurses' wellbeing in the workplace and to identify measures for organizations to support mental health nurses' wellbeing with a focus on New Zealand. Seven articles were included in this review after a search, data extraction and evaluation. Data were synthesized and categorized using thematic analysis. The findings indicate organizations can invest in several initiatives to enhance mental health nurses' wellbeing in the workplace. These include professional development, skills to build resilience, enabling time to reflect on practice, enhancing professional supervision, having the right managerial support and focusing on individual's strengths. Organizations need to prioritize mental health nurses' wellbeing by embedding the practical strategies this review identified and by addressing organizational barriers to wellbeing. Organizations should consider implementing multileveled organizational wellbeing initiatives to nurture and grow the New Zealand mental health nursing workforce which in turn will contribute to quality care and enable mental health nurses to have long meaningful careers. Time, investment and resources are essential for these initiatives to be effective.

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.

Restorative clinical supervision: a chance for change but are we ready?

In the wake of the COVID-19 pandemic, nurses are experiencing increasing stress, burnout and mental health problems. The Advocating and Educating for Quality ImProvement (A-EQUIP) model of clinical supervision aims to support staff wellbeing, promote positive work cultures and improve patient care. Although a growing body of empirical evidence supports the positive impact of clinical supervision, several individual and organisational barriers may impede the implementation of A-EQUIP in practice. Organisational culture, staffing and workforce pressures all affect employees' ability to engage with supervision, and organisations and clinical leaders must consciously work to sustain lasting change.

The experience of nurses participating in peer group supervision: a qualitative systematic review

AIM

This systematic review will identify, appraise, and synthesise the best available qualitative studies exploring nurses' experiences of peer group supervision. The review purpose draws from the synthesised evidence recommendations to enhance policy and implementation of peer group supervision in practice.

BACKGROUND

Clinical Supervision is increasing in acceptance as a means of professional and best practice support in nursing. Peer group supervision is a non-hierarchical, leaderless model of clinical supervision delivery and is an option for implementation by nursing management when prioritising staff support with limited resources. This systematic review will provide a synthesis of the qualitative literature regarding the nursing peer group supervision experience. Understanding the experience of peer group supervision from those participating may provide constructive insights regarding implementation of this practice to benefit both nurse and patient driven outcomes.

DESIGN

Included are peer reviewed journals focused on nurses' experiences of participating in peer group supervision. Participants are registered nurses of any designation. Qualitative articles, written in English and relating to any area of nursing practice and/or speciality are included. The standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement were used to guide the review. Two investigators independently screened titles, abstracts and selected full text studies describing the experience of peer group supervision. Pre-designed data extraction tools were utilised, and the review followed the Joanna Briggs Institute qualitative meta-aggregation approach with a hermeneutic interpretive analysis.

RESULTS

Results identified seven studies that met the inclusion criteria. A total of 52 findings that described the experiences of nursing peer group supervision are synthesised into eight categories. Four overarching synthesised findings resulted: 1. facilitating professional growth 2. trusting the group 3. professional learning experience and 4. shared experiences. Benefits such as sharing of experiences whilst receiving feedback and support were identified. Challenges identified related to group processes.

CONCLUSIONS

The paucity of international research into nursing peer group supervision poses challenges for nurse decision makers. Significantly, this review provides insight into the value of peer group supervision for nurses regardless of clinical context and setting. The ability to share and reflect with nursing peers enhances both personal and professional aspects of practice. The worth of the peer group supervision model varied across studies however the outcomes provided important insights into facilitating professional growth, enabling a space to share experiences and reflect, and to build teams where trust and respect develops in groups.

Peer group clinical supervision for community health nurses: Perspectives from an interpretive hermeneutic study

AIM

To explore the lived experience of utilizing peer group supervision in practice for community health nurses.

BACKGROUND

Community health nursing is an autonomous and challenging role where quality clinical supervision has benefits for the registered nurse. The structured New Zealand Coaching and Mentoring model of peer group supervision provides the foundation for this research.

METHOD

An interpretative hermeneutic study explored the experience of peer group supervision in a regional health service in Australia. Qualitative in-depth interviews were conducted with all levels of nursing staff to gain an understanding of their experience of peer group supervision.

RESULTS

Data interpretation through hermeneutic analysis revealed the value and professional sustenance gained by participants. Identified game changers include adherence to rules and the influence of group dynamics. These areas were found to impact the quality of supervision.

CONCLUSIONS

This research provides different perspectives of peer group supervision that shares the experience of staff immersed in the process. Peer group supervision yields benefits for community health nurses; however, the research has implications for practice.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers require information when making key decisions regarding workplace implementation. Effective supervision is only possible when balance between benefits and game changers are achieved.

Forensic Mental Health Nurses' Perceptions of Clinical Supervision: A Qualitative Descriptive Study

Mental health nursing in the forensic services is perceived as stressful as there is often a tension between therapeutic and custodial processes. Clinical supervision has been discussed as a support strategy for nurses. The aim of this paper is to explore forensic mental health nurses understanding of clinical supervision and their perception of its utility within their practice. A qualitative descriptive method was used and 10 mental health nurses were interviewed with the aid of an interview guide. Qualitative data was analysed using a thematic approach culminating in the emergence of three themes.Participants talked about the tension between caring and custodial roles within the forensic services which was stressful and created difficulties in the maintenance of a therapeutic relationship. Clinical supervision was seen as a necessary support to assist nurses working in the forensic services. The findings support the premise that there is a tension between therapeutic and custodial practices. Acknowledgement of the complexities of working within the forensic services and the provision of clinical supervision within a confidential, non-judgemental relationship may assist nurses in the provision of care and the maintenance of therapeutic relationships.

Investigating the impact of a psychoanalytic nursing development group within an adolescent psychiatric intensive care unit (PICU)

OBJECTIVE

To evaluate the impact of an adapted psychoanalytic work discussion group for mental health nurses working in adolescent PICU.

BACKGROUND

There is no prior research investigating interventions that effectively support and enable adolescent PICU nursing teams to sustain the therapeutic tasks of their work and their own sense of wellbeing.

METHODS

A bespoke psychoanalytic work discussion group was implemented within an adolescent PICU. Data was collected using in-depth semi-structured interviews with participants, about the impact of the group upon their practice. Data analysis used thematic analysis.

RESULTS

The group positively impacted upon participant knowledge and understanding, emotion management, personal efficacy, therapeutic relationship building, managing challenging behaviour, leadership, professional identity and team cohesion.

CONCLUSION

Mechanisms by which these outcomes were achieved are elaborated utilising the concepts of projective identification, emotional containment and 'temporary outsider-ship'. There is a need to account for the interplay between adolescent defense mechanisms, nursing anxieties and setting-specific organisational dynamics, in the design of effective support interventions for adolescent mental health nurses.

'There need to be a balance': Mental health nurses' perspectives on medication education in university and clinical practice

Working with medication is an important role of the mental health nurse. However, little research has focused on staff nurses' perspectives on where the responsibility lies for preparing student nurses for safe, competent medication management. This study investigated mental health nurses' perspectives on medication education. An interpretive descriptive approach was used. Two focus groups were conducted, and data were analysed using inductive content analysis. It was found that participants embraced a medical approach to servicer user care, with less positive attitudes demonstrated towards psychosocial approaches. There were also tensions expressed between clinical practice and the university, with uncertainty voiced about whose responsibility it was to educate students about medication management. It is important that both environments complement each other in order to enhance the student nurse educational experience. While mental health nurses should be educated in this area to practice in a safe and competent manner, it is also key that a holistic approach to care is considered.

Workplace resilience and emotional labour of Australian mental health nurses: Results of a national survey

Emotional labour is a form of adversity faced by mental health nurses in the context of their workplace interactions. Frequent exposure to emotional adversity can negatively impact mental health nurses' biopsychosocial well-being, workplace relationships, and performance. Workplace resilience is a dynamic interactive process within and between the person and their environment that promotes positive adaptation to adverse events and restores well-being. Workplace resilience could be a protective process that helps mental health nurses positively adapt to workplace emotional adversity. This study aimed to investigate Australian mental health nurses' workplace resilience and emotional labour and explore the relationship between them. A national cross-sectional online survey comprising the Resilience at Work and Emotional Labour scales was completed by registered nurses (n = 482) working in a mental health role or setting across Australia. There was a strong negative relationship between resilience and the emotional labour strategy of surface acting. A positive association between resilience, frequency of emotional labour, and clinical supervision was also found. These findings point to a potential link between mental health nurses' skills of cognitive reframing, and emotional and behavioural regulation needed to effectively manage their emotions and remain therapeutic in interpersonal interactions. Clinical supervision may be a key strategy in supporting mental health nurses' resilience. Further investigation of workplace individuals' internal and external resources, and organizational resources, supports, and strategies that can promote and strengthen mental health nurses' well-being is needed.

Resistance to group clinical supervision: A semistructured interview study of non-participating mental health nursing staff members

This present study is a report of an interview study exploring personal views on participating in group clinical supervision among mental health nursing staff members who do not participate in supervision. There is a paucity of empirical research on resistance to supervision, which has traditionally been theorized as a supervisee's maladaptive coping with anxiety in the supervision process. The aim of the present study was to examine resistance to group clinical supervision by interviewing nurses who did not participate in supervision. In 2015, we conducted semistructured interviews with 24 Danish mental health nursing staff members who had been observed not to participate in supervision in two periods of 3 months. Interviews were audio-recorded and subjected to discourse analysis. We constructed two discursive positions taken by the informants: (i) 'forced non-participation', where an informant was in favour of supervision, but presented practical reasons for not participating; and (ii) 'deliberate rejection', where an informant intentionally chose to not to participate in supervision. Furthermore, we described two typical themes drawn upon by informants in their positioning: 'difficulties related to participating in supervision' and 'limited need for and benefits from supervision'. The findings indicated that group clinical supervision extended a space for group discussion that generated or accentuated anxiety because of already-existing conflicts and a fundamental lack of trust between group members. Many informants perceived group clinical supervision as an unacceptable intrusion, which could indicate a need for developing more acceptable types of post-registration clinical education and reflective practice for this group.