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Garza B, Bang SH, Lin LC. Professional self-concept of BSN students: A cross-sectional correlational study. NURSE EDUCATION TODAY 2024; 139:106238. [PMID: 38728990 DOI: 10.1016/j.nedt.2024.106238] [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: 12/16/2023] [Revised: 04/25/2024] [Accepted: 05/04/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Professional self-concept consists of one's judgments, attitudes about oneself professionally, and one's own perception as a professional. A positive professional self-concept can support students and new nurses throughout their nursing careers. OBJECTIVE To describe levels of self-concept among pre-licensure undergraduate students. PARTICIPANTS/SETTING The participants were nursing students in a Bachelor of Science in Nursing program in the United States. DESIGN/METHODS This is a cross-sectional correlational study with self-report instruments, including demographics and the Professional Self-Concept of Nurses Instrument. Data (N = 103) were analyzed with SPSS/WIN 29.0. Descriptive statistics and professional self-concept scores were examined with independent t-tests, ANOVA, and Pearson's correlations. RESULTS Most participants were female (n = 90), with a mean age of 20 years (SD = 1). The mean professional self-concept of nurses score was 78 (SD = 7), ranging from 27 to 108, and professional self-concept was positively correlated with receiving tutoring through the university's program, working as a tutor for nursing students or students in prerequisite classes, transferring into the nursing program, and participating in campus nursing organizations. Professional self-concept was negatively correlated with advancement in semesters of the nursing program, being a first-generation college student, having a family member who is a nurse, GPA, and having clinical-related work experience in healthcare. CONCLUSIONS Higher levels of exposure to nursing may be related to lower professional self-concept. This is important to recognize and it may generalize to other nursing schools and health-related departments. Schools of nursing should enhance students' resilience by promoting self-concept. Our findings also shade light on self-care and the mental health of healthcare professionals.
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Affiliation(s)
- Brianna Garza
- The University of Texas Southwestern Medical Center, United States of America.
| | - So Hyeon Bang
- School of Nursing, The University of Texas at Austin, United States of America.
| | - Li-Chen Lin
- School of Nursing, The University of Texas at Austin, United States of America.
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Yehene E, Asherman A, Goldzweig G, Simana H, Brezner A. Secondary traumatic stress among pediatric nurses: Relationship to peer-organizational support and emotional labor strategies. J Pediatr Nurs 2024; 74:92-100. [PMID: 38029691 DOI: 10.1016/j.pedn.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Even though the cost of caring is acknowledged in multiple helping professions, research into secondary traumatic stress in pediatric nursing remains limited. This study aimed to determine the prevalence of secondary traumatic stress among pediatric nurses and examine its correlation with demographics, perceived organizational support, peer support, and emotional labor strategies. DESIGN AND METHODS A total of 186 nurses working in a pediatric hospital completed questionnaires addressing secondary traumatic stress, perceived organizational support, peer support, and emotional labor strategies. Through correlational and mediation analyses, we explored the relationships between the study variables. RESULTS Approximately 77.8% of the pediatric nurses surveyed exhibited moderate to severe secondary traumatic stress. Notably, the level of secondary traumatic stress did not correlate with demographic variables. Increased peer support was significantly associated with a heightened use of all emotional labor strategies (surface acting, deep acting, and natural expression) and with elevated levels of secondary traumatic stress. However, surface acting was the sole mediator of this relationship. Conversely, greater perceived organizational support correlated with decreased levels of surface acting and secondary traumatic stress, with surface acting serving as the mediator. CONCLUSIONS Pediatric nurses are greatly impacted by secondary traumatic stress. Enhancing organizational support and carefully assessing peer support can reduce this, by decreasing nurses' need to suppress or feign genuine emotions. PRACTICE IMPLICATIONS To enhance nurses' psychological well-being, healthcare institutions should raise awareness of secondary traumatization and foster a supportive organizational environment that prioritizes effective team emotional support and evaluates collegial emotional labor.
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Affiliation(s)
- Einat Yehene
- School of Behavioral Sciences, the Academic College of Tel Aviv - Yaffo, Israel; Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel.
| | - Adi Asherman
- School of Behavioral Sciences, the Academic College of Tel Aviv - Yaffo, Israel
| | - Gil Goldzweig
- School of Behavioral Sciences, the Academic College of Tel Aviv - Yaffo, Israel
| | - Hadar Simana
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel
| | - Amichai Brezner
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel
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Li B, Chen J. Barriers to community healthcare delivery in urban China: a nurse perspective. Int J Qual Stud Health Well-being 2023; 18:2220524. [PMID: 37300842 DOI: 10.1080/17482631.2023.2220524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE There is considerable research on China's community healthcare, but little examining its delivery from a nurse perspective. This article, set in the context of Shenzhen, elicits community nurses' views on barriers to healthcare delivery, providing an initial evidence framework to improve community nursing practice at organizational and policy levels. METHODS We used qualitative methods. Data from semi-structured interviews with 42 community nurses in Shenzhen underwent inductive content analysis. Consolidated criteria for reporting qualitative research were consulted to structure our reporting. RESULTS Our analysis suggests four elements discouraging community nurses in care delivery: lack of equipment, stressful work environments, staff incompetence, and patient distrust. Centralized means of procurement, management indifference to nurses' well-being, unsystematic training and reluctance to enter the community healthcare sector, and public prejudices against nursing contributed to these constraints, preventing community nurses from performing patient-centred care, devoting energy to caring, freeing themselves from heavy workloads, and building trust-based care relationships. CONCLUSIONS Delivery barriers devalued community health services systematically and undermined nurses' professional advancement and psychological well-being. Targeted management and policy inputs are necessary to reduce caring barriers and enhance the ability of community nursing to safeguard population health.
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Affiliation(s)
- Bo Li
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Juan Chen
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
- Mental Health Research Centre, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
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Meng Z, Zhang L, Zan H, Wang J. Psychological resilience and work engagement of Chinese nurses: a chain mediating model of career identity and quality of work life. Front Psychol 2023; 14:1275511. [PMID: 38034289 PMCID: PMC10687206 DOI: 10.3389/fpsyg.2023.1275511] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023] Open
Abstract
Aim To investigate how nurses' psychological resilience affects their work engagement and the resulting pathways, namely, the intermediary effect of career identity and quality of work life. Background Psychological resilience is the ability to adapt to new circumstances and overcome difficulties. Work engagement is a positive, perfect emotional and cognitive state in the work process, which has a positive effect on nurses' physical and mental health and career development. The importance of psychological resilience in nursing is growing in popularity. However, few studies have explored the relationship between psychological resilience and nurses' work engagement. Design This is a cross-sectional study. Methods From March to April 2023, 356 nurses in the First Affiliated Hospital of Jinzhou Medical University in China received valid questionnaires. The study was surveyed using the Connor-Davidson, Resilience Scale, the Nursing Career Identity Scale, the Work-Related Quality of Life Scale, and the 15-item Utrecht Work Engagement Scale. Process version 3.5 plug-in SPSS 25 was used to test the mediating effect. Results (1) Psychological resilience was significantly and positively correlated with career identity, quality of work life, and work engagement (r = 0.702-0.803, p < 0.001). (2) Career identity and quality of work life partially mediated the relationship between psychological resilience and work engagement, with effect sizes of 0.2382 and 0.0958, respectively. (3) There was a chain mediation model between psychological resilience and work engagement that had a value of 0.1219. Conclusion Career identity and quality of work life played a chain-mediating role between psychological resilience and work engagement. Thus, in order to enhance the work engagement of clinical nurses, it is necessary for nursing managers to take measures to enhance not only psychological resilience but also their career identity and the quality of work life.
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Affiliation(s)
- Zhixing Meng
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Lan Zhang
- Department of Nursing, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Haijing Zan
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Jingru Wang
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
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Rizzo A, Yıldırım M, Öztekin GG, Carlo AD, Nucera G, Szarpak Ł, Zaffina S, Chirico F. Nurse burnout before and during the COVID-19 pandemic: a systematic comparative review. Front Public Health 2023; 11:1225431. [PMID: 37732086 PMCID: PMC10507882 DOI: 10.3389/fpubh.2023.1225431] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/27/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction This review aimed to compare available evidence examining burnout using the Maslach Burnout Inventory (MBI) in nurses before and during the COVID-19 pandemic. The specific objective was to compare nurse burnout scores in terms of emotional exhaustion, depersonalization, and personal accomplishment. Methods A comprehensive search was conducted for studies on nurses' burnout using the MBI published between 1994 and 2022. In total, 19 studies conducted prior to the pandemic and 16 studies conducted during the pandemic were included and compared using the criteria from the Joanna Briggs Institute Critical Appraisal Tool. Results Surprisingly, the results indicated that nurses' burnout scores did not differ significantly before (N = 59,111) and during (N = 18,629) the pandemic. The difference observed was qualitative rather than quantitative. Discussion The outbreak of the COVID-19 pandemic exacerbated an already critical situation, and while COVID-19 may serve as an additional triggering factor for staff mental illness, it cannot solely explain the observed burnout levels. These findings underscore the need for long-term clinical and preventive psychological interventions, suggesting that psychological resources should not be limited to emergencies but extended to address the ongoing challenges faced by nurses. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=399628, identifier: CRD42023399628.
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Affiliation(s)
- Amelia Rizzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Murat Yıldırım
- Department of Psychology, Faculty of Science and Letters, Agri Ibrahim Cecen University, Agri, Türkiye
| | - Gülçin Güler Öztekin
- Department of Psychology, Faculty of Science and Letters, Agri Ibrahim Cecen University, Agri, Türkiye
| | - Alessandro De Carlo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gabriella Nucera
- Department of Emergency, Fatebenefratelli Hospital, ASST Fatebenefratelli and Sacco, Milan, Italy
| | - Łukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Salvatore Zaffina
- Occupational Medicine Unit, Bambino Gesù Children's Hospital, Scientific Institutes for Research and Care (IRCCS), Rome, Italy
| | - Francesco Chirico
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Health Service Department, Italian State Police, Ministry of the Interior, Centro Sanitario Polifunzionale, Milan, Italy
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Pomaranik W, Kludacz-Alessandri M. Talent management and job satisfaction of medical personnel in Polish healthcare entities. Front Psychol 2023; 14:1146073. [PMID: 37564317 PMCID: PMC10409650 DOI: 10.3389/fpsyg.2023.1146073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/05/2023] [Indexed: 08/12/2023] Open
Abstract
Background There is a mass exodus of qualified medical personnel in countries such as Poland. As a result, it is becoming increasingly important to study the satisfaction of medical personnel employed in public healthcare entities and the factors influencing this satisfaction. One such factor is the quality of talent management. Purpose The study aimed to assess the quality of talent management in Polish healthcare entities and its impact on the job satisfaction of medical personnel. The study also considered the impact of other demographic, organizational and behavioral factors on medical personnel satisfaction, such as social competencies, job mobility, orientation toward the patient, gender and education stage. Methods A questionnaire for healthcare professionals was used to collect data. A total of 747 respondents (506 defined as medical talent) participated in the survey. A 5-point Likert scale was adopted to assess job satisfaction and talent management practices. Reliability analysis was conducted to investigate the properties of this scale and the items that comprise it. The data was analyzed using descriptive statistics and structural equation modeling. Results The survey showed that the quality of talent management in Polish healthcare institutions is not well assessed. Professional satisfaction of medical personnel working in Polish public healthcare entities depends mainly on talent management measured by talent motivation, talent development, employee appraisal and organizational culture. Among the factors that have a positive but smaller impact on job satisfaction are job mobility and the education stage. The impact of gender, patient orientation and social competence had the smallest but most significant impact on job satisfaction. Conclusion Healthcare organizations should improve their talent management strategy to meet healthcare professionals' current and future demands and improve their job satisfaction.
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Gelaw YM, Hanoch K, Adini B. Burnout and resilience at work among health professionals serving in tertiary hospitals, in Ethiopia. Front Public Health 2023; 11:1118450. [PMID: 37346106 PMCID: PMC10279861 DOI: 10.3389/fpubh.2023.1118450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
Background The quality of healthcare service is strongly affected by the health professionals' levels of burnout and resilience at work (RaW). Developing resilience is a key component of medical professionalism. Although burnout and resilience are indicators used to assess the level of workplace hardship, there is a dearth of information in most developing countries, including Ethiopia. Objective To assess the levels of burnout and 'resilience at work' among health professionals who work in the surgical care departments in teaching Ethiopian hospitals. Methods A cross-sectional study design was applied among health professionals employed in surgical, gynecologic, and obstetric (Gyn/Obs) departments of two acute-care hospitals (n = 388). A structured self-administered English version questionnaire, consisting of validated scales to measure RaW and burnout, was used to collect the data;22 items of Maslach's burnout inventory human service survey tool and 20 items of Win wood's resilience at work' measuring tool" was employed to assess the health professionals' burnout level and Resilience at work, respectively. Linear logistics regression was employed for inferential statistical analysis to identify factors that predict RaW and burnout. Results Burnout syndrome was shown among 101 (26.0%) study participants. Furthermore, 205 (52.8%), 150 (38.7%), and 125 (32.2%) participants presented high emotional exhaustion, high depersonalization, and low personal accomplishment, respectively. Emotional exhaustion was predicted by the participants' profession, the hope of promotion, professional recognition, and workload. Depersonalization was predicted by age, profession, and perceived workload of the participants. The predictors for personal accomplishment were profession, relationship at work, professional recognition, and having a managerial position in addition to clinical duty. The participants' mean RaW score was 78.36 (Standard deviation ±17.78). A negative association was found between RaW and emotional exhaustion and depersonalization. In contrast, a positive association was identified between RaW and personal accomplishment. The type of profession and marital status were positive predictors of RaW. Conclusion A substantial amount of health professionals experience high burnout in one or more burnout dimensions. Level of RaW is more affected by burnout syndrome. Therefore, promoting activities that increase the level of professional RaW and recognition in their professional practice is needed to reduce job burnout. These findings are especially important concerning low socio-economic countries, as resilience is a vital component of the development of healthcare systems.
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Affiliation(s)
- Yared Mulu Gelaw
- Department of Emergency and Disaster Management, Sackler Faculty of Medicine, School of Public Health, Tel-Aviv University, Tel Aviv, Israel
- Department of Health Service Management, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kashtan Hanoch
- Department of Health Service Management, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Bruria Adini
- Department of Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Eyni S, Mousavi SE, Taghavi R. Developing a causal model of nurses’ compassion competence based on professional self-concept and work conscience: The mediating role of self-efficacy (case study: Nurses in psychiatric ward of Ardabil hospitals). CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-022-04200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Ni YX, Wu D, Bao Y, Li JP, You GY. The mediating role of psychological needs on the relationship between perceived organizational support and work engagement. Int Nurs Rev 2022; 70:204-210. [PMID: 35962469 DOI: 10.1111/inr.12797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022]
Abstract
AIM To examine the mediating effect of basic psychological needs on the relationship between perceived organizational support and work engagement among nurses. BACKGROUND The satisfaction of basic psychological needs is crucial for breeding and sustaining individuals' intrinsic motivation. Little is known about the underlying motivational mechanisms that explain the relationship among perceived organizational support, basic psychological needs, and work engagement in a nursing context. METHODS This was a cross-sectional online survey. A sample of 858 nurses from 12 hospitals was surveyed on their perceived organizational support, basic psychological needs, and work engagement. Structural equation models and bootstrapping methods were used to examine the hypotheses. STROBE reporting guidelines were utilized. RESULTS Perceived organizational support was positively associated with basic psychological needs and work engagement. Basic psychological needs were positively associated with work engagement. Basic psychological needs mediated the relationship between perceived organizational and work engagement. CONCLUSION Perceived organizational support may enhance work engagement by fulfilling the basic psychological needs of nurses. IMPLICATIONS FOR NURSING AND NURSING POLICY Basic psychological needs deserve more attention in nursing organizations. Managers should seek optimal strategies to fulfill nurses' needs for autonomy, competence, and relatedness to stimulate their intrinsic motivation to enhance work engagement.
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Affiliation(s)
- Yun-Xia Ni
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Sichuan, China
| | - Dan Wu
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Sichuan, China
| | - Yun Bao
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Sichuan, China
| | - Ji-Ping Li
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Sichuan, China
| | - Gui-Ying You
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Sichuan, China
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Wójcik G, Wontorczyk A, Barańska I. Job Demands, Resources and Burnout Among Polish Nurses During the Late Wave of COVID-19 Pandemic: The Mediating Role of Emotional Labor. Front Psychiatry 2022; 13:931391. [PMID: 35898625 PMCID: PMC9309251 DOI: 10.3389/fpsyt.2022.931391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Burnout has been recognized as a serious health problem. Nurses as a professional group are at a high risk of burnout occurrence, especially when facing burden associated with the COVID-19 pandemic. Despite evidence that higher job demands lead to burnout, there is less known about the indirect effect of job demands and resources on burnout via surface acting. Using the JD-R framework, this study examined how job demands and resources affected burnout among Polish nurses and whether these relationships are mediated by surface acting and moderated by coping with the workload. Materials and Methods A sample of 270 nurses from the biggest hospital in Southern Poland filled out an online questionnaire at the time between the fourth and the fifth wave of the COVID-19 pandemic in Poland. The Polish adaptations of Oldenburg Burnout Inventory (OLBI), Organizational Constraints Scale (OCS), Interpersonal Conflict at Work Scale (ICAWS), Areas of Worklife Survey (AWS), and Emotional Labor Scale (ELS) were used. Mediation and moderation analyses were carried out in the SPSS macro-PROCESS. Results Surface acting partially mediated the positive association between organizational constraints and interpersonal conflict at work and burnout, as well as the negative association between the perceived organizational support and burnout. Coping with workload moderated the direct effect of organizational constraints on burnout via surface acting. Conclusion The findings enrich the knowledge of the mediating and moderating mechanisms to explain the association between job demands, resources and burnout among nurses. There have been proposed interventions concerning increasing organizational support, effective emotional regulation of management education and psychological training regarding adequate coping strategies which could help reduce or prevent the occurrence of burnout in this professional group.
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Affiliation(s)
- Grzegorz Wójcik
- Department of Medical Sociology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Antoni Wontorczyk
- Institute of Applied Psychology, Faculty of Management and Social Communication, Jagiellonian University, Kraków, Poland
| | - Ilona Barańska
- Department of Medical Sociology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
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Professional Self-Concept, Job Stress, and Triage Competency Among Emergency Nurses: Secondary Data Analysis of a Cross-Sectional Survey. J Emerg Nurs 2022; 48:288-298. [DOI: 10.1016/j.jen.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 11/17/2022]
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Kim MN, Yoo YS, Cho OH, Hwang KH. Emotional Labor and Burnout of Public Health Nurses during the COVID-19 Pandemic: Mediating Effects of Perceived Health Status and Perceived Organizational Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010549. [PMID: 35010814 PMCID: PMC8744956 DOI: 10.3390/ijerph19010549] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/31/2021] [Accepted: 01/02/2022] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to identify the mediating effects of perceived health status (PHS) and perceived organizational support (POS) in the association between emotional labor and burnout in public health nurses (PHNs). The participants were 207 PHNs convenience sampled from 30 public health centers and offices in Jeju, Korea. Data regarding emotional labor, PHS, POS, and burnout were collected between February and March 2021 using a structured questionnaire. Collected data were analyzed by Pearson’s correlation coefficient and multiple regression analysis. Burnout of PHNs was positively correlated with emotional labor (r = 0.64, p < 0.001) and negatively correlated with PHS (r = −0.51, p < 0.001) and POS (r = −0.51, p < 0.001). In the association between emotional labor and burnout, PHS (B = −1.36, p < 0.001) and POS (B = −0.42, p = 0.001) had a partial mediating effect. Reduction of burnout among PHNs requires not only effective management of emotional labor but also personal and organizational efforts to improve PHS and POS.
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Affiliation(s)
- Mi-Na Kim
- College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seoul 06591, Korea;
| | - Yang-Sook Yoo
- College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seoul 06591, Korea;
- Correspondence:
| | - Ok-Hee Cho
- Department of Nursing, College of Nursing and Health, Kongju National University, 56 Gongju-deahak-ro, Gongju-si 32588, Korea;
| | - Kyung-Hye Hwang
- Department of Nursing, Suwon Science College, 288 Seja-ro, Hwaseong-si 18516, Korea;
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Cheng J, Cui J, Yu W, Kang H, Tian Y, Jiang X. Factors influencing nurses' behavioral intention toward caring for COVID-19 patients on mechanical ventilation: A cross-sectional study. PLoS One 2021; 16:e0259658. [PMID: 34739532 PMCID: PMC8570482 DOI: 10.1371/journal.pone.0259658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/23/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To investigate nurses' behavioral intention toward caring for COVID-19 patients on mechanical ventilation, as well as the factors affecting their intention. BACKGROUND COVID-19 patients undergoing mechanical ventilation have many care needs and pose more challenges for nurses, which might adversely affect nurses' intention toward caring behavior. METHODS A cross-sectional study was conducted by using simple random sampling to recruit 598 nurses from five tertiary hospitals in Sichuan Province, China. The participants responded to an online questionnaire that included questions on demographic characteristics; the Attitude, Subjective Norms, and Behavioral Intention of Nurses toward Mechanically Ventilated Patients (ASIMP) questionnaire; the Nursing Professional Identity Scale (NPIS); and the Compassion Fatigue-Short Scale (CF-Short Scale). ANOVA, Spearman correlation analysis, and multiple linear regression were performed to analyze the data. RESULTS The mean total behavioral intention score was 179.46 (± 14.83) out of a total score of 189.00, which represented a high level of intention toward caring for patients on mechanical ventilation. Multiple linear regression revealed that subjective norms (β = 0.390, P<0.001), perceived behavioral control (β = 0.149, P<0.001), professional identity (β = 0.101, P = 0.009), and compassion fatigue (β = 0.088 P = 0.024) were significant predictors of nurses' behavioral intention. CONCLUSIONS Most nurses have a positive behavioral intention to care for COVID-19 patients undergoing mechanical ventilation. The findings in this study provide some insight for developing effective and tailored strategies to promote nurses' behavioral intention toward caring for ventilated patients under the pandemic situation.
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Affiliation(s)
- Jingxia Cheng
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Sichuan, China
| | - Jinbo Cui
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Sichuan, China
| | - Wenwen Yu
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Sichuan, China
| | - Hua Kang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Yongming Tian
- West China Hospital, Sichuan University, Sichuan, China
| | - Xiaolian Jiang
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Sichuan, China
- * E-mail:
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Al-Hakim L, Sevdalis N. A Novel Conceptual Approach to Lean: Value, Psychological Conditions for Engagement With Work and Perceived Organisational Support in Hospital Care. Int J Qual Health Care 2021; 33:6404025. [PMID: 34668018 PMCID: PMC8897978 DOI: 10.1093/intqhc/mzab148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/20/2021] [Accepted: 10/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background Lean thinking (LT) has emerged as a promising approach for reducing waste and improving efficiency. However, its applicability to and effectiveness within healthcare, particularly within hospital-based care, remains clouded by uncertainty. This paper attempts to answer the question ‘how lean thinking can best be applied to hospital-based care’. Methods Narrative review and conceptual synthesis Results We first review the principles of LT and how some of them are challenging to apply within hospital-based care. We then highlight that lean is an approach that was always meant as a combination of technical expertise and a focus on people—supported by a suite of human resource management supportive practices. We proceed to introduce evidence stemming from the literature studies on perceived organizational support and the psychological conditions for successful staff engagement with their work (namely, psychological meaningfulness, availability and safety as experienced by staff) and review how they may apply to hospital-based health workers. We finally advance a set of hypotheses regarding how different facets of value in a hospital care pathway may be correlated and these relationships mediated/moderated by perceived organizational support and the psychological conditions for engagement with work. Conclusion We conclude with a discussion of the limitations of our work and the aspiration that the conceptual analysis we have offered is a useful and actionable framework for hospital management to explore how best to support their staff—in a manner that ultimately achieves better quality and patient experience of care.
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Affiliation(s)
- Latif Al-Hakim
- School of Business, University of Southern Queensland, West Street, Toowoomba, Queensland, QLD 4350
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, UK
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Alrawashdeh HM, Al-Tammemi AB, Alzawahreh MK, Al-Tamimi A, Elkholy M, Al Sarireh F, Abusamak M, Elehamer NMK, Malkawi A, Al-Dolat W, Abu-Ismail L, Al-Far A, Ghoul I. Occupational burnout and job satisfaction among physicians in times of COVID-19 crisis: a convergent parallel mixed-method study. BMC Public Health 2021; 21:811. [PMID: 33906619 PMCID: PMC8079229 DOI: 10.1186/s12889-021-10897-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Healthcare professionals including physicians were subjected to an increased workload during the COVID-19 crisis, leaving them exposed to significant physical and psychological distress. Therefore, our present study aimed to (i) assess the prevalence of burnout and levels of job satisfaction among physicians in Jordan, and (ii) explore physicians' opinions, experiences, and perceptions during the pandemic crisis. METHODS This was a mixed-method study that utilized a structured web-based questionnaire and semi-structured individual interviews. The 10-Item Burnout Measure-Short version (BMS), and the 5-Item Short Index of Job Satisfaction (SIJS) were adopted to assess occupational burnout and job satisfaction, respectively. Semi-structured interviews were conducted, based on a conceptual framework that was developed from Herzberg's Two-Factor Theory of Motivation and Job Demands-Resources Model. Descriptive statistics and regression models, as well as inductive thematic analysis, were used to analyze quantitative and qualitative data, respectively. RESULTS A total of 973 survey responses and 11 interviews were included in our analysis. The prevalence of burnout among physicians was (57.7%). Several significant factors were positively associated with burnout, including female gender, working at highly loaded hospitals, working for long hours, doing night shifts, lack of sufficient access to personal protective equipment, and being positively tested for SARS-CoV-2. Regarding job satisfaction, regression analysis revealed that age was positively associated with higher levels of job satisfaction. On contrary, being a general practitioner or specialist, working at highly loaded hospitals, low salaries, and suffering from burnout have predicted lower levels of job satisfaction. Besides, four themes have emerged from the thematic analysis: (i) Work-induced psychological distress during the pandemic, (ii) Decision-driven satisfactory and dissatisfactory experiences, (iii) Impact of the pandemic on doctor-patient communication and professional skills, and (iv) Economic impacts of the pandemic crisis and lockdown. CONCLUSION A significant physical and psychological burden was associated with the COVID-19 pandemic. Reliable efforts should be implemented aiming at protecting physicians' physical and mental wellbeing, enhancing their working conditions, and raising awareness about burnout. Evidence-based decisions and proper utilization of financial and human resources at institutional and national levels are believed to be crucial for the sustainability of the health workforce, especially in crises.
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Affiliation(s)
| | - Ala'a B Al-Tammemi
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary.
| | - Mohammad Kh Alzawahreh
- Department of Special Surgery, Division of Urology, Al Bashir Hospital, Ministry of Health, Amman, Jordan
| | - Ashraf Al-Tamimi
- Department of Radiology, King Hussein Hospital, Jordanian Royal Medical Services, Amman, Jordan
| | - Mohamed Elkholy
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Fawaz Al Sarireh
- Department of Ophthalmology, College of Medicine, Mutah University, Karak, Jordan
| | - Mohammad Abusamak
- Department of General and Special Surgery, Division of Ophthalmology, Faculty of Medicine, Al Balqa Applied University, Salt, Jordan
| | - Nafisa M K Elehamer
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Faculty of Public and Environmental Health, University of Khartoum, Khartoum, Sudan
| | - Ahmad Malkawi
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Department of Health Promotion, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Wedad Al-Dolat
- Department of Ophthalmology, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Luai Abu-Ismail
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Ali Al-Far
- Department of Orthopedic and Trauma Surgery, Jordan Hospital, Amman, Jordan
| | - Imene Ghoul
- Department of Pediatrics, Ibn Al Haytham Hospital, Amman, Jordan
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16
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Hosseini A, Mousavi SH, Hajibabaee F, Haghani S. The relationship between workplace bullying and professional self-concept in Iranian nurses. Nurs Open 2021; 8:232-240. [PMID: 33318831 PMCID: PMC7729657 DOI: 10.1002/nop2.622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 11/08/2022] Open
Abstract
Aim To determine the level of workplace bullying among Iranian nurses and its relationship with their professional self-concept. Design This was a descriptive correlational study. Methods This study was performed on 200 nurses working in the emergency departments and intensive care units of Imam Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences, Iran, in 2020. The participants were chosen using the simple random sampling method and data collection tools were Negative Acts Questionnaire-Revised and Nurse Self-Concept Questionnaire. The Pearson correlation coefficient was used to determine the relationship between workplace bullying and professional self-concept. Results Based on the experience of daily or weekly workplace bullying, the mean scores of workplace bullying in nurses in terms of work-related bullying, person-related dimension and physical intimidation were 10.11%, 4.27% and 5.66%, respectively, and the overall mean score was 6.68%. The results of this study also showed that workplace bullying is inversely related to professional self-concept and almost all of its dimensions (p = .002, r = -.219).
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Affiliation(s)
- Amin Hosseini
- Medical‐Surgical NursingSchool of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Seyed Hossein Mousavi
- Psychiatric NursingSchool of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Fatemeh Hajibabaee
- School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Shima Haghani
- BiostatisticsNursing Care Research CenterIran University of Medical SciencesTehranIran
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17
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Li Z, Zuo Q, Cheng J, Zhou Y, Li Y, Zhu L, Jiang X. Coronavirus disease 2019 pandemic promotes the sense of professional identity among nurses. Nurs Outlook 2020; 69:389-398. [PMID: 33077203 PMCID: PMC7538146 DOI: 10.1016/j.outlook.2020.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/13/2020] [Accepted: 09/20/2020] [Indexed: 02/08/2023]
Abstract
Background Under the COVID-19 pandemic, nurses are the mainstay in the fight against the pandemic. Purpose To evaluate potential impact of the pandemic on nurses’ professional identity. Method Self-report questionnaires were distributed online. Data collected were compared with available norms. Multivariate logistic regression analyses were employed to calculate the OR of frontline vs. nonfrontline nurses. Findings The mean of the total score of the scale was 121.12 out of 150. Both the total score and scores on the five dimensions were significantly higher than norms. Frontline nurses had a significantly higher professional identity than non-frontline nurses (total score: odds ratio [OR], 1.19; professional identity evaluation: OR, 1.27; professional social support: OR, 1.18; professional social proficiency: OR, 1.33; and dealing with professional frustration: OR, 1.19). The most frequently mentioned tags were Hope, Frontline, Protection, Outbreak, Work, Situation. Discussion COVID-19 outbreak was associated with an enhancement in the professional identity of nurses.
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Affiliation(s)
- Zhuyue Li
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Qiantao Zuo
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Jingxia Cheng
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Yu Zhou
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Yingying Li
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Longling Zhu
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolian Jiang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China.
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18
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McCoy TP, Hoffart N, Lewallen LP, Thorpe S. The Validity and Reliability of Professional Self-Concept in Nursing in Accelerated Bachelor's and Master's Nursing Students. J Nurs Meas 2020; 28:382-403. [PMID: 32430356 DOI: 10.1891/jnm-d-18-00107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Accelerated bachelor's and master's nursing students supported through the New Careers in Nursing program were surveyed (n = 3,506) using subscales from Arthur's Professional Self-Concept in Nursing Instrument (PSCNI). Reliability and validity of the instrument was assessed. METHODS Factor analysis using a random split-half design were conducted and differences investigated based on characteristics. RESULTS Four factors were revealed: leadership (α = .85), skill (α = .89), career positivity (α = .72), and career negativity (α = .72), with acceptable confirmatory fit. Gender and race/ethnicity differences were found in self-perceived leadership and skill and in career positivity by race/ethnicity. Accelerated bachelor's and master's students were different on skill and career positivity. CONCLUSIONS Self-perceived leadership, skill, career positivity, and career negativity are distinct PSCNI concepts.
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Affiliation(s)
- Thomas P McCoy
- Clinical Professor, School of Nursing, University of North Carolina at Greensboro, Greensboro, NC
| | - Nancy Hoffart
- Forsyth Medical Center Distinguished Professor, School of Nursing, University of North Carolina at Greensboro, Greensboro, NC
| | - Lynne P Lewallen
- Professor and Associate Dean, Academic Affairs, School of Nursing, University of North Carolina at Greensboro, Greensboro, NC
| | - Shemeka Thorpe
- Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY
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19
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Yue P, Xu T, Greene B, Wang Y, Wang R, Dai G, Xu L. Caring in community nursing practice: Inductive content analysis reveals an inter-dynamic system between patients and nurses. J Clin Nurs 2020; 29:3025-3041. [PMID: 32353918 DOI: 10.1111/jocn.15312] [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: 10/30/2019] [Revised: 03/15/2020] [Accepted: 04/12/2020] [Indexed: 12/16/2022]
Abstract
AIMS AND OBJECTIVES To examine the understanding of caring in the practice of community nursing from the perspectives of patients and nurses. BACKGROUND An increasing population of patients with chronic disease has produced a need for humanistic caring in communities. As a result, caring has become a core value of community nursing professionals. However, community nurses meet many difficulties in trying to practice person-centred care with their clients. Furthermore, most community nurses-especially in China-lack systematic education and training about caring because the practical meaning of caring in community practice is unknown. DESIGN The qualitative study described herein employed inductive content analysis. METHODS Eleven community patients with chronic disease and fifteen community nurses who were nominated as a caring nurse from different community clinics in Beijing, China, participated in thirty-one interviews during January to August in 2018. Nine documents from the interviewed nurses were collected. Both interview data and documents were analysed using strategies of inductive content analysis. The COREQ checklist was used. RESULTS Patients and their corresponding nurses described a wide range of caring experiences that were generalised into 28 concepts. Caring emerged as an inter-dynamic system that comprised the foundation and quality of a caring relationship, the caring philosophy and behaviours of interactions, and positive feedback from caring interactions. A relationship-based framework of caring in community nursing practice was constructed. CONCLUSIONS Identifying this systematic concept of caring provides insights that are applicable to the creation of targeted management, education and practice interventions to ultimately enhance the quality of community health care-in China or elsewhere. RELEVANCE TO CLINICAL PRACTICE The systematic understanding of caring in community nursing practice will inform nurses in community health clinics, their educators and their managers on how to provide care to community patients and how to develop caring competence for community nurses.
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Affiliation(s)
- Peng Yue
- School of Nursing, Capital Medical University, Beijing, China
| | - Tianmeng Xu
- School of Nursing, Capital Medical University, Beijing, China
| | - Brian Greene
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yongli Wang
- Yuetan Community Health Service Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Rongjin Wang
- School of Nursing, Capital Medical University, Beijing, China
| | - Guizhi Dai
- Yongdingmenwai Community Health Service Center, Dongcheng District, Beijing, China
| | - Lijie Xu
- School of Nursing, Capital Medical University, Beijing, China
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20
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Yu M, Yang S, Qiu T, Gao X, Wu H. Moderating Role of Self-Esteem Between Perceived Organizational Support and Subjective Well-Being in Chinese Nurses: A Cross-Sectional Study. Front Psychol 2019; 10:2315. [PMID: 31681108 PMCID: PMC6798956 DOI: 10.3389/fpsyg.2019.02315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/27/2019] [Indexed: 01/29/2023] Open
Abstract
Purpose Nurses are undertaking tremendous physical and psychological pressure, which may reduce their subjective well-being (SWB). This study is aimed to identify the relationship among perceived organizational support (POS), self-esteem, and SWB, and to further explore whether self-esteem could be a moderator in the association between POS and SWB in Chinese nurses. Materials and Methods This study was conducted in Liaoning Province in China, in 2018. 606 valid questionnaires were collected. Demographic factors, job conditions, the Index of Well-Being, Survey of Perceived Organizational Support (SPOS), and Rosenberg's Self Esteem Scale (RSES) were included in each questionnaire. The association among POS, self-esteem, and POS × self-esteem interaction with SWB were examined by hierarchical multiple regression analysis. The interaction was visualized by using simple slope analysis. Results Average score of SWB in Chinese nurses was 8.27 ± 2.64. Being married was positively related to SWB, while having longer work time per week, having night shift and dissatisfied with nurse-patient relationship were correlated with lower SWB. POS and self-esteem were important factors for SWB. Self-esteem could moderate the relationship between POS and SWB. When self-esteem was higher, POS had a greater effect on SWB. Conclusion Subjective well-being of nurses in the study was at a low level. Self-esteem could moderate the association between POS and SWB. More interventions related to POS and self-esteem will be helpful to improve SWB among nurses.
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Affiliation(s)
- Mingli Yu
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Shihan Yang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Tian Qiu
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Xuege Gao
- Department of Mathematics, University of California, San Diego, San Diego, CA, United States
| | - Hui Wu
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
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21
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Li H, Yuan B, Meng Q, Kawachi I. Contextual Factors Associated with Burnout among Chinese Primary Care Providers: A Multilevel Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193555. [PMID: 31547533 PMCID: PMC6801650 DOI: 10.3390/ijerph16193555] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/12/2019] [Accepted: 09/20/2019] [Indexed: 11/16/2022]
Abstract
Burnout is a common and growing phenomenon in the health care setting. The objective of the present study is to examine contextual factors in the workplace associated with burnout among primary care providers (PCPs) in Shandong Province, China. A cross-sectional survey was conducted among 951 PCPs nested within 48 primary health institutions (PHIs). Burnout was measured using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). We used two-level random intercept linear regression models to examine individual- versus workplace-level risk factors for burnout. The result revealed that 33.12%, 8.83% and 41.43% PCPs were experiencing a high degree of emotional exhaustion (EE), depersonalization (DP) and low personal accomplishment (PA). In multilevel analysis, the most significant and common individual-level predictors of burnout were lack of perceived work support and autonomy. At the institutional level, workload was positively related to EE (odds ratio (OR): 6.59; 95% confidence interval (CI): 3.46-9.72), while work support was related to higher PA (OR: 3.49; 95% CI: 0.81-6.17). Greater attention should be paid to the influence of the work environment factors (workload and work support) to prevent burnout. Strategies such as increasing human resources allocated to PHIs and establishing a supportive work environment are encouraged to prevent and reduce burnout among PCPs in China.
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Affiliation(s)
- Huiwen Li
- School of Public Health, Peking University, Beijing 100191, China.
- China Center for Health Development Studies, Peking University, Beijing 100191, China.
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Beibei Yuan
- China Center for Health Development Studies, Peking University, Beijing 100191, China.
| | - Qingyue Meng
- School of Public Health, Peking University, Beijing 100191, China.
- China Center for Health Development Studies, Peking University, Beijing 100191, China.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
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22
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Panari C, Caricati L, Pelosi A, Rossi C. Emotional exhaustion among healthcare professionals: the effects of role ambiguity, work engagement and professional commitment. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:60-67. [PMID: 31292416 PMCID: PMC6776181 DOI: 10.23750/abm.v90i6-s.8481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/21/2019] [Indexed: 11/23/2022]
Abstract
Background and aim: The study aims at identifying the antecedents and consequences of emotional exhaustion in health professionals and, particularly, examining the process that leads from a hindrance demand, like role ambiguity, to exhaustion and job satisfaction. Emotional exhaustion is a phenomenon that affect health professionals with negative consequence on job satisfaction, and literature has underlined that job demands could be may be a cause of this chronic stress. However, the relationship among job demands, work engagement and exhaustion has produced results not always converging. Method: A self-report questionnaire was administered to 66 health professionals. Results: The results showed that the effect of role ambiguity on emotional exhaustion was mediated by work engagement and the emotional exhaustion impairs job satisfaction when workers are not committed to their profession. Conclusions: Role ambiguity represents a psychosocial risk factor that influence workers’ wellbeing diminishing the level of motivation and this process leads to emotional exhaustion. However, professional commitment appears to be a resource that can protect professionals preventing a decrease in satisfaction. These findings suggest that human resource management should remove hindrance stressors and enhance the mission of Healthcare Professionals in order to increase employees’ work engagement and prevent exhaustion. (www.actabiomedica.it)
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Garcia GPA, Marziale MHP. Indicators of burnout in Primary Health Care workers. Rev Bras Enferm 2019; 71:2334-2342. [PMID: 30365802 DOI: 10.1590/0034-7167-2017-0530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/27/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to analyze the indicators of burnout peculiar to health workers from units of Primary Health Care. METHOD integrative review of the literature structured in the stages: guiding question; search; categorization of studies; assessment; discussion; and interpretation of results, and synthesis of knowledge. Search for original articles and reviews published from 2000 to 2016, in Portuguese, English and Spanish, in the main databases of the health area. Descriptors used: Nursing, Burnout and Primary Health Care. RESULTS 14 articles met the proposed inclusion criteria, six (42.85%) presented a sample of nurses and eight (57.15%) health professionals. CONCLUSION Primary Health Care workers are exhausted due to inadequate working conditions characterized by the lack of human and physical resources that leads to work overload, workplace violence and difficulty with teamwork, despite being satisfied with the work environment.
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Nurses as enactors of workplace aggression: Can perception of organisational support cushion the influence of job demands on them? CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-0100-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Karanikola M, Doulougeri K, Koutrouba A, Giannakopoulou M, Papathanassoglou EDE. A Phenomenological Investigation of the Interplay Among Professional Worth Appraisal, Self-Esteem and Self-Perception in Nurses: The Revelation of an Internal and External Criteria System. Front Psychol 2018; 9:1805. [PMID: 30327626 PMCID: PMC6174859 DOI: 10.3389/fpsyg.2018.01805] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 09/05/2018] [Indexed: 11/13/2022] Open
Abstract
Nurses’ professional self-concept is strongly associated with professional worth appraisal, which encompasses their feelings and perceptions regarding their task efficacy and value of input to clinical outcomes. Professional self-concept and professional worth appraisal are incorporated in one’s overall professional role perception. Data show that the way nurses think and feel about themselves personally and professionally, is associated with their well-being, the quality of provided patient care, their job satisfaction and retention. Although researchers indicate that professional self-concept is a different entity from personal self-concept, however, a clear differentiation and possible interaction between these constructs has not been yet adequately described in nursing literature. Personal self-concept mirrors the way people interpret them-selves, incorporating their self-awareness and personal effectiveness. Following purposeful sampling and informed consent, a phenomenological approach based on Munhall’s methodology was employed to explore the living experience of professional role perception in 16 critical and emergency nurses, with special focus on their perceptions and feelings about personal and professional-role worth appraisal. Data and theoretical saturation criteria were implemented, along with all nine Munhall’s criteria for the rigor and trustworthiness of phenomenological studies. The participants’ narratives suggested a possible interaction between professional attitude and personality traits, illuminating as the core theme an interplay among self-perception, personal and professional worth appraisal process. Additionally, the present study emphasized the way self-evaluation criteria system may be associated with the personal and professional self-concept in nurses. In particular, it was highlighted that the way nurses think and feel about themselves is associated with the way they experience their professional role and vice versa, and that professional role-based self-concept and professional worth perception can be linked with their well-being. Furthermore, positive feelings about the self and personal competencies seemed to enhance the perception of effectiveness in clinical settings and adequacy of professional skills, resulting in empowered professional identity and vice versa. Overall, the present findings are discussed in relation to nurses’ experience of work-related stressors and relevant interventions. Further exploration of the effectiveness of interventions for facilitating adaptive personal and professional self-appraisal are suggested.
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Affiliation(s)
- Maria Karanikola
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Karolina Doulougeri
- Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Anna Koutrouba
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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Dugani S, Afari H, Hirschhorn LR, Ratcliffe H, Veillard J, Martin G, Lagomarsino G, Basu L, Bitton A. Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: A systematic review. Gates Open Res 2018; 2:4. [PMID: 29984356 PMCID: PMC6030396 DOI: 10.12688/gatesopenres.12779.3] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). Methods: We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of factors associated with provider burnout. Results: A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, midwives, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout (for example, among nurses, pharmacists, and rural health workers) was associated with high job stress, high time pressure and workload, and lack of organizational support. Conclusions: Our comprehensive review of published literature showed that provider burnout is prevalent across various health care providers in LMICs. Further studies are required to better measure the causes and consequences of burnout and guide the development of effective interventions to reduce or prevent burnout.
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Affiliation(s)
- Sagar Dugani
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, USA
- University of Toronto, Toronto, Canada
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Henrietta Afari
- Department of Medicine , Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | | | - Hannah Ratcliffe
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jeremy Veillard
- The World Bank Group, Washington, D.C., USA
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | | | | | - Lopa Basu
- Armstrong Institute for Patient Safety & Quality, Johns Hopkins University, Baltimore, USA
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, USA
- Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, USA
- Department of Health Care Policy, Harvard Medical School, Boston, USA
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Dugani S, Afari H, Hirschhorn LR, Ratcliffe H, Veillard J, Martin G, Lagomarsino G, Basu L, Bitton A. Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: A systematic review. Gates Open Res 2018. [PMID: 29984356 DOI: 10.12688/gatesopenres.12779.1] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). Methods: We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of factors associated with provider burnout. Results: A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, midwives, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout (for example, among nurses, pharmacists, and rural health workers) was associated with high job stress, high time pressure and workload, and lack of organizational support. Conclusions: Our comprehensive review of published literature showed that provider burnout is prevalent across various health care providers in LMICs. Further studies are required to better measure the causes and consequences of burnout and guide the development of effective interventions to reduce or prevent burnout.
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Affiliation(s)
- Sagar Dugani
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, USA.,University of Toronto, Toronto, Canada.,Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Henrietta Afari
- Department of Medicine , Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | | | - Hannah Ratcliffe
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jeremy Veillard
- The World Bank Group, Washington, D.C., USA.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | | | | | - Lopa Basu
- Armstrong Institute for Patient Safety & Quality, Johns Hopkins University, Baltimore, USA
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, USA.,Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, USA.,Department of Health Care Policy, Harvard Medical School, Boston, USA
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Dugani S, Afari H, Hirschhorn LR, Ratcliffe H, Veillard J, Martin G, Lagomarsino G, Basu L, Bitton A. Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: A systematic review. Gates Open Res 2018; 2:4. [PMID: 29984356 PMCID: PMC6030396 DOI: 10.12688/gatesopenres.12779.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2018] [Indexed: 07/16/2024] Open
Abstract
Background: Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). Methods: We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of factors associated with provider burnout. Results: A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, midwives, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout (for example, among nurses, pharmacists, and rural health workers) was associated with high job stress, high time pressure and workload, and lack of organizational support. Conclusions: Our comprehensive review of published literature showed that provider burnout is prevalent across various health care providers in LMICs. Further studies are required to better measure the causes and consequences of burnout and guide the development of effective interventions to reduce or prevent burnout.
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Affiliation(s)
- Sagar Dugani
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, USA
- University of Toronto, Toronto, Canada
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Henrietta Afari
- Department of Medicine , Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | | | - Hannah Ratcliffe
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jeremy Veillard
- The World Bank Group, Washington, D.C., USA
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | | | | | - Lopa Basu
- Armstrong Institute for Patient Safety & Quality, Johns Hopkins University, Baltimore, USA
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, USA
- Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, USA
- Department of Health Care Policy, Harvard Medical School, Boston, USA
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Labrague LJ, McEnroe Petitte DM, Leocadio MC, Van Bogaert P, Tsaras K. Perceptions of organizational support and its impact on nurses' job outcomes. Nurs Forum 2018; 53:339-347. [PMID: 29693264 DOI: 10.1111/nuf.12260] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PROBLEM Strong organizational support can promote a sense of well-being and positive work behaviors in nurses. However, despite the importance of organizational support in nursing, this topic remains unexplored in the Philippines. PURPOSE The aim of this study was to examine the impact of organizational support perceptions on nurses' work outcomes (organizational commitment, work autonomy, work performance, job satisfaction, job stress, and turnover intention). METHODS A descriptive, cross-sectional research design was adopted in this study to collect data from one hundred eighty (180) nurses in the Philippines during the months of September 2015 to December 2015. Seven standardized tools were used: the Job Satisfaction Index, the Job Stress Scale, the Burnout Measure Scale, the Work Autonomy Scale, the Six Dimension Scale of Nursing Performance, the Turnover Intention Inventory Scale, and the Perception of Organizational Support Scale. FINDINGS Nurses employed in government-owned hospitals perceived low levels of organizational support as compared to private hospitals. Significant correlations were identified between perceived organizational support (POS), hospital bed capacity, and nurses' work status. No significant correlations were found between perceived organizational supportand the six outcomes perceived by nurses in the Philippines (organizational commitment, work performance, job autonomy, job satisfaction, job stress, and turnover intention). CONCLUSION Perceptions of organizational support were low in Filipino nurses compared to findings in other international studies. Perceived organizational support did not influence job outcomes in nurses.
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Empathy, loneliness, burnout, and life satisfaction in Chilean nurses of palliative care and homecare services. ENFERMERIA CLINICA 2017; 27:379-386. [PMID: 28587755 DOI: 10.1016/j.enfcli.2017.04.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/12/2017] [Accepted: 04/20/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Empathy has been described as an essential competence of healthcare professionals who are working in palliative care and homecare services. In these services, usually accompanied by a high risk of physical and emotional burnout, empathy can play an important role in the improvement of occupational wellbeing. The aim of this study was to confirm the role of empathy in the prevention of loneliness and burn out, and in the promotion of life satisfaction. METHODS In 2016, an observational study was carried out in Chile with professional nurses who were working in palliative care and homecare services. Empathy with the patients, loneliness, life satisfaction, and burnout were measured using psychometric scales. Correlation analyses were applied to confirm relationships among the elements measured. RESULTS In a sample of 64 participants, positive correlations were confirmed between empathy and life satisfaction (P = 0.40; p = 0.003), and between empathy and professional experience (P = 0.29; p = 0.04). On the other hand, inverse correlations were confirmed between empathy and burnout (P = -0.38; p = 0. 01), and between empathy and loneliness (P = -0.41; p = 0.004). CONCLUSIONS These findings confirm the important role that empathy plays in the prevention of loneliness and burnout, and in the promotion of life satisfaction. Evidence found suggests that empathetic abilities can be improved by the professional experience.
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Chang HY, Shyu YIL, Wong MK, Chu TL, Lo YY, Teng CI. How does burnout impact the three components of nursing professional commitment? Scand J Caring Sci 2017; 31:1003-1011. [DOI: 10.1111/scs.12425] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 12/01/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Hao-Yuan Chang
- School of Nursing; National Taiwan University; Taipei Taiwan
- Department of Nursing; National Taiwan University Hospital; Taipei Taiwan
| | | | - May-Kuen Wong
- Taoyuan Branch; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Tsung-Lan Chu
- Department of Nursing; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Yuan-Yu Lo
- Department of Planning and Management; MacKay Memorial Hospital; Taipei Taiwan
| | - Ching-I Teng
- Department of Industrial and Business Management; Chang Gung University; Taoyuan Taiwan
- Department of Rehabilitation; Chang Gung Memorial Hospital; Taoyuan Taiwan
- Department of Business and Management; Ming Chi University of Technology; Taoyuan Taiwan
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Gómez-Urquiza JL, Monsalve-Reyes CS, San Luis-Costas C, Fernández-Castillo R, Aguayo-Estremera R, Cañadas-de la Fuente GA. [Risk factors and burnout levels in Primary Care nurses: A systematic review]. Aten Primaria 2017; 49:77-85. [PMID: 27363394 PMCID: PMC6876264 DOI: 10.1016/j.aprim.2016.05.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/11/2016] [Accepted: 05/03/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To determine the risk factors and levels of burnout in Primary Care nurses. METHODS A systematic review was performed. DATA SOURCES CINAHL, CUIDEN, LILACS, PubMed, ProQuest, ScienceDirect and Scopus databases were consulted. Search equations were 'burnout AND community health nursing' and 'burnout AND primary care nursing'. The search was performed in October 2015. STUDY SELECTION The final sample was n=12 studies. Quantitative primary studies that used Maslach Burnout Inventory for burnout assessment in Primary Care nurses were included without restriction by publication date. DATA EXTRACTION The main variables were the mean and standard deviation of the three burnout dimensions, high, medium and low prevalence rates of each dimension, and socio-demographic, occupational and psychological variables that potentially influence burnout level. RESULTS Studies show high prevalence rates, generally between 23% and 31%, of emotional exhaustion. The prevalence rates of high depersonalisation and low personal accomplishment show heterogeneity, varying between 8%-32% and 4%-92% of the sample, respectively. Studies show that older nurses with more seniority, anxiety and depression, among other variables, have higher burnout levels, while nurses with higher salary, high job satisfaction, organisational support, and good self-concept have less burnout. CONCLUSION High emotional exhaustion is the main affected dimension of burnout in Primary Care nursing. There is heterogeneity in depersonalisation and personal accomplishment. Burnout must be prevented in these professionals, by increasing protective factors and monitoring its appearance in those with risk factors.
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Affiliation(s)
- Jose L Gómez-Urquiza
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Campus Universitario de Ceuta, Universidad de Granada, Ceuta, España.
| | - Carolina S Monsalve-Reyes
- Departamento de Ciencias Sociales, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Concepción San Luis-Costas
- Departamento de Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), Madrid, España
| | - Rafael Fernández-Castillo
- Departamento de Enfermería, Facultad de Ciencias de la Salud de Granada, Universidad de Granada, Granada, España
| | - Raimundo Aguayo-Estremera
- Departamento de Psicología Social, Facultad de Ciencias Sociales de Melilla, Universidad de Granada, Melilla, España
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