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Yi L, Cai J, Shuai T, Jiménez-Herrera MF, Gu L, Tian X. Mediating effect of moral sensitivity and professional identity between moral courage and compassion fatigue among nursing interns: a cross-sectional study. BMC Nurs 2024; 23:551. [PMID: 39135157 PMCID: PMC11320776 DOI: 10.1186/s12912-024-02173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/12/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Compassion fatigue in nursing interns contributes to career indecision and worsens the nursing shortage. While work environment and psychological factors are well-studied, the ethical dimension remains unexplored. Understanding these mechanisms, particularly the role of moral courage, is essential for designing interventions to combat compassion fatigue and address the workforce crisis. This study investigates the influence of moral courage on compassion fatigue among Chinese nursing interns, focusing on the mediating roles of moral sensitivity and professional identity. METHODS A quantitative, cross-sectional study was conducted in accordance with the STROBE guidelines. We used the convenience sampling method to recruit 467 nursing interns from four public junior colleges in Hunan Province, China in February, 2024. Data were collected using Compassion Fatigue Short Scale, Moral Courage Scale, Revised Moral Sensitivity Questionnaire, and Professional Identity Scale. Data analyses were conducted using SPSS 22.0 and Amos 21.0. RESULTS The modified model exhibited a good fit (χ2/df = 3.437, AGFI = 0.928, IFI = 0.984, TLI = 0.976, CFI = 0.984, NFI = 0.977, RMSEA = 0.072). Moral sensitivity positively influenced both moral courage and professional identity, while professional identity negatively impacted compassion fatigue. Importantly, the effect of moral courage on compassion fatigue was entirely mediated by moral sensitivity and professional identity (β = -0.114, P = 0.001). CONCLUSION This study suggests that moral courage in nursing interns mitigates compassion fatigue through the combined mediating effects of moral sensitivity and professional identity. Ethics education programs fostering moral courage, moral sensitivity, and professional values in nursing students could be crucial in alleviating compassion fatigue.
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Affiliation(s)
- Lijuan Yi
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou, 412000, China
- Nursing Department, Universitat Rovira i Virgili, Tarragona, Spain
| | - Jian Cai
- School of Nursing, Yongzhou Vocational Technical College, Yongzhou, 425000, China
| | - Ting Shuai
- Second Clinical Division, Peking University School and Hospital of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, China
| | | | - Lei Gu
- School of sports & arts, Hunan University of Chinese medicine, Changsha, 410000, China
| | - Xu Tian
- Chongqing Center for Evidence-based Traditional Chinese Medicine, Division of Science & Technology and Foreign Affairs the First Affiliated Hospital of Chongqing University of Chinese Medicine, No. 6 of 7th Brach of Panxi Road, Jiangbei District, Chongqing, 400020, China.
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2
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Nikel C, Gildenblatt L. Finding compassion when compassion fatigued. Int J Psychiatry Med 2024; 59:447-454. [PMID: 37982798 DOI: 10.1177/00912174231215923] [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] [Indexed: 11/21/2023]
Abstract
Objective: The unrelenting turmoil of the COVID-19 pandemic has been especially hard on those in the healthcare field. This chronic stress has resulted in depleted compassion towards patients served and colleagues. Researchers have suggested that empathy is a finite resource that must be replenished. For physicians in residency training and those in practice, where finding meaning and purpose in their work is already a challenge, the spark for medicine and helping others may easily become extinguished.This article explores interventions implemented in two family medicine residency programs to address concerns about burnout and compassion fatigue exacerbated by the COVID-19 pandemic.Methods: A qualitative research approach is employed here through case studies of two family medicine programs, along with a description of several interventions intended to mitigate burnout and compassion fatigue during the pandemic.Participants were 36 family medicine residents from "residency #1" and 36 family medicine residents from "residency #2."Results: The authors describe several interventions used in the two residency programs to reduce issues of compassion fatigue. These include meditation, gratitude practice, guided group support, and a focus on clinicians' physical health.Feedback from residents and program leaders suggest that these interventions were useful tools to help physicians navigate their new normal as they began to practice during a pandemic, thereby reducing burnout and challenges with compassion fatigue. A strategic plan is outlined to help other programs implement some of these strategies.Conclusions: It is imperative that training programs continue to implement interventions that emphasize resident and post-residency wellness to reduce compassion fatigue in order to navigate the new stressors that came with the COVID-19 pandemic and those that will come with pandemics in the future.
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Affiliation(s)
- Carlie Nikel
- Department of Community and Family Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, MO, USA
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Huang J, Fu L, Fu Y, Creedy DK, Gamble J, Da Z, Yao J, Li J, Wang N. Exposure to disrespectful maternity care and perceptions of respectful maternity care among nursing and midwifery pre-registration students in China: A national cross-sectional study. Nurse Educ Pract 2024; 78:104026. [PMID: 38901276 DOI: 10.1016/j.nepr.2024.104026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024]
Abstract
AIMS To 1) determine the prevalence and types of disrespectful maternity care witnessed by students; 2) describe students' perceptions of respectful maternity care and associated factors; and 3) investigate whether witnessing disrespectful care influences their perceptions of respectful maternity care. BACKGROUND Limited evidence exists about nursing and midwifery students' perceptions of respectful maternity care and prevalence of disrespectful maternity care in China. Understanding students' perceptions can inform pre-registration curricula and clinical practice programs, promoting the implementation of respectful maternity care. DESIGN An exploratory national online survey was conducted. METHODS Data were analysed using bivariate analysis and multi-factor analysis of variance. RESULTS Among 733 students, positive perceptions towards respectful maternity care were common. Approximately one-fifth witnessed disrespect, with physical violence, lack of communication and untimely care most frequently reported. A better understanding of respectful maternity care was associated with female students of Han ethnicity, majoring in midwifery, undertaking a longer internship/practicum and reporting fewer instances of observed disrespect. Although students reported positive perceptions of respectful maternity care, inadequate understanding was evident. Incorporating relevant content about respectful care into the curriculum is suggested. Reducing students' exposure to disrespectful maternity care may ensure that certain forms of disrespect or abuse do not become normalized among students. This requires system-level efforts to create a safe and supportive working environment for maternity health providers. CONCLUSION To promote respectful maternity care in China, system-level changes are warranted. Respectful maternity care needs to be essential content in pre-registration midwifery and nursing curricula. Encouraging students to identify poor practice and discuss good practice in a safe learning environment is warranted.
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Affiliation(s)
- Jing Huang
- School of Nursing, Capital Medical University, No.10 Xitoutiao Road, Fengtai District, Beijing 100069, China; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London SE18WA, UK
| | - Li Fu
- School of nursing, Liaoning University of Traditional Chinese Medicine Shenyang, No 79 Chongshan East Road, Huanggu District, Shenyang 110847, China; School of Nursing, Peking University, No.38 Xueyuan Road, Haidian District, Beijing 100191,China
| | - Yu Fu
- School of Nursing, Xinjiang Medical University, No.567 Shangde North Road, Shuimogou District, Urumqi 830017, China
| | - Debra K Creedy
- School of Nursing and Midwifery, Griffith University Logan Campus, University Drive, Meadowbrook, Queensland 4131, Australia
| | - Jenny Gamble
- School of Nursing and Midwifery, Griffith University Logan Campus, University Drive, Meadowbrook, Queensland 4131, Australia
| | - Zhen Da
- Tibet Medical University, No.36 Jiangsu Road, Lhasa, Tibetan Autonomous Region 850000, China
| | - Jiasi Yao
- School of Nursing, Hebei Medical University, No.309 Jianhua Street, Yuhua District, Shijiazhuang, Hebei Province, China
| | - Junying Li
- Handan Vocational College of Science and Technology, No.1 Fuyang Road, Jinan New District, Handan City, Hebei Province 056046, China
| | - Na Wang
- School of Nursing, Capital Medical University, No.10 Xitoutiao Road, Fengtai District, Beijing 100069, China.
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Chen X, Zhang Y, Zheng R, Hong W, Zhang J. Latent profiles of nurses' moral resilience and compassion fatigue. Nurs Ethics 2024; 31:635-651. [PMID: 38148631 DOI: 10.1177/09697330231222594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
BACKGROUND Compassion fatigue is often associated with moral distress in the nursing practice among registered nurses. Moral resilience is an important ability to maintain, restore, or promote their physical and mental health in response to ethical dilemmas in nursing. Moral resilience can be utilized as a potential solution to aid registered nurses in effectively managing compassion fatigue. AIM To identify latent profiles of moral resilience among registered nurses and to explore the relationships of these profiles with compassion fatigue. RESEARCH DESIGN From August 2022 to December 2022, 569 nurses were recruited in two general hospitals, in China. A Rushton Moral Resilience Scale and the Chinese version of Compassion Fatigue-Short Scale were given to the participants. A latent profile analysis was conducted to explore moral resilience latent profiles. Predictors of profiles membership was evaluated using multinomial logistic regression analysis, and the compassion fatigue scores of each latent profile were compared using a one-way analysis of variance. ETHICAL CONSIDERATIONS We obtained ethical approval from the Institution Review Board of Xiangya School of Nursing, Central South University (IRB No. E202293, approved 15/July/2022). RESULTS A four-profile moral resilience model best fit the data. Different levels and shapes differentiated the four profiles: high moral resilience (28.7%), moderate moral resilience (52.3%), low responses and high efficacy (16.2%), and low moral resilience (2.8%). Nurses with bachelor's degrees were more likely to belong to the high moral resilience (OR = 0.118, p = .038) and moderate moral resilience (OR = 0.248, p = .045); Nurses who were divorced or separated (OR = 11.746, p = .025) and very dissatisfied with their work (OR = 0.001, p = .049) were more probably belonging to low moral resilience. Nurses who had received ethical training in the hospital were more likely involved in high moral resilience (OR = 5.129, p = .003) and low responses and high efficacy (OR = 5.129, p = .003). In each profile of moral resilience, compassion fatigue was experienced differently by the participants (F = 13.05, p < .001). CONCLUSIONS Developing and implementing interventions tailored to each nurse's moral resilience profile would maximize interventions' effectiveness and reduce nurses' compassion fatigue.
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Affiliation(s)
- Xuelei Chen
- Central South University
- Guilin Medical University
| | | | | | - Wei Hong
- The Second Affiliated Hospital of Guilin Medical University
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Gan RK, Arcos González P, Fernandez-Tardon G, Zerbo A, Calota VC, Klöslová Z, Otelea MR, Fabiánová E, Rodriguez-Suarez MM, Tardon A. Development, validation, and accuracy of ORCHESTRA emotional exhaustion screening questionnaire among healthcare workers during COVID-19 Pandemic. Br J Health Psychol 2024; 29:430-453. [PMID: 37957891 DOI: 10.1111/bjhp.12706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/29/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND The COVID-19 pandemic has posed unprecedented challenges, particularly for healthcare workers (HCWs). The prolonged struggles exposed the HCWs to a variety of stressors, potentially leading to burnout. Emotional exhaustion is widely recognized as the core component of burnout. This research aims to conceptualize and develop an emotional exhaustion screening questionnaire through literature review, validation, and accuracy testing. METHOD A literature review of questionnaires and extraction of items on emotional exhaustion were performed in June 2022. We proceed with the face validity of the items by experts. The items with good content validity ratio and index were selected and reworded to suit the context of HCWs working during the COVID-19 pandemic. A pilot test of the questionnaire was done in the Central University Hospital of Asturias (HUCA) from October to December 2022 with a sample of 148 HCWs from the ORCHESTRA cohort to determine its reliability, convergent validity, and accuracy. RESULTS Our literature review identified 15 validated questionnaires. After exclusion, 32 items were sent for content validation by experts, yielding five final items that proceeded with the pilot test. Resulting in a Cronbach's alpha-coefficient of .83 for the scale and .78 for dichotomous responses, demonstrating good internal consistency and convergent validity. The result of our accuracy test yielded sensitivity (90.6%) and specificity (91.6%) for the OEEQ scale; and sensitivity (88.7%) and specificity (89.5%) for OEEQ dichotomous responses. CONCLUSION This study developed and validated the ORCHESTRA Emotional Exhaustion Questionnaire, demonstrating the questionnaire's clarity, relevance, and comprehensibility in screening emotional exhaustion among HCWs.
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Affiliation(s)
- Rick Kye Gan
- Public Health Department, Unit for Research in Emergency and Disaster, Universidad de Oviedo, Oviedo, Spain
| | - Pedro Arcos González
- Public Health Department, Unit for Research in Emergency and Disaster, Universidad de Oviedo, Oviedo, Spain
| | - Guillermo Fernandez-Tardon
- Public Health Department, Health Research Institute of Investigation (ISPA) and CIBERESP, Universidad de Oviedo, Oviedo, Spain
| | - Alexandre Zerbo
- Public Health Department, Unit for Research in Emergency and Disaster, Universidad de Oviedo, Oviedo, Spain
| | - Violeta Claudia Calota
- Occupational Health and Toxicology Department, National Institute of Public Health, National Center for Environmental Risk Monitoring, Bucharest, Romania
| | - Zuzana Klöslová
- Department of Occupational Health, The Regional Authority of Public Health in Banská Bystrica, Banská Bystrica, Slovakia
| | - Marina Ruxandra Otelea
- Occupational Medicine Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Eleonóra Fabiánová
- Department of Occupational Health, The Regional Authority of Public Health in Banská Bystrica, Banská Bystrica, Slovakia
| | - Marta-Maria Rodriguez-Suarez
- Public Health Department, Health Research Institute of Investigation (ISPA) and CIBERESP, Universidad de Oviedo, Oviedo, Spain
| | - Adonina Tardon
- Public Health Department, Health Research Institute of Investigation (ISPA) and CIBERESP, Universidad de Oviedo, Oviedo, Spain
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Cleary M, West S, Hungerford C. Resilience: One Part of a Larger Toolkit for Managing Stress. Issues Ment Health Nurs 2024; 45:114-117. [PMID: 37672763 DOI: 10.1080/01612840.2023.2239913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
- Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, Australia
| | - Sancia West
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, Australia
| | - Catherine Hungerford
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, Australia
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Cleary M, West S, Hungerford C. Mental Health Nurses Overcoming Adversity: A Discursive Review. Issues Ment Health Nurs 2023; 44:944-950. [PMID: 37616589 DOI: 10.1080/01612840.2023.2236698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
The mental health nursing profession has experienced various challenges since its inception. This discursive review considers these challenges, including how mental health nurses have and can continue to overcome adversity as individuals and as a profession. The discussion examines the influence of the profession's historical involvement in institutionalization and coercive care; the continuing impact of stigma; and the increasing demand for mental health services, amidst chronic staff shortages. Collectively, mental health nurses must harness strong therapeutic relationships, intra- and multi-disciplinary collaboration, personal and professional resilience, education that prepares them for the future, and sector-wide planning and innovation, to respond positively to these challenges. These approaches will support mental health nurses to overcome adversity and achieve positive outcomes for the profession and people with the lived experience of mental illness.
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Affiliation(s)
- Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
| | - Sancia West
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
| | - Catherine Hungerford
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
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Chen Z, Foo ZST, Tang JY, Sim MWC, Lim BL, Fong KY, Tan KH. Sleep quality and burnout: A Singapore study. Sleep Med 2023; 102:205-212. [PMID: 36706670 DOI: 10.1016/j.sleep.2022.12.026] [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: 06/02/2022] [Revised: 11/30/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Improved sleep hygiene is postulated to be protective against burnout. Previous studies assessing a potential association between poor sleep quality and burnout showed incongruent results. OBJECTIVE To investigate the relationship between sleep quality and burnout. DESIGN Setting and Participants: A survey was conducted in a large health care cluster in Singapore and included health care staff from different professions (N = 4777). The Maslach Burnout Inventory - Human Services Survey was used to measure burnout across 3 sub-scales: Emotional Exhaustion, Depersonalization and Personal Accomplishment, while the Pittsburgh Sleep Quality Index (PSQI) was used to gauge the participants' sleep quality. Multi-variable general linear model ANOVA was used for correlation analysis. RESULTS There is a strong correlation between sleep quality and all 3 burnout sub-scales. PSQI is associated with Emotional Exhaustion (F value = 90.65, P-value <.0001), Depersonalization (F value = 49.46, P-value <.0001) and Personal Accomplishment (F value = 12.29, P-value <.0001). PSQI shows a significant linear upward trend with Emotional Exhaustion (linear contrast = 957.06, P-value <.0001) and with Depersonalization (linear contrast = 521.92, P-value <.0001). With Personal Accomplishment, PSQI shows a significant linear downward trend (linear contrast = 123.61, P-value <.0001). CONCLUSION Poor sleep quality is progressively and linearly associated with burnout and its 3 sub-scales. Future studies that evaluate interventions which improve sleep quality among health care workers may be useful in reducing burnout and improving patient care.
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Affiliation(s)
- Zhengyong Chen
- Duke-NUS Medical School, Singapore; SingHealth Duke-NUS Institute for Patient Safety & Quality, Singapore.
| | - Zann Sue Ting Foo
- SingHealth Duke-NUS Institute for Patient Safety & Quality, Singapore
| | - Joo Ying Tang
- SingHealth Duke-NUS Institute for Patient Safety & Quality, Singapore
| | - Mabel Wan Chi Sim
- SingHealth Duke-NUS Institute for Patient Safety & Quality, Singapore
| | - Boon Leng Lim
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Kok Yong Fong
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore
| | - Kok Hian Tan
- SingHealth Duke-NUS Institute for Patient Safety & Quality, Singapore
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Fantus S, Cole R, Hawkins L. "The hierarchy is your constraint:" a qualitative investigation of social workers' moral distress across a U.S. health system. SOCIAL WORK IN HEALTH CARE 2022; 61:387-411. [PMID: 36189981 DOI: 10.1080/00981389.2022.2128156] [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: 12/30/2021] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
This paper reports findings from a qualitative study on the triggers of hospital social workers' moral distress at a large southern U.S. health system. Moral distress occurs when ethical conflict cannot be resolved in a way that aligns with an individual's personal and professional values and ethics. Participants indicated that moral distress derives from both individual interactions and the culture and climate of health systems. For example, participants expressed how sources of moral distress derived from client-centered decisions, such as end-of-life care and patient autonomy; interpersonal dynamics, including team or supervisory conflict; structural issues, such as insurance barriers or internal hospital policies; and organizational values, such as perceptions of institutional support and validation. Implications of this research suggest that health systems need to foster positive ethical environments that nurture clinicians' health and mental health through programs that aim to increase moral resilience, promote empowerment, and foster wellness.
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Affiliation(s)
- Sophia Fantus
- School of Social Work, The University of Texas at Arlington, Arlington, Texas, USA
| | - Rebecca Cole
- School of Social Work, The University of Texas at Arlington, Arlington, Texas, USA
| | - Lataya Hawkins
- School of Social Work, The University of Texas at Arlington, Arlington, Texas, USA
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Ross LJ, Mitchell LJ, Williams EC, Lynch PJ, Munro JP, Williams LT. Impact of a resilience and wellbeing program: A longitudinal cohort study of student dietitians. Nurs Health Sci 2022; 24:591-600. [PMID: 35596538 PMCID: PMC9545560 DOI: 10.1111/nhs.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
In response to growing evidence that student healthcare professionals find professional practicum stressful and that it negatively affects their mental health, a six‐session psychoeducation Resilience and Wellbeing Program was implemented by a professional counselor in Year 3 of the Bachelor of Nutrition and Dietetics at Griffith University, Australia. The aim of this study was to evaluate student dietitians' perceptions of whether the program improved their ability to cope with practicum stressors. The study used a longitudinal cohort design, with students completing surveys at three time points: before and after the program and after the final practicum. The study was completed with two cohorts of students between 2018 and 2020 (n = 111). Most respondents (95%) found their professional practicum to be stressful or challenging on at least some occasions, mostly due to constantly being assessed (56%), finances (40%), and being away from usual supports (38%). Almost all students rated the program as having some value (99%), with the content about stress and self‐care the most highly rated. Qualitative comments revealed the program helped students to manage stress by prioritizing their personal needs. Students used stress management skills during the practicum to achieve balance in their lives, despite pandemic conditions.
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Affiliation(s)
- Lynda J Ross
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Lana J Mitchell
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Emily C Williams
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Patrick J Lynch
- Student Health, Counselling & Wellbeing, Griffith University, Gold Coast, Queensland, Australia
| | - Jonathan P Munro
- Student Health, Counselling & Wellbeing, Griffith University, Gold Coast, Queensland, Australia.,School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Lauren T Williams
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
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Balancing standardisation and individualisation in transitional care pathways: a meta-ethnography of the perspectives of older patients, informal caregivers and healthcare professionals. BMC Health Serv Res 2022; 22:430. [PMID: 35365140 PMCID: PMC8974038 DOI: 10.1186/s12913-022-07823-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transitional care implies the transfer of patients within or across care settings in a seamless and safe way. For frail, older patients with complex health issues, high-quality transitions are especially important as these patients typically move more frequently within healthcare settings, requiring treatment from different providers. As transitions of care for frail people are considered risky, securing the quality and safety of these transitions is of great international interest. Nevertheless, despite efforts to improve quality in transitional care, research indicates that there is a lack of clear guidance to deal with practical challenges that may arise. The aim of this article is to synthesise older patients, informal caregivers and healthcare professionals' experiences of challenges to achieving high-quality transitional care. METHODS We used the seven-step method for meta-ethnography originally developed by Noblit and Hare. In four different but connected qualitative projects, the authors investigated the challenges to transitional care for older people in the Norwegian healthcare system from the perspectives of older patients, informal caregivers and healthcare professionals. In this paper, we highlight and discuss the cruciality of these challenging issues by synthesising the results from twelve articles. RESULTS The analysis resulted in four themes: i) balancing person-centred versus efficient care, ii) balancing everyday patient life versus the treatment of illness, iii) balancing user choice versus "What Matters to You", and iv) balancing relational versus practical care. These expressed challenges represent tensions at the system, organisation and individual levels based on partial competing assumptions on person-centred-care-inspired individualisation endeavours and standardisation requirements in transitional care. CONCLUSIONS There is an urgent need for a clearer understanding of the tension between standardisation and individualisation in transitional care pathways for older patients to ensure better healthcare quality for patients and more realistic working environments for healthcare professionals. Incorporating a certain professional flexibility within the wider boundary of standardisation may give healthcare professionals room for negotiation to meet patients' individual needs, while at the same time ensuring patient flow, equity and evidence-based practice.
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12
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Lopez V, Anderson J, West S, Cleary M. Does the COVID-19 Pandemic Further Impact Nursing Shortages? Issues Ment Health Nurs 2022; 43:293-295. [PMID: 34586955 DOI: 10.1080/01612840.2021.1977875] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | - Sancia West
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Bathurst, Australia
| | - Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, Australia
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13
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McDonald T. Nurses' response to the science of COVID-19 and variants. Nurs Health Sci 2021; 23:676-677. [PMID: 34176202 PMCID: PMC8450810 DOI: 10.1111/nhs.12865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/20/2021] [Indexed: 01/03/2023]
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