1
|
Völz D, Grabenweger R, Best MC, Hau P, Jones KF, Linker R, Paal P, Bumes E. "Not me!" a qualitative, vignette-based study of nurses' and physicians' reactions to spiritual distress on neuro-oncological units. Support Care Cancer 2024; 32:499. [PMID: 38985361 PMCID: PMC11236889 DOI: 10.1007/s00520-024-08704-y] [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: 10/21/2023] [Accepted: 07/01/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE People with primary malignant brain tumors experience serious health-related suffering caused by limited prognosis and high symptom burden. Consequently, neuro-oncological healthcare workers can be affected emotionally in a negative way. The aim of this study was to analyze the attitudes and behavior of nurses and physicians when confronted with spiritual distress in these patients. METHODS Neurospirit-DE is a qualitative vignette-based, multicenter, cross-sectional online survey that was conducted in Bavaria, Germany. Reflexive thematic analysis was used for data analysis. RESULTS A total of 143 nurses and physicians working in neurological and neurosurgical wards in 46 hospitals participated in the survey. The participants questioned if the ability to provide spiritual care can be learned or is a natural skill. Spiritual care as a responsibility of the whole team was highlighted, and the staff reflected on the appropriate way of involving spiritual care experts. The main limitations to spiritual care were a lack of time and not viewing spiritual engagement as part of the professional role. Some were able to personally benefit from spiritual conversations with patients, but many participants criticized the perceived emotional burden while expressing the imminent need for specific training and team reflection. CONCLUSIONS Most neuro-oncological nurses and physicians perceive spiritual care as part of their duty and know how to alleviate the patient's spiritual distress. Nonetheless, validation of spiritual assessment tools for neuro-oncology and standardized documentation of patients' distress, shared interprofessional training, and reflection on the professional and personal challenges faced when confronted with spiritual care in neuro-oncology require further improvement and training.
Collapse
Affiliation(s)
- Daniela Völz
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Reinhard Grabenweger
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Megan C Best
- Institute for Ethics and Society, The University of Notre Dame Australia, Sydney, Australia
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Kate F Jones
- Institute for Ethics and Society, The University of Notre Dame Australia, Sydney, Australia
| | - Ralf Linker
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Piret Paal
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Elisabeth Bumes
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany.
| |
Collapse
|
2
|
Baiden D, Nerenberg K, Hillan EM, Dogba MJ, Adombire S, Parry M. A Scoping Review of Risk Factors of Hypertensive Disorders of Pregnancy in Black Women Living in High-Income Countries: An Intersectional Approach. J Cardiovasc Nurs 2024; 39:347-358. [PMID: 38424670 DOI: 10.1097/jcn.0000000000001085] [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: 03/02/2024]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are maternity-related increases in blood pressure (eg, gestational hypertension, preeclampsia, and eclampsia). Compared with women of other races in high-income countries, Black women have a comparatively higher risk of an HDP. Intersectionality helps to provide a deeper understanding of the multifactorial identities that affect health outcomes in this high-risk population. OBJECTIVE In this review, we sought to explore the literature on HDP risk factors in Black women living in high-income countries and to assess the interaction of these risk factors using the conceptual framework of intersectionality. METHODS We conducted this review using the Arksey and O'Malley methodology with enhancements from Levac and colleagues. Published articles in English on HDP risk factors with a sample of not less than 10% of Black women in high-income countries were included. Six databases, theses, and dissertations were searched from January 2000 to July 2021. A thematic analysis was used to summarize the results. RESULTS A final total of 36 studies were included from the 15 480 studies retrieved; 4 key themes of HDP risks were identified: (1) biological; (2) individual traditional; (3) race and ethnicity, geographical location, and immigration status; and (4) gender related. These intersectional HDP risk factors intersect to increase the risk of HDP among Black women living in high-income countries. CONCLUSION Upstream approaches are recommended to lower the risks of HDP in this population.
Collapse
|
3
|
van den Berg NM, Paans W, Schroevers MJ, van der Wal-Huisman H, van Leeuwen BL. Does a participatory live music practice support nurses to deliver compassionate care to hospitalised patients? A qualitative study. J Clin Nurs 2024. [PMID: 38764215 DOI: 10.1111/jocn.17213] [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: 09/28/2023] [Revised: 04/16/2024] [Accepted: 04/27/2024] [Indexed: 05/21/2024]
Abstract
AIM To gain more insight into how nurses experience a participatory live music practice in relation to their ability to deliver compassionate care to medically hospitalised patients. DESIGN Qualitative interpretive design. METHODS Sixteen nurses participating in a live music practice with patients were interviewed using in-depth interviews with open-ended questions. Audio recordings were transcribed verbatim and subsequently coded. Theory-driven inductive and deductive approaches were applied in thematic data analysis. RESULTS We identified four themes: (1) Nurses' empathy and compassion; (2) The caring nurse-patient relationship; (3) Person-centred approaches to care and (4) Nurses' subjective wellbeing. By observing patients' reactions to the music, nurses described that they obtained a deeper insight and understanding of patients' emotional wellbeing. These observations led to increased feelings of compassion in patient contact and stimulated informal communication between nurses and patients through a sense of shared humanity. According to nurses, these aspects positively affected collaboration with patients in delivering care and stimulated them to pursue person-centred approaches to care. Participating in the live music practice also positively affected nurses' wellbeing, enhanced relaxation and created an ambiance in which compassion could be expressed. CONCLUSION A live music practice can positively contribute to the delivery of compassionate care by providing meaningful shared moments that increase feelings of empathy and compassion and strengthen the caring relationship. IMPLICATIONS FOR THE PROFESSION Offering a live music practice at the ward and bedside offers a unique possibility to enhance engagement in person-centred, compassionate care. IMPACT While compassion and compassionate care are essential component of nursing, nurses often experience multiple barriers to its provision in daily practice. An innovative way to stimulate compassionate care is through the participation of nurses and patients in a live music practice, providing a meaningful moment shared between them. This stimulates feelings of shared humanity and bonding in the caring relationship. REPORTING METHOD The COnsolidated criteria for REporting Qualitative research (COREQ). No Patient or Public Contribution.
Collapse
Affiliation(s)
- Nina M van den Berg
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wolter Paans
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
| | - Maya J Schroevers
- Department of Health Sciences, Section Health Psychology, University Medical Center Groningen, Groningen, The Netherlands
| | - Hanneke van der Wal-Huisman
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
4
|
Cañas-Lerma AJ, Hidalgo-Andrade P, Araujo-Lugo V, Moya G, Verger S. Emotional experiences in palliative care and professional quality of life: a qualitative approach. Palliat Care Soc Pract 2024; 18:26323524241246531. [PMID: 38682085 PMCID: PMC11047252 DOI: 10.1177/26323524241246531] [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] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/22/2024] [Indexed: 05/01/2024] Open
Abstract
Objective To explore the experiences that significantly impact the professional quality of life of people providing palliative care (PC) in Ecuador. Design Observational cross-sectional qualitative research. Methods In September 2022, 10 focus groups were carried out in four cities in Ecuador; each group lasted from 1 to 2 h, was audio recorded, and transcribed verbatim. Recruitment was conducted through convenience sampling, and a total of 71 individuals (15 students, 50 professionals, and 6 volunteers) linked to PC participated. Content analysis with a phenomenological and inductive approach was used to analyze the data. Results People recognized their experiences in PC as having positive and negative impacts on their professional quality of life. Experiences were mapped as affecting them at individual, relational, and contextual levels. These experiences included personal growth, opportunity to provide care, teamwork, death-related issues, inability to deal with work-related stress, social acceptance of PC, and dealing with inefficient health systems, among others. Conclusion Despite the positive emotions that arise with caring for others, individuals working and volunteering in PC experience situations that influence their professional quality of life. Addressing these factors to increase satisfaction and ease the burden of PC work is essential. Undergraduate education, continuous professional training, and PC teams should incorporate actions to address these factors at all levels, such as teaching coping skills, fostering social support, and increasing awareness of PC.
Collapse
Affiliation(s)
| | - Paula Hidalgo-Andrade
- Grupo de Investigación Bienestar, Salud y Sociedad, Escuela de Psicología y Educación, Universidad de Las Américas, Campus UDLAPARK, Antigua vía a Nayón s/n, Quito 170124, Ecuador
| | - Viviana Araujo-Lugo
- Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador Hospital SOLCA Guayaquil, Guayaquil, Ecuador
| | - Gabriela Moya
- Asociación Ecuatoriana de Cuidados Paliativos (ASECUP), Quito, Ecuador
| | - Sebastià Verger
- Applied Pedagogy and Psychology of Education Department, Universitat de les Illes Balears, Palma, Spain
| |
Collapse
|
5
|
Salamon E, Fodor É, Földesi E, Hauser P, Kriván G, Csanádi K, Garami M, Kovacs G, Csóka M, Tiszlavicz LG, Kiss C, Dergez T, Ottóffy G. The Impact of Qualification and Hospice Education on Staff Attitudes during Palliative Care in Pediatric Oncology Wards-A National Survey. CHILDREN (BASEL, SWITZERLAND) 2024; 11:178. [PMID: 38397290 PMCID: PMC10886866 DOI: 10.3390/children11020178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Our knowledge about the attitudes of healthcare staff to palliative care in pediatric oncology is scarce. We aimed to assess their perceptions of palliative care in Hungary and find answers to the question of how to provide good palliative care for children. METHOD Physicians (n = 30) and nurses (n = 43) working in the field of pediatric oncology (12 of them specialized in hospice care) were interviewed. Palliative care practice (communication, integration of palliative care, professionals' feelings and attitudes, and opportunities for improvement) was assessed by semi-structured interviews evaluated in a mixed quantitative and qualitative way by narrative categorical content analysis and thematic analysis. RESULTS All providers displayed high negative emotions, positive evaluations, and used many active verbs. Nurses showed higher levels of denial, more self-references, and were more likely to highlight loss. Physicians emphasized the importance of communication regarding adequate or inadequate palliative care. Hospice specialists showed a higher passive verb rate, a lower self-reference, a lower need for psychological support, and a greater emphasis on teamwork and professional aspects. CONCLUSION Our results show that nurses are more emotionally stressed than doctors in palliative care in pediatric oncology. To our knowledge, a study comparing doctors and nurses in this field has yet to be carried out. Our results suggest that pediatric oncological staff can positively evaluate a child's palliative care despite the emotional strain. Regarding hospices, professional practice in palliative care may be a protective factor in reducing emotional distress and achieving professional well-being.
Collapse
Affiliation(s)
- Eszter Salamon
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Pécs Medical School, József A. Street 7, 7623 Pécs, Hungary; (É.F.); (G.O.)
| | - Éva Fodor
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Pécs Medical School, József A. Street 7, 7623 Pécs, Hungary; (É.F.); (G.O.)
| | - Enikő Földesi
- Institute of Behavioural Sciences, Semmelweis University, Nagyvárad tér 4, 1089 Budapest, Hungary
| | - Peter Hauser
- Pediatric Center, Semmelweis University, Tűzoltó utca 7–9, 1094 Budapest, Hungary; (P.H.)
- Velkey László Child’s Health Center, Borsod-Abaúj-Zemplén County Central Hospital and University Teaching Hospital, Szentpéteri kapu 72–76, 3526 Miskolc, Hungary
| | - Gergely Kriván
- Department for Pediatric Hematology and Hemopoietic Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary
| | - Krisztina Csanádi
- Hemato-Oncology Unit, Heim Pál National Pediatric Institute, 1089 Budapest, Hungary;
| | - Miklós Garami
- Pediatric Center, Semmelweis University, Tűzoltó utca 7–9, 1094 Budapest, Hungary; (P.H.)
| | - Gabor Kovacs
- Pediatric Center, Semmelweis University, Tűzoltó utca 7–9, 1094 Budapest, Hungary; (P.H.)
| | - Monika Csóka
- Pediatric Center, Semmelweis University, Tűzoltó utca 7–9, 1094 Budapest, Hungary; (P.H.)
| | | | - Csongor Kiss
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - Tímea Dergez
- Institute of Bioanalysis, University of Pécs, 7624 Pécs, Hungary;
| | - Gábor Ottóffy
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Pécs Medical School, József A. Street 7, 7623 Pécs, Hungary; (É.F.); (G.O.)
| |
Collapse
|
6
|
Pilkey J. Palliative care, COVID-19, and the suffering quotient. Palliat Support Care 2024:1-4. [PMID: 38178277 DOI: 10.1017/s147895152300192x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVES The COVID-19 pandemic presented many challenges for patients with palliative care needs and their care providers. During the early days of the pandemic, visitors were restricted on our palliative care units. These restrictions separated patients from their families and caregivers and led to considerable suffering for patients, families, and health-care providers. Using clinical vignettes that illustrate the suffering caused by visiting restrictions during the pandemic, the introduction of a new concept to help predict when health-care providers might be moved to advocate for their patients is introduced. METHODS We report 3 cases of patients admitted to a palliative care unit during the COVID-19 pandemic and discuss the visiting restrictions placed on their families. In reviewing the cases, we coined a new concept, the "Suffering Quotient" (SQ), to help understand why clinical staff might be motivated to advocate for an exemption to the visiting restrictions in one situation and not another. RESULTS This paper uses 3 cases to illustrate a new concept that we have coined the Suffering Quotient. The Suffering Quotient (SQ) = Perceived Individual (or small group) Suffering/Perceived Population Suffering. This paper also explores factors that influence perceived individual suffering (the numerator) and perceived population suffering (the denominator) from the perspective of the health-care provider. SIGNIFICANCE OF RESULTS The SQ provides a means of weighing perceived patient and family suffering against perceived contextual population suffering. It reflects the threshold beyond which health-care providers, or other outside observers, are moved to advocate for the patient and ultimately how far they might be prepared to go. The SQ offers a potential means of predicting observer responses when they are exposed to multiple suffering scenarios, such as those that occurred during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Jana Pilkey
- Departments of Internal Medicine and Family Medicine, Section of Palliative Care Medicine, University of Manitoba, Winnipeg, MB, Canada
- Palliative Care Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| |
Collapse
|
7
|
Akbarian-Rokni M, Mardani-Hamooleh M, Abbasi M, Seyedfatemi N, Pezaro S. Nurses' perceptions of the challenges involved in providing of end-of-life care to people with heart failure: a context-based study. BMC Palliat Care 2023; 22:180. [PMID: 37968669 PMCID: PMC10648333 DOI: 10.1186/s12904-023-01305-2] [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: 02/07/2023] [Accepted: 11/09/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND High quality end-of-life care is essential. Yet for those experiencing heart failure, the provision of high-quality end- of -life care can be challenging. The aim of this study was to explore Iranian nurses' perceptions of the challenges involved in providing of end-of-life care to people with heart failure. METHODS Conventional content analysis was used to analyze qualitative data collected from nurses (n = 33) using semi-structured and individual interviews. Participants were aged between 29 and 51 years. The majority of participants were women (n = 20). Most had a bachelor's degree (n = 24), and work experience of between 7 and 18 years. RESULTS Nurses challenges in providing end-of-life care to those with heart failure included (1) adverse consequences relating to compassion fatigue and continued futility in care and (2) lack of palliative care services with regards to a lack of specialists, lack of support from health systems, and poor teamwork. CONCLUSIONS This is the first qualitative study to explore Iranian nurses' challenges in providing end-of-life care to those with heart failure. Investment is required in education and research in this area. Particular attention must be paid to prevention of compassion fatigue. Law changes would enable the delivery of higher-quality palliative care in this context overall.
Collapse
Affiliation(s)
- Mostafa Akbarian-Rokni
- Department of Nursing, Nursing and Midwifery Care Research Centre, Iran University of Medical Sciences, Zafar St, Tehran, 1996713883, Iran
| | - Marjan Mardani-Hamooleh
- Department of Nursing, Nursing and Midwifery Care Research Centre, Iran University of Medical Sciences, Zafar St, Tehran, 1996713883, Iran.
| | - Mohammad Abbasi
- Department of Nursing, Nursing and Midwifery Care Research Centre, Iran University of Medical Sciences, Zafar St, Tehran, 1996713883, Iran
| | - Naima Seyedfatemi
- Department of Nursing, Nursing and Midwifery Care Research Centre, Iran University of Medical Sciences, Zafar St, Tehran, 1996713883, Iran
| | - Sally Pezaro
- Research Centre for Healthcare and Communities' at Coventry University, Coventry University, Coventry, UK
| |
Collapse
|
8
|
Bové HM, Noer VR, Mousing CA. Being a Hospice Nurse in Times of the COVID-19 Pandemic: A Phenomenological Study of Providing End-of-Life Care. J Hosp Palliat Nurs 2023; 25:277-285. [PMID: 37302804 DOI: 10.1097/njh.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
End-of-life care changed during the COVID-19 pandemic, and the previous prevailing hospice philosophy and essential values of hospice care were suddenly under pressure. The aim was to explore hospice nurses' lived experience of providing end-of-life care to patients admitted in an out-hospital hospice setting during the COVID-19 pandemic. Data consist of 10 individual in-depth interviews of hospice nurses. A purposive sampling strategy was used, and the data collection and analysis was guided by a descriptive phenomenology. Providing end-of-life care was described through an existential dimension and a practical-related dimension. The pandemic and the ensuing constraints created an unfamiliar gap, triggering insecurity and unfamiliarity within nursing. Findings are elaborated in the following constituents: being a hospice nurse and providing end-of-life care. The latter constituent was further elucidated in additional perspectives: a new job position and bending the rules. Providing end-of-life care during the COVID-19 regime was a highly challenging and distressing experience due to the coercion of maintaining rules and restrictions as well as providing care. An experience of having to reinvent and work within a new agenda was present. Furthermore, the nurses experienced significant loss of job satisfaction and may be morally injured as well as highly exposed to secondary traumatization.
Collapse
|
9
|
Gupta S, Bhatia G, Sagar R, Sagar S. Assessment of Psychological Well-being Among Medical Professionals Working with Patients Who Suffer from Physical Trauma: An Observational Study from India. Indian J Crit Care Med 2023; 27:493-502. [PMID: 37502289 PMCID: PMC10369315 DOI: 10.5005/jp-journals-10071-24488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/17/2023] [Indexed: 07/29/2023] Open
Abstract
Background Healthcare providers working with victims of physical trauma are exposed to significant human suffering at work. This may place them at risk of burnout, secondary traumatic stress (STS), and other psychological disturbances. This study aimed to evaluate the professional quality of life and psychological well-being among trauma professionals. Methodology This was a cross-sectional study conducted among 153 staff members (nursing officers, resident doctors, and faculty) of a Level 1 trauma center in North India. The Professional Quality of Life (ProQoL-5) and Depression, Anxiety, and Stress (DASS-21) Scales were used. Results More than 50% of the participants had a moderate risk of burnout and STS. In addition, 54% of participants reported having anxiety, 40% stress, and 36% depressive symptoms. Depression, anxiety, and stress were all strongly predicted by burnout and STS. Conclusion Psychological distress symptoms were seen in a significant portion of professionals working in the trauma center. Workplace interventions for the promotion of psychological well-being among trauma professionals are recommended. How to cite this article Gupta S, Bhatia G, Sagar R, Sagar S. Assessment of Psychological Well-being Among Medical Professionals Working with Patients Who Suffer from Physical Trauma: An Observational Study from India. Indian J Crit Care Med 2023;27(7):493-502.
Collapse
Affiliation(s)
- Sahil Gupta
- Division of Trauma Surgery and Critical Care; Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Gayatri Bhatia
- Department of Psychiatry, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Sagar
- Division of Trauma Surgery and Critical Care; Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
10
|
Higashibata T, Hamano J, Nagaoka H, Sasahara T, Fukumori T, Arahata T, Kazama I, Maeno T, Kizawa Y. Work environmental factors associated with compassion satisfaction and end-of-life care quality among nurses in general wards, palliative care units, and home care settings: A cross-sectional survey. Int J Nurs Stud 2023; 143:104521. [PMID: 37201336 DOI: 10.1016/j.ijnurstu.2023.104521] [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: 12/24/2022] [Revised: 03/14/2023] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Nurses providing end-of-life care experience not only burnout and compassion fatigue, but also positive effects such as compassion satisfaction. Nurses' compassion satisfaction was shown to be related to job satisfaction, work engagement, and nurse caring. Studies in emergency departments, intensive care units, oncology wards, and general wards have identified work environmental factors associated with nurses' compassion satisfaction, but no similar studies have been conducted in palliative care units or home care settings. It is also unknown whether work environmental factors associated with compassion satisfaction contribute to end-of-life care quality. OBJECTIVE To explore work environmental factors associated with nurses' compassion satisfaction and end-of-life care quality in three types of workplaces: general wards, palliative care units, and home care settings. DESIGN A cross-sectional survey of nurses providing end-of-life care. SETTINGS Sixteen general wards, 14 palliative care units, and 25 home-visit nursing agencies in Japan. PARTICIPANTS There were 347 study participants: 95 nurses in general wards, 128 in palliative care units, and 124 in home care settings. METHODS Compassion satisfaction was assessed using the Professional Quality of Life Scale, and end-of-life care quality was rated on a 4-point scale. Work environments were assessed using the Areas of Worklife Survey, which measures the fit between an individual and their work environment in six areas: workload, control, reward, community, fairness, and values. RESULTS Compared to nurses in general wards and palliative care units, home care nurses scored statistically significantly higher on all work environmental factors except reward. Work environmental factors that were significantly positively associated with higher compassion satisfaction were values in general wards (β = 0.335, P = 0.007), reward and workload in palliative care units (β = 0.266, P = 0.009 and β = 0.179, P = 0.035), and community and control in home care settings (β = 0.325, P = 0.001 and β = 0.261, P = 0.004). In addition, higher scores for workload in general wards (odds ratio = 5.321; 95 % confidence interval, 1.688-16.775) and for community in palliative units (odds ratio = 2.872; 95 % confidence interval, 1.161-7.102) were associated with higher end-of-life care quality. No associated work environmental factors were found in home care settings. CONCLUSIONS Work environmental factors associated with nurses' compassion satisfaction and end-of-life care quality varied between workplaces. These results may contribute to creating work environments that are appropriate for each workplace type to maintain both nurses' compassion satisfaction and end-of-life care quality. TWEETABLE ABSTRACT Work environmental factors associated with nurses' compassion satisfaction and end-of-life care quality were identified in three workplaces.
Collapse
Affiliation(s)
- Takahiro Higashibata
- Department of Palliative and Supportive Care, University of Tsukuba Hospital, Tsukuba, Japan.
| | - Jun Hamano
- Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroka Nagaoka
- Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Takaki Fukumori
- Graduate School of Integrated Arts and Sciences, Tokushima University, Tokushima, Japan
| | - Tomoko Arahata
- Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
| | - Ikuko Kazama
- Division of Nursing, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tetsuhiro Maeno
- Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | | |
Collapse
|
11
|
Morrow E, Zidaru T, Ross F, Mason C, Patel KD, Ream M, Stockley R. Artificial intelligence technologies and compassion in healthcare: A systematic scoping review. Front Psychol 2023; 13:971044. [PMID: 36733854 PMCID: PMC9887144 DOI: 10.3389/fpsyg.2022.971044] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/05/2022] [Indexed: 01/18/2023] Open
Abstract
Background Advances in artificial intelligence (AI) technologies, together with the availability of big data in society, creates uncertainties about how these developments will affect healthcare systems worldwide. Compassion is essential for high-quality healthcare and research shows how prosocial caring behaviors benefit human health and societies. However, the possible association between AI technologies and compassion is under conceptualized and underexplored. Objectives The aim of this scoping review is to provide a comprehensive depth and a balanced perspective of the emerging topic of AI technologies and compassion, to inform future research and practice. The review questions were: How is compassion discussed in relation to AI technologies in healthcare? How are AI technologies being used to enhance compassion in healthcare? What are the gaps in current knowledge and unexplored potential? What are the key areas where AI technologies could support compassion in healthcare? Materials and methods A systematic scoping review following five steps of Joanna Briggs Institute methodology. Presentation of the scoping review conforms with PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Eligibility criteria were defined according to 3 concept constructs (AI technologies, compassion, healthcare) developed from the literature and informed by medical subject headings (MeSH) and key words for the electronic searches. Sources of evidence were Web of Science and PubMed databases, articles published in English language 2011-2022. Articles were screened by title/abstract using inclusion/exclusion criteria. Data extracted (author, date of publication, type of article, aim/context of healthcare, key relevant findings, country) was charted using data tables. Thematic analysis used an inductive-deductive approach to generate code categories from the review questions and the data. A multidisciplinary team assessed themes for resonance and relevance to research and practice. Results Searches identified 3,124 articles. A total of 197 were included after screening. The number of articles has increased over 10 years (2011, n = 1 to 2021, n = 47 and from Jan-Aug 2022 n = 35 articles). Overarching themes related to the review questions were: (1) Developments and debates (7 themes) Concerns about AI ethics, healthcare jobs, and loss of empathy; Human-centered design of AI technologies for healthcare; Optimistic speculation AI technologies will address care gaps; Interrogation of what it means to be human and to care; Recognition of future potential for patient monitoring, virtual proximity, and access to healthcare; Calls for curricula development and healthcare professional education; Implementation of AI applications to enhance health and wellbeing of the healthcare workforce. (2) How AI technologies enhance compassion (10 themes) Empathetic awareness; Empathetic response and relational behavior; Communication skills; Health coaching; Therapeutic interventions; Moral development learning; Clinical knowledge and clinical assessment; Healthcare quality assessment; Therapeutic bond and therapeutic alliance; Providing health information and advice. (3) Gaps in knowledge (4 themes) Educational effectiveness of AI-assisted learning; Patient diversity and AI technologies; Implementation of AI technologies in education and practice settings; Safety and clinical effectiveness of AI technologies. (4) Key areas for development (3 themes) Enriching education, learning and clinical practice; Extending healing spaces; Enhancing healing relationships. Conclusion There is an association between AI technologies and compassion in healthcare and interest in this association has grown internationally over the last decade. In a range of healthcare contexts, AI technologies are being used to enhance empathetic awareness; empathetic response and relational behavior; communication skills; health coaching; therapeutic interventions; moral development learning; clinical knowledge and clinical assessment; healthcare quality assessment; therapeutic bond and therapeutic alliance; and to provide health information and advice. The findings inform a reconceptualization of compassion as a human-AI system of intelligent caring comprising six elements: (1) Awareness of suffering (e.g., pain, distress, risk, disadvantage); (2) Understanding the suffering (significance, context, rights, responsibilities etc.); (3) Connecting with the suffering (e.g., verbal, physical, signs and symbols); (4) Making a judgment about the suffering (the need to act); (5) Responding with an intention to alleviate the suffering; (6) Attention to the effect and outcomes of the response. These elements can operate at an individual (human or machine) and collective systems level (healthcare organizations or systems) as a cyclical system to alleviate different types of suffering. New and novel approaches to human-AI intelligent caring could enrich education, learning, and clinical practice; extend healing spaces; and enhance healing relationships. Implications In a complex adaptive system such as healthcare, human-AI intelligent caring will need to be implemented, not as an ideology, but through strategic choices, incentives, regulation, professional education, and training, as well as through joined up thinking about human-AI intelligent caring. Research funders can encourage research and development into the topic of AI technologies and compassion as a system of human-AI intelligent caring. Educators, technologists, and health professionals can inform themselves about the system of human-AI intelligent caring.
Collapse
Affiliation(s)
| | - Teodor Zidaru
- Department of Anthropology, London School of Economics and Political Sciences, London, United Kingdom
| | - Fiona Ross
- Faculty of Health, Science, Social Care and Education, Kingston University London, London, United Kingdom
| | - Cindy Mason
- Artificial Intelligence Researcher (Independent), Palo Alto, CA, United States
| | | | - Melissa Ream
- Kent Surrey Sussex Academic Health Science Network (AHSN) and the National AHSN Network Artificial Intelligence (AI) Initiative, Surrey, United Kingdom
| | - Rich Stockley
- Head of Research and Engagement, Surrey Heartlands Health and Care Partnership, Surrey, United Kingdom
| |
Collapse
|
12
|
Davis A, Repar P, Wilson M, De Luca E, Doutrich D, Thanasilp S. Transforming Nurse Self-Care Through Integration of Spirituality: Lessons From an International Collaboration in Palliative Care. J Transcult Nurs 2023; 34:91-99. [PMID: 36408564 DOI: 10.1177/10436596221134814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION With growing evidence of compassion fatigue and burnout in health care, it is time for a deeper look at the vital practice of self-care among professionals providing palliative care. The purpose of this study was to provide insights into ways empowerment, caring for self, environment, and building relationships impact well-being among palliative care professionals. METHODS Interpretative descriptive methods framed focus group interviews, conducted during a conference on palliative care integrative health practices held in Thailand. An interprofessional research team used inductive reasoning processes to analyze the interviews. RESULTS Three themes emerged from the four focus groups (N = 22): Buddhist Beliefs and Practices, Community-mindedness, and Empowerment. Aspects of spirituality were consistently woven into self-care practices. DISCUSSION Findings suggest that self-care can be reimagined to include highly personal and unique expressions of spirituality. Health care communities are called to integrate ritual in culturally congruent ways, thus supporting health care professionals to find new sources of meaning, enrichment, and empowerment.
Collapse
|
13
|
McCool N, Reidy J, Steadman S, Nagpal V. The Buddy System: An Intervention to Reduce Distress and Compassion Fatigue and Promote Resilience on a Palliative Care Team During the COVID-19 Pandemic. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2022; 18:302-324. [PMID: 36129825 DOI: 10.1080/15524256.2022.2122650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The SARS-CoV-2 pandemic (COVID-19) dramatically increased the number of stressors on healthcare workers, including palliative care practitioners. Restrictions and increased demands on time made it difficult for the UMass Memorial Health palliative care team to utilize preexisting wellness strategies. In response to team members' stress reactions, a buddy system intervention was conceived and implemented to restore a sense of connection and self-efficacy (Phase 1). Our objective with this quality improvement project was to assess the feasibility and effectiveness of the buddy system and evaluate staff attitudes toward this intervention. After four months, feedback from team members informed redesign to a more structured buddy system (Phase 2). A mixed-methods design of this project included a qualitative online survey along with quantitative data collection with the Professional Quality of Life Scale V (ProQOL V) and the Brief Resilience Scale (BRS) during Phase 1. Phase 2 was also evaluated quantitatively with ProQOL V and BRS. Semi-structured interviews were conducted at the end of this project to enhance qualitative data on staff attitudes and beliefs. Of the 12 study participants, 10 completed all phases of the study. Participants reported the buddy system was a useful, easy-to-implement intervention for mitigating personal distress and compassion fatigue (CF) by providing a strong sense of support and connection to team members.
Collapse
Affiliation(s)
- Nancy McCool
- Division of Palliative Care, UMass Chan Medical School, UMass Memorial Health, Worcester, MA, USA
| | - Jennifer Reidy
- Division of Palliative Care, UMass Chan Medical School, UMass Memorial Health, Worcester, MA, USA
| | - Shawna Steadman
- Division of Palliative Care, UMass Chan Medical School, UMass Memorial Health, Worcester, MA, USA
| | - Vandana Nagpal
- Division of Palliative Care, UMass Chan Medical School, UMass Memorial Health, Worcester, MA, USA
| |
Collapse
|
14
|
Li J, Wang Q, Guan C, Luo L, Hu X. Compassion fatigue and compassion satisfaction among Chinese palliative care nurses: A province-wide cross-sectional survey. J Nurs Manag 2022; 30:3060-3073. [PMID: 35689416 DOI: 10.1111/jonm.13708] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 02/05/2023]
Abstract
AIMS We aim to explore the prevalence and potential facilitators and inhibitors of compassion fatigue and compassion satisfaction among Chinese palliative care nurses. BACKGROUND Nurses with compassion fatigue may suffer from health-related problems, causing decreased work efficiency and quality of care. Palliative care nurses are especially at risk of compassion fatigue due to close contact with terminal patients. METHODS A province-wide cross-sectional survey using convenience sampling was conducted among 318 palliative care nurses at 25 hospitals and healthcare institutions in Sichuan Province, China. Data were collected using demographic questionnaire and five scales: Professional Quality of Life Scale, General Self-Efficacy Scale, Perceived Social Support Scale, Simplified Coping Style Questionnaire, and Connor-Davison Resilience Scale. Data analyses including descriptive statistics, t-test, one-way ANOVA, simple linear regression, and multiple linear regression. RESULTS Mean scores (SD) for burnout, secondary traumatic stress, and compassion satisfaction were 25.42 (4.75), 26.08 (5.72), and 35.67 (5.77), respectively. Related factors predicted 40.30%, 27.10%, and 35.4% of the variance in the model of burnout, secondary traumatic stress, and compassion satisfaction, respectively (all p < .001). CONCLUSIONS The levels of burnout and secondary traumatic stress among Chinese palliative care nurses were higher than those among other types of nurses. Social support, resilience, positive coping, family recognition of work, and income satisfaction are inhibitors of compassion fatigue among palliative care nurses. IMPLICATIONS FOR NURSING MANAGEMENT Nursing administrators and educators should consider providing effective and targeted strategies (e.g. ongoing training and psychological interventions) to decrease compassion fatigue among palliative care nurses based on the cultural and ethical settings.
Collapse
Affiliation(s)
- Juejin Li
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Wang
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Chang Guan
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Luo
- Human Resource Department, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaolin Hu
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
15
|
Nishihara T, Ohashi A, Nakashima Y, Yamashita T, Hiyama K, Kuroiwa M. Compassion fatigue in a health care worker treating COVID-19 patients: a case report. Biopsychosoc Med 2022; 16:10. [PMID: 35428306 PMCID: PMC9012067 DOI: 10.1186/s13030-022-00239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background Doctors treating COVID-19 are under extreme stress. It was reported that healthcare workers providing palliative care could present elevated levels of compassion fatigue. We herein report a case if the attending doctor of severe COVID-19 cases who felt extreme psychological difficulty and suffered from compassion fatigue. Case presentation A 29-year-old female doctor presented with anxiety and insomnia. Her stress from overwork was exacerbated during the treatment of two related COVID-19 patients, a 47-year-old man with COVID-19 and his 76-year-old mother, who suffered acute stress disorder after the death of her son. The mother first refused treatment, but with psychiatric intervention she was able to recover and be discharged. In the course of these cases of COVID-19, their attending physician felt psychological distress and presented with insomnia and anticipatory anxiety due to the poor prognosis of the mother. After being presented with a systematic approach to improve her work situation by the hospital executive staff and undergoing psychotherapy for compassion fatigue, she recovered and was able to return to work. Conclusions We report a physician in charge of severe cases of COVID-19, who suffered an adverse impact on her mental health. Excessively empathic engagement in the care of patients who do not survive and their relatives provides high risk for compassion fatigue. The stress-related distress of HCWs should be more widely recognized in order to improve support systems for them.
Collapse
|