Interventions to manage compassion fatigue in oncology nursing

Self-compassion and psychological well-being of radiographers at work

OBJECTIVES

The aim of this study was to assess how self-compassion affects the psychological well-being of radiographers at work.

METHODS

An online survey was sent to radiology and radiotherapy departments in Rhône-Alpes, a region of France (from October 2021 to February 2022). The study is mixed: quantitative data, with closed questions and two validated scales, and qualitative data, with open questions aimed at assessing perceptions among radiologists as regards self-compassion.

RESULTS

A total of 253 radiographers (mean age 32.9 years), took part in this survey. Radiographers reported a poor level of well-being and a moderate level of self-compassion. We found a link between well-being at work and self-compassion. Gender, age, number of years of experience and the desire to receive training on well-being appear to have an impact on the level of self-compassion. The perception of self-compassion by radiologists is essentially positive.

CONCLUSION

Particular attention should be paid to radiologists who are female, young, and with only a few years of experience. Self-compassion is a protective factor for radiologists and may help them take care of themselves to continue caring for others. Training related to self-compassion should be promoted in medical imaging departments.

Compassion Fatigue: A Comprehensive Discussion on its Development and Repercussions Among Oncology Nurses

OBJECTIVES

This study aimed to discuss how compassion fatigue (CF) develops and its repercussions on the personal and professional lives of oncology nurses.

METHODS

A discursive article, with systematic searches were performed in seven databases to find publications on CF in oncology nurses.

RESULTS

So as to better organize the findings, three categories were developed to present and discuss issues related to CF: (1) Characteristics of CF and its developments: describes the components related to CF and the manifestation of this phenomenon; (2) Repercussions of compassion fatigue: reports on the impact of CF on the personal and professional life of oncology nurses; and (3) Resources for dealing with compassion fatigue: lists interventions, sources of support, professional personal training, qualified nursing care in the face of adversity, and gratitude and recognition.

CONCLUSION

the factors that trigger or protect CF are multifactorial, with the need for collective and individual interventions as a way of helping oncology nurses to protect themselves, to avoid or manage this phenomenon. CF has a direct clinical impact on the life of the oncology nurse, causing several changes. It also indirectly impacts the patient's life clinically, as it is a phenomenon that has repercussions on the provision of care.

IMPLICATIONS FOR NURSING PRACTICE

CF affects the personal and professional lives of oncology nurses, so nurses need to seek resources to deal with it. Nursing staff employers and managers can use the evidence from this research to help nurses manage and protect themselves from compassion fatigue.

How Mental Health Nurses Report Their Compassion Fatigue and Compassion Satisfaction: A Cross-Sectional Study and the Implications for Healthcare Leaders

Compassion fatigue is the cost of caring for others in emotional pain where the helping professional absorbs the trauma of those they help and cannot detach emotionally at the end of the day. Stressful and perceived unsupportive work environments may leave the caregiver at a heightened risk for compassion fatigue. To study the level of compassion fatigue and compassion satisfaction experienced by mental health nurses. A descriptive, cross-sectional, electronic survey design was utilized. The Professional Quality of Life Scale-5 was used. The study was conducted at a large, urban hospital that exclusively treats patients with mental health and addiction issues located in Ontario, Canada. The sample included all nurses who were listed on the hospital's Email list. All nurses who are displayed on this list are mental health nurses. Analyses were conducted to assess for differences between the characteristics and the subscales of professional quality of life. One hundred and forty-eight mental health nurses completed a questionnaire. The response rate was 21%. Seventy-six percent reported moderate levels of burnout, 59% reported moderate levels of secondary traumatic stress, and 21% reported high levels of compassion satisfaction. Predictors were seen for the characteristics of gender, ethnicity, marital status, area, exposure to violence and support felt. Compassion fatigue has clear implications. Organizations willing to invest in reducing it, have the potential to improve patient outcomes and the well-being of nurses. The majority of mental health nurses reported moderate levels for each of the subscales.

Comparison of Compassion Fatigue, Burnout and Compassion Satisfaction of Oncology-Hematology & Dialysis Nurses

Background: It is known that health professionals who work with chronic patients for a long time are at risk in terms of compassion fatigue and burnout. Purpose: The study aims to compare the levels of compassion fatigue, burnout, and compassion satisfaction of nurses working on oncology-hematology and dialysis and determine the predictors. Methods: This study was carried out using descriptive and correlational research design. The research was conducted with 278 nurses. Participants were enrolled using a convenience sampling technique from the oncology-hematology inpatient services, outpatient chemotherapy units, and bone marrow transplant units and dialysis nurses of purposively selected hospitals in Istanbul, Turkey. Personal information form and Professional Quality of Life-IV. Potential predictors were analyzed using univariate analysis. We conducted multiple stepwise linear regression analyses to reveal the outcome variables. Results: A sub-analysis comparing the dialysis specialty with the oncology-hematology revealed that dialysis nurses report significantly higher compassion fatigue scores than oncology nurses. Working willingly in the current unit and the level of received social support were determined as predictors for all outcome variables. Conclusions: This is the first study comparing compassion fatigue, burnout, and compassion satisfaction levels of oncology-hematology and dialysis nurses. This study indicates the need for nurse managers to be aware of compassion fatigue and plan compassion fatigue prevention programs. In addition, this study guides the interventional studies to be conducted in the future.

Factors Contributing to Grief Experience Among Oncology Nurses: A Qualitative Study

OBJECTIVES

Care provision to patients with cancer can cause varying levels of grief for oncology nurses. Grief in turn significantly affects nurses' personal and professional life. However, there is limited information about the contributing factors to grief experience among oncology nurses. The aim of this study was to explore the contributing factors to grief experience among oncology nurses.

DATA SOURCES

This qualitative study was conducted in Iran from May 2020 to October 2021. Participants were 18 oncology nurses purposively selected from several hospitals in Iran. Data were gathered via in-depth semistructured interviews and analyzed via the conventional content analysis method proposed by Graneheim and Lundman. Lincoln and Guba's criteria were used to ensure trustworthiness.

CONCLUSION

The four categories of the contributing factors to oncology nurses' grief experience were exposure to patients' painful death, depressing work atmosphere, knowing the heavy financial burden of cancer for patients, and patients' helplessness in the healthcare system. Oncology nurses experience deep grief due to a wide range of personal, professional, environmental, and sociocultural factors.

IMPLICATIONS FOR NURSING PRACTICE

The findings of this study can be used to better understand the contributing factors to grief experience among oncology nurses, determine their needs, and develop strategies to strongly support them.

Compassion fatigue in the community nursing workforce: a scoping review

BACKGROUND

compassion fatigue is a phenomenon in areas of nursing practice such as oncology, ICU, palliative care, hospice, and dementia care, but less so among community nurses (Joinson, 1992). A gap in enquiry exists around CN and compassion fatigue around end-of-life patient care.

METHODS

a scoping review with narrative analysis of selected literature on compassion fatigue in nursing using CINHAL, ProQuest, Science Direct, and the Cochrane Library.

FINDINGS

whilst no specific studies were located on compassion fatigue and UK community nurses. Australian, Spanish, and Taiwanese studies report of environment, care relationship duration, resources and poor organisational support being linked to a likelihood of developing compassion fatigue.

CONCLUSION

compassion fatigue is under-researched in community nursing and merits further enquiry to understand the challenges posed by providing end-of-life care.

The Prevalence of Compassion Fatigue among Oncology Healthcare Professionals in Three Public Healthcare Facilities in Kwazulu-Natal, South Africa

Compassion fatigue (CF) is a serious global challenge among healthcare professionals dealing with diseases with poor health outcomes in clinical settings. Chronic exposure to the suffering of others is inevitable in the oncology setting and remains one of the main contributors to CF. Therefore, this study determined the prevalence of CF among oncology healthcare professionals (OHPs) in three public healthcare facilities in KwaZulu-Natal, South Africa. This cross-sectional descriptive study was conducted among 73 OHPs using the Professional Quality of Life Scale version 5 questionnaire, and the data were analysed using the Statistical Package for Social Sciences. More than half (56.2%) of the participants reported average scores for CF, with 43.8% of them scoring low. The participants from Inkosi Albert Luthuli Central Hospital had the highest CF mean score (26.8) compared to those from Addington Hospital (21.2) and Greys Hospital (22.9). Female OHPs had a higher mean score (24.3) for CF, compared to their male counterparts (20.6). The CF scores were positively correlated with older age and longer work experience of the OHPs. The prevalence of CF among OHPs was average, compared to those reported by other local and international studies. Nevertheless, these results cannot be taken lightly, given the straining effects of unmanaged CF on the healthcare system generally and on patient care in particular. The results of this study can potentially contribute to policy development and the planning of intervention strategies towards the effective management of CF among OHPs.

Post-traumatic stress symptoms and burnout in healthcare professionals working in neonatal intensive care units: Results from the STRONG study

BACKGROUND

Newborns' deaths and life-threatening conditions represent extremely stressful events for parents and professionals working in NICUs, facilitating the onset of secondary traumatic stress symptoms. The STRONG study aims to better understand the psychological impact on Italian NICUs staff of bereavement care.

METHODS

The STRONG (STress afteR lOss in NeonatoloGy) study is a cross-sectional study based on a web survey consisted of four sections: sociodemographic, CommuniCARE-Newborn questionnaire, the Maslach Burnout Inventory and the Impact of Event Scale-Revised.

RESULTS

227 NICU workers (42.7% nurses, 23.3% midwives, 22.2% physicians, 11.8% other HCPs) answered the survey. The hardest tasks were "communicating baby's death" and "informing on autopsy results"; 44.7% of HCPs did not receive formal training in communicating bad news, 44.2% 'learned from the field' by watching other colleagues; 41.2% declared that they do not have any communication strategy. More than 90% of professionals thought that training on bereavement care is necessary. The majority of HCPs showed some degree of post-traumatic stress symptoms: 34% medium and 35.3% severe. Professionals with training in bereavement care and/or in communication had less probability to develop stress symptoms. A multivariate analysis showed that higher levels of burnout were associated with 4 or more monthly losses and medium or severe stress symptoms. Having a well-defined communication strategy for breaking bad news was independently associated with a better personal accomplishment.

CONCLUSION

Dealing with newborns' deaths is a highly stressful task; professionals should receive proper support such as debriefing, psychological support and training in order to prevent post-traumatic stress symptoms and reduce professional burnout.

Compassion Fatigue in Informal Caregivers of Children with Cancer; a Section from Turkey

Compassion fatigue is the natural stress caused by the strong desire to help a valued person and alleviate the pain he/she suffers after he/she undergoes a traumatizing event. That caregiver who witnesses the physical suffering of the patient, who makes intense effort during the process deprived of the social, psychological, or economic support they need is among the reasons causing compassion fatigue. In this study, the aim was to test and describe the effects of compassion fatigue on informal caregivers of children with cancer. The study is phenomenological, a form of a qualitative study. The participants were the relatives of children with cancer. The data were obtained through in-depth interviews. The audio-recorded interviews were analyzed through the inductive thematic analysis to obtain answers to the questions. The findings were categorized under four headings which compassion fatigue was addressed: Empathy ability, compassion stress, problems experienced by the participants as components of compassion fatigue. The results of this study demonstrated that mothers were at risk of compassion fatigue. Those who give care to their relatives are faced with problems more than professionals. It is recommended that the implementation of multidisciplinary interventions that will improve caregivers' well-being, and preventive social work interventions, will prevent them from compassion fatigue.

Measuring Professional Quality of Life in Nurses: A Realist Review

Oncology nurses are at risk for compassion fatigue, which is often assessed using the Professional Quality of Life Scale (ProQOL). Nursing researchers and leaders use the ProQOL to determine risk for compassion fatigue or effectiveness of interventions to reduce compassion fatigue. However, the ProQOL was designed for social workers, and research has shown it to be less suitable to assess the work of nurses. This article synthesizes a realist review of the literature about instruments measuring nurses' professional quality of life (QOL). The following three themes emerged: (a) a robust body of literature aimed at defining professional QOL, (b) a limited historical context of the ProQOL instrument, and (c) newer instruments. Findings suggest that the ProQOL-21 and the Risk Factors for Compassion Fatigue Inventory are more specific to nursing and better suited to measure nurses' perceived professional QOL.

Examining the Constructs of Burnout, Compassion Fatigue, Secondary Traumatic Stress in Physicians Using Factor Analyses

Background

Adverse affective experiences have been well-documented in healthcare providers. Research describes them under a variety of terms, including burnout, secondary traumatic stress (STS), and compassion fatigue (CF). The present study evaluates conflicting models of STS, CF, and burnout constructs in physicians.

Methods

Surveys were mailed to all allopathic physicians with active Rhode Island medical licenses. Three hundred and seventy-five complete responses were received. The survey included common measures of STS, CF, and burnout. Confirmatory Factor Analysis (CFA) was used to evaluate discriminant validity of the three constructs and test 5 a priori (1-, 2-, and 3-factor) theoretical models, and Exploratory Factor Analysis (EFA) was planned assess underlying factor structure in the case that CFA did not provide evidence supporting any existing model.

Results

By CFA, all five a priori models of burnout, CF, and STS fail to demonstrate adequate model fit (Standardized Root Mean Square Residual >0.10, Tucker-Lewis Index <0.90). EFA with parallel analysis extracts four factors underlying the three burnout, STS, and CF measures. The four factors describe 54.3% of variance and can be described as (1) depressive mood; (2) primary traumatic stress-like symptoms; (3) responses to patients' trauma; and (4) sleep disturbances.

Conclusion

In spite of abundant discussion surrounding burnout, CF, and STS in physicians, measures of these constructs did not uphold their theoretical factor structures in the present study. Future research might explore other constructs and measures that may describe adverse affective physician experiences.

Prevalence and factors associated with compassion satisfaction and compassion fatigue among Chinese oncology healthcare professionals: A cross-sectional survey

Objective

This cross-sectional study examined the prevalence and factors associated with compassion satisfaction and fatigue among oncology healthcare professionals (doctors and nurses) in mainland China.

Methods

A total of 337 subjects were recruited via convenience sampling from the oncology departments of five general hospitals in Guangzhou, Guangdong, China. They were invited to complete a survey that included demographic characteristics, the Profession Quality of life Scale, the Brief Cope Questionnaire, and the Connor-Davidson Resilience Scale.

Results

The findings showed medium levels of compassion satisfaction, burnout, and secondary traumatic stress among oncology healthcare professionals in China, reaching rates of 78.34%, 63.50% and 75.96%, respectively. Multiple regression analyses suggested that active coping, positive reframing, and strength were the significant factors of compassion satisfaction, explaining 48.6% of the total variance (P ​< ​0.001). Substance use and self-blame were the significant factors of burnout, explaining 45.1% of the total variance (P ​< ​0.001). Venting, denial, substance use, self-blame, and strength were the significant factors of secondary traumatic stress, explaining 37.6% of the total variance (P ​< ​0.001).

Conclusions

The high prevalence of compassion fatigue warrants the attention of the hospitals' senior management. The effective coping styles identified may be considered when developing strategies to improve the professional quality of life among oncology healthcare professionals.

A Continuing Educational Program Supporting Health Professionals to Manage Grief and Loss

Health professionals working in oncology face the challenge of a stressful work environment along with impacts of providing care to those suffering from a life-threatening illness and encountering high levels of patient loss. Longitudinal exposure to loss and suffering can lead to grief, which over time can lead to the development of compassion fatigue (CF). Prevalence rates of CF are significant, yet health professionals have little knowledge on the topic. A six-week continuing education program aimed to provide information on CF and support in managing grief and loss and consisted of virtual sessions, case-based learning, and an online community of practice. Content included personal, health system, and team-related risk factors; protective variables associated with CF; grief models; and strategies to help manage grief and loss and to mitigate against CF. Participants also developed personal plans. Pre- and post-course evaluations assessed confidence, knowledge, and overall satisfaction. A total of 189 health professionals completed the program (90% nurses). Reported patient loss was high (58.8% > 10 deaths annually; 12.2% > 50). Improvements in confidence and knowledge across several domains (p < 0.05) related to managing grief and loss were observed, including use of grief assessment tools, risk factors for CF, and strategies to mitigate against CF. Satisfaction level post-program was high. An educational program aiming to improve knowledge of CF and management of grief and loss demonstrated benefit.

Anxiety level among newly hired nurse in a specialized oncology hospital: An observational study

Background: Anxiety is common among oncology nurses due to the complexity of oncology patients' needs and demands. The current study aimed to assess the anxiety level among newly hired nurses in a specialized oncology hospital throughout their initial period of employment, deploying a General Nursing Orientation (GNO) and the Clinical Resource Nurse (CRN) role.

Methods: A longitudinal one-group repeated measure design was used. Participants' demographics sheet and Sate-Trait Anxiety Inventory for Adults questionnaire were used. A total of 181 newly hired nurses participated in the study.

Results: The anxiety level among newly hired oncology nurses was (mean=38.65, SD=9.58) at the beginning of GNO, and the level of anxiety was highest after 90 days of employment (mean=45.71, SD=7.20). The level of anxiety among newly hired oncology nurses increased gradually from day one of the GNO, the last day of GNO, and finally, after 90 days of employment.

Conclusions: Nurses working in oncology workplaces face anxiety. It is important to seek nursing administrators' attention to apply proper strategies to decrease the anxiety level among newly hired nurses to help them smoothly fit into a new team to ensure safe patient care.

Palliative Care Professionals' Inner Life: Exploring the Mediating Role of Self-Compassion in the Prediction of Compassion Satisfaction, Compassion Fatigue, Burnout and Wellbeing

CONTEXT

Palliative care professionals are exposed to suffering on a daily basis. Working in such an environment frequently raises existential issues, psychological challenges, and emotional distress, that can detract from compassionate care. Identifying factors that help professionals cope with frequent exposure to issues related to mortality, such as compassion, could enhance palliative care providers' and patients' quality of life and wellbeing.

OBJECTIVES

To improve our understanding of the factors associated with professionals' inner life studying the role of self-compassion as a mediating variable between self-care and awareness and professionals' quality of life, and quantifying the impact of compassionate care.

METHODS

A cross-sectional online survey of palliative care professionals was conducted through the Spanish Society of Palliative Care. 296 professionals answered the survey.

RESULTS

The model tested showed an adequate fit (χ²(212) = 476.688 (P < .001), CFI = .907, RMSEA = .066 [.058,.073], and SRMR = .068), and the hypotheses were supported. Self-care and awareness predicted coping with death and self-compassion, which in turn predicted professional quality of life. Self-compassion had the greatest predictive power. Professional quality of life showed a statistically significant and positive effect on personal wellbeing, explaining more than 50% of its variance (R² = .574; P < .001).

CONCLUSION

For palliative care professionals, the cultivation of self-compassion is equally needed as compassion for others. Professional quality of life and compassionate care are related to professionals' wellbeing: when professionals take care of themselves, this will lead in a more compassionate care, but also in healthier, happier professionals.

Compassion Fatigue in the Burn Unit: A Review of Quantitative Evidence

Healthcare staff across varied clinical settings are faced with varied stressors that can lead to compassion fatigue. However, there is currently no review examining the phenomenon in-depth in the burn unit. Thus, the current study sought to scope existing studies to ascertain the prevalence, contributing factors, and effects of compassion fatigue in the burn unit. Compassion fatigue was conceptualised as comprising of burnout and secondary traumatic stress. Arksey and O'Malley scoping review approach was used and reported according to the PRISMA extension guidelines. Searches were undertaken across peer-reviewed databases and grey literature sources for quantitative studies. Following the search and screening process, nine studies were retained. Codes were formulated across studies following which narrative synthesis was undertaken. Majority of the studies (n=5) focused on burn care nurses. High levels of emotional exhaustion and depersonalization and comparatively low level of personal achievement were reported among burn care staff which is indicative of burnout. Compassion fatigue was also observed to be high among burn care staff. Contributing factors are varied albeit some variables such as age, staffing levels, remuneration, nature of the work environment, and number of years worked were consistent across some studies. In conclusion, working in the burn unit is challenging with significant stressors that can lead to burnout, traumatic stress, and subsequently, compassion fatigue. Interventions to promote resilience, hardiness, optimal working environment, peer, and psychosocial support are greatly needed.

The emotional experience of nurses in the Home Hospitalization Unit in palliative care: A qualitative exploratory study

OBJECTIVE

To explore the emotions experienced by the nurses of a Home Hospitalization Unitas a result of their work role.

METHOD

A qualitative exploratory study was carried out with a phenomenology approach toexplore people's experiences and inner-life experiences. The participants were 9 nurses workingin the home hospitalization unit. An analysis of qualitative content was undertaken. Units ofmeaning were grouped into 13 codes that, in turn, were classified into 4 categories, emotionaldimension, beneficial and distressing aspects, daily working life and personal life.

RESULTS

Nursing professionals working in palliative care suffer continuous exposure to traumaticsituations, although they also report feeling satisfactory emotions that compensate for momentsof distress. Having resources such as training in self-care and emotional regulation, as well associal support seems to be key to providing quality care and avoiding the onset of compassionfatigue.

CONCLUSIONS

Maintaining psychosocial well-being in the workplace is crucial for palliative care nurses to be able to undertake their work in the best possible way.

The Relationship Between Psychological Resilience and Professional Quality of Life in Nurses

The current descriptive study investigated the correlation between psychological resilience and quality of professional life in clinic nurses. Nurses should have psychological resilience to have high compassion satisfaction and low burnout and compassion fatigue. The sample comprised 280 hospital nurses in Istanbul. Data were analyzed using descriptive statistics and Pearson correlation coefficient. Psychological resilience was positively correlated with compassion satisfaction (r = 0.372; p < 0.01) and negatively correlated with burnout (r = -0.379; p < 0.01) and compassion fatigue (r = -0.336; p < 0.01). Psychological resilience was positively correlated with professional quality of life. Managerial interventions and training should be developed and implemented to help nurses develop psychological resilience to create a positive organizational culture. [Journal of Psychosocial Nursing and Mental Health Services, 59(6), 31-36.].

The Personal Wellbeing Index in Spanish Palliative Care Professionals: A Cross-Sectional Study of Wellbeing

Health professionals are especially exposed to stress, with consequences on professionals’ health and wellbeing. However, palliative care professionals’ wellbeing has been the subject of very little research. The aim of this work is to study the Personal Wellbeing Index (PWI) in a sample of Spanish palliative care professionals, as well as to study their levels of wellbeing and the relationships of wellbeing with variables such as gender, age, marital status, profession, and professional quality of life. A cross-sectional survey of Spanish palliative care professionals was conducted. The Spanish version of the PWI and the Short version of the Professional Quality of Life Scale were used. Here, 296 palliative care professionals attending patients at the end of life participated in the study. They showed medium to high levels of wellbeing. The PWI showed an adequate internal structure [χ²₍₂₀₎ = 116.130 (p < 0.001)]; Comparative Fit Index (CFI) = 0.970; standardized root mean square residual (SRMR) = 0.041; root mean square error of approximation (RMSEA) = 0.140 (0.116, 0.166)] and excellent estimates of reliability [α = 0.879 and Composite Reliability Index (CRI) = 0.923]. Wellbeing was higher for married compared to single and showed no relation with age, gender, and profession. Additionally, a structural equation model was estimated, in which a positive relation was found between wellbeing and compassion satisfaction and a negative one with burnout. The PWI is adequate to measure personal wellbeing in Spanish palliative care professionals.

Compassion Satisfaction to Combat Work-Related Burnout, Vicarious Trauma, and Secondary Traumatic Stress

Helping professionals play an essential role in the recovery of victims of trauma. However, research has demonstrated that, as a result of their work, helping professionals' indirect exposure to clients' trauma increases the likelihood of experiencing negative psychological responses, including vicarious trauma (VT), secondary traumatic stress (STS), and burnout. The present study examined the concurrent validity between the STS subscale on the Professional Quality of Life (ProQoL) scale and the Secondary Traumatic Stress Scale (STSS). Furthermore, the relationships between compassion satisfaction (CS) and burnout were investigated. Participants were recruited using a comprehensive web search of agencies across the United States that employed victim advocates, a subtype of helping professionals that are understudied. A list of possible agencies (N = 75) was generated, and each agency was sent an email about the study. In total, 132 victim advocates provided data for these analyses. Findings revealed positive correlations between the STS subscale on the ProQoL and the STSS. In addition, a negative correlation was found between burnout and CS. Two-level hierarchical multiple regression analyses demonstrated that burnout accounted for 47.3% of the variance in STS, and CS contributed an additional 3.9%. Furthermore, burnout accounted 45.8% of the variance in VT, whereas CS contributed an additional 0.6%, indicating that burnout is a strong predictor of VT and STS, but CS may serve as a protective factor against experiencing both. Prevention and intervention efforts should target reducing burnout to combat these psychological sequelae and increasing CS.

"We are all a family" Staff Experiences of Working in Children's Blood and Cancer Centers in New Zealand-A Constructivist Grounded Theory

Background: The purpose of this study is to explore staff experiences of working in a children's blood and cancer center in New Zealand, with a particular focus on how staff maintain resilience in their work and sustain working in this difficult area. Methods: Constructivist grounded theory (GT) methods were used to collect data using focus groups and individual interviews with all staff (nursing, medical, allied health, cleaning, and support staff) working in the area. Data were analyzed using constant comparative analysis, and data collection continued until theoretical saturation was achieved. Results: The GT constructed in this study is being a work family, which includes three core categories: finding attachment, becoming a work family, and having an identity. Discussion: This study found that regardless of profession or discipline, all staff experience similar feelings about their work, and can develop and enhance their resilience by belonging to a "work family." Being socially connected to the work family was recognized as the most supportive intervention, and was identified as being of greater value than the traditional one-on-one support that is currently encouraged.

The emotional experience of nurses in the Home Hospitalization Unit in palliative care: A qualitative exploratory study

OBJECTIVE

To explore the emotions experienced by the nurses of a Home Hospitalization Unit as a result of their work role.

METHOD

A qualitative exploratory study was carried out with a phenomenology approach to explore people's experiences and inner-life experiences. The participants were 9nurses working in the home hospitalization unit. An analysis of qualitative content was undertaken. Units of meaning were grouped into 13 codes that, in turn, were classified into 4 categories, emotional dimension, beneficial and distressing aspects, daily working life and personal life.

RESULTS

Nursing professionals working in palliative care suffer continuous exposure to traumatic situations, although they also report feeling satisfactory emotions that compensate for moments of distress. Having resources such as training in self-care and emotional regulation, as well as social support seems to be key to providing quality care and avoiding the onset of compassion fatigue.

CONCLUSIONS

Maintaining psychosocial well-being in the workplace is crucial for palliative care nurses to be able to undertake their work in the best possible way.

Oncology Nurses' Needs Respecting Healthy Work Environment in Iran: A Descriptive Exploratory Study

Objective:

The work environment of oncology nurses is often unpleasant due to the complexities of cancer treatment and care. Yet, there is limited information about their perspectives on healthy work environment (HWE) and their HWE-related needs. This study aimed to explore oncology nurses' HWE-related needs.

Methods:

This descriptive exploratory qualitative study was conducted in 2018–2019. Participants were 52 nurses and 11 oncology specialists, nursing instructors and managers, and occupational and environmental health experts, who had the experience of promoting nurses' work conditions. They were recruited from eight teaching specialty cancer treatment centers in different cities of Iran (Tehran, Isfahan, Mashhad, Shiraz, and Babolsar). Data were collected via semi-structured interviews. Data were analyzed via conventional content analysis.

Results:

Oncology nurses' HWE-related needs were grouped into the four main categories of physical–structural improvement, mental health improvement in work environment, organizational improvement, and sociocultural improvement.

Conclusions:

A wide range of physical–structural, mental health, organizational, and sociocultural improvements should be made to oncology nurses' work environment in order to fulfill their HWE-related needs. Health-care managers can use the findings of the present study to create HWE for oncology nurses.

Palliative Care Professionals' Inner Lives: Cross-Cultural Application of the Awareness Model of Self-Care

Compassionate professional qualities traditionally have not received the most attention in either critical or end of life care. Constant exposure to death, time pressure and workload, inadequate coping with personal emotions, grieving, and depression urge the development of an inner curricula of competences to promote professional quality of life and compassionate care. The COVID-19 pandemic highlights the universality of these problems and the need to equip ourselves with rigorously validated measurement and monitoring approaches that allow for unbiased comparisons. The main objective of this study was to offer evidence on the generalizability of the awareness model of self-care across three care systems under particular idiosyncrasy. Regarding the sample, 817 palliative care professionals from Spain, Argentina, and Brazil participated in this cross-sectional study using a multigroup structural equation modeling strategy. The measures showed good reliability in the three countries. When testing the multigroup model against the configural and constrained models, the assumptions were fulfilled, and only two relationships of the model revealed differences among contexts. The hypotheses posited by the awareness model of self-care were supported and a similar predictive power on the professional quality of life dimensions was found. Self-care, awareness, and coping with death were competences that remained outstanding no matter the country, resulting in optimism about the possibility of acting with more integrative approaches and campaigns by international policy-makers with the consensus of world healthcare organizations.

Experiences of compassion fatigue in direct care nurses: a qualitative systematic review

OBJECTIVE

The objective of this review was to describe the experiences of direct care nurses with work-related compassion fatigue.

INTRODUCTION

The cumulative demands of experiencing and helping others through suffering have been considered to contribute to the potential of compassion fatigue. However, there is a lack of clarity on what specifically contributes to and constitutes compassion fatigue. Nurses suffering from compassion fatigue experience physical and emotional symptoms that leave them disconnected from patients and focused on the technical rather than the compassionate components of their role. This disconnect can also affect personal relationships outside of work.

INCLUSION CRITERIA

This review included any qualitative studies describing the experiences of direct care nurses from any specialty or any nursing work setting.

METHODS

This review followed the Joanna Briggs Institute (JBI) approach for qualitative systematic reviews. Studies included in this review include those published in full text, English and between 1992, when the concept of compassion fatigue was first described, and May 2017, when the search was completed. The main databases searched for published and unpublished studies included: PubMed, CINAHL, Academic Search Premiere, Science Direct, Scopus, PsycINFO, Web of Science and the Virginia Henderson Library.

RESULTS

Twenty-three papers, representing studies conducted in seven countries and 821 total nurse participants, met the criteria for inclusion. From these, a total of 261 findings were extracted and combined to form 18 categories based on similarity in meaning, and four syntheses were derived: i) Central to the work of nursing and the professional environment in which nurses work are significant psychosocial stressors that contribute to compassion stress and, if left unchecked, can lead to compassion fatigue; ii) Protection against the stress of the work and professional environment necessitates that the individual and team learn how to respond to "the heat of the moment"; iii) Nurses and other administrative and colleague staff should be alert to the symptoms of compassion fatigue that present as profound, progressive, physical and emotional fatigue: a feeling that the nurse just can't go on and a sense of being disconnected and drained, like a gas tank on empty; and iv) Keeping compassion fatigue at bay requires awareness of the threat of compassion fatigue, symptoms of compassion fatigue, and the need for work-life balance and active self-care strategies.

CONCLUSIONS

The major conclusions of this review are that compassion fatigue prevention and management must be acknowledged, and both personal and organizational coping strategies and adaptive responses are needed to keep nurses balanced, renewed and able to continue compassionate connection and caring.

Self-Compassion Explains Less Burnout Among Healthcare Professionals

Objectives

Healthcare professionals are prone to experience burnout-a psychological syndrome resulting from chronic stressors at work. Some individual differences, like self-compassion-the non-judgmental observation of one's own pain and failure, while understanding that these are part of being human-can protect against burnout.

Methods

We administered the Maslach Burnout Inventory, the Self-Compassion Scale, and the Stressful Life Events Scale to a sample of healthcare professionals (medical residents, nurses, and physicians) in Lebanon (N = 93).

Results

The sample demonstrated a high degree of Emotional Exhaustion (M = 27, SD = 11.79), average levels of Depersonalization (M = 9.46, SD = 6.35), and Personal Accomplishment (M = 34.95, SD = 6.58), and moderate levels of Self-compassion (M = 3.25). All burnout components were significantly and inversely associated with self-compassion, with the strongest association found between Emotional Exhaustion and Self-compassion (r = -.37, p < .001). Self-compassion significantly explained burnout, above and beyond sociodemographic and occupational variables (Emotional Exhaustion: ΔR ² = .11, F (1.85) = 12.71, p < .01; Depersonalization: ΔR ² = .07, F (1.85) = 6.73, p = .01; Low Personal Accomplishment: ΔR ² = .11, F (1.85) = 11.29, p < .01).

Conclusions

Burnout is prevalent in the sample, yet self-compassion may be a possible protective factor.

Self-Care, Burnout, and Compassion Fatigue in Oncology Professionals

Context:

With the rising number of cancer cases in India, the stress levels of the treating team have increased. It has affected their self-care and made them susceptible to problems like burnout and compassion fatigue that adversely affect the quality of patient care.

Aims:

The aim of the study was to assess and compare the levels of burnout, compassion fatigue, and self-care in three groups of oncology professionals (clinical oncologists, nurses, and psychologists).

Settings and Design:

The study included 134 oncology professionals working in New Delhi, Bengaluru, and Mumbai.

Methods and Material:

Sociodemographic data sheet, Professional Quality of Life Scale V and Self-Care Assessment Worksheet were used.

Statistical Analysis Used:

Kruskal-Wallis, Mann-Whitney U test, and Correlation Analysis.

Results:

The majority of the professionals reported moderate levels of burnout (60.4%) and compassion fatigue (56%). Oncology nurses reported an elevated risk as they scored significantly higher on these domains and had a lower degree of self-care. Interestingly, psychologists reported comparatively lower levels of burnout and compassion fatigue, despite the fact that they interact with the patients at a deeper level, looking after their psychological and emotional needs. Young age and a poor degree of self-care were identified as major risk factors.

Conclusions:

The moderate levels of burnout and compassion fatigue, though not severe, are a cause of concern and cannot be overlooked. The study highlights the need for self-care in this regard and suggests that individual and institutional level interventions, particularly for nurses and young professionals, would prove useful.

Compassion fatigue in critical care nurses. An integrative review of the literature

Objectives:

To provides a critical evaluation of current empirical evidence related to the prevalence, causes and outcomes of compassion fatigue among critical care nurses. Compassion fatigue is characterized the development of emotional, physical, and/or spiritual exhaustion as a result of working with traumatized individuals.

Methods:

Data was collected using an integrated review framework via an advanced search of healthcare databases; namely, ProQuest, Science Direct, and CINAHL for research articles on compassion fatigue among nurses in critical care settings. Analysis was performed on the articles which met the inclusion criteria for this review (n=10) to identify the key themes and issues related to the compassion fatigue in critical care situations. Articles were assessed for quality and rigor using the Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The search was limited to research studies undertaken from 2000 to 2018.

Results:

The main findings to emerge from this integrative review was that the prevalence of compassion fatigue among nurses varied across the range of critical care settings. In terms of the causes and consequences of compassion fatigue, this review found work environment and nurse demographics such as age and years of experience, were predictors of compassion fatigue, and the factors mitigating compassion fatigue affects among critical nurse included leader and administrative support within the clinical setting and the coping strategies employed by the nurses.

Conclusion:

There is inconclusive evidence to identify unequivocal predictors of compassion fatigue among critical nurses. However, it is likely the onset of compassion fatigue among critical care nurses may be reduced with close monitoring of physical and emotional wellbeing in the critical care environment as well as through the provision of education to nurses to assist with the development of coping strategies to avoid compassion fatigue.

Physical Effects of Maternal Deaths on Midwives' Health: A Qualitative Approach

Grief does not only affect human emotions but also impacts their physical health. Understanding physical grief of people can bring to bear the grip of its daunting nature, a situation where routines become challenging. A qualitative explorative descriptive research method was used. A purposive sample of 18 ward supervisors and 39 ward midwives was used to ascertain the physical effects of maternal deaths on these caregivers in the Ashanti Region of Ghana. Data were collected through semistructured and focus group discussions. Data analysis was done parallel with data collection till saturation was reached. Ethics was obtained from the University of the Western Cape, South Africa, and Ghana Health Service. The findings indicated that generally, as a result of grieving over the deaths of their patients, midwives experienced physical health sufferings. Therefore, reported depression is expressed as insomnia, appetite loss, exhaustion, and social isolation. There is the need to reduce the physical effects of patients' death on caregivers in Ghana and therefore, the study recommends that all hospitals in Ghana utilize employee assistance programmes, a workplace intervention programme designed for such purposes.

Communication Training: Needs Among Oncology Nurses Across the Cancer Continuum

BACKGROUND

Oncology nurses are responsible for communication-aimed prognosis, patient education about cancer care and treatment, survivorship, and care coordination. Communication difficulties and uncomfortable communication topics put nurses at risk for compassion fatigue.

OBJECTIVES

Supporting nurse communication skills requires institutional policies and structures to foster patient-centered communication. This study reports on communication training needs for oncology nurses to inform future development of communication curricula and institutional training.

METHODS

A national survey of oncology nurse teams (N = 355) attending one of four communication training courses was used. Surveys were used to evaluate institutions' current patient-centered communication practices and to ascertain institutional communication training needs.

FINDINGS

Nurses' role in communicating prognosis remains unclear, and training is needed for discussing survivorship. Curriculum development should be congruent with institutionally defined roles for nurse communication.

Community-Based Implementation of a Paraprofessional-Delivered Cognitive Behavioral Therapy Program for Youth Involved with the Criminal Justice System

Psychosocial interventions for common emotional and behavioral difficulties have been developed for use in correctional facilities, yet these programs are largely unavailable upon community re-entry due to a shortage of trained mental health specialists. In this study, we developed and piloted a youth worker-delivered cognitive behavioral therapy (CBT) program for young men at high risk for incarceration receiving services at a youth development organization. We formed a community-academic partnership to support the conduct of research across all phases of this project (2014-2016). We analyzed data gathered through focus groups and individual interviews with program staff, administrators, and young men. This study reports on implementation process and outcomes across phases. Main findings indicate the preliminary feasibility and acceptability of the youth worker-delivered CBT curriculum. We discuss strengths and limitations of our approach and provide suggestions for future studies that aim to implement paraprofessional-delivered CBT programs within community-based organizations.

Are We Making Progress on Communication with People Who Are Near the End of Life in the Australian Health System? A Thematic Analysis

Initiating end-of-life (EoL) discussions with patients is often delayed or avoided altogether by healthcare practitioners even in light of imminent death. This continues despite the availability of guidelines and conceptual frameworks on how to communicate prognoses at EoL. We surveyed healthcare practitioners to elicit their exposure to and confidence in EoL discussions and to better understand factors that enable or challenge the initiation of discussions in Australian healthcare settings. Thematic analysis identified that EoL discussions could be emotionally burdensome for healthcare practitioners but were regarded as valuable. Effective communications were challenged by conflict with families and between healthcare practitioners as to appropriate care goal transition, and by prognostic uncertainty. Communication skills appeared to be developed more from experience, and beneficial strategies such as role play and mentoring particularly for younger nurses and doctors were identified. Specific training in EoL communications should target undergraduates and new healthcare practitioners.

Nurse-Patient Connectedness and Nurses' Professional Quality of Life: Experiences of Volunteering at a Pediatric Oncology Camp

Objective: Pediatric oncology nurses can experience burnout, vicarious traumatization, and compassion fatigue related to the unique stressors of their profession. Opportunities to enhance nurses' professional commitment and nurse-patient connectedness may mitigate these stressors. This study explored the impact of volunteering at a local oncology camp on pediatric oncology nurses' professional quality of life and connectedness with their oncology patients. Method and Sample: Pediatric oncology nurses from a single institution were invited to participate in this mixed methods study. Participants completed a survey assessing professional quality of life, professional commitment, and patient connectedness. Nurses who had oncology camp volunteer experience were invited to participate in a qualitative interview. Results: Compared with noncamp nurses (n = 23), camp nurses (n = 25) had increased odds of a low burnout score (odds ratio = 6.74, 95% confidence interval [1.10, 41.43], p = .039) and increased odds of a high compassion satisfaction score (odds ratio = 4.69, 95% confidence interval [1.14, 19.32], p = .033). Qualitative interviews supported the impact of volunteering at camp on nurses' personal and professional perspective, nursing practice, and delivery of person-centered care. Conclusion: Volunteering at a pediatric oncology camp provided nurses the opportunity to engage with patients, share experiences, and view patients as individuals while still maintaining professional boundaries. Nurses who volunteer at camp described a perspective moving beyond patient-centered to person-centered care, and for some pediatric oncology nurses, camp volunteering may be a novel way to mitigate burnout and an important tool to enhance resiliency.

Development and Psychometric Assessment of Risk Factors of Compassion Fatigue Inventory in Nurses

BACKGROUND AND PURPOSE

Identifying the risk factors of compassion fatigue is the basic step in designing effective interventions to prevent and manage compassion fatigue. This study developed an inventory of compassion fatigue risk factors and investigated its psychometric properties.

METHODS

This methodological study consisted of two phases: item pool generation through semistructured interviews with 13 nurses and reviewing of 38 related articles and the psychometric validation.

RESULTS

The initial item pool contained 62 items. The psychometric properties was examined and exploratory factor analysis revealed a four-factor structure. Risk Factors of Compassion Fatigue Inventory (RFCFI) contained 20 items. The Cronbach's alpha, intra-class correlation coefficient (ICC), and standard error of measurement (SEM) were .86, 0.83, and 5.73 respectively.

CONCLUSION

RFCFI is a short, self-reporting, valid, and reliable inventory for determining the risk factors of compassion fatigue in nurses and can be easily used by managers, nurses, and scholars.

Nurses Providing End-of-Life Care for Infants and Their Families in the NICU: A Review of the Literature

BACKGROUND

Nurses working in the neonatal intensive care unit (NICU) who care for dying infants and their families say they do not necessarily have the expertise or the specific training to provide quality end-of-life-care (EOLC).

PURPOSE

The purpose of this review was to critically appraise the existing qualitative literature regarding nurses' experiences when caring for infants during end of life in the NICU and to identify barriers and enablers to provide quality EOLC.

SEARCH STRATEGY

A literature search was conducted using CINAHL and OVID databases. Studies that explored nurses' experiences when caring for infants who were dying or when lifesaving care was withdrawn were retrieved and 15 studies were thematically analyzed.

RESULTS

Five major themes emerged: advocating for the dying infant, building close relationships with the family, providing an appropriate care environment, nurses' emotional responses to dying or death, and professional inadequacy in EOLC.

IMPLICATIONS FOR PRACTICE

Nurses face multiple challenges when providing EOLC including moral dilemmas and feelings of professional inadequacy. Avoidance was a common strategy used by nurses to cope with the stress associated with EOLC. Managers can foster quality EOLC by implementing education sessions about infant mortality, EOLC, advocacy, team communication, and self-care practices.

IMPLICATIONS FOR RESEARCH

Research could evaluate the effectiveness of EOLC education sessions to build nurses' competence and confidence in advocacy and EOLC clinical skills.

Effects of a Multimodal Program Including Simulation on Job Strain Among Nurses Working in Intensive Care Units: A Randomized Clinical Trial

Importance

Nurses working in an intensive care unit (ICU) are exposed to occupational stressors that can increase the risk of stress reactions, long-term absenteeism, and turnover.

Objective

To evaluate the effects of a program including simulation in reducing work-related stress and work-related outcomes among ICU nurses.

Design, Setting, and Participants

Multicenter randomized clinical trial performed at 8 adult ICUs in France from February 8, 2016, through April 29, 2017. A total of 198 ICU nurses were included and followed up for 1 year until April 30, 2018.

Interventions

The ICU nurses who had at least 6 months of ICU experience were randomized to the intervention group (n = 101) or to the control group (n = 97). The nurses randomized to the intervention group received a 5-day course involving a nursing theory recap and situational role-play using simulated scenarios (based on technical dexterity, clinical approach, decision making, aptitude to teamwork, and task prioritization), which were followed by debriefing sessions on attitude and discussion of practices.

Main Outcomes and Measures

The primary outcome was the prevalence of job strain assessed by combining a psychological demand score greater than 21 (score range, 9 [best] to 36 [worst]) with a decision latitude score less than 72 (score range, 24 [worst] to 96 [best]) using the Job Content Questionnaire and evaluated at 6 months. There were 7 secondary outcomes including absenteeism and turnover.

Results

Among 198 ICU nurses who were randomized (95 aged ≤30 years [48%] and 115 women [58%]), 182 (92%) completed the trial for the primary outcome. The trial was stopped for efficacy at the scheduled interim analysis after enrollment of 198 participants. The prevalence of job strain at 6 months was lower in the intervention group than in the control group (13% vs 67%, respectively; between-group difference, 54% [95% CI, 40%-64%]; P < .001). Absenteeism during the 6-month follow-up period was 1% in the intervention group compared with 8% in the control group (between-group difference, 7% [95% CI, 1%-15%]; P = .03). Four nurses (4%) from the intervention group left the ICU during the 6-month follow-up period compared with 12 nurses (12%) from the control group (between-group difference, 8% [95% CI, 0%-17%]; P = .04).

Conclusions and Relevance

Among ICU nurses, an intervention that included education, role-play, and debriefing resulted in a lower prevalence of job strain at 6 months compared with nurses who did not undergo this program. Further research is needed to understand which components of the program may have contributed to this result and to evaluate whether this program is cost-effective.

Trial Registration

ClinicalTrials.gov Identifier: NCT02672072.

Pediatric oncology social workers' experience of compassion fatigue

Pediatric oncology social workers play an important role in supporting cancer patients and their families as they learn to talk about and cope with the physical and psychological impacts of cancer. As a result, social workers are particularly vulnerable to compassion fatigue and the associated psychological and physical impacts. The purpose of this qualitative study was to understand the experience of compassion fatigue among 27 pediatric oncology social workers. Four main themes emerged throughout the five focus groups: Conditions that contribute to compassion fatigue; the influence of compassion fatigue; coping strategies to alleviate compassion fatigue; and desire for systematic support to prevent compassion fatigue. Our study findings emphasize the importance of developing programs, policies and research geared toward the prevention of compassion fatigue, in addition to coping with symptoms. Further, this study brings attention to the importance of including pediatric oncology social workers in efforts to develop and implement systemic supports.

Supporting Parent Caregivers of Children with Life-Limiting Illness

The well-being of parents is essential to the well-being of children with life-limiting illness. Parents are vulnerable to a range of negative financial, physical, and psychosocial issues due to caregiving tasks and other stressors related to the illness of their child. Pediatric palliative care practitioners provide good care to children by supporting their parents in decision-making and difficult conversations, by managing pain and other symptoms in the ill child, and by addressing parent and family needs for care coordination, respite, bereavement, and social and emotional support. No matter the design or setting of a pediatric palliative care team, practitioners can seek to provide for parent needs by referral or intervention by the care team.