Burnout in the caring nurse: learning resilient behaviours

Strain and serenity: exploring the interplay of stress, burnout, and well-being among healthcare professionals

Introduction

Stress and burnout can negatively affect performance, mental health, and the overall well-being of healthcare workers. The study aims to examine the prevalence of stress and burnout, and investigate links between stress, burnout, mental state, and well-being among healthcare workers in the Czech Republic.

Methods

A cross-sectional survey was conducted in the Czech Republic, focusing on healthcare professionals working in various healthcare settings. A total of 1,064 healthcare workers participated in the study. A standardized questionnaire battery was used, consisting of the Maslach Burnout Inventory (MBI), Perceived Stress Scale (PSS) and Supso-7 measuring mental state. Separate correlation and multiple regression analyses were conducted.

Results

46.24% of the healthcare workers reported high levels of emotional exhaustion, 25.56% reported high levels of depersonalization, 24.15% reported low levels of personal accomplishment, while 11.18% reported high levels of perceived stress. The findings revealed that emotional exhaustion, a core component of burnout, was associated with increased feelings of anxiety and depression. Perceived stress was also linked to anxiety and depression, while personal accomplishment appeared to mitigate depression and support positive psychological well-being.

Conclusion

The study provides promising evidence suggesting that addressing stress and emotional exhaustion, while fostering a sense of personal achievement, could lead to improvements in the mental health and work performance of healthcare workers. These findings highlight the importance of addressing burnout and stress management strategies to support the overall well-being of healthcare professionals.

Understanding the Mental Health Impacts of the COVID-19 Pandemic on Railway Workers: Risks and Protective Factors

OBJECTIVE

Railway workers have provided an essential service throughout the COVID-19 pandemic. This study explored the effects of COVID-19 on the mental well-being of railway workers (N = 906) in the United Kingdom during the third lockdown period.

METHOD

The online survey included measures of COVID-19-related risk factors (perceived risk, stress, burnout, trauma) and protective factors (resilience coping, team resilience, general help seeking) associated with mental well-being. Responses were analyzed using multiple regression and content analysis.

RESULTS

COVID-19-related risk factors negatively predicted well-being. Higher scores on adaptive resilience, intentions to seek help, and team resilience significantly predicted higher mental well-being scores. Mental health decline throughout the COVID-19 pandemic and concerns for the future were reported.

CONCLUSIONS

Building a resilient railway workforce requires attention to staff mental well-being and to ensuring that support systems are robust and accessible.

Community Health Nurses' Spirituality Shapes Their Practice Working With Indigenous Communities in British Columbia, Canada

Common conceptions of spirituality in nursing often concentrate on nurses providing spiritual care, but there is insufficient research indicating how nurses' spirituality impacts their nursing practice. This study examines how Indigenous and non-Indigenous community health nurses' experiences of spirituality, regardless of any religious affiliation, shape their nursing practice with Indigenous communities. Results indicate that spirituality is a pervasive nursing ethic manifesting respect, connectedness, love, acceptance, caring, hope, endurance, and compassion toward clients. Participants' experiences of spirituality promote self-awareness, open-mindedness, and acceptance of others and encourage participants' reflexivity, which grounds their nursing practice. Nurses' spiritual awareness fosters an appreciation for Indigenous community healing, leading to more reciprocal interactions with community members. Significantly, these participants provide care spiritually; they do not provide spiritual care.

Assessing the fidelity of delivery style of a mental skills training programme for young people experiencing homelessness

There is a need for positive youth development/strengths-based approaches to support the wellbeing and social inclusion of young people experiencing or at risk of homelessness. My Strengths Training for Life™ (MST4Life™) uses a strengths-based approach with the aim to improve young people's resilience, self-worth, wellbeing and engagement in education, employment, and training. This mixed methods study assessed the fidelity of delivery style of the MST4Life™ programme, the extent to which frontline service staff can delivery psychologically informed programmes to service users and identified barriers and enablers to delivering with fidelity to the intended style. Observations of programme delivery (two facilitators per session) took place across early, middle, and late phases of the programme across a pilot phase (n = 18) and main study (n = 45). Facilitators also completed self-reflection forms following each session. The mean observation score was 82.2 ± 15.7 %, and facilitator self-report mean adherence score was 89.3 ± 6.2 % which indicate that the programme was delivered with high fidelity. Quantitative data was also analysed using non-parametric statistical test (Mann-Whitney U Test). There was a significant difference between observation scores for deliverers with postgraduate psychology training compared to deliverers without postgraduate psychology training (p = .029). Qualitative data were analysed using inductive thematic analysis. Barriers and enablers included communication, frontline staff support, logistics, and participant behaviours. Overall, this study highlights that despite the challenges of delivering complex community programmes to young people experiencing homelessness, it was possible for frontline service staff to deliver MST4Life™ with high fidelity.

Walking a tightrope: A meta-synthesis from frontline nurses during the COVID-19 pandemic

Nursing staff plays a key role in the public health response to the COVID-19 pandemic, being in the front line of care. This study sought to synthesise the qualitative literature on care experiences of frontline nurses during the COVID-19 pandemic. A search was conducted on five databases in January 2021. Fifteen qualitative studies met the inclusion criteria and were included in the research, being submitted to interpretive meta-synthesis according to the eMERGe guide. The final synthesis included a line of argument that shows the experiences of frontline nurses during the COVID-19 pandemic, divided into three major themes: 'Instability on the edge of a cliff: unpredictable and unknown context,' 'The price of walking the tightrope: the uncertainty surrounding care,' and 'Finding the balance to reach the other side: dealing with the emotional demands of care.' Although essential in the health response to the COVID-19 pandemic, nurses experienced an emotional impact arising from the hampered care provision. Our results point to need for strengthening the training of nurses and future nurses, creating and promoting measures that contribute to their psycho-emotional well-being, ensuring a safe environment for their clinical practice, and promoting their participation in decision-making processes.

Proactive Integration of Mental Health Care in Hospital Medicine: PRIME Medicine

BACKGROUND

Proactive consultation-liaison (C-L) psychiatry has been shown to reduce hospital length of stay (LOS), increase psychiatric C-L consult rate, and improve hospital staff satisfaction. Nursing attrition has not been studied in relation to proactive C-L.

OBJECTIVE

Our primary aim in evaluating the proactive C-L service called Proactive Integration of Mental Health Care in Medicine (PRIME Medicine) is to analyze change in LOS over 10 months using historical and contemporary comparison cohorts. As secondary aims, we assess change in psychiatric consultation rate, time to consultation, and change in nurse attrition.

METHODS

PRIME Medicine was implemented in 3 hospital medicine units as a quality-improvement project. Team members systematically screened patients arriving to assigned units for psychiatric comorbidity. Identified patients were reviewed with hospitalist teams and nurses with the goal of early intervention.

RESULTS

Including historical and contemporary comparison cohorts, the mean sample age was 62.4 years (n = 8884). Absolute LOS was unchanged, but difference-in-difference analysis trended toward reduced LOS by 0.16 day (P = 0.08). Consultation rate increased from 1.6% (40 consults) to 7.4% (176 consults). Time to consultation was unchanged (4.0-3.8 d). Annual per-unit nursing turnover increased from 4.7 to 5.7 in PRIME units but from 8.5 to 12.0 in comparison units. Nurses citing "population" as the reason for leaving decreased from 2.7 to 1.7 in PRIME units but increased from 1.5 to 4.5 in comparison units. PRIME Medicine led to increased consultation rate, and our unit-wide outcomes provide a conservative estimate of effect. Factors that may have influenced effect size include our cohort's advanced age, considerable emergency department boarding times, increasing proportion of patients discharged to skilled nursing facilities, and concurrent LOS-reduction initiatives on all units. The favorable trends in nursing attrition on PRIME units may be explained in part by our prior finding that PRIME Medicine was associated with enhanced nursing satisfaction.

CONCLUSIONS

While PRIME Medicine had no more than a modest effect on LOS, it was associated with a markedly increased psychiatric consult rate and favorable trends in nursing retention. This analysis highlights important factors that should be considered when implementing and determining value metrics for a proactive C-L service.

Integration of a proactive, multidisciplinary mental health team on hospital medicine improves provider and nursing satisfaction

OBJECTIVE

Psychiatric comorbidity among hospital medicine patients is common and often complicates care delivery and compromises outcomes. Team-based, proactive consultation-liaison (CL) psychiatry has been shown to reduce hospital length of stay (LOS) and care costs, but staff satisfaction with this model has not been explored in detail. Here we evaluate its impact on hospital medicine provider and nurse satisfaction.

METHODS

We implemented a team-based proactive CL service that reviews all admitted hospital medicine patients across 3 units for psychiatric comorbidity and provides unit-wide integrated mental health care. Hospital medicine staff completed surveys before and after a 6-month pilot phase: 10-item provider surveys covered resource adequacy, safety, time for healthcare improvements, and burnout; 26-item nurse surveys included the same 10 items plus 8 on behavioral health assessment competency and 8 on intervention competency. Additionally, we characterized psychiatric comorbidity, calculated consultation latency and volume and also average LOS during these 6 months.

RESULTS

The provider response rate was 57% (20/35 before; 21/37 after) and roughly a third for nurses (32/~90 and 31/~90, respectively). Providers rated 9 of 10 items as improved, including one on burnout. Nursing satisfaction improved similarly but with lower effect sizes. During the pilot (n = 1590), 71% had chart-identified psychiatric comorbidity. Consultation latency decreased by 0.86 days; consultation rate increased nearly 3-fold; and average LOS decreased by 0.33 days.

CONCLUSIONS

Team-based proactive CL psychiatry enhances provider and nurse satisfaction and may even reduce provider burnout. We also confirmed that this model is associated with reduced average LOS.

Vulnerability in Nurses: A Phenomenon That Cuts Across Professional and Private Spheres

Patients' vulnerability is a core concern in nursing. However, the nurse's endeavor to succeed may precipitate her vulnerability. Involving master students, 14 nurses' experiences of vulnerability in their professional roles were explored with a descriptive phenomenological approach. Vulnerability among nurses showed to be a latent feeling that manifests via bodily reactions including being overwhelmed by one's feelings and struggling to avoid being hurt. These experiences were evident in situations with patients and relatives, but also coworkers and working conditions, the latter suggests that the exposure of vulnerability may be possible to reduce by organizational awareness.

Honoring Life After Death: Mapping the Spread of the Pause

Background:

Health care is a high-risk environment for clinicians and patients. The risk of burnout increases with increased patient acuity and workload demands. The Pause is a contemplative intervention that has been deployed to foster honor and self-care.

Objective:

We aimed to reveal how clinicians and educators use The Pause and how it changes systems of thinking or practice.

Methods:

Using a modified Delphi method, we interviewed 11 participants who had used The Pause or intend on using it.

Results:

The Pause is being used in 4 continents and many countries. It is most widely learned about by the bedside in practice settings. Participants believe it is malleable and has a powerful systemic effect in fostering a culture of support and honor.

Conclusion:

The Pause should continue to be taught in clinical scenarios to foster a broader humanistic ethos in health care.

Burnout among direct-care workers in nursing homes: Influences of organisational, workplace, interpersonal and personal characteristics

AIMS AND OBJECTIVES

The many negative effects of burnout have prompted researchers to better understand the factors contributing to it. The purpose of this paper is to add to this body of knowledge through the study of burnout among direct-care workers in nursing homes.

BACKGROUND

Perhaps the factor most often associated with employee burnout is the level of staffing-insufficient staffing results in work overload and eventually employee burnout. A closer look at research findings suggests that there are many other factors also contributing to burnout. These range from those at the organisational level, such as availability of training and resources to individual characteristics such as self-esteem and length of employment.

METHODS

A self-administered survey instrument was completed by 410 direct-care workers working within 11 nursing homes in the north Texas region. Regression analyses were performed, adjusting for clustering by nursing home. Beta coefficients and structure coefficients are reported. Burnout was measured through three dimensions: emotional exhaustion, depersonalisation and personal accomplishment.

RESULTS

Organisational, work design, interpersonal and individual characteristics were found to be associated with one or more dimensions of burnout.

CONCLUSIONS

The analyses largely support previous research. Organisational variables of significance included the availability of resources to do the work, available training and fair pay. Work design variables of significance included adequate staffing. The individual characteristic, self-esteem, appeared to have the strongest impact on burnout. Commitment to the organisation also had a large impact.

RELEVANCE TO CLINICAL PRACTICE

While the data do not allow for the testing of causal relationships, the data do suggest that providing adequate staffing, perceived fair pay, sufficient work resources (e.g., towels, gowns), management support and adequate training may result in less direct-care worker burnout on the job.

Burnout Evaluation and Potential Predictors in a Greek Cohort of Mental Health Nurses

BACKGROUND

Job burnout is one of the most serious occupational health hazards, especially, among mental health nurses. It has been attributed among others to staff shortages, health service changes, poor morale and insufficient employee participation in decision-making.

AIM

The aim of this study was to measure burnout among mental health nurses, investigate relations between burnout and organizational factors and examine potential predictors of nurses' burnout. Specifically, this study aimed to investigate whether role conflict, role ambiguity, organizational commitment and subsequent job satisfaction could predict each of the three dimensions of burnout.

DESIGN/METHODOLOGY/APPROACH

During current cross sectional, the survey was administered to 232 mental health nurses, employed in four private psychiatric clinics in the region of Larissa, Thessaly, Greece in May 2015. Our findings were based on the responses to 78 usable questionnaires. Different statistical analyses, such as correlation analyses, regression analyses and analyses of variance were performed in order to explore possible relations.

FINDINGS

High emotional exhaustion (EE) accounted for 53.8% of the sample, while high depersonalization (DP) and high personal accomplishment (PA) accounted for 24.4% and 25.6%, respectively. The best predictors of burnout were found to be role conflict, satisfaction with workload, satisfaction with training, role ambiguity, satisfaction with pay and presence of serious family issues.

PRACTICAL IMPLICATIONS

These findings have implications for organizational and individual interventions, indicating that mental health nurses' burnout could be reduced, or even prevented by team building strategies, training, application of operation management, clear instructions and psychological support.

Nursing Students' Attitudes and Use of Holistic Therapies for Stress Relief

PURPOSE

The purpose of this study was to explore student nurses' openness to using or recommending holistic therapies, the strategies they use to manage stress from school or work, and their perceptions of the impact of holistic therapies on personal health.

STUDY DESIGN

Qualitative component of a quasi-experimental, mixed-methods study.

METHODS

A convenience sample of undergraduate nursing students in a southeastern U.S. university completed baseline surveys, including demographics and three open-ended questions regarding attitudes toward holistic therapies and strategies used for stress management. Qualitative thematic analysis was undertaken to identify recurring themes in textual data.

FINDINGS

Students are open to using or recommending holistic therapies but identify lack of knowledge and lack of time as barriers to their practice. Among strategies used by student nurses to manage stress from school or work were physical activity, prayer and meditation, time management, distraction, socialization, artistic pursuits, animal interactions, and other activities. Themes describing holistic therapies' impact on personal health were wholeness, self-empowerment, relaxation/restoration, and alternative/complement to traditional medicine.

CONCLUSIONS

Findings indicate receptiveness by student nurses to the use of holistic therapies but point to the need for the inclusion of informational as well as experiential education on holistic therapies within nursing curricula.

Examination of a therapeutic-recreation based clinical placement for undergraduate nursing students: A self-determined perspective

Nursing students across the globe are expected to undertake clinical placements. To date, there have been no studies that have examined the potential educational benefits for undergraduate nursing students engaged in a mental health clinical placement grounded in self-determination theory. The present study examined the experiences of undergraduate students engaged in a mental health clinical placement termed Recovery Camp. An ethnographic methodology within a case study approach was used. The researchers were immersed in the clinical placement, which took place at a YMCA camp facility. Participants were 20 3rd year undergraduate nursing students. To gain insight and understanding, the researchers used interviews, observations, and reflective journals. The constant-comparative method was used to analyse the data. Emergent themes identified from systematic analysis were: (a) social connection and (b) experiential learning. Recovery Camp facilitated a sense of inclusion and positive/supportive behaviour. It also enhanced student learning and understanding of symptoms of mental illness. Findings from this study support and extend findings for the use of therapeutic-recreation based work placement experiences in the clinical education of future nurses. Findings demonstrated a link between this type of placement and undergraduate student's development of deeper knowledge of symptoms and experiences associated with mental illness.

Emotional labour in mental health nursing: An integrative systematic review

Emotional labour is the effort consumed by suppressing one's own emotions to care for others effectively while also caring for oneself. Mental health nurses are required to engage in effective therapeutic interactions in emotionally-intense situations. The aim of the present integrative systematic review was to investigate the emotional labour of mental health work and how this manifested, the impacts, and the ways to mitigate these impacts. In June 2016, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology, a systematic search of the bibliographic databases was undertaken to identify relevant literature. Screening, data extraction, and synthesis were performed by three reviewers. The inclusion criteria included any original research that investigated the emotional work of mental health nurses. We identified a total of 20 papers to be included in this review. Thematic synthesis of the findings revealed three emergent themes: emotional labour and caring, emotional exhaustion, and self-protection (expressed as emotional intelligence). Emotional labour, emotional exhaustion, and emotional intelligence were considered to be intrinsically linked, where they were both the influencing factor for burnout and a contributor to attrition. The results highlighted that emotional labour could inspire the development and personal growth of emotional intelligence in mental health nurses. In light of these findings, recommendations for clinical practice were considered; they included supportive work environments, involving nurses in shared decision-making, and the provision of ongoing professional development opportunities that facilitate the development of emotional intelligence and resilience.

Towards resilience and wellbeing in nurses

Nursing is a physically and emotionally demanding profession. High role expectations and difficult working conditions place some nurses at risk of burnout and stress-related illness. In spite of the challenges in the current healthcare system, nurses continue to deliver high-quality patient care, retain resilience and progress professionally in the face of adversity. This article provides an overview, with discussion of the evidence in the literature, of some of the suggested methods to improve resilience and enhance staff wellbeing in the nursing profession at an individual and organisational level.

Vulnerability in patients and nurses and the mutual vulnerability in the patient-nurse relationship

AIMS AND OBJECTIVES

To examine the mutual vulnerability of patients and nurses, anticipating that an enhanced understanding of the phenomenon may help reduce vulnerability.

BACKGROUND

Patient vulnerability is a key issue in nursing, aimed at protecting the patient from harm. In the literature, vulnerability is described both from a risk perspective and a subjective perspective. This implies that the objective dimension of patient vulnerability does not necessarily reflect the patient's own perception of being vulnerable. However, external judgment may influence internal perception. Adding to this complexity, attention has also been drawn to the vulnerability of the nurse.

DESIGN

A definition deduced from central literature on vulnerability captures the complexity of objective versus subjective vulnerability. Based on the perspective of vulnerability in general, vulnerability in healthcare services shows how dependency may increase patient vulnerability. Further, despite education, training and supportive settings, patients may increase nurse vulnerability. The core of this mutuality is explored in the light of Martin Heidegger's philosophy of being.

CONCLUSION

The patient's need for help from the nurse opens the patient to engage in supportive and/or harmful encounters. Thus, dependency adds to the vulnerability related to health issues. The nurse's vulnerability lies in her engagement in caring for the patient. If failing to provide proper care, the nurse's existence as 'a good nurse' is threatened. This is exacerbated if the patient turns against the nurse. Therefore, the core of vulnerability seems to lie in the fact that the patient and the nurse are both striving to be the persons they want to be, and the persons they have not yet become.

RELEVANCE TO CLINICAL PRACTICE

Recognition of the mutual vulnerability in the patient-nurse relationship calls for collective acknowledgement of the demanding nature of caring relationships, for support and for a strengthening of professional skills.

Coping and caring: support resources integral to perioperative nurses during the process of organ procurement surgery

AIMS AND OBJECTIVES

To discuss and explore the levels of support provided to perioperative nurses when participating in multi-organ procurement surgery and the impact to their overall well-being.

BACKGROUND

Assisting within multi-organ procurement surgical procedures has been recognised to impact on the well-being of perioperative nurses leaving little opportunity for them to recover from their participation or to seek available support resources. To date, this area has remained largely unexplored with limited evidence of how nurses manage and cope with these procedures, in addition to the support received in the workplace.

DESIGN

A qualitative grounded theory method.

METHODS

The study was informed by perioperative nurses (n = 35) who had previous participatory experience in these surgical procedures from two Australian states. Theoretical sampling directed the collection of data via semistructured in-depth interviews. Data were analysed using the constant comparative method.

RESULTS

Three components of levels of support were identified from the data: lacking support within the operating room organisation; surgical team support and access to external professional support.

CONCLUSION

These findings offer new insights into how nurses manage and cope with their participation in organ procurement surgical procedures and what types of support resources can be seen as barriers or enablers to their overall experiences. The need for timely and adequate support is vital to their overall well-being and future participation in organ procurement surgery. These findings have the potential to guide further research with implications for clinical initiatives and practices, looking at new ways of supporting perioperative nurses within the clinical environment both locally and internationally.

RELEVANCE TO CLINICAL PRACTICE

Healthcare organisations need to acknowledge the emotional, psychosocial and psychological health and well-being of nurses impacted by these surgical procedures and provide appropriate and timely clinical support within the work environment.

Burnout, compassion fatigue, compassion satisfaction, and secondary traumatic stress in trauma nurses

The relationship of burnout (BO), compassion fatigue (CF), compassion satisfaction (CS), and secondary traumatic stress (STS) to personal/environmental characteristics, coping mechanisms, and exposure to traumatic events was explored in 128 trauma nurses. Of this sample, 35.9% had scores consistent with BO, 27.3% reported CF, 7% reported STS, and 78.9% had high CS scores. High BO and high CF scores predicted STS. Common characteristics correlating with BO, CF, and STS were negative coworker relationships, use of medicinals, and higher number of hours worked per shift. High CS correlated with greater strength of supports, higher participation in exercise, use of meditation, and positive coworker relationships. Caring for trauma patients may lead to BO, CF, and STS; identifying predictors of these can inform the development of interventions to mitigate or minimize BO, CF, and STS in trauma nurses.

Moral distress in physicians practicing in hospitals affiliated to medical sciences universities

BACKGROUND

Researchers have regarded moral distress as a major concern in the health care system. Symptoms associated with moral distress may manifest as frustration, dissatisfaction, and anxiety and may lead to burnout, job leaving, and finally, failure to provide safe and competent care to patients. Proper management of this phenomenon can be fulfilled through study of its causes at different levels of health services and taking necessary measures to solve them.

OBJECTIVES

This study aimed to determine the status of moral distress in physicians practicing in hospitals affiliated to Medical Sciences Universities in Tehran.

MATERIALS AND METHODS

This cross-sectional study was carried out using the Standard Hamric Scale to collect data after modification and evaluation of its reliability and validity. A total of 399 physicians responded to the scale. Data analysis was performed using descriptive and correlation statistics with respect to the variables.

RESULTS

Results showed that the frequency of moral distress of physicians was 1.24 ± 0.63 and the intensity of moral distress and composite score of moral distress were 2.14 ± 0.80 and 2.94 ± 2.38, respectively. A significant negative correlation existed between age and frequency and composite score (r = -0.15, P < 0.01 and r = -0.16, P < 0.01, respectively) as well as years of experience and composite score (r = -0.11, P = 0.04). Moral distress composite score in adults specialists was higher than pediatricians (P = 0.002), but lower in physicians participated in medical ethics training courses compared to those not participated.

CONCLUSIONS

Physicians may encounter moral distress during their practice; therefore, the common causes of distress should be identified in order to prevent its occurrence.

A comparison of burnout among oncology nurses working in adult and pediatric inpatient and outpatient settings

PURPOSE/OBJECTIVES

To investigate differences in burnout among oncology nurses by type of work setting, coping strategies, and job satisfaction.

DESIGN

Descriptive.

SETTING

A metropolitan cancer center.

SAMPLE

A convenience sample of 74 oncology nurses.

METHODS

Participants completed a demographic data form, the Nursing Satisfaction and Retention Survey, and the Maslach Burnout Inventory.

MAIN RESEARCH VARIABLES

Burnout, coping strategies, job satisfaction, and oncology work setting (inpatient versus outpatient and adult versus pediatric).

FINDINGS

The participants most often used spirituality and coworker support to cope. Emotional exhaustion was lowest for youngest nurses and highest for outpatient RNs. Personal accomplishment was highest in adult settings. Job satisfaction correlated inversely with emotional exhaustion and the desire to leave oncology nursing.

CONCLUSIONS

The findings support that the social context within the work environment may impact emotional exhaustion and depersonalization, and that demographics may be more significant in determining burnout than setting.

IMPLICATIONS FOR NURSING

The findings raise questions of whether demographics or setting plays a bigger role in burnout and supports organizational strategies that enhance coworker camaraderie, encourage nurses to discuss high-stress situations, and share ways to manage their emotions in oncology settings.

KNOWLEDGE TRANSLATION

Spirituality and coworker relationships were positive coping strategies among oncology nurses to prevent emotional exhaustion. Nurses who rely on supportive social networks as a coping mechanism have lower levels of depersonalization. Age was inversely related to emotional exhaustion.

The art of mental health practice: the role of drama in developing empathy

PURPOSE

This paper explores concepts central to acting, and details how these concepts can be related to mental health nursing practice.

DESIGN AND METHODS

The work of the acting theorists Constantin Stanislavski and Lee Strasberg is examined and recontextualized to illustrate how their work is relevant in modern mental health practice, and the development of empathy.

FINDINGS

While these concepts are still utilized in drama, they have not been fully explored in their original context. Their use could combat stress and burnout, heighten awareness, and enhance the projection of emotions.

PRACTICE IMPLICATIONS

These concepts can be linked with reflective practice in mental health, and a stronger emphasis on the values of this approach could allow the nurse to strengthen the level of empathy they demonstrate.

Reflective practice groups for nurses: a consultation liaison psychiatry nursing initiative: part 1--The model

In the present study, we outline the evolution of a process-focused reflective practice group (RPG) model for nurses working in clinical settings. The groups were initiated at Redcliffe and Caboolture hospitals by the consultation liaison psychiatry nurse and author. An associated article provides an evaluation of these RPG. The literature review identifies the key themes and theories on which the model is based, and the article outlines the process and practicalities of facilitating RPG in critical care, midwifery, and oncology specialties over a 3-year period. The model proposes that the effectiveness and sustainability of RPG arises from adequate preparation and engagement with prospective participants. Group rules, based on principles of confidentially, supportiveness, and diversity, were collaboratively developed for each group. Facilitation utilized a group-as-a-whole approach to manage process and stimulate reflection. While the purpose of RPG was a reflection on interpersonal aspects of nursing, contextual workplace issues were frequently raised in groups. Acknowledgement and containment of such issues were necessary to maintain clinical focus. The literature highlights facilitator credibility and style as crucial factors in the overall success of RPG, and it is proposed that reflective practice as a process-focused model for groups succeeds when nurse facilitators are trained in group process and receive concurrent supervision.

Does nurses' vulnerability affect their ability to care?

Recent reports from the Department of Health (2008), the Parliamentary and Health Service Ombudsman (2011) and the Commission on Dignity in Care for Older People (2012) have been highly critical regarding the care that some patients have experienced. They have highlighted that fundamental aspects of care are missing resulting in a lack of high quality individualised nursing care, which is in contrast with holistic nursing philosophy. We have to ask ourselves what is happening within nursing, as many enter the profession owing to a desire to 'make a difference'. Drawing on focus group data exploring perceptions of caring for residents with dementia in a care home setting, the authors found that nurses and healthcare assistants experience a mutual vulnerability with patients. This paper explores whether this mutual vulnerability could lead to nurses focusing on the clinical aspects of their role to the detriment of the compassionate, caring components of nursing.

A work-based educational intervention to support the development of personal resilience in nurses and midwives

A work-based educational programme was the intervention used in a collective case study aiming to develop, strengthen and maintain personal resilience amongst fourteen nurses and midwives. The participants attended six, monthly workshops and formed a participatory learning group. Post-intervention, participants reported positive personal and professional outcomes, including enhanced self-confidence, self-awareness, communication and conflict resolution skills. They strengthened relationships with their colleagues, enabling them to build helpful support networks in the workplace. The intervention used new and innovative ways of engaging nurses and midwives exhibiting the effects of workplace adversity - fatigue, pressure, stress and emotional labour. Participants were removed from their usual workplace environment and brought together to engage in critical reflection, experiential learning and creativity whilst also learning about the key characteristics and strategies of personal resilience. Participants' experiences and skills were valued and respected; honest airing of the differences within the group regarding common workplace issues and concerns was encouraged. The new contribution of this intervention for nursing and midwifery education was supporting the learning experience with complementary therapies to improve participants' wellbeing and reduce stress.

An institutional ethnography of nurses' stress

There are three main conceptualizations of nurses' stress: occupational stress, moral distress, and traumatization (compassion fatigue, secondary traumatic stress, vicarious trauma). Although we have learned a great deal from these fields, some of them lack important contextual aspects of nurses' practice, such as the gendered nature of the workforce and the nature of the work, including bodily caring. The purpose of this study was to reformulate the nature of stress in nursing, with attention to important contextual aspects of nurses' practice. Smith's sociological frame of institutional ethnography was used to explicate the social organization of nurses' stress. Data collection methods included in-depth interviews, participant observation, and focus groups with pediatric intensive care nurses. Data analysis focused on the social organization of nurses' stress, including negotiating power-based hierarchies and articulating the patient to the system. The article concludes with recommendations for addressing nurses' stress through a more critical and contextual analysis.

'You're whatever the patient needs at the time': the impact on health and social care professionals of supporting people with epidermolysis bullosa

OBJECTIVES

Professionals working with people who encounter pain and suffering can experience adverse emotional effects themselves. However, to provide effective support it is necessary to understand specific work-related experiences and contexts. This study investigated the impact on professionals of supporting people with the skin condition 'epidermolysis bullosa'.

METHODS

A two-part mixed methods design was utilized. Part one comprised interviews with specialist nursing and social care professionals (n = 7). Part two comprised a survey administered to a range of EB specialist professionals (n = 26).

RESULTS

The interview data were analysed inductively and informed the survey design. The survey data were analysed deductively and compared to the interview findings. Three integrated themes were subsequently depicted: the intensity and depth of involvement; managing with limited resources; and the need to look after yourself.

DISCUSSION

Findings show the ways in which the work can affect well-being and how the impact is intensified by the low numbers of specialist professionals in the field. But the support of team members, access to effective supervision and the rewards of working with a remarkable population make the professional role worthwhile. Adequate clinical supervision, skills training and access to multi-disciplinary expertise were all highlighted as beneficial for well-being.

The Impact of Work Environment on Telephone Advice Nursing

Telephone advice nursing (TAN) is part of a current effort to improve patient access while reducing cost and encouraging self-care. However, the environment in which TAN occurs can significantly affect both nurse and patient outcomes. This research builds on findings from a large health maintenance organization study by Valanis et al. in which questionnaires and call descriptions were used to correlate TAN nurse and caller/patient perceptions of calls at three regional sites. The survey tools were used to identify nurse perceptions of their work environments (WEs) as well as caller perceptions of using the advice service. The sample included 88 nurse questionnaires and 865 caller questionnaires. Multivariate analysis of covariance revealed significant site perception differences in the WE of stress, communication, and autonomy, whereas no significant differences were noted in collegial relationships and organizational support. Each site was also determined to be a unique predictor of patient perceptions of satisfaction with the advice. Findings indicate nursing professionals act as a filter to mask stressful WE effects experienced by nurses and ensure patient outcomes thereby supporting patient satisfaction with the service.

Spanish nephrology nurses' views and attitudes towards caring for dying patients

Patients with advanced chronic kidney disease are increasingly elderly with increasing numbers of co-morbidites. Some may not be suitable for dialysis, some will choose to withdraw from treatment after a period of time and some will reach the end of their lives while still on dialysis. Studies have shown nurses' attitudes towards caring for dying patients affect the quality of care. A descriptive study was conducted to explore Spanish nurses' views and attitudes in this context and to assess any relationship between demographic variables and attitudes. Two measurement tools were used: a demographic survey and the Frommelt Attitude Toward Care of the Dying Scale-Form B. Two hundred and two completed questionnaires were returned. Although respondents demonstrated positive attitudes in this domain, 88.9% viewed end-of-life (EOL) care as an emotionally demanding task, 95.3% manifested that addressing death issue require special skills and 92.6% reported that education on EOL care is necessary. This paper suggests strategies which could ease the burden in this area of care.

Moral distress: inability to act or discomfort with moral subjectivity?

Amidst the wealth of literature on the topic of moral distress in nursing, a single citation is ubiquitous, Andrew Jameton's 1984 book Nursing practice. The definition Jameton formulated reads '... moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action'. Unfortunately, it appears that, despite the frequent use of Jameton's definition of moral distress, the definition itself remains uncritically examined. It seems as if the context of how moral distress arises (i.e. anger, frustration etc.) has been co-opted as its definition. This current work suggests that the current definition is not moral distress as defined by Jameton, but rather, in large part, nursing's discomfort with moral subjectivity in end-of-life decision making. A critical examination of how the Catholic tradition's normative ethical framework accounts for moral subjectivity in end-of-life decision making serves to aid nursing's discomfort and as a starting point to recontextualize moral distress.

Burnout and perceptions of conscience among health care personnel: A pilot study

Although organizational and situational factors have been found to predict burnout, not everyone employed at the same workplace develops it, suggesting that becoming burnt out is a complex, multifaceted phenomenon. The aim of this study was to elucidate perceptions of conscience, stress of conscience, moral sensitivity, social support and resilience among two groups of health care personnel from the same workplaces, one group on sick leave owing to medically assessed burnout (n = 20) and one group who showed no indications of burnout (n = 20). The results showed that higher levels of stress of conscience, a perception of conscience as a burden, having to deaden one’s conscience in order to keep working in health care and perceiving a lack of support characterized the burnout group. Lower levels of stress of conscience, looking on life with forbearance, a perception of conscience as an asset and perceiving support from organizations and those around them (social support) characterized the non-burnout group.

Distress and burnout among genetic service providers

PURPOSE

To determine the nature, sources, prevalence, and consequences of distress and burnout among genetics professionals.

METHODS

Mailed survey of randomly selected clinical geneticists (MDs), genetic counselors, and genetic nurses.

RESULTS

Two hundred and fourteen providers completed the survey (55% response rate). Eight discrete sources of distress were identified forming a valid 28-item scale (alpha = 0.89). The greatest sources of distress were compassion stress, the burden of professional responsibility, negative patient regard, and concerns about informational bias. Genetic counselors were significantly more likely to experience personal values conflicts, burden of professional responsibility, and concerns about informational bias than MDs or nurses. Burnout scores were lower among those practicing more than 20 years and nurses. Distress scores were positively correlated with burnout and professional dissatisfaction (P < 0.0001). Eighteen percent of respondents think about leaving patient care, and burnout was the most significant predictor. Predictors of burnout included greater distress, fewer years in practice, working in university-based settings, being a genetic counselor or an MD, and deriving less meaning from patient care.

CONCLUSIONS

Genetic service providers experience various types of distress that may be risk factors for burnout and professional dissatisfaction. Interventions to reduce distress and burnout are needed for both trainees and practitioners.

Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital

AIM

To determine the prevalence and contributing factors of moral distress in medical and surgical nurses.

BACKGROUND

Moral distress from ethical conflicts in the work environment is associated with burnout and job turnovers in nurses.

METHOD

A prospective cross-sectional survey using the Moral Distress Scale tool was administered to medical and surgical nurses at an adult acute tertiary care hospital.

RESULTS

The survey was completed by 260 nurses (92% response rate). The intensity of moral distress was uniformly high to situations related to physician practice, nursing practice, institutional factors, futile care, deception and euthanasia. Encounter frequencies for situations associated with futile care and deceptions were particularly high. Encounter frequencies increased with years of nursing experience and caring for oncology and transplant patients.

CONCLUSION

Moral distress is common among nurses in acute medical and surgical units and can be elicited from different types of situations encountered in the work environment. Nursing experience exacerbated the intensity and frequency of moral distress.

IMPLICATIONS FOR NURSING MANAGEMENT

Strategies aimed to minimize exposure to situations of moral distress and augment mechanisms mitigating its effect on nurses are necessary to enhance job satisfaction and retention.