Coping strategies, emotional outcomes and spiritual quality of life in palliative care nurses

Positive Childhood Experiences and Spiritual Well-Being: Psychological Flexibility and Meaning-Based Coping as Mediators in Turkish Sample

Spiritual well-being enhances life quality, acts as a stress reliever, and mitigates unfavorable feelings. It helps individuals find meaning and purpose, increasing inner peace and happiness while improving stress management and overall well-being. This study examined whether positive childhood experiences are linked to spiritual well-being and if psychological flexibility and meaning-based coping serve as mediators. The sample included 1061 participants (Mage = 39.38; SD = 8.82) from various Turkish cities. Structural equation modeling assessed relationships between spiritual well-being, positive childhood experiences, psychological flexibility, and meaning-based coping. Results showed that positive childhood experiences directly enhance spiritual well-being, mediated by psychological flexibility and meaning-based coping. This underscores the significance of fostering positive childhood experiences to promote spiritual well-being and coping mechanisms.

Burnout and quality of life in Portuguese healthcare professionals working in oncology and palliative care-a preliminary study

BACKGROUND

Palliative care is an approach that improves the quality of life of patients and their families who are facing challenges associated with life-threatening illness, through the prevention and relief of suffering. Palliative care health professionals are considered a risk group for the development of burnout, since they live with severe disease and death, on a daily basis. With this work, the authors intend to evaluate the quality of life and risk of burnout in a group of health professionals, who work in a tertiary hospital dedicated to cancer patients.

MATERIAL AND METHODS

The authors conducted a quantitative, descriptive, correlational and transversal study on palliative care professionals working with cancer patients. The evaluation protocol used to collect data included a sociodemographic questionnaire, WHO Quality of life Assessment instrument and Maslach Burnout Inventory. Statistical analysis was performed using the SPSS®Statistics program.

RESULTS

In the sample, there is a predominance of female gender (79,4%) with a mean age of 43,2 ± 10,8 years. The most representative professional group was nursing (47,1%). The sample response rate was 91.9%. Analyzing Maslach Burnout Inventory score, it appears that physicians and nurses have higher levels of exhaustion when compared to the other groups. In relation to quality of life (QoL), it was observed that in all dimensions, there was a homogeneous distribution of responses. It was verified that it was not possible to establish any relationship between the dimensions of burnout and QoL. Thus, the various dimensions behaved independently.

DISCUSSION

Physicians and nurses had the highest burnout levels in the most dimensions of Burnout score, in which they were followed by the operational assistants, who had moderate scores. Despite hight prevalence of Burnout, there is no correlation between Burnout and quality of life in this population. The perception of QoL is very satisfactory in the sample studied may result from the fact that these individuals have developed adequate self-protection strategies, thus preventing QoL from being affected by Burnout.

CONCLUSION

Prevention, diagnosis and intervention at burnout level is an important measure to be taken in health organizations, since the consequences that come from the experiences experienced by professionals will be reflected both in the quality of services provided to patients and in the QoL and well-being of professionals. Interventions are needed to promote better coping mechanisms when dealing with stress in this population. After this study, a Burnout Consultation was created at the Institution, to support professionals at risk or already affected.

The development of the revised COPE 68 inventory with English and Slovak versions

Introduction

Although there have been several attempts at improving the COPE Inventory, the factor structure of the instrument is still in dispute. In addition, studies have shown low reliability coefficients for some of the first-order factors, with Mental Disengagement having the lowest factor loadings. In a recent study on the external validation of the instrument, two additional first-order factors were identified in the qualitative analysis, namely Self-care and Care for Others.

Methods

Based on these arguments we created the Revised COPE 68 Inventory, changing some of the problematic items in the first order factor Mental Disengagement and adding items for the two new factors (Self-care and Care for Others). We then tested its reliability and performed factor analyses on the first and second-order factorial structure. The data were collected through social media in two languages, English and Slovak, using convenience and snowball sampling techniques. The English sample contained 834 participants with mean age 25.27  years (SD = 8.467) and the Slovak sample comprised 1,425 participants with mean age 33 years (SD = 14.59). For the statistical analyses we used Exploratory Structural Equation Model (ESEM) analyses with target rotation and WLSMV, Exploratory and second-order confirmatory factor analysis with the scores of the COPE Inventory and EFA.

Results

The Revised COPE 68 inventory had a good fit for all 17 first-order factors in both languages, including for the new factors Self-care and Care for Others. It appears that the first-order factors form a three-factor solution in both samples, consisting of active coping, social-emotional coping and avoidant coping. The revised Mental Disengagement has better psychometric properties as well.

Discussion

The Revised COPE 68 inventory was found to be a reliable multidimensional instrument for measuring various coping strategies in both the English and Slovak language versions.

Mediating effect of resilience on the relationship between perceived social support and burnout among Chinese palliative nurses

AIMS AND OBJECTIVES

To detect the mediating effect of resilience on the relationship between perceived social support and burnout in Chinese palliative nurses.

BACKGROUND

Palliative nurses are a group that is vulnerable to burnout. Perceived social support may contribute to decreasing palliative nurses' burnout and facilitating their personal resilience, and resilience may be associated with lower levels of burnout. However, these relationships were unclear in the Chinese context.

DESIGN

A cross-sectional design.

METHODS

The STROBE guideline was performed to report this study. A mixed sampling method including convenience sampling and stratified sampling was used to recruit participants, and a total of 319 palliative nurses completed the Nursing Burnout Scale, the Perceived Social Support Scale and the Connor-Davidson Resilience Scale from May 2021 to September 2021. Influencing factors were primarily identified using independent-sample t tests and one-way ANOVA. Bootstrap method was used to detect the mediating effect of resilience.

RESULTS

The level of burnout in palliative nurses (23.4 ± 7.68) was higher than that of general nurses in China. Education level, health condition and monthly income were influencing factors of burnout. Resilience was detected as a mediator in the relationships between perceived social support and dimensions of burnout.

CONCLUSIONS

Chinese palliative nurses experience a relatively high level of burnout, which may be influenced by several sociodemographic variables. Resilience could mediate the effect of perceived social support on the dimensions of burnout. Problem-oriented and palliative-tailored strategies should be developed to further address burnout in Chinese palliative nurses.

RELEVANCE TO CLINICAL PRACTICE

Nurse managers and policy makers should support nurse ongoing education, adopt health-promoting interventions and optimise salary systems. In addition, perceived social support resources and resilience training programmes are also warranted.

PATIENT OR PUBLIC CONTRIBUTION

All participants were invited to complete the informed consent form and paper questionnaires. Human resource managers helped us collect some subjective data through the personnel management system. Nurse managers of palliative units conducted regular staff meetings to promote the data collection process.

The Factor Structure and External Validity of the COPE 60 Inventory in Slovak Translation

The COPE Inventory (Carver et al., 1989) is the most frequently used measure of coping; yet previous studies examining its factor structure yielded mixed results. The purpose of the current study, therefore, was to validate the factor structure of the COPE Inventory in a representative sample of over 2,000 adults in Slovakia. Our second goal was to evaluate the external validity of the COPE inventory, which has not been done before. Firstly, we performed the exploratory factor analysis (EFA) with half of the sample. Subsequently, we performed the confirmatory factor analysis with the second half of the sample. Both factor analyses with 15 factor solutions showed excellent fit with the data. Additionally, we performed a hierarchical factor analysis with fifteen first-order factors (acceptance, active coping, behavioral disengagement, denial, seeking emotional support, humor, seeking instrumental support, mental disengagement, planning, positive reinterpretation, religion, restraint, substance use, suppression of competing activities, and venting) and three second-order factors (active coping, social emotional coping, and avoidance coping) which showed good fit with the data. Moreover, the COPE Inventory’s external validity was evaluated using consensual qualitative research (CQR) analysis on data collected by in-depth interviews. Categories of coping created using CQR corresponded with all COPE first-order factors. Moreover, we identified two additional first-order factors that were not present in the COPE Inventory: self-care and care for others. Our study shows that the Slovak translation of the COPE Inventory is a reliable, externally valid, and well-structured instrument for measuring coping in the Slovak population.

Adaptation and continuous learning: integrative review of coping strategies of palliative care professionals

BACKGROUND

Coping is essential to manage palliative care professionals' challenges. The focus has been on the effects of coping mechanism; however, little is known about coping itself in palliative care.

AIM

To synthesise evidence of coping strategies in palliative care professionals, and how different strategies play roles over time.

DESIGN

Systematically conducted integrative review.

DATA SOURCES

PubMed; CINAHL; Medline; PsycINFO and B-ON were searched (1996-2021) combining 'coping' AND 'palliative care'. A predefined data extraction sheet was developed to report data. Two researchers performed constant comparative analysis using Nvivo®.

RESULTS

Thirty-one studies were included. Four main strategies with recurrent reference to time were found: (a) proactive coping, involving activities to achieve self-confidence and control situations and emotions; (b) self-care based coping, including self-protection and self-awareness activities, with behavioural disconnection; (c) self-transformation coping, involving activities to accept limits; and (d) encountering deep professional meaning, is a coping mechanism based on meaning, frequently considering the deepest meaning of work. The dynamic and influencing factors were training, team interaction, professional motivation and family. They were usually protective factors, though sometimes they represented risk factors. The emotional burden associated with healthcare and systemic stressors were always risk factors. An explanatory model describes a complex and dynamic process, in which everyday strategies and more introspective strategies are combined.

CONCLUSIONS

The model showed a process of adaptation and learning to persevere in palliative care. It changes over time under factors and strategies, and evolves in a personal and professional transformation, parallel to the working life. It would be worth assessing coping in healthcare professionals who chose to leave palliative care and to investigate the reasons they did so and their coping mechanisms.

Exploring the Feelings of Nurses during Resuscitation—A Cross-Sectional Study

Cardiopulmonary resuscitation (CPR) is one of the most stressful situations in emergency medicine. Nurses involved in performing basic and advanced resuscitation procedures are therefore exposed to a certain amount of stress. The purpose of this study was to determine the stressors and the level of stress experienced by nurses during resuscitation. A cross-sectional quantitative study was done. The sample consisted of 457 nurses who worked in emergency units. First demographic data were collected, followed by a questionnaire regarding the effect of different situations that occur during and after resuscitation on nurses including Post-Code Stress Scale questionnaire. The most disturbing situations for respondents were resuscitation of young person (MV = 3.7, SD = 1.4), when they fail to establish an intravenous pathway (MV = 3.5, SD = 1.4), chaotic situation during resuscitation (MV = 3.4, SD = 1.4) and making decision about termination of resuscitation (MV = 3.1, SD = 1.5). Research has shown that nurses are exposed to a certain amount of stress during resuscitation, but most of them manage to compensate for stress effectively.

Association between spirituality/religiousness and quality of life among healthy adults: a systematic review

BACKGROUND

Health-related quality of life (HRQoL) is determined by multiple factors that include components such as spirituality and religiousness (S/R). Even though various systematic reviews have investigated the association between S/R and improved health outcomes in the most different groups, healthy young individuals are seldom addressed.

OBJECTIVE

To assess the association between S/R and HRQoL among young, healthy individuals.

METHODS

Systematic review of papers published in the last ten years and indexed in four academic research databases (PubMed, Web of Science, Cochrane Library, and Scopus) and two gray literature databases. Inclusion criteria were studies assessing S/R and HRQoL using validated instruments and assessing healthy adults (i.e., non-clinical patients, not belonging to any specific group of chronic diseases), aged between 18 and 64 years old.

RESULTS

Ten out of 1,952 studies met the inclusion criteria: nine cross-sectional and one longitudinal cohort study, in which 89% of the participants were college students. Nine studies report a positive association between S/R and HRQoL, while one study did not report any significant association. The main HRQoL domains associated with S/R were the psychological, social relationships, and environment domains, while the S/R most influent facets/components were optimism, inner strength, peace, high control, hope, and happiness.

CONCLUSIONS

Higher S/R levels among healthy adult individuals were associated with higher HRQoL levels, suggesting the S/R can be an important strategy to deal with adverse environmental situations even among those without chronic diseases, enhancing the wellbeing of individuals. Registration of systematic review: PROSPERO-CRD42018104047.

Job demands, job control, and social support as predictors of job satisfaction and burnout in Croatian palliative care nurses

The Job Demands-Control-Support (JDCS) model has seldom been tested in palliative care settings, and occupational well-being of palliative care professionals has never before been investigated in Croatia. Our aim was therefore to fill that gap by testing the JDCS model among Croatian nurses providing palliative care. More specifically, we wanted to see how job demands, job control, and social support at work affect occupational well-being outcomes (i.e. job satisfaction and burnout dimensions of exhaustion and disengagement from work) in terms of the model’s iso-strain and buffer hypotheses. This cross-sectional study included 68 nurses working in various palliative care institutions across Croatia, who answered our online questionnaire. Overall, the nurses did not report high levels of burnout or low job satisfaction. The only significant effect was that of job control on job satisfaction (β=0.38; P<0.01) and disengagement (β=-0.45; P<0.01), while job demands and social support at work had a significant interaction effect on the burnout dimension of exhaustion (β=0.39; P<0.01) in the sense that high social support at work buffered the increase in exhaustion associated with high job demands. These findings suggest that interventions aimed at increasing perceived job control and social support at the workplace could improve occupational well-being of nurses working in palliative care.

Using natural language processing to explore heterogeneity in moral terminology in palliative care consultations

Background

High quality serious illness communication requires good understanding of patients’ values and beliefs for their treatment at end of life. Natural Language Processing (NLP) offers a reliable and scalable method for measuring and analyzing value- and belief-related features of conversations in the natural clinical setting. We use a validated NLP corpus and a series of statistical analyses to capture and explain conversation features that characterize the complex domain of moral values and beliefs. The objective of this study was to examine the frequency, distribution and clustering of morality lexicon expressed by patients during palliative care consultation using the Moral Foundations NLP Dictionary.

Methods

We used text data from 231 audio-recorded and transcribed inpatient PC consultations and data from baseline and follow-up patient questionnaires at two large academic medical centers in the United States. With these data, we identified different moral expressions in patients using text mining techniques. We used latent class analysis to explore if there were qualitatively different underlying patterns in the PC patient population. We used Poisson regressions to analyze if individual patient characteristics, EOL preferences, religion and spiritual beliefs were associated with use of moral terminology.

Results

We found two latent classes: a class in which patients did not use many expressions of morality in their PC consultations and one in which patients did. Age, race (white), education, spiritual needs, and whether a patient was affiliated with Christianity or another religion were all associated with membership of the first class. Gender, financial security and preference for longevity-focused over comfort focused treatment near EOL did not affect class membership.

Conclusions

This study is among the first to use text data from a real-world situation to extract information regarding individual foundations of morality. It is the first to test empirically if individual moral expressions are associated with individual characteristics, attitudes and emotions.

The assessment of spiritual well-being in cancer patients with advanced disease: which are its meaningful dimensions?

BACKGROUND

Spirituality is particularly important for patients suffering from life-threatening illness. Despite research showing the benefits of spiritual assessment and care for terminally ill patients, their spiritual needs are rarely addressed in clinical practice. This study examined the factor structure and reliability of the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp) in patients with advanced cancer. It also examined the clinical meaning and reference intervals of FACIT-Sp scores in cancer patients subgroups through a literature review.

METHODS

A forward-backward translation procedure was adopted to develop the Italian version of the FACIT-Sp, which was administered to 150 terminally ill cancer patients. Exploratory factor analysis was used for construct validity, while Cronbach's α was used to assess the reliability of the scale.

RESULTS

This study replicates previous findings indicating that the FACIT-Sp distinguish well between features of meaning, peace, and faith. In addition, the internal consistency of the FACIT-Sp was acceptable. The literature review also showed that terminal cancer patients have the lowest scores on the Faith and Meaning subscales, whereas cancer survivors have the highest scores on Faith.

CONCLUSIONS

The Italian version of the FACIT-Sp has good construct validity and acceptable reliability. Therefore, it can be used as a tool to assess spiritual well-being in Italian terminally ill cancer patients. This study provides reference intervals of FACIT-Sp scores in newly diagnosed cancer patients, cancer survivors, and terminally ill cancer patients and further highlights the clinical meaning of such detailed assessment.

The Spirituality in End-of-Life Cancer Patients, in Relation to Anxiety, Depression, Coping Strategies and the Daily Spiritual Experiences: A Cross-Sectional Study

This study aimed to investigate "Faith" and "Meaning/Peace" dimensions of the functional assessment of chronic illness therapy-spiritual well-being scale (FACIT-Sp-12) in relation to coping strategies, anxiety and depression, and to analyze the relationship between FACIT-Sp-12 and the daily spiritual experience scale in end-of-life cancer patients. A sample of 152 participants were involved. The daily spiritual experiences correlated the most with "Faith" subscale. Moreover, religious coping, depression and daily spiritual experiences resulted "Faith" significant predictors, while depression, anxiety, self-distraction, positive reframing and behavioral disengagement were "Meaning/Peace" subscale's significant predictors. These findings highlighted the considerable impact of the daily spiritual experiences on patients' spiritual well-being.

Do Health Promotion Behaviors Affect Levels of Job Satisfaction and Job Stress for Nurses in an Acute Care Hospital?

OBJECTIVE

The aim of this study was to explore the relationships between nurse-reported health-promoting behaviors (HPBs), job stress, and job satisfaction in a hospital setting.

BACKGROUND

Job stress and satisfaction are key components of the nursing work environment; however, evidence of the relationship between HPB and job stress and satisfaction is lacking.

METHODS

A cross-sectional, 144-item survey was administered to nurses working in an acute care, community hospital in the southeastern United States.

RESULTS

Higher levels of HPB were associated with lower job stress and higher job satisfaction. Total HPB was associated with the competence subscale of job stress. Lower job stress was significantly associated with HPB subscales: spiritual growth, interpersonal relations, and stress management.

CONCLUSIONS

Nursing organizations can implement interventions that support HPB for nurses to reduce job stress and improve satisfaction.

Quality-of-life and spirituality

Spirituality has been identified as an important dimension of quality-of-life. The objective of this study was to review the literature on quality-of-life and spirituality, their association, and assessment tools. A search was conducted of the keyterms 'quality-of-life' and 'spirituality' in abstract or title in the databases PsycINFO and PubMed/Medline between 1979-2005, complemented by a new search at PUBMED from 2006-2016. Quality-of-life is a new concept, which encompasses and transcends the concept of health, being composed of multiple domains: physical, psychological, environmental, among others. The missing measure in health has been defined as the individual's perception of their position in life in the context of culture and value system in which they live and in relation to their goals, expectations, standards, and concerns. There is consistent evidence of an association between quality-of-life and religiosity/spirituality (R/S), through studies with reasonable methodological rigour, using several variables to assess R/S (e.g. religious affiliation, religious coping, and prayer/spirituality). There are also several valid and reliable instruments to evaluate quality-of-life and spirituality. Further studies are needed, however, especially in Brazil. Such studies will provide empirical data to be used in planning health interventions based on spirituality, seeking a better quality-of-life. In the last 10 years, research is consistently growing about quality-of-life and spirituality in many countries, and also in many areas of health research.

Stress and Coping of Critical Care Nurses After Unsuccessful Cardiopulmonary Resuscitation

BACKGROUND

Participation by a critical care nurse in an unsuccessful resuscitation can create a unique heightened level of psychological stress referred to as postcode stress, activation of coping behaviors, and symptoms of posttraumatic stress disorder (PTSD).

OBJECTIVES

To explore the relationships among postcode stress, coping behaviors, and PTSD symptom severity in critical care nurses after experiencing unsuccessful cardiopulmonary resuscitations and to see whether institutional support attenuates these repeated psychological traumas.

METHODS

A national sample of 490 critical care nurses was recruited from the American Association of Critical-Care Nurses' eNewsline and social media. Participants completed the Post-Code Stress Scale, the Brief COPE (abbreviated), and the Impact of Event Scale-Revised, which were administered through an online survey.

RESULTS

Postcode stress and PTSD symptom severity were weakly associated (r = 0.20, P = .01). No significant associations between coping behaviors and postcode stress were found. Four coping behaviors (denial, self-distraction, self-blame, and behavioral disengagement) were significant predictors of PTSD symptom severity. Severity of postcode stress and PTSD symptoms varied with the availability of institutional support.

CONCLUSIONS

Critical care nurses show moderate levels of postcode stress and PTSD symptoms when asked to recall an unsuccessful resuscitation and the coping behaviors used. Identifying the critical care nurses most at risk for PTSD will inform the development of interventional research to promote critical care nurses' psychological well-being and reduce their attrition from the profession.

Profiles of Recovery from Mood and Anxiety Disorders: A Person-Centered Exploration of People's Engagement in Self-Management

Context: A shift toward person-centered care has been occurring in services provided to people with mood and anxiety disorders. Recovery is recognized as encompassing personal aspects in addition to clinical ones. Guidelines now recommend supporting people's engagement in self-management as a complementary recovery avenue. Yet the literature lacks evidence on how individualized combinations of self-management strategies used by people relate to their clinical and personal recovery indicators.

Objectives: The aims of this study were to identify profiles underlying mental health recovery, describe the characteristics of participants corresponding to each profile, and examine the associations of profiles with criterion variables.

Method: 149 people recovering from anxiety, depressive, or bipolar disorders completed questionnaires on self-management, clinical recovery (symptom severity), personal recovery (positive mental health), and criterion variables (personal goal appraisal, social participation, self-care abilities, coping).

Results: Latent profile analysis (LPA) revealed three profiles. The Floundering profile included participants who rarely used self-management strategies and had moderately severe symptoms and the lowest positive mental health. The Flourishing profile was characterized by frequent use of self-empowerment strategies, the least severe symptoms, and the highest positive mental health. Participants in the Struggling profile engaged actively in several self-management strategies focused on symptom reduction and healthy lifestyle. They concomitantly reported high symptom severity and moderately high positive mental health. The study revealed that Floundering was associated with higher probabilities of being a man, being single, and having a low income. People in the Flourishing profile had the most favorable scores on criterion variables, supporting the profiles' construct validity.

Discussion: The mixed portrait of Struggling participants on recovery indicators suggests the relationship between health engagement and recovery is more intricate than anticipated. Practitioners should strive for a holistic understanding of their clients' self-management strategies and recovery indicators to provide support personalized to their profile. While people presenting risk factors would benefit from person-centered support, societal efforts are needed in the long term to reduce global health inequalities. The integration of constructs from diverse fields (patient-centered care, chronic illness, positive psychology) and the use of person-oriented analysis yielded new insights into people's engagement in their health and well-being.

The transformation process for palliative care professionals: The metamorphosis, a qualitative research study

BACKGROUND

Palliative care professionals are exposed daily to high levels of suffering. This makes them particularly vulnerable to suffering from stress, which can lead to burnout and/or compassion fatigue.

AIMS

To analyse the professional trajectory of palliative care workers over time and the factors which influence this trajectory.

DESIGN

A qualitative study was designed based on the Grounded Theory approach, using semi-structured individual interviews. Interviews were recorded audio-visually and transcribed verbatim for subsequent analysis using the procedure described by Miles and Huberman. This process was supported using ATLAS.ti 6 software.

SETTING/PARTICIPANTS

A total of 10 palliative care professionals from Extremadura (Spain) took part in the study.

RESULTS

The analysis revealed a common trajectory followed by participants in their working lives: pre-palliative care/honeymoon/frustration/maturation. In addition, factors which influence this trajectory were identified. Details of the self-care strategies that these professionals have developed are described. The result of this process, which we have metaphorically termed 'metamorphosis', is the formation of a professional who can work satisfactorily within a palliative care context.

CONCLUSION

During their professional activity, palliative care professionals go through a series of phases, depending on the relationship between the cost of caring and the satisfaction of caring, which can influence both the care provided to patients and families and their own personal circumstances. Being aware of this risk, and implementing self-care strategies, can protect professionals and enable them to conduct their work in an optimal manner. Reflecting on the experiences of these professionals could be useful for other health professionals.

Impact of Death Work on Self: Existential and Emotional Challenges and Coping of Palliative Care Professionals

Palliative care professionals, such as social workers, often work with death and bereavement. They need to cope with the challenges on "self" in working with death, such as coping with their own emotions and existential queries. In this study, the authors explore the impact of death work on the self of palliative care professionals and how they perceive and cope with the challenges of self in death work by conducting a qualitative study. Participants were recruited from the palliative care units of hospitals in Hong Kong. In-depth interviews were conducted with 22 palliative care professionals: five physicians, 11 nurses, and six social workers. Interviews were transcribed to text for analysis. Emotional challenges (for example, aroused emotional distress from work) and existential challenges (for example, shattered basic assumptions on life and death) were identified as key themes. Similarly, emotional coping (for example, accepting and managing personal emotions) and existential coping (for example, rebuilding and actualizing life-and-death assumptions) strategies were identified. This study enhances the understanding of how palliative care professionals perceive and cope with the challenges of death work on the self. Findings may provide insights into how training can be conducted to enhance professionals' self-competence in facing these challenges.

Socioeconomic status and glycemic control in adult patients with type 2 diabetes: a mediation analysis

OBJECTIVE

The purpose of this study is to examine the contribution of health behaviors (self-management and coping), quality of care, and individual characteristics (depressive symptoms, self-efficacy, illness representations) as mediators in the relationship between socioeconomic status (SES) and glycemic control.

METHODS

A sample of 295 adult patients with type 2 diabetes was recruited at the end of a diabetes education course. Glycemic control was evaluated through glycosylated hemoglobin (HbA1c). Living in poverty and education level were used as indicators of SES.

RESULTS

Bootstrapping analysis showed that the significant effects of poverty and education level on HbA1c were mediated by avoidance coping and depressive symptoms. The representation that diabetes is unpredictable significantly mediated the relationship between living in poverty and HbA1c, while healthy diet mediated the relationship between education level and HbA1c.

CONCLUSIONS

To improve glycemic control among patients with low SES, professionals should regularly screen for depression, offering treatment when needed, and pay attention to patients' illness representations and coping strategies for handling stress related to their chronic disease. They should also support patients in improving their self-management skills for a healthy diet.

Paediatric death and dying: exploring coping strategies of health professionals and perceptions of support provision

Without question a child's death is a devastating event for parents and families. Health professionals working with the dying child and family draw upon their expertise and experience to engage with children, parents and families on this painful journey. This is a delicate and sensitive area of practice and has strong and penetrating effects on health professionals. They employ physical, emotional, spiritual and problem solving strategies to continue to perform this role effectively and to protect their continued sense of wellbeing.

AIM

To explore health professionals' perceptions of bereavement support surrounding the loss of a child.

METHODS

The research was underpinned by social constructionism. Semi-structured interviews were held with 10 health professionals including doctors, nurses and social workers who were directly involved in the care of the dying child and family in 7 cases of paediatric death. Health professional narratives were analysed consistent with Charmarz's (2006) approach.

RESULTS

For health professionals, constructions around coping emerged as peer support, personal coping strategies, family support, physical impact of support and spiritual beliefs. Analysis of the narratives also revealed health professionals' perceptions of their support provision.

CONCLUSION

Health professionals involved in caring for dying children and their families use a variety of strategies to cope with the emotional and physical toll of providing support. They also engage in self-assessment to evaluate their support provision and this highlights the need for self-evaluation tools in paediatric palliative care.

Mental health self-management questionnaire: Development and psychometric properties

BACKGROUND

Through self-management, people living with depression, anxiety or bipolar disorders can play an active role in their recovery. However, absence of a validated questionnaire limits empirical research on self-management. The study aimed to develop a French instrument, the Mental Health Self-Management Questionnaire (MHSQ), and to investigate its psychometric properties

METHODS

A pool of 86 items was created based on a qualitative study with 50 people in recovery from depression, anxiety or bipolar disorders. The 64 most pertinent items were identified following ratings from 14 experts. A sample of 149 people in recovery completed these items and criterion-related measures (specific aspects of self-management, clinical and personal recovery, social desirability), and 93 participants also completed MHSQ two weeks later

RESULTS

Exploratory and confirmatory factor analyses show that MHSQ is composed of three subscales: Clinical (getting help and using resources), Empowerment (building upon strengths and positive self-concept to gain control) and Vitality (active and healthy lifestyle). These subscales had satisfying consistency and test-retest reliability, and were mostly unrelated to social desirability. Correlations with criterion variables support convergent and concurrent validity, especially for Empowerment and Vitality. Comparison of structural models provides evidence of the distinct nature of MHSQ in comparison to the constructs of clinical and personal recovery

LIMITATIONS

Longitudinal studies with larger samples are needed to explore the validity of MHSQ for predicting recovery over time

CONCLUSION

MHSQ is a psychometrically-sound instrument, useful for establishing the role of self-management in recovery and monitoring the efficacy of self-management support programs.

Work stress among nurses engaged in palliative care on general wards

OBJECTIVE

The objective of the present study was to elucidate the work stress among nurses engaged in palliative care on general wards. The relationship between nurses' psychological characteristics and stress was the particular focus of this study in order to clarify the actual stress situation.

METHODS

Nurses with ≥3 years of experience in palliative care on general wards were surveyed with respect to their personal characteristics, work stress using a scale created by the authors, the Profile of Mood States (POMS) short version, and the Coping Inventory for Stressful Situations (CISS). Correlations between each derived variable and stress were tested. Variables found to be significant were set as independent variables, and multiple regression analysis was performed with overall stress as the dependent variable.

RESULTS

A total of 402 nurses participated. The questionnaire response rate was 68.2%, with a valid response rate of 59.7%. The analysis involved 240 participants (96.7% female participants; mean age, 36.2 years old). Tension-Anxiety (POMS), Fatigue (POMS), Confusion (POMS), and Emotion-Oriented Coping (CISS) were the significant variables. On multiple regression analysis with these four variables, the coefficient of determination was R(2)  = 0.103, and the coefficient of determination adjusted for degrees of freedom was R(2)  = 0.087. Fatigue (POMS) (β = 0.179, p < 0.05) and Emotion-Oriented Coping (CISS; β = 0.197, p < 0.05) were found to be significantly related to stress among nurses providing palliative care on general wards.

CONCLUSIONS

The stress among nurses engaged in palliative care on general wards can be predicted by the degree of 'fatigue' and 'emotion-oriented coping'. Mechanisms to address these issues are needed.

The experiences of stress of palliative care providers in Malaysia: a thematic analysis

A qualitative study was conducted with semistructured interviews to explore the experiences of stress in 20 palliative care providers of University Malaya Medical Centre in Malaysia. The results were thematically analyzed. Nine basic themes were generated: (1) organizational challenges, (2) care overload, (3) communication challenges, (4) differences in opinion, (5) misperceptions and misconceptions, (6) personal expectations, (7) emotional involvement, (8) death and dying thoughts, and (9) appraisal and coping. A total care model of occupational stress in palliative care was conceptualized from the analysis. This model may inform the development of interventions in the prevention and management of stress in palliative care.

The Psychological Experience of Hospice Workers during Encounters with Death

While the nature of their experience is unknown, hospice workers may unconsciously strive for encounters with death as a way of healing themselves and preparing for death. The purpose of this case study was to explore the psychological experience of hospice workers, whose repeated encounters with death may affect their own psyche. The study integrated psycho-biographical and hermeneutic methods. Personal growth was conceptually defined as a process of turning inward and integration of personal experiences into a larger reality. The elements supporting personal growth were present in 53 to 88% of the 17 hospice workers of the sample. The emerging themes were interconnectedness, suffering and sacrifice, and birth and rebirth. Caring to the dying becomes practice for one's own death and a form of renewal in the life of the hospice workers.

Reporting of "quality of life": a systematic review and quantitative analysis of research publications in palliative care journals

CONTEXT

Palliative care clinical practice depends upon an evidence-based decision-making process which in turn is based upon current research evidence. One of the most important goals in clinical palliative care is to improve patients' quality of life (QoL).

AIM

This study aimed to perform a quantitative analysis of research publications in palliative care journals for reporting characteristics of articles on QoL.

SETTINGS AND DESIGN

This was a systematic review of palliative care journals.

MATERIALS AND METHODS

Twelve palliative care journals were searched for articles with "QoL" in the title of the articles published from 2006 to 2010. The reporting rates of all journals were compared. The selected articles were categorized into assessment and treatment, and subsequently grouped into original and review articles. The original articles were subgrouped into qualitative and quantitative studies, and the review articles were grouped into narrative and systematic reviews. Each subgroup of original article category was further classified according to study designs.

STATISTICAL ANALYSIS USED

Descriptive analysis using frequencies and percentiles was done using SPSS for Windows, version 11.5.

RESULTS

The overall reporting rate among all journals was 1.95% (71/3634), and Indian Journal of Palliative Care (IJPC) had the highest reporting rate of 5.08% (3/59), followed by Palliative Medicine (PM) with 3.71% (20/538), and Palliative and Supportive Care (PSC) with 3.64% (9/247) reporting.

CONCLUSIONS

The overall reporting rate for QoL articles in palliative care journals was 1.95% and there were very few randomized clinical trials and systematic reviews found. The study findings indicate further high-quality research to establish an adequate evidence base for QoL.

Implicações do sofrimento moral para os(as) enfermeiros(as) e aproximações com o Burnout

Realizou-se uma revisão integrativa, com o objetivo de identificar as implicações do sofrimento moral para os(as) enfermeiros(as), aproximações entre sofrimento moral e burnout, e estratégias de enfrentamento do sofrimento moral, na literatura científica nacional e internacional publicada nos últimos 10 anos. As bases de dados foram CINAHL, MEDLINE e SAGE, e as palavras-chave, sofrimento moral, burnout e enfermagem. Obtiveram-se 21 artigos para análise, realizada em quatro etapas: redução, visualização e comparação dos dados, e verificação e esboço da conclusão. Identificou-se que o sofrimento moral vivenciado pelos(as) enfermeiros(as) manifesta-se na dimensão pessoal, com alterações emocionais e físicas, e na dimensão profissional, com insatisfação no trabalho, burnout e abandono da profissão. Constataram-se estratégias de enfrentamento em três dimensões: educativa, comunicativa e organizacional. Considera-se necessário maior exploração dessa temática, contribuindo para a prevenção do sofrimento moral.

Burnout in palliative care: A systematic review

Burnout is a phenomenon characterized by fatigue and frustration, usually related to work stress and dedication to a cause, a way of life that does not match the person’s expectations. Although it seems to be associated with risk factors stemming from a professional environment, this problem may affect any person. Palliative care is provided in a challenging environment, where professionals often have to make demanding ethical decisions and deal with death and dying. This article reports on the findings of a systematic review aimed at identifying described burnout levels in palliative care nurses and physicians, and the related risks and protective factors. The main findings indicate that burnout levels in palliative care, or in health care settings related to this field, do not seem to be higher than in other contexts.

Impact of death and dying on the personal lives and practices of palliative and hospice care professionals

Background Working within the landscape of death and dying, professionals in palliative and hospice care provide insight into the nature of mortality that may be of benefit to individuals facing the end of life. Much less is known about how these professionals incorporate these experiences into their personal lives and clinical practices. Methods This ethnographic inquiry used semi-structured interviews and participant observation to elicit an in-depth understanding of the impact of death and dying on the personal lives of national key leaders (n = 6) and frontline clinicians (n = 24) involved in end-of-life care in Canada. Analysis of findings occurred in the field through constant comparative method and member checking, with more formal levels of analysis occurring after the data-collection phase. Results Eleven specific themes, organized under three overarching categories (past, present and future), were discovered. Early life experiences with death were a common and prominent feature, serving as a major motivator in participants' career path of end-of-life care. Clinical exposure to death and dying taught participants to live in the present, cultivate a spiritual life, reflect on their own mortality and reflect deeply on the continuity of life. Interpretation Participants reported that their work provided a unique opportunity for them to discover meaning in life through the lessons of their patients, and an opportunity to incorporate these teachings in their own lives. Although Western society has been described as a "death-denying" culture, the participants felt that their frequent exposure to death and dying was largely positive, fostering meaning in the present and curiosity about the continuity of life.

Caritas, spirituality and religiosity in nurses' coping

The purpose of this qualitative study was to investigate registered nurses' coping processes when working with terminally ill and dying cancer patients, with special focus on religious aspects of coping resources. What religious components can be identified as coping resources in oncology nurses' orienting system and what function has religiosity in the nurse's work? The theoretical reference is care philosophy and the psychology of religion and coping. The material consists of interviews with 15 Swedish registered oncology nurses. The results highlight different dynamic aspects of the nurses' life orientation such as caritas, religiosity, spirituality and atheism and demonstrate that religiosity can have a protective function that facilitates coping, as the nurse has something to turn to. Religious coping dominated by basic trust where prayer is used as a coping strategy may support the nurse.