Is work stress in palliative care nurses a cause for concern? A literature review

How Views on Death and Time Perspectives Relate to Palliative Care Nurses' Attitudes Toward Terminal Care?

This study's purpose was to explore how palliative care nurses' views on death and time perspectives are related to their terminal care attitudes. A questionnaire survey-consisting of the Death Attitude Inventory, Experiential Time Perspective Scale, and the Japanese version of the Frommelt Attitudes Toward Care of the Dying Scale-was administered to 300 individuals. Cluster analysis was conducted to categorize the way nurses perceive death, which revealed four types: Avoidant, middle, accepting, and indifferent. As a result of the analysis of variance on the terminal care attitudes, based on the types of views on death and time attitudes, it was found that the middle and accepting types, as well as the adaptive formation of time attitudes, were related to positive terminal care attitudes. In conclusion, more effective improvements in attitudes toward terminal care can be expected by incorporating time perspective, in addition to the conventional approaches focusing on death.

Cross-Sectional Study of the Professional Quality of Life of Palliative Care Professionals during the COVID-19 Pandemic

BACKGROUND

The display of compassionate care by palliative care professionals is of the utmost importance to the patients, their families, and even to their own professional well-being. Lately and, especially due to the emergence of the COVID-19 pandemic, palliative care professionals have been subjected to greater pressures stemming from their work environment, organizational standpoint, and emotional sense of view. Not only have these factors made it harder for professionals to deliver compassionate care to their patients, but they have also decreased their overall well-being. The aim is to study how sociodemographics, workplace characteristics, internal resources, and the COVID-19 pandemic-derived pressures have affected the professionals' capacity to perform compassionate care and their well-being while at the same time exploring the relationship between compassionate care and well-being.

METHODS

This study used a cross-sectional design with data gathered from Spanish palliative care professionals. The final sample was formed by 241 participants. They were surveyed about compassion, professional quality of life, well-being, sociodemographic data, working conditions, self-care, and coping with death competence, and the impact of the COVID-19 pandemic. The analyses used were descriptive statistics, bivariate tests, and the construction of a structural equation model.

RESULTS

Compassion was predicted by the ability to control their workload and the ability to cope with death. Burnout was predicted by age, workload, workload control, self-care, material resources, and changes in teamwork. Moreover, compassion, age, workload control, and changes in teamwork and self-care were shown to significantly predict compassion satisfaction. When it comes to compassion fatigue, different variables were shown to predict it, those being compassion, control over the workload, social self-care, and the ability to cope with death.

CONCLUSIONS

Having a healthy lifestyle and an adequate social support system is key to maintaining professional well-being in the case of palliative care professionals. Inner resources such as the ability to perform self-care and the capacity to cope with death are of vital importance to taking care of these professionals. Thus, it would be beneficial to establish training programs focused on these aspects in the myriad of sanitary centers that perform these tasks, as these abilities are necessary to withstand the work-related pressures and, at the same time, be able to provide compassionate care for patients.

Psychometric properties of the Korean version of the Palliative Care Nursing Self-Competence scale for infant use

BACKGROUND

Despite the significant advances in neonatal treatment and care over the past 30 years, palliative care in the neonatal intensive care unit has not been fully provided in South Korea. Neonatal nurses are essential professionals in palliative care as they are directly involved in the care, but there is little information on their palliative care competency because no assessment instrument is available in Korea.

OBJECTIVES

The aim of this study was to develop and test the validity and reliability of the Korean version of the Palliative Care Nursing Self-Competence scale for neonatal palliative care.

METHODS

This scale for infant care was developed through parallel translation techniques and revised based on cognitive interviews. Survey data were then collected from 220 neonatal nurses who worked in 13 neonatal intensive care units in Korea. Internal consistency reliability, construct validity based on exploratory factor analysis, and criterion-related validity were tested.

RESULTS

The final version of the scale included 40 items in five domains that explained 53.4% of the variance. Criterion-related validity was confirmed based on a positive correlation with the Korean version of the attitudes towards neonatal palliative care measurement tool. The Cronbach's alpha for the scale was 0.95.

CONCLUSIONS

The Korean version of the Palliative Care Nursing Self-Competence scale for infant care has satisfactory construct validity and reliability to measure palliative care self-competence of neonatal nurses in Korea and evaluate an education program in future studies.

Resourcefulness and stress among hospice and palliative nurses: the role of positive thinking

Background: Among healthcare professionals, hospice and palliative nurses have a high risk of experiencing work stress. However, little attention has been paid to protective factors that could mitigate the impact of daily stressors on hospice and palliative nurses. Aim: This study aimed to determine whether resourcefulness and positive thinking have a negative association with perceived stress among hospice and palliative nurses, and whether positive thinking moderates or mediates the link between resourcefulness and stress among hospice and palliative nurses. Method: A cross-sectional, correlational design was used to address these two aims. Results: A convenience sample of 86 hospice and palliative nurses (95% female) in the US completed an online survey. The results demonstrated that positive thinking and resourcefulness are useful predictors of stress reduction and help mitigate the effects of stress. Positive thinking did not mediate the relationship between resourcefulness and stress. Conclusion: Moderation analysis suggests that social resourcefulness may be especially helpful in reducing stress among hospice and palliative nurses with a low level of positive thinking.

Burdens and Resources of Staff of a Specialized Ward for Neuropalliative Care: A Cross-Sectional Survey

Palliative care adds significant burdens to healthcare workers. In neuropalliative care (NPC), additional challenges include patient symptom burdens, such as impairments in mobility, cognition, and communication. After one year of operating the first NPC ward in Germany, we assessed burdens, resources, and the number of deaths perceived as stressful. NPC physicians and nursing staff were compared with the team of other neurological wards, including a stroke unit. The assessment took place between March 2022 and May 2022. All 64 team members were contacted; the responder rate was 81%. The perceived burden was high but did not differ between groups. There were no differences between the NPC- and the neurological wards in the number of deaths perceived as stressful. However, rather than the number of deaths, the circumstances of dying influence the perceived distress. The resources mentioned were similar between groups, with the team and private life being most important. Communication difficulties were frequently cited as stressful, whereas successful communication was identified as a resource.

Influence of Palliative Care Qualifications on the Job Stress Factors of General Practitioners in Palliative Care: A Survey Study

Due to demographic change, the number of patients in palliative care (PC) is increasing. General Practitioners (GPs) are important PC providers who often have known their patients for a long time. PC can be demanding for GPs. However, there are few studies on the job stress factors of GPs performing PC and the potential influence of their PC training. To get more insights, a postal survey was performed with GPs in North Rhine, Germany. The questionnaire was based on a literature search, qualitative pre-studies, and the Hospital Consultants' Job Stress & Satisfaction Questionnaire (HCJSSQ). Participants state that a high level of responsibility, conflicting demands, and bureaucracy are the most important stressors they experienced in PC. The influence of PC qualification level on their perceived job stress factors is low. Only advanced but not specialist qualification shows a correlation with renumeration-related stress. Gender and work experience are more dominant influences. In our study, female GPs and physicians with more work experience tend to be more stressed. In conclusion, organisational barriers, such as administration, should be reduced and renumeration should be increased to facilitate the daily work of GPs.

Experiences of Nurses in Nursing Homes during the COVID-19 Pandemic in Germany: A Qualitative Study

(1) Background: The aim of this qualitative study was to examine pandemic-related changes in nursing work in nursing homes, the resulting work-related stresses and external as well as internal alleviating measures. (2) Methods: We conducted 10 interviews from March to June 2021 with nurses from eight facilities. Data were analysed according to qualitative content analysis. (3) Results: Nurses faced increased workloads due to regulations and guidelines paired with staffing shortages. Work became more difficult due to personal protective equipment (PPE), conflict with residents’ relatives and, in the case of outbreaks, excess death and suffering. Nurse-to-resident care work became more emotionally demanding, with residents more distressed due to the lockdown, while families and social workers were not allowed into the facility. Residents with dementia posed an additional challenge, as they did not remember hygiene and distancing rules. Internal and external measures were not sufficient to alleviate the situation. However, some measures, such as training programmes or existing palliative care concepts, were considered helpful. (4) Conclusions: Facing other possible upcoming pandemics, ways to improve facility administration to prepare for future pandemics are highly needed, such as regular training programmes to prepare for possible lockdown scenarios, PPE use or potential hygiene measures.

Moderating the work distress experience among inpatient hospice staff: a qualitative study

Background: Palliative and hospice care health professionals may be at risk of poorer psychological outcomes. It is unclear what specific stressors are experienced by staff and what impact they have on their psychological wellbeing. Aims: To identify stressors experienced when working in an adult hospice inpatient unit environment and how these are managed. Methods: Individual interviews were conducted with healthcare professionals working in a hospice adult inpatient unit. Findings: A total of 19 staff were interviewed. Six themes were constructed, with four related to stressors experienced: unrealistic workload, patient care, managing relationships, and work culture. Two themes concerned strategies for managing stressors were identified: peer support and time out. Conclusion: Changes within hospice care provision are placing demands on staff and reducing the amount of available resources. This may be alleviated by a move towards more compassionate workplaces. There is a need for further research to identify how distress can best be managed and how hospice organisations can best support healthcare staff.

Palliative Professionals' Experiences of Receiving Gratitude: A Transformative and Protective Resource

Providing palliative care can be both challenging and rewarding. It involves emotionally demanding work and yet research shows that burnout is lower than in other fields of health care. Spontaneous expressions of gratitude from patients and family members are not uncommon and are highly valued. This study explored the experience of Spanish palliative professionals who received expressions of gratitude from their patients and families. A phenomenological approach was used to better understand the role of receiving gratitude in participants' lives. Interviews were transcribed verbatim and a phenomenological approach to analysis was undertaken using macro-thematic and micro-thematic reflection. Two team members independently engaged in this reflection with an inductive approach. The analysis was shared and discussed at periodic meetings to identify the key themes and sub-themes of the gratitude experience. Ten palliative professionals were interviewed. Participants engaged in a process of recognizing, internalizing, and treasuring the expressions of gratitude which they then used for reflection and growth. These expressions were a powerful and deeply meaningful resource that the palliative professionals revisited over time. Receiving expressions of gratitude invited a stronger sense of the value of one's self and one's work that was motivational and protective, particularly during challenging times.

Attitudes of Palliative Care Practitioners Towards Enrolling Patients in Clinical Trials

Background: Recruitment of participants for clinical trials remains a key consideration for investigators. This is particularly relevant in palliative care, where practitioners are sometimes reluctant to refer patients for consideration of enrolment. Reasons for this reluctance range from concerns about excessive burden to patients, through to debate about the appropriateness of undertaking trials in the palliative care setting. Aim: The aim of this study was (1) to explore palliative care practitioners' attitudes and views of clinical trials, (2) to compare these findings with those of a similar survey undertaken more than a decade earlier, and (3) to explore predictors associated with key concepts of interest associated with clinical trials. Design: The palliative care clinician's attitudes to clinical research survey undertaken in 2007 formed the basis of a repeat survey conducted in 2019. Setting/Participants: Australian and New Zealand palliative care practitioners were surveyed. Results: Surveys were completed by 135 palliative care practitioners. Comparing results of the current study and those findings of more than a decade earlier revealed that attitudes have either not substantially changed or indeed in some areas have become less accepting of clinical trials. This is despite the dramatic increase in the volume of research carried out within palliative care over the last decade. Conclusion: Our survey suggests that the reasons for engagement in research are complex and likely to differ according to local conditions. Careful attention to understanding of the local environment and particularly the attitudes of local practitioners is likely to be essential to be successful in this endeavour.

Does context count? The association between quality of care and job characteristics in residential aged care and hospital settings: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

Within residential aged care settings, reduced quality of care (QOC), abuse, and neglect have been global phenomena which require urgent intervention. As the reported rate of these problems is much higher in aged care compared to hospital settings, we investigated whether differing job design characteristics between the two settings might explain the difference.

RESEARCH DESIGN AND METHODS

We used a meta-analysis to compare differences in the relationships between high job demands, low job resources, and job strain with QOC and counter-productive work behaviors (CWBs) across aged care and hospital settings.

RESULTS

Data was extracted from 42 studies (n=55 effects). QOC was negatively correlated with high job demands (ρ̅ =-.22, 95% CI: -.29:-.15, k=7), low job resources (ρ̅ = -.40, 95% CI:-.47:-.32, k=15), and job strain (ρ̅ =-.32, 95% CI: -.38:.-.25, k=22), CWBs had a positive relationship with job demands (ρ̅ =.35, 95%CI: .10:.59, k=3) and job strain (ρ̅ =.34, 95% CI: .13:.56, k=6). The association between poor QOC and low job resources was stronger in aged care (r=-.46, 95% CI:-.55:-36, k=8) than in hospital settings (r= -.30, 95% CI:-.41:-.18, k=7).

DISCUSSION AND IMPLICATIONS

Our findings suggest that relationships between low job resources and poor quality of care are exacerbated in residential aged care contexts. To improve care outcomes, stakeholders should improve job resources such as skill discretion, supervisory supports, and increased training and staffing levels in residential aged care.

Self-Care as a Method to Cope With Suffering and Death: A Participatory Action-Research Aimed at Quality Improvement

Introduction

Palliative care is an emotionally and spiritually high-demanding setting of care. The literature reports on the main issues in order to implement self-care, but there are no models for the organization of the training course. We described the structure of training on self-care and its effects for a Hospital Palliative Care Unit.

Method

We used action-research training experience based mostly on qualitative data. Thematic analysis of data on open-ended questions, researcher’s field notes, oral and written feedback from the trainer and the participants on training outcomes and satisfaction questionnaires were used.

Results

Four major themes emerged: (1) “Professional role and personal feelings”; (2) “Inside and outside the team”; (3) “Do I listen to my emotions in the care relationship?”; (4) “Death: theirs vs. mine.” According to participants’ point of view and researchers’ observations, the training course resulted in ameliorative adjustments of the program; improved skills in self-awareness of own’s emotions and sharing of perceived emotional burden; practicing “compassionate presence” with patients; shared language to address previously uncharted aspects of coping; allowing for continuity of the skills learned; translation of the language learned into daily clinical practices through specific facilitation; a structured staff’s support system for emotional experiences.

Discussion

Self-care is an important enabler for the care of others. The core of our intervention was to encourage a meta-perspective in which the trainees developed greater perspicacity pertaining to their professional role in the working alliance and also recognizing the contribution of their personal emotions to impasse experienced with patients.

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.

Burdens, resources, health and wellbeing of nurses working in general and specialised palliative care in Germany - results of a nationwide cross-sectional survey study

BACKGROUND

Palliative care in Germany is divided into general (GPC) and specialised palliative care (SPC). Although palliative care will become more important in the care sector in future, there is a large knowledge gab, especially with regard to GPC. The aim of this study was to identify and compare the burdens, resources, health and wellbeing of nurses working in GPC and SPC. Such information will be helpful for developing prevention programs in order to reduce burdens and to strengthen resources of nurses.

METHODS

In 2017, a nationwide cross-sectional survey was conducted. In total, 437 nurses in GPC and 1316 nurses in SPC completed a questionnaire containing parts of standardised instruments, which included parts of the Copenhagen Psychosocial Questionnaire (COPSOQ), the Patient Health Questionnaire (PHQ-2), the Resilience Scale (RS-13) Questionnaire, a single question about back pain from the health survey conducted by the Robert Koch Institute as well as self-developed questions. The differences in the variables between GPC and SPC nurses were compared.

RESULTS

SPC nurses reported higher emotional demands as well as higher burdens due to nursing care and the care of relatives while GPC nurses stated higher quantitative demands, i.e. higher workload. SPC nurses more often reported organisational and social resources that were helpful in dealing with the demands of their work. Regarding health, GPC nurses stated a poorer health status and reported chronic back pain as well as a major depressive disorder more frequently than SPC nurses. Furthermore, GPC nurses reported a higher intention to leave the profession compared to SPC nurses.

CONCLUSIONS

The findings of the present study indicate that SPC could be reviewed as the best practice example for nursing care in Germany. The results may be used for developing target group specific prevention programs for improving health and wellbeing of nurses taking the differences between GPC and SPC into account. Finally, interventional and longitudinal studies should be conducted in future to determine causality in the relationship of burdens, resources, health and wellbeing.

Psychological challenges for nurses working in palliative care and recommendations for self-care

Working in palliative care services has an impact on the personal and professional lives of healthcare staff. The complex practicalities of the role and additional factors such as moral distress, burnout, compassion fatigue and death anxiety all impact on the overall quality of services and patient care. This article aims to highlight what is known of the practical and emotional challenges for palliative nursing care and offers recommendations to services to support staff at an organisational as well as individual level, to help create a more supportive workplace for staff and patients alike. It follows previous research on working in palliative and end-of-life care.

Belastungen, Ressourcen und der berufliche Verbleib von Mitarbeitenden in der spezialisierten ambulanten Palliativversorgung (SAPV) in Bayern

Hintergrund Ziel der Studie ist es, Belastungen und Ressourcen von SAPV-Mitarbeitenden sowie deren Auswirkungen auf die Einschätzung des beruflichen Verbleibs in der SAPV zu untersuchen.

Methode Fragebogenerhebung in 30 SAPV-Teams in Bayern (457 Mitarbeitende) in Kooperation mit dem Landesverband SAPV Bayern e. V. Auswertung: deskriptive Statistik, T-Tests, logistische Regression (IBM SPSS 24).

Ergebnisse Die Rücklaufquote beträgt 53,4 % (n = 244). 64 Befragte (26,2 %) sind bzgl. des beruflichen Verbleibs in der SAPV unsicher. Die höchsten Belastungen werden auf den Skalen »Eigene Betroffenheit« und »Unkontrollierbarkeit« berichtet. Befragte, die höhere Belastung durch »Arbeitszeitorganisation« und »Überlastung« oder geringe »persönliche Ressourcen« berichten, sind eher unsicher bezüglich des beruflichen Verbleibs in der SAPV.

Schlussfolgerungen Es sind nicht Belastungen mit besonderer Relevanz in der SAPV (z. B. Unkontrollierbarkeit), sondern Arbeitszeitorganisation und Überlastung, die im Gesundheitswesen weitverbreitet sind, welche Mitarbeitende bzgl. ihres beruflichen Verbleibs in der SAPV unsicher sein lassen.

Development of an Instrument to Measure Stress in Korean Nurses Performing End-of-Life Care for Children

PURPOSE

This study aims to develop a scale to assess the stress of nurses caring for terminally ill children and to test the validity and reliability of the scale.

BACKGROUND

Nurses caring for children experience various stressors that are different from those experienced by nurses caring for adult patients. It is important to understand the level of stress of nurses caring for dying children and their families. Instruments to measure these stress levels, however, are not available.

DESIGN

This study used a methodological approach.

METHOD

The initial items were identified through literature reviews and in-depth interviews. Content validation of the items was evaluated by seven experts. Participants were 357 pediatric nurses working at 11 institutions in six cities. Data were analyzed using item analysis, exploratory and confirmatory factor analysis, internal consistency, and test-retest. This study followed the STROBE checklist.

FINDINGS

The final scale consisted of 22 items chosen and classified into 5 factors (psychological difficulties, conflict with parents, difficulties in communication, lack of end-of-life care knowledge, and restricted working environment), which explained 61.13% of the total variance. The 5-subscale model was validated by confirmatory factor analysis. Cronbach's alpha for the total item was 0.90, and the intra-class correlation coefficient was 0.89.

CONCLUSION

This scale can be used to contribute toward the assessment of stress among nurses performing end-of-life care for children.

PRACTICE IMPLICATIONS

This scale will contribute to the improvement of the quality of life of not only nurses, but also children and their families in pediatric settings.

A Qualitative Study on the Experiences and Reflections of Junior Doctors During a Palliative Care Rotation: Perceptions of Challenges and Lessons Learnt

CONTEXT

Doctors caring for patients with life-limiting illness are often exposed to emotional distress.

OBJECTIVES

We aimed to explore the experiences and perceptions of junior doctors working full time in a palliative care rotation. We examined the lessons junior doctors learnt in managing their emotions as they face patients' death on a daily basis.

METHODS

We conducted a qualitative study with seven focus group discussions involving 21 junior doctors (medical officers and residents). Data were analyzed using qualitative thematic analysis to identify the themes related to the perceived challenges of these junior doctors and how they managed the struggles. Interviews were conducted with junior doctors who spent at least two months in a palliative care unit in a tertiary hospital or an inpatient hospice.

RESULTS

Junior doctors caring for dying patients in a palliative care rotation faced internal conflicts. Conflicting feelings arose because of differing expectations from their preconceived notions of their roles as doctors. Two main themes of internal struggles were professional distancing and emotional detachment as well as prognostic uncertainty and when to withhold and withdraw medical treatments. Coping strategies that helped included mentoring and role modeling provided by palliative care physicians, reframing their care experiences and reflection to find meaning in their work.

CONCLUSION

A palliative care rotation exposes junior doctors to emotionally overwhelming experiences. With proper guidance, this exposure is useful in teaching junior doctors important coping strategies, allowing learning to occur at a deeper level.

Attitudes of registered nurses about the end - of - life care in multi-profile hospitals: a cross sectional survey

BACKGROUND

End-of-life care is provided in a variety of healthcare settings, not just palliative care hospitals. This is one reason why it is very important to assess all barriers to end-of-life care and to provide safe and quality services to patients. This study was aimed at describing nurses' attitudes in providing end-of-life care and exploring barriers and facilitating behaviors of nurses in multi-profile hospitals in Eastern Europe.

METHODS

A descriptive, correlational design was applied in this study, using a cross-sectional survey of 1320 registered nurses within 7 hospitals in Lithuania.

RESULTS

Registered nurses working in the three different profiles emphasized safe and effective care and the importance of meeting the patient's spiritual needs at the end of life. The main barriers assigned by nurses caring for patients at the end of life were angry family members, inadequate understanding of nursing care by the patient's relatives; lack of time to talk to patients, lack of nursing knowledge to deal with the bereaved patient's family, lack of evaluation of nurses' opinions, and the evasion by physicians to talk about the diagnosis and their over-optimistic view of the situation. The main facilitating behaviors to improve nursing care were end-of-life training, volunteering, and family involvement.

CONCLUSIONS

Spiritual needs were identified by nurses as the primary needs of patients at the end of life. Family-related barriers remain one of the main barriers to end-of-life care. Also, the behavior of physicians and their relationship with nurses remains one of the most sensitive issues in end-of-life care.

[The significance of home care in caring for the elderly in their twilight years: the human perspective of the SUS professional]

The access to healthcare of elderly individuals in their twilight years needing palliative care in the home serve as a wake-up call in terms of current healthcare programs and strategies. This study seeks to analyze the relevance of home visits within the scope of primary healthcare actions for the elderly from the standpoint of professionals of the Unified Health System (SUS). It is a study with a qualitative theoretical and methodological approach, involving comprehensive research together with 12 health professionals, based on the thinking of German philosopher Hans-Georg Gadamer. The data were systematized and analyzed using the Content Analysis method and interpreted by means of philosophical hermeneutics. It is perceived that home visits for the elderly are somewhat stressful, albeit effective, which generate human processes of trust and collective action for care with respect to the condition of others. The consensus of home visits embraces the dialogical reflection of the representation of human care and solidarity in the work of SUS. It is believed that this study will provide guidelines such that primary care managers may reflect on how important, necessary, and stressful the performance of home care in the Brazilian reality is in practice.

A novel mindful-compassion art therapy (MCAT) for reducing burnout and promoting resilience for end-of-life care professionals: a waitlist RCT protocol

INTRODUCTION

End-of-life (EoL) care professionals are prone to burnout given the intense emotional nature of their work. Previous research supports the efficacy of art therapy in reducing work-related stress and enhancing emotional health among professional EoL caregivers. Integrating mindfulness meditation with art therapy and reflective awareness complementing emotional expression has immense potential for self-care and collegial support. Mindful-compassion art therapy (MCAT) is a novel, empirically informed, and highly structured intervention that aims to reduce work-related stress, cultivate resilience, and promote wellness. This study aims to assess the potential effectiveness of MCAT for supporting EoL care professionals in Singapore.

METHODS

This is an open-label waitlist randomized controlled trial. Sixty EoL care professionals, including doctors, nurses, social workers, and personal care workers, are randomly allocated to one of two groups: (i) an intervention group that receives MCAT immediately and (ii) a waitlist-control group that receives MCAT after the intervention group completes treatment. Face-to-face self-administered outcome assessments are collected at three different time points-baseline (T1) for both groups, post-intervention (T2), and 6-week follow-up (T3) for intervention group-as well as pre-intervention (T2) and post-intervention (T3) for the waitlist-control group. The primary outcome measure is burnout, and secondary measures include emotional regulation, resilience, compassion, quality of life, and death attitudes. Between- and within-participant comparisons of outcomes are conducted, and the appropriate effect size estimates are reported. An acceptability and feasibility study is to be conducted by using a triangulation of qualitative data with framework analysis.

DISCUSSION

The outcomes of this study will contribute to advancements in both theories and practices for supporting professional EoL caregivers around the world. It will also inform policy makers about the feasibility, acceptability, and effectiveness of delivering a multimodal psycho-socio-spiritual intervention within a community institutional setting. The study has received ethical approval from the institutional review board of Nanyang Technological University.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03440606 . Retrospectively registered February 21, 2018.

Clinicians' perceptions of opioid error-contributing factors in inpatient palliative care services: A qualitative study

BACKGROUND

Opioid errors are a leading cause of patient harm and adversely impact palliative care inpatients' pain and symptom management. Yet, the factors contributing to opioid errors in palliative care are poorly understood. Identifying and better understanding the individual and system factors contributing to these errors is required to inform targeted strategies.

OBJECTIVES

To explore palliative care clinicians' perceptions of the factors contributing to opioid errors in Australian inpatient palliative care services.

DESIGN

A qualitative study using focus groups or semi-structured interviews.

SETTINGS

Three specialist palliative care inpatient services in New South Wales, Australia.

PARTICIPANTS

Inpatient palliative care clinicians who are involved with, and/or have oversight of, the services' opioid delivery or quality and safety processes.

METHODS

Deductive thematic content analysis of the qualitative data. The Yorkshire Contributory Factors Framework was applied to identify error-contributing factors.

FINDINGS

A total of 58 clinicians participated in eight focus groups and 20 semi-structured interviews. Nine key error contributory factor domains were identified, including: active failures; task characteristics of opioid preparation; clinician inexperience; sub-optimal skill mix; gaps in support from central functions; the drug preparation environment; and sub-optimal clinical communication.

CONCLUSION

This study identified multiple system-level factors contributing to opioid errors in inpatient palliative care services. Any quality and safety initiatives targeting safe opioid delivery in specialist palliative care services needs to consider the full range of contributing factors, from individual to systems/latent factors, which promote error-causing conditions.

The significance of gratitude for palliative care professionals: a mixed method protocol

BACKGROUND

In palliative care (PC) patients and relatives (P/R) often show their gratitude to the healthcare professionals (HP) who care for them. HP appreciate these displays of gratitude, although the impact of the same has not been examined in detail. Publications analysed tell personal experiences in which HP say that displays of gratitude create sensations of well-being, pride and increased motivation to carry on caring. No systematic examination in PC was found. These aspects related to gratitude may be important in the field of PC, where there is constant exposure to suffering and the preoccupation which arises from wanting to help HP to go on with their work, but it needs closer study and systemisation. The purpose of this study is to understand the significance and the role of the gratitude received from P/R for palliative care health professionals (PCHP).

METHODS

A suitable mixed method will be used. The first phase will be quantitative and will consist of a survey, piloted by experts, whose goal is to explore the current situation in Spain as regards displays of gratitude received by HP at PC services. It will be sent by e-mail. The results from this part will be incorporated into the second part which will be qualitative and whose goal is to understand the significance of the experience of receiving displays of gratitude from the perspective of PCHP, using a phenomenological approach. Interviews will be undertaken amongst PCHP. The interview guide will be designed after taking the survey results into account. The project has been granted ethical approval.

DISCUSSION

These results are set to provide a key contribution within the context of the growing preoccupation on how to care for HP, how to ensure retention and keep them from resigning, as well as preventing burnout, emotional fatigue and boosting their resilience. In order to do this, it is both interesting and ground breaking, to analyse the repercussion of spontaneous gratitude shown by P/R towards PCHP, to see if this is a useful resource to reduce these problems and to encourage the greater presence of dignity and humanisation, for both those receiving care and for those providing it. This gratitude may be one of these strategies.

Oncology nurses' perceptions of work stress and its sources in a university-teaching hospital: A qualitative study

AIM

To explore and understand work stress and its sources among oncology nurses in a Saudi university-teaching hospital.

DESIGN

Qualitative descriptive study using semistructured interviews.

METHODS

Fourteen oncology nurses working in a university-teaching hospital were interviewed between October - December 2016. Qualitative content analysis according to the Krippendorff method was used to explore work-related stressors among oncology nurses in Saudi Arabia.

RESULTS

Two categories were emerged including "extent of work stress" and "work-related stressors". The second category included the following subcategories of workload and staff shortage, emotional demands, lack of social support, language barriers, and lack of respect from patients and family members and cultural differences.

Food and Nutrition Care in Long-Term Care Facilities: Examining the Perspectives of Frontline Workers

Malnutrition in older adults residing in long-term care facilities continues to be a problem in the United States. Existing research has identified a list of possible contributing factors, including staffing problems. Few studies on food and nutrition care have attempted to gain the perspectives of nursing or dietary aides (henceforth, aides), the frontline staff who work most closely with the residents of long-term care facilities. The current study takes a qualitative approach grounded in a theoretical perspective based on Total Quality Management (TQM) to increase understanding of the interpersonal and management practices that affect resident wellbeing, health, and nutrition. Four focus groups (n = 24) were conducted with aides working in long-term care facilities. Aides expressed emotional closeness with residents and provided detailed knowledge about food and nutrition care. They reported both compassion fatigue and satisfaction. An element of dissatisfaction related to aide relationships with management and other employees who did not actively solicit their perspectives and knowledge on resident feeding. The knowledge and experience of aides could be better utilized by shifting management strategies to focus on employee empowerment and training. Principles of TQM could be applied to improve food and nutrition care in long-term care facilities.

Burnout, compassion fatigue and psychological capital: Findings from a survey of nurses delivering palliative care

BACKGROUND

Ageing populations worldwide and a concomitant increase in chronic conditions translates into an increased demand for the delivery of palliative and end of life care by nurses. This increasing demand for palliative care provision may produce stressors resulting in negative outcomes such as burnout and compassion fatigue.

AIM

The purpose of this study was to explore burnout and compassion fatigue, as well as potential protective factors, among nurses in New Zealand.

METHODS

An online survey was conducted with 256 registered nurses (between January 2016 and February 2017) recruited through nursing organisations and a large tertiary level hospital. Data analysis consisted of descriptive statistics, multivariate analysis of variance, Pearson correlations, and hierarchical multiple regression.

RESULTS

Psychological empowerment and the commitment and challenge components of psychological hardiness significantly predicted lower scores for the burnout while previous palliative care education and challenge predicted lower scores for the secondary traumatic stress component of compassion fatigue. Significant predictors of compassion satisfaction included previous palliative care education, psychological empowerment and both the commitment and challenge components of psychological hardiness.

CONCLUSION

Nurses draw upon unique combinations of "psychological capital" to deal with caring for patients with life-limiting illnesses. Any interventions to increase nurse palliative care education uptake must be tailored to develop and support these internal resources.

Nurses' Experiences of Grief Following Patient Death: A Qualitative Approach

PURPOSE

To explore the lived experiences of nurses' feelings, emotions, grief reactions, and coping mechanisms following their patients' death.

BACKGROUND

On a daily basis, nurses are experiencing patients' death, which exposes them to grief. Nurses' grief has not been sufficiently addressed in practice settings, although it has been a well-known threat to health and work performance.

DESIGN

A qualitative design guided by a phenomenological approach was adopted.

METHOD

Data were collected from a purposive sample of 21 Jordanian nurses by conducting three focus groups and analyzed using Colaizzi's framework.

FINDINGS

Four themes were generated in which participants reported feelings of grief following their patients' death. Their grief emotions were reported as sadness, crying, anger, shock, denial, faith, fear, guilt, fear of the family's reaction, and powerlessness.

CONCLUSIONS

The study provided evidence that nurses respond emotionally to patients' death and experience grief. Nurses are burdened by recurrent patients' deaths and try to cope and overcome their grief. This study emphasizes the importance of developing strategies to help nurses positively cope with their grief from a holistic perspective. This will reflect positively on the nurses' performance.

Association between level of exposure to death and dying and professional quality of life among palliative care workers

ABSTRACTBackground:Exposure to the death and dying of others is an anxiety-provoking condition that can contribute to psychological stress. However, the results of empirical studies that evaluated work-related outcomes among physicians and nurses with repeated exposure to dying patients are not consistent.

OBJECTIVE

Our aim was to evaluate whether a high level of exposure to death and dying (LED) can increase the risk for poor professional quality of life (ProQoL) in most healthcare workers, but it can also improve ProQoL in a subset of healthcare workers with specific characteristics.

METHOD

We employed a cross-sectional survey designed to better understand the role of LED as a predictor of ProQoL among healthcare workers.

SETTING AND PARTICIPANTS

Comparison of physicians and nurses with high LED (home-based palliative care units) with a matched group of physicians and nurses with low LED (primary care units) and evaluation of possible interaction effects among LED, death anxiety (DA), and engagement as predictors of ProQoL.

RESULTS

The final sample included 110 questionnaires from the high-LED group (response rate = 39%) and 131 from the low-LED (response rate = 24%) group. Workers with high LED reported an increased level of compassion satisfaction (CS) and low to moderate levels of burnout (BU) and secondary traumatic stress (STS), with no significant differences with respect to other healthcare providers. Although levels of CS, STS, and BU did not differ between groups, a univariate MANOVA revealed that the interaction effect of LED × Engagement reduced levels of CS and that the interaction effect of LED × DA increased STS among workers with high LED.

SIGNIFICANCE OF RESULTS

LED was significantly correlated with ProQoL among healthcare workers with high LED due to the reported interaction effect. These findings imply, for the first time, that there is a possible correlation between engagement and the risk for poor ProQoL among workers with high LED. Further research is essential to gain a better understanding of this issue.

A new contribution to the classification of stressors affecting nursing professionals

Objective:

to identify and classify the most important occupational stressors affecting nursing professionals in the medical units within a hospital.

Method:

quantitative-qualitative, descriptive and prospective study performed with Delphi technique in the medical units of a general university hospital, with a sample of 30 nursing professionals.

Results:

the stressors were work overload, frequent interruptions in the accomplishment of their tasks, night working, simultaneity of performing different tasks, not having enough time to give emotional support to the patient or lack of time for some patients who need it, among others.

Conclusion:

the most consensual stressors were ranked as work overload, frequent interruptions in the accomplishment of their tasks, night working and, finally, simultaneity of performing different tasks. These results can be used as a tool in the clinical management of hospital units, aiming to improve the quality of life of nursing professionals, organizational models and, in addition, continuous improvement in clinical treatment.

Mindful Attention Awareness in Spanish Palliative Care Professionals

Abstract. Mindfulness is conceived as a state in which the individual pays full attention to everything that is happening around him or her. The Mindful Attention Awareness Scale (MAAS) is the most popular instrument for assessing mindfulness. Studies on its structure have shown some conflicting results. This study aims to offer new evidence on the dimensionality and reliability of the MAAS, handling both SEM and IRT procedures, in palliative professionals. The sample was composed of 385 professionals from a national online survey. First, two Confirmatory Factor Analyses (CFAs) were specified, estimated, and tested, with one- and two-factor structures, respectively. Second, the Graded Response Model (GRM) was used and accuracy of the MAAS using information functions was estimated. Results showed appropriate fit for the two CFA models. As the correlation between the two factors in the two-factor model was extremely high and the original authors posited a one-factor solution, this structure was retained for parsimony. The GRM also supported this structure, but found that the scale offered more information on professionals with lower levels of mindfulness, pointing at items 1, 2, 6, and 15 as the less discriminative, in line with the CFA lower factor loadings for these very same items.

Impact of a physical activity program on the anxiety, depression, occupational stress and burnout syndrome of nursing professionals

Objective

to assess the effects of a workplace physical activity (WPA) program on levels of anxiety, depression, burnout, occupational stress and self-perception of health and work-related quality of life of a nursing team in a palliative care unit.

Methods

the WPA was conducted five days per week, lasting ten minutes, during three consecutive months. Twenty-one nursing professionals were evaluated before and after the intervention, with the Hospital Anxiety and Depression Scale, the Maslch Burnout Inventory, and the Job Stress Scale. The changes in self-perceived health and work-related quality of life were measured using a semi-structured questionnaire.

Results

the WPA did not yield significant results on the levels of anxiety, depression, burnout or occupational stress. However, after the intervention, participants reported improved perceptions of bodily pain and feeling of fatigue at work.

Conclusion

the WPA did not lead to beneficial effects on occupational stress and psychological variables, but it was well accepted by the nursing professionals, who reported improvement in perceptions of health and work-related quality of life.

Improving the wellbeing of staff who work in palliative care settings: A systematic review of psychosocial interventions

BACKGROUND

Staff in palliative care settings perform emotionally demanding roles which may lead to psychological distress including stress and burnout. Therefore, interventions have been designed to address these occupational risks.

AIM

To investigate quantitative studies exploring the effectiveness of psychosocial interventions that attempt to improve psychological wellbeing of palliative care staff.

DESIGN

A systematic review was conducted according to methodological guidance from UK Centre for Reviews and Dissemination.

DATA SOURCES

A search strategy was developed based on the initial scans of palliative care studies. Potentially eligible research articles were identified by searching the following databases: CINAHL, MEDLINE (Ovid), PsycINFO and Web of Science. Two reviewers independently screened studies against pre-set eligibility criteria. To assess quality, both researchers separately assessed the remaining studies using the Quality Assessment Tool for Quantitative Studies.

RESULTS

A total of 1786 potentially eligible articles were identified - nine remained following screening and quality assessment. Study types included two randomised controlled trials, two non-randomised controlled trial designs, four one-group pre-post evaluations and one process evaluation. Studies took place in the United States and Canada (5), Europe (3) and Hong Kong (1). Interventions comprised a mixture of relaxation, education, support and cognitive training and targeted stress, fatigue, burnout, depression and satisfaction. The randomised controlled trial evaluations did not improve psychological wellbeing of palliative care staff. Only two of the quasi-experimental studies appeared to show improved staff wellbeing although these studies were methodologically weak.

CONCLUSION

There is an urgent need to address the lack of intervention development work and high-quality research in this area.

Emergency nurses' ways of coping influence their ability to empower women to move beyond the oppression of intimate partner violence

Background

Millennium Developmental Goal 3 (MDG 3) aims at enhancing gender equity and empowerment of women. Emergency nurses who often encounter women injured by their intimate partners are at risk of developing vicarious traumatisation, which may influence their ability to empower women to move beyond the oppression of intimate partner violence.

Aim

This article aims to, (1) describe emergency nurses’ ways of coping with the exposure to survivors of intimate partner violence, and (2) recommend a way towards effective coping that will enhance emergency nurses’ abilities to empower women to move beyond the oppression of intimate partner violence to contribute to the achievement of MDG 3.

Setting

The study was conducted in emergency units of two public hospitals in an urban setting in South Africa.

Method

A qualitative design and descriptive phenomenological method was used. Emergency nurses working in the setting were purposively sampled and interviewed. The data were analysed by searching for the essence and meaning attached to the exposure of emergency nurses to survivors of intimate partner violence.

Results

Emergency nurses’ coping responses were either aimed at avoiding or dealing with their exposure to survivors of intimate partner violence. Coping aimed at dealing with the exposure included seeking support, emotion regulation and accommodative coping.

Conclusion

Emergency nurses employ either effective or ineffective ways of coping. Less effective ways of coping may increase their risk of vicarious and secondary traumatisation, which in turn may influence their ability to empower women to move beyond the oppression of intimate partner violence.

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.

Exploring Oncology Nurses' Grief: A Self-study

Oncology nursing, like many other nursing fields, often provides nurses with the opportunity to get to know their patients and their families well. This familiarity allows oncology nurses to show a level of compassion and empathy that is often helpful to the patient and their family during their struggle with cancer. However, this familiarity can also lead to a profound sense of grief if the patient loses that struggle. This self-study provided me the opportunity to systematically explore my own experience with grief as an oncology nurse, helping me to identify specific stressors and also sources of stress release.

Validation of a New Instrument for Self-care in Spanish Palliative Care Professionals Nationwide

Self-care is a cornerstone issue for those who deal with stressful events, as it is the case of palliative care professionals. It has been related to awareness, coping with death and quality of life, among others, but no measurement instruments have been used in palliative care professionals. This research presents and validates a brief new measure with clinical and psychometric good properties, called Professional Self-Care Scale (PSCS). The PSCS assesses professionals' self-care in three areas: physical self-care, inner self-care, and social self-care. Data come from a cross-sectional survey in a sample of 385 professionals of palliative care. The Mindful Attention Awareness Scale, the Coping with Death Scale, and the Professional's Quality of Life measure were also used. Results of the CFA showed adequate fit (χ2(24, N = 385) = 140.66, p < .01; CFI = .91; GFI = .93; SRMR = .09; and RMSEA = .10). Evidence pointed better reliability indices for the 3-item physical and inner factors of self-care than for the social dimension (Rho and GLB of .64, .90, and .57, respectively). Evidence regarding validity was consistent with previous literature. When levels of self-care were examined, women showed higher levels of inner and social self-care (F(3, 371) = 3.19, p = .02, η2 = .03, as also did psychologists when compared to doctors and nurses (F(9, 1074) = 2.00, p = .04, η2 = .02. The PSCS has shown adequate psychometric properties, and thus it could be used as diagnostic instrument when studying professionals' health.

Palliative Care Professionals' Inner Life: Exploring the Relationships Among Awareness, Self-Care, and Compassion Satisfaction and Fatigue, Burnout, and Coping With Death

CONTEXT

Professionals working in the landscape of death and dying frequently are exposed to existential issues, psychological challenges, and emotional distress associated with care at the end of life. Identifying factors that help professionals cope with frequent exposure to issues related to mortality could enhance palliative care providers' and patients' quality of life.

OBJECTIVES

To improve our understanding of the factors associated with professionals' inner life, through the assessment of an adapted version of Kearney and Kearney's awareness model of self-care. The main assumptions of the study were that competence in coping with death and awareness would be positively related to compassion satisfaction and negatively to compassion fatigue and burnout; moreover, participating in a specific training program aimed at facing suffering and death, and self-care would positively predict coping with death.

METHODS

A cross-sectional online survey of Spanish palliative care professionals was conducted through the member e-mail list of the Spanish Society of Palliative Care. A total of 387 professionals completed the survey, which included demographic data, and personal and professional scales on the mentioned constructs.

RESULTS

Data fit reasonably well with the estimated model. Whereas the hypothesis relating spiritual training to coping with death was not supported by the data, all other aspects of the hypotheses were supported, namely self-care and awareness positively predicted professionals' competence in coping with death, and this, together with awareness, positively predicted compassion satisfaction and negatively predict compassion fatigue and burnout.

CONCLUSION

The awareness-based model of self-care was successfully tested in a multidisciplinary sample of Spanish palliative care professionals. This research applies a quantitative evaluation of the model, providing evidence of a constellation of key variables for health professionals' quality of life, such as specific training, self-care, awareness and coping with death competency.

Pediatric nurses' grief experience, burnout and job satisfaction

Correlations among grief, burnout, and job satisfaction among highly satisfied pediatric nurses were examined using the Revised Grief Experience Inventory (RGEI), Maslach Burnout Inventory (MBI), and Index of Work Satisfaction (IWS). Results showed that grief had significant correlations; positive with burnout, negative with job satisfaction. RN's reported significantly higher emotional exhaustion if their primary patients died and higher guilt if patients died younger. Conclusions suggest a dynamic statistical interaction among nurses' grief, burnout, and job satisfaction representing a pathway to intention to leave their unit, organization, or nursing. Recommendations include implementation and evaluation of grief intervention and education 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.