Resilience and death: the nursing professional in the care of children and adolescents with life-limiting illnesses

Worker Experiences of the Work Health and Safety Impacts of Exposure to Dying and Death in Clinical Settings: A Qualitative Scoping Review

Workers employed in clinical healthcare settings often encounter dying and death of patients as a part of their role. This scoping review aimed to explore the physical and psychosocial OHS impacts on health workers exposed to death within their occupational role and their inherent coping strategies. Six electronic databases PsycINFO (Ovid), Medline (Ovid), AMED (EBSCO), CINAHL (EBSCO), and Proquest Social Sciences were searched for peer reviewed research articles published between March 1971 and April 2022. PRISMA-ScR guidelines were followed. Three authors independently assessed articles for inclusion. Fifty-three studies with focus settings in hospitals, hospice, general practice and residential care were identified. Five main themes were developed and organized using and ergonomic systems approach: Cultural Environment, Workplace, Job Demands, Impacts and Coping. The findings demonstrate that caring for dying patients, the dead and their families in clinical settings impacts workers emotionally, physically, behaviorally and spiritually.

Nurses and nursing students' experiences on pediatric end-of-life care and death: A qualitative systematic review

BACKGROUND

End-of-Life care and experiencing death of infants, children, and teenagers remain one of the most difficult and traumatic events for nurses and nursing students, potentially leading to personal and professional distress. Although efforts have been made to alleviate stressors in these settings, improvements remain slow. Understanding nurses and nursing students' experiences of pediatric End-of-Life care and death in multiple care settings may direct interventions to better support quality of care and healthcare professionals in these areas.

OBJECTIVE

This review aimed to qualitatively synthesize existing literature to examine the nurses and nursing students' experiences of providing End-of-Life care to children and the death of pediatric patients.

DESIGN

The qualitative systematic review was conducted using Sandelowski and Barroso's guidelines. The included studies were appraised using the Critical Appraisal Skill Program.

DATA SOURCES

This qualitative systematic review was registered with the International Prospective Register of Systematic Reviews. Six electronic databases (Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, PsychINFO, Scopus, and Mednar) were searched from the database inception date through May 2021.

RESULTS

Thirty articles were included to form three key themes: (1) Emotional impact of pediatric End-of-Life care and death, (2) Perspective of delivering optimal care: What works and what does not, and (3) The complex role of nurses in pediatric End-of-Life care. Overall, the findings suggested that in an emotionally taxing environment, clinical and emotional support were paramount. Furthermore, there is a need to examine nurses' role in End-of-Life decision making and provide more discussion on professional boundaries.

CONCLUSION

This review offered nurses' and nursing students' perceptions of pediatric End-of Life care and death in the nursing profession. Findings can provide useful insights towards the planning of educational programs and institutional changes that supports nurses and nursing students in these settings.

Characteristics of Resilience Among Disaster Rescue Workers: A Systematic Review

Disasters can cause long-lasting damage to survivors and rescue workers. Some rescue workers suffer negative physical and psychological consequences, while others do not. Thus, it is of value to fully understand the characteristics of rescuers who have not been affected by rescue activities. Resilience refers to the ability or capacity to cope with adversity. The aim of this review is to explore and identify the characteristics of resilience among rescue workers. A systematic literature search was conducted of seven electronic databases from inception to May 2019, using keywords and medical subject heading terms related to the resilience of rescuers. Hand searches and searches of leading authors were also performed. A total of 31 articles were eligible for review. Six domains were identified to characterize the resilience of rescuers namely, demographic and physical characteristics, personality traits, coping strategies, perceived resources, being equipped with special skills for disaster rescue, and having less adverse consequences from exposure to disaster. Researchers and disaster managers can take note of these characteristics to comprehensively understand the 'positive concept' of resilience. This enhanced understanding of 'positive resilience' can in turn be used to develop a framework to assess and establish interventions, and consequently to improve the psychological wellbeing of rescuers after disaster rescue efforts.

Burnout syndrome among healthcare professionals in intensive care units: a cross-sectional population-based study

Objective

To assess the prevalence of and factors associated with Burnout syndrome among intensive care unit professionals.

Methods

In this cross-sectional population-based study, a questionnaire assessing sociodemographic, behavioral, and occupational data was administered to 241 nurses and physicians working in 17 public intensive care units in São Luis (MA), Brazil. The Maslach Burnout Inventory - Human Services Survey was used to identify Burnout syndrome based on Maslach’s and Grunfeld’s criteria. The prevalence of each dimension of the syndrome was estimated with a 95% confidence interval. Associations were estimated by the odds ratios via multiple logistic regression analyses (α = 5%).

Results

The prevalence of Burnout syndrome was 0.41% (0.01 - 2.29) according to Maslach’s criteria and 36.9% (30.82 - 43.36) according to Grunfeld’s criteria. Infant intensive care unit professionals were more likely to develop emotional exhaustion than other intensive care professionals (OR = 3.16). Respondents over the age of 35 were less likely to develop emotional exhaustion (OR = 0.32) and depersonalization (OR = 0.06). Longer working hours in intensive care units were associated with a reduced sense of personal accomplishment (OR = 1.13). Among nurses, males had a lower sense of professional accomplishment, and not exercising regularly was associated with more emotional exhaustion and less depersonalization. Among physicians, working in infant and cardiology intensive care units made them less likely to have a reduced sense of personal accomplishment, and physicians without a postgraduate degree who worked in intensive care units had a higher chance of having a lower sense of personal accomplishment.

Conclusion

This study demonstrated the low prevalence of Burnout syndrome. Most of the professionals reported low levels for each dimension of Burnout, including low levels of emotional exhaustion, low levels of depersonalization, and a lower likelihood of having a reduced sense of personal accomplishment. Nurses and physicians have different characteristics associated with Burnout syndrome.

Nursing students' relationships among resilience, life satisfaction, psychological well-being, and attitude to death

PURPOSE

This study attempted to examine the influence of resilience, life satisfaction, and psychological well-being on attitude to death.

METHODS

A predictive correlational design was used. The participants were 184 nursing students from three universities of Korea. They responded to a self-report questionnaire, with items on demographics, resilience, life satisfaction, psychological well-being, and attitude to death.

RESULTS

The mean score for attitude to death was 2.77±0.39 (range, 1-4), and a significant difference was observed depending on age, grade, and death-related education. Attitude to death was positively correlated with death-related education, resilience, life satisfaction, and psychological well-being. Results of the hierarchical multiple regression analysis indicated that death-related education and psychological well-being were significant predictors of attitude to death, explaining 26.6% of the latter. The most important factor was psychological well-being.

CONCLUSION

Although death-related education and psychological well-being are two of the most influential factors among nursing students, no more than 30.4% of this study's participants received death-related education. Death-related education is necessary to help nursing students so that they can cope positively with stressful situations by finding positive meaning. It is necessary to develop a systematic curriculum so that these students can establish a positive attitude to death.

Dynamics of stress generation and reduction in the nursing team at an oncology center

OBJECTIVE

to represent the dynamics of stress generation, accumulation and reduction in the nursing team at an oncology therapy center.

METHOD

a mathematical simulation model of system dynamics was developed based on data collection in loco. The model served to test the impact of three policies aimed at reducing stress in the team, namely i) increase in the service load; ii) increase in the size of shift teams and iii) reduction of service hours per bed.

RESULTS

the model showed that the policy of increasing the size of the team obtained the best results, with the absenteeism index stabilizing at 8%; staff at leave also stabilizing at 4-5 people per month, as well as accumulated stress reduced to baseline levels.

CONCLUSION

measures to monitor physical and emotional demands, hiring staff, better technical training for so-called stressful activities, and a better distribution of tasks can be effective in reducing absenteeism rates and improving the quality of life of these workers.

Case: A Second Victim Support Program in Pediatrics: Successes and Challenges to Implementation

PURPOSE

While there is growing attention to making health care safer, there has been less emphasis on helping health care workers to cope with stressful patient related events (these workers are commonly referred to as second victims). We used the RISE (Resilience In Stressful Events) peer support program at the Johns Hopkins Hospital as a case study for evaluating effectiveness, and identifying barriers to addressing the needs of second victims.

DESIGN AND METHODS

The study used a mixed-method approach that included: 1) quantitative analysis of surveys of health care workers in the Department of Pediatrics before RISE implementation and four years after, and 2) content analysis of open-ended commentaries about respondents' experience with seeking second victim support, as well as feedback on RISE.

RESULTS

Survey response rates were 22.4% and 23.3% respectively. Quantitative analysis showed that respondents at the later time point were more likely to contact an organizational support structure, and had greater awareness of the availability of support. Respondents were very likely (93%) to recommend RISE to others. Content analysis identified barriers to using RISE: overcoming blame culture, need to promote the initiative, and need for more staff time to handle adverse events. Respondents reported varied preferences for the support format and specific support interventions.

CONCLUSIONS

The mixed-method approach allowed a comprehensive evaluation of RISE and provided some evidence for its effectiveness in supporting pediatric health care workers.

PRACTICE IMPLICATIONS

The findings suggest an important role of organizational culture in second victim support program implementation and evaluation.

Hospitalized child and teenager with chronic diseases: feelings about death

OBJECTIVE

Analyze the feelings of hospitalized children and adolescents with chronic diseases towards death.

METHODOLOGY

Qualitative research, with four children and one teenager with chronic diseases, aged between 11 and 13 years old, who were admitted at a teaching hospital in Brazil, in the period from January to March 2009. In-depth interviews were carried out using a ludic material for therapeutic purposes, named ''As a guest in the hospital". The empirical material was submitted to thematic analysis.

RESULTS

Two mains meanings were obtained: Feelings of hospitalized children and adolescents with chronic diseases dealing with the death of the other; and children and adolescents with chronic diseases and the fear of their own deaths. Hospitalization makes children and adolescents come across the death of other sick people, arousing feelings of sadness, consternation, anxiety, making the fear of their own death become a threat.

CONCLUSION

The health team needs to be attentive to the feelings of hospitalized children and adolescents facing death so that they can get the demands, minimizing fears and anguish.