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Giacomelli L, Papa S, Vecchi L, Mercante A, Benini F. Unravelling the role of mind-body therapies in paediatric palliative care: A narrative review. Acta Paediatr 2024; 113:881-891. [PMID: 38197439 DOI: 10.1111/apa.17097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024]
Abstract
AIM Given the multifaceted nature of paediatric palliative care (PPC), integrative medicine and mind-body therapies, in particular, are increasingly used in this setting. However, to our knowledge, their use in PPC has never been specifically reviewed. Therefore, this work aims to provide a comprehensive overview of the application and possible beneficial effects of mind-body therapies in the PPC setting. METHODS Papers about the use of meditation and mindfulness, biofeedback, hypnosis, yoga, tai chi and qi gong, imagery, creative outlets, and art therapy in PPC were identified by browsing PubMed and CINHAL. RESULTS We found that the harmless nature of mind-body therapies has been extensively described, and available studies consistently show some benefits on the anxiety, stress, and quality of life of parents/caregivers and healthcare providers. However, well-grounded and robust evidence does not fully support the efficacy of mind-body therapies, especially in patients. CONCLUSION Considering the peculiarity of the PPC setting, we suggest that mind-body therapies should be further considered and properly investigated through larger controlled studies and according to the different populations of PPC children, as well as for parents, caregivers, and healthcare professionals.
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Affiliation(s)
| | | | | | - Anna Mercante
- Child and Adolescent Neuropsychiatry Unit, Ospedale San Bortolo, Vicenza, Italy
| | - Franca Benini
- Department of Women's and Children's Health, Pediatric Palliative Care, Pain Service, University of Padua, Padua, Italy
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Bradford N, Moore E, Taylor K, Cook O, Gent L, Beane T, Williams N, Alexander K, Pitt E, Still J, Wellard C, McErlean G, Kirk D, Monterosso L, McCarthy A, Lokmic-Tomkins Z, Balson J, Gates P. The cancer nursing workforce in Australia: a national survey exploring determinants of job satisfaction. BMC Nurs 2023; 22:461. [PMID: 38057825 DOI: 10.1186/s12912-023-01629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND To maintain and improve the quality of the cancer nursing workforce, it is crucial to understand the factors that influence retention and job satisfaction. We aimed to investigate the characteristics of cancer nurses in Australia and identify predictors of job satisfaction. METHODS We analysed data from an anonymous cross-sectional survey distributed through the Cancer Nurses Society Australia membership and social media platforms from October 2021 to February 2022. The survey was compared to national nursing registration data. Data were analysed with non-parametric tests, and a stepwise, linear regression model was developed to best predict job satisfaction. RESULTS Responses were received from 930 cancer nurses. Most respondents (85%) described themselves as experienced nurses, and more than half had post-graduate qualifications. We identified individual, organizational, and systemic factors that contribute to job satisfaction and can impact in workforce shortages. The findings include strategies to address and prioritize workforce challenges. There were 89 different titles for advanced practice nursing roles. Managing high workload was a reported challenge by 88%. Intention to stay less than 10 years was reported by nearly 60%; this was significantly correlated with job satisfaction and age. Significantly higher scores for job satisfaction were associated with those who had career progression opportunities, career development opportunities, adequate peer support and a clearly defined scope of role. Conversely, job satisfaction scores decreased the more people agreed there was a lack of leadership and they had insufficient resources to provide quality care. CONCLUSION Cancer nurses are critical to the delivery of cancer care however, the workforce faces multiple challenges. This study provides an understanding of the Australian cancer nursing workforce characteristics, their roles and activities, and highlights important considerations for retaining nurses in the profession.
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Affiliation(s)
- Natalie Bradford
- Cancer and Palliative Care Outcomes Centre and School of Nursing, Queensland University of Technology, QLD, Brisbane, QLD, Australia.
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia.
| | - Elizabeth Moore
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Karen Taylor
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Cancer Network WA, Perth, WA, Australia
| | - Olivia Cook
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- McGrath Foundation - Level 1, 32 Walker St North Sydney, Sydney, NSW, Australia
- Monash Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
| | - Lucy Gent
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Sir Charles Gairdner Osborne Park Hospitals Health Care Group, Perth, WA, Australia
- Edith Cowan University, Perth, WA, Australia
| | - Theresa Beane
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Hervey Bay Hospital, Queensland Health, Pialba, QLD, Australia
| | - Natalie Williams
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- King Edward Memorial Hospital, Perth, WA, Australia
| | - Kimberly Alexander
- Cancer and Palliative Care Outcomes Centre and School of Nursing, Queensland University of Technology, QLD, Brisbane, QLD, Australia
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
| | - Erin Pitt
- Cancer and Palliative Care Outcomes Centre and School of Nursing, Queensland University of Technology, QLD, Brisbane, QLD, Australia
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
| | - Jemma Still
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Gemma McErlean
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Deborah Kirk
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Edith Cowan University, Perth, WA, Australia
| | - Leanne Monterosso
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Notre Dame University, Perth, WA, Australia
| | - Alexandra McCarthy
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- The University of Queensland, Brisbane, QLD, Australia
| | - Zerina Lokmic-Tomkins
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Monash Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
| | - Jessica Balson
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Priscilla Gates
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Deakin University, Melbourne, VIC, Australia
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3
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Emal LM, Tamminga SJ, Kezic S, Schaafsma FG, Nieuwenhuijsen K, van der Molen HF. Diagnostic Accuracy and Measurement Properties of Instruments Screening for Psychological Distress in Healthcare Workers-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6114. [PMID: 37372701 DOI: 10.3390/ijerph20126114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/16/2023] [Accepted: 04/21/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Instruments with sufficient diagnostic accuracy are better able to detect healthcare workers (HCWs) who are at risk of psychological distress. The objective of this review is to examine the diagnostic accuracy and measurement properties of psychological distress instruments in HCWs. METHODS We searched in Embase, Medline and PsycINFO from 2000 to February 2021. We included studies if they reported on the diagnostic accuracy of an instrument. To assess the methodological quality of the studies with regard to diagnostic accuracy, we used the Quality Assessment of Diagnostic Accuracy Studies and, for the measurement properties, the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). RESULTS Seventeen studies reporting on eight instruments were included. Overall, the methodological quality assessing the diagnostic accuracy and measurement properties was low, specifically for items addressing the domain 'index test'. The items addressing 'reference standard', 'time and flow' and 'patient selection' were mostly unclear. The criterion validity of the single-item burnout, the Burnout-Thriving Index, and the Physician Well-Being Index (PWBI) was sufficient, with area under the curve ranging from 0.75 to 0.92 and sensitivity 71-84%, respectively. CONCLUSION Our findings indicate that it is questionable whether screening for HCWs at risk of psychological distress can be performed sufficiently with the included instruments due to the low numbers of studies per instrument and the low methodological quality.
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Affiliation(s)
- Lima M Emal
- Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health, Public and Occupational Health, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sietske J Tamminga
- Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health, Public and Occupational Health, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sanja Kezic
- Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health, Public and Occupational Health, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Frederieke G Schaafsma
- Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health, Public and Occupational Health, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Karen Nieuwenhuijsen
- Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health, Public and Occupational Health, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Henk F van der Molen
- Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health, Public and Occupational Health, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Slater PJ, Herbert AR. Mentoring the Wellbeing of Specialist Pediatric Palliative Care Medical and Nursing Trainees: The Quality of Care Collaborative Australia. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:183-194. [PMID: 36895617 PMCID: PMC9990446 DOI: 10.2147/amep.s393052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The Quality of Care Collaborative Australia (QuoCCA), working across 6 tertiary centers throughout Australia, builds capability in the generalist and specialist pediatric palliative care (PPC) workforce, by providing education in metropolitan and regional areas. As part of the education and mentoring framework, Medical Fellows and Nurse Practitioner Candidates (trainees) were funded by QuoCCA at four tertiary hospitals throughout Australia. OBJECTIVE This study explores the perspectives and experiences of clinicians who had occupied the QuoCCA Medical Fellow and Nurse Practitioner trainee positions in the specialised area of PPC at Queensland Children's Hospital, Brisbane, to identify the ways in which they were supported and mentored to maintain their wellbeing and facilitate sustainable practice. METHODS Discovery Interview methodology was used to collect detailed experiences of 11 Medical Fellows and Nurse Practitioner candidates/trainees employed by QuoCCA from 2016 to 2022. RESULTS The trainees were mentored by their colleagues and team leaders to overcome challenges of learning a new service, getting to know the families and building their competence and confidence in providing care and being on call. Trainees experienced mentorship and role modelling of self-care and team care that promoted wellbeing and sustainable practice. Group supervision provided dedicated time for reflection as a team and development of individual and team wellbeing strategies. The trainees also found it rewarding to support clinicians in other hospitals and regional teams that cared for palliative patients. The trainee roles provided the opportunity to learn a new service and broaden career horizons as well as establish wellbeing practices that could be transferred to other areas. CONCLUSION Collegial interdisciplinary mentoring, with the team learning together and caring for each other along common goals, contributed immensely to the wellbeing of the trainees as they developed effective strategies to ensure their sustainability in caring for PPC patients and families.
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Affiliation(s)
- Penelope J Slater
- Oncology Services Group, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Anthony R Herbert
- Paediatric Palliative Care Service, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
- Centre for Children’s Health Research, Queensland University of Technology, Brisbane, QLD, Australia
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Bašković M, Luetić F, Fusić S, Rešić A, Striber N, Šogorić S. Self-esteem and Work-related Quality of Life: Tertiary Centre Experience. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221128718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The goal of every organisation is to have employees with high self-esteem and employees with a good work-related quality of life (WRQoL), given that such employees are more satisfied and provide better service, which is ultimately a benefit for the organization. In order for employees to have the best possible WRQoL, the responsibility lies with the administration or health system of a particular country, which is obliged to improve the organisation in all aspects. A sample of 409 participants in the Children’s Hospital Zagreb examined their self-esteem and WRQoL. The research included both health and non-health employees. For the purpose of the research, the Rosenberg self-esteem scale and the WRQoL scale were used. The Pearson correlation coefficient between these two variables was calculated, which is the first such study. The results showed that we have employees with a high level of self-esteem, which is an excellent resource given the fact that high self-esteem has positive implications for job satisfaction and job performance. In contrast to self-esteem, employees were extremely dissatisfied with the quality of life-related to work, especially in the following categories; Working Conditions, Job and Career Satisfaction, and Control at Work. Following the above, and qualitative research, key factors were found that the management needs to address to raise the WRQoL of employees.
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Affiliation(s)
- Marko Bašković
- Department of Pediatric Surgery, Children’s Hospital Zagreb, Zagreb, Croatia
- Department of Quality and Improvement of Healthcare, Children’s Hospital Zagreb, Zagreb, Croatia
| | - Franka Luetić
- Department of Quality and Improvement of Healthcare, Children’s Hospital Zagreb, Zagreb, Croatia
| | - Snježana Fusić
- Department of Quality and Improvement of Healthcare, Children’s Hospital Zagreb, Zagreb, Croatia
| | - Arnes Rešić
- Department of Quality and Improvement of Healthcare, Children’s Hospital Zagreb, Zagreb, Croatia
- Department of Pediatric Clinical Pharmacology and Toxicology, Children’s Hospital Zagreb, Zagreb, Croatia
| | - Neda Striber
- Department of Quality and Improvement of Healthcare, Children’s Hospital Zagreb, Zagreb, Croatia
- Department of Ophthalmology, Children’s Hospital Zagreb, Zagreb, Croatia
| | - Selma Šogorić
- Department of Social Medicine and Organization of Health Care, School of Public Health ‘Andrija Štampar’, Zagreb, Croatia
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Macintyre MR, Brown BWJ, Schults JA. Factors Influencing Pediatric Hematology/Oncology Nurse Retention: A Scoping Review. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:402-417. [PMID: 35815893 DOI: 10.1177/27527530221099899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Nursing staff retention is an ongoing concern within pediatric hematology/oncology settings globally. Work-related stressors cause emotional burden, psychological distress, and burnout to which nurses respond by leaving their workplace. Consequently, workplace culture and functionality are negatively impacted, quality of care reduces, and potential harm to patients increases. This paper aims to identify the "most" influencing factors for intention to leave among pediatric hematology/oncology nurses. Methods: A systematic search was undertaken on 29 July 2021 across five electronic databases, Cumulative Index to Nursing and Allied Health Literature, Joanna Briggs Institute, MEDLINE, PubMed, and Web of Science, using MeSH and keywords related to pediatric hematology/oncology nurse retention. Results: The initial search yielded 283 articles. Following abstract and full-text review, nine articles met inclusion criteria. Across all studies, strong links between health service organizational factors (e.g., unit acuity and time constraints), clinician demographics (e.g., age, education, experience, and coping mechanisms), and nursing retention within pediatric hematology/oncology settings were observed. Direct patient care and long-term relationships with pediatric hematology/oncology patients were identified as the most frequent and intense stressors, while also presenting the most rewarding aspect of the nurse's work. Discussion: Clinician burnout and retention were found to be complex and multifaceted organizational and individual issues, which most importantly evolved from accumulative exposure to specialty-specific stressors. Interventions to prevent clinician burnout and improve staff retention, therefore, need to comprise individual and organizational level strategies specific to the healthcare context.
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Affiliation(s)
| | - Brandon W J Brown
- College of Medicine and Public Health, 1065Flinders University, Bedford Park, SA, Australia
| | - Jessica A Schults
- School of Nursing and Midwifery, 5723Griffith University, Nathan, QLD, Australia.,157827Metro North Hospital and Health Service, Herston Infectious Disease Institute, Herston, QLD, Australia.,1974University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, QLD, Australia
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Nutting R, Ofei-Dodoo S, Rose-Borcherding K, Strella G. Brief Mindfulness Intervention for Emotional Distress, Resilience, and Compassion in Family Physicians During COVID-19: A Pilot Study. PRIMER (LEAWOOD, KAN.) 2022; 6:3. [PMID: 35481235 DOI: 10.22454/primer.2022.746202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background and Objective There are high rates of professional burnout among family physicians and trainees. We undertook this study to investigate whether a brief mindfulness intervention could help manage burnout and improve well-being among family physicians in a residency program. Methods A total of 21 family physicians participated in a brief, 8-week mindfulness program. We used a single-sample, pre/post design at a Midwestern family medicine residency program. At two points in time (baseline and postintervention), participants completed an online survey measuring burnout, depression, anxiety, stress, perceived resilience, and compassion. We used linear mixed models to estimate the effect of the intervention on the outcome measures. Results Participants had improvements after the 8-week intervention. At postintervention, they had significantly better scores on anxiety (P<.004), stress (P<.001), perceived resilience (P<.001), and compassion (P<.001). There were no significant changes on the personal accomplishment, emotional exhaustion, and depersonalization subscales of either the abbreviated Maslach Burnout Inventory or the depression subscale of the Depression Anxiety Stress Scales-21. Conclusion This brief mindfulness program was associated with significant reduction in the scores of anxiety and stress as well as significant improvement in perceived resilience and compassion scores. Brief mindfulness interventions may be a convenient and effective approach to support and improve health and well-being among family physicians.
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Affiliation(s)
- Ruth Nutting
- University of Kansas School of Medicine-Wichita, Department of Family and Community Medicine, Wichita, KS
| | - Samuel Ofei-Dodoo
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Katherine Rose-Borcherding
- University of Kansas School of Medicine-Wichita, Department of Family and Community Medicine, Wichita, KS
| | - Grace Strella
- University of Kansas School of Medicine-Wichita, Department of Family and Community Medicine, Wichita, KS
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8
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Emal LM, Tamminga SJ, Daams JG, Kezic S, Timmermans DRM, Schaafsma FG, van der Molen HF. Risk communication about work-related stress disorders in healthcare workers: a scoping review. Int Arch Occup Environ Health 2022; 95:1195-1208. [PMID: 35292839 PMCID: PMC8923828 DOI: 10.1007/s00420-022-01851-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
Purposes Healthcare workers are at risk of stress-related disorders. Risk communication can be an effective preventive health measure for some health risks, but is not yet common in the prevention of stress-related disorders in an occupational healthcare setting. The overall aim is to examine whether risk communication was part of interventions aimed at the prevention of stress-related disorders in healthcare workers. Method We performed a scoping review using the framework of Arksey and O’Malley. We searched in Medline, Web of Science and PsychInfo for studies reporting on preventive interventions of stress-related disorders in healthcare workers between 2005 and December 2020. Studies were included when the intervention reported on at least one element of risk communication and one goal. We predefined four elements of risk communication: risk perception, communication of early stress symptoms, risk factors and prevention; and three goals: inform, stimulate informed decision-making and motivate action. Results We included 23 studies that described 17 interventions. None of the included interventions were primarily developed as risk communication interventions, but all addressed the goals. Two interventions used all four elements of risk communication. The prominent mode of delivery was face to face, mostly delivered by researchers. Early stress symptoms and risk factors were measured by surveys. Conclusions Risk communication on risk factors and early signs of stress-related disorders is not that well studied and evaluated in an occupational healthcare setting. Overall, the content of the communication was not based on the risk perception of the healthcare workers, which limited the likelihood of them taking action. Supplementary Information The online version contains supplementary material available at 10.1007/s00420-022-01851-x.
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Affiliation(s)
- Lima M Emal
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Universiteit van Amsterdam, Meibergdreef 9, PO Box 22700, 1100 DE, Amsterdam, Noord-Holland, The Netherlands.
| | - Sietske J Tamminga
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Universiteit van Amsterdam, Meibergdreef 9, PO Box 22700, 1100 DE, Amsterdam, Noord-Holland, The Netherlands
| | - Joost G Daams
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Universiteit van Amsterdam, Meibergdreef 9, PO Box 22700, 1100 DE, Amsterdam, Noord-Holland, The Netherlands
| | - Sanja Kezic
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Universiteit van Amsterdam, Meibergdreef 9, PO Box 22700, 1100 DE, Amsterdam, Noord-Holland, The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Frederieke G Schaafsma
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Universiteit van Amsterdam, Meibergdreef 9, PO Box 22700, 1100 DE, Amsterdam, Noord-Holland, The Netherlands
| | - Henk F van der Molen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Universiteit van Amsterdam, Meibergdreef 9, PO Box 22700, 1100 DE, Amsterdam, Noord-Holland, The Netherlands
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9
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Lanini I, Tringali D, Lauro Grotto R. Psychological Needs and Resources of the Staff in a Pediatric Neurosurgery Ward: A Phenomenological-Hermeneutic Study. Front Psychol 2022; 12:751651. [PMID: 35046865 PMCID: PMC8761729 DOI: 10.3389/fpsyg.2021.751651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Brain tumors are a common form of solid tumors in children and, unfortunately, they are characterized by a very uncertain prognosis. The treatment of this pathology often includes one or more very invasive surgical procedures, quite often in the very first steps of the treatment. Cases of brain tumors in children represent one of the greatest challenges for health care professionals in the domain of pediatric neurosurgery. This is clearly due to the complexity of the therapeutic plan, but also to the nature of the bond that is established between the child, the parents, and the members of the staff during the often-dramatic initial phase of the illness. In this phenomenological-hermeneutic study, we explore both the emotional and organizational needs, as well as the available professional and personal resources of the staff in the Neurosurgery ward of the Meyer Children’s Hospital in Florence (Italy). The ward staff, composed of 7 surgeons, a pediatric neuro-oncologist, 12 nurses, and 4 auxiliary health care professionals, underwent in-depth interviews that were recorded (with the consensus of the participants). The recordings were then transcribed and submitted to content analysis according to COREQ standards. A complex picture of emotional as well as organizational demands emerged from the data. Shared experiences were pointed out, together with more specific and idiosyncratic contents characteristic of different professional roles. The focus of the present paper was twofold, first, we considered the needs that are overtly expressed by the staff, and then we discussed the main sources of their motivational drives. We found that the latter is mainly found in the quality of the therapeutic bond that is established with the children and the family members, together with the deep interest in one’s own professional activity and the effective complementarity and integration of the personal and professional qualities of the staff members within the multidisciplinary caring group.
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Affiliation(s)
- Iacopo Lanini
- Department of Health Sciences, University of Florence, Florence, Italy.,Laboratory for Multidisciplinary Analysis of Relationships in Health Care, UNISER, Pistoia, Italy
| | - Debora Tringali
- Laboratory for Multidisciplinary Analysis of Relationships in Health Care, UNISER, Pistoia, Italy.,Associazione LAPO O.N.L.U.S., Florence, Italy
| | - Rosapia Lauro Grotto
- Department of Health Sciences, University of Florence, Florence, Italy.,Laboratory for Multidisciplinary Analysis of Relationships in Health Care, UNISER, Pistoia, Italy
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Whiting L, O'Grady M, Whiting M, Petty J. Factors influencing nurse retention within children's palliative care. J Child Health Care 2021; 25:587-602. [PMID: 33131297 DOI: 10.1177/1367493520971426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Retention of staff presents major challenges within children's palliative care; this has substantial implications for children, families and the nursing workforce. To address this, a programme was undertaken that provided pathways of professional development for senior nurses working in this field. This study reports the views of nurses completing this programme, the overall project manager (PM) and the day-to-day programme lead (PL) as well as factors that influence nurse retention within children's palliative care nursing. The study drew on an Appreciative Inquiry approach that comprised of interviews with the PM and PL as well as focus groups and questionnaires with senior nurses from the children's palliative care sector, who participated in the training programme. Thematic analysis of data from interviews and focus groups revealed factors influencing nurse retention: speciality, positivity and making a difference, support, provision of adequate resources, tailored education/professional development and resilience. These themes were supported by the questionnaire findings. The programme was perceived as having a positive influence on nurse retention within the children's palliative care workforce. In addition, it was felt to be very beneficial in terms of shared learning and development. Participants highlighted the need for similar opportunities in the future.
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Affiliation(s)
- Lisa Whiting
- Children's Nursing, 229434University of Hertfordshire, Hatfield, UK
| | - Michele O'Grady
- Children's Nursing, 229434University of Hertfordshire, Hatfield, UK
| | - Mark Whiting
- Children's Community and Specialist Nursing, Hertfordshire Community NHS Trust, UK
| | - Julia Petty
- Children's Nursing, 229434University of Hertfordshire, Hatfield, UK
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11
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Tang ML, Goh HS, Zhang H, Lee CN. An Exploratory Study on Death Anxiety and Its Impact on Community Palliative Nurses in Singapore. J Hosp Palliat Nurs 2021; 23:469-477. [PMID: 34183589 DOI: 10.1097/njh.0000000000000782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurses working in palliative care settings encounter death and dying regularly and face a greater risk of developing death anxiety and negative attitudes than their counterparts. Such distress and apprehension can cause care fatigue and affect patients' quality of life. Death anxiety remains an underresearched area in Asia, where death and dying are still considered taboo. This study explored death anxiety and its impact on community palliative nurses in Singapore and was conducted at a community hospital in Singapore from January to June 2018. Purposive sampling was used to recruit 16 nurses of different job grades for the face-to-face interviews, which were transcribed verbatim and analyzed using the data analytical approach of Miles et al. Four overarching themes were generated: (1) intrinsic factors influencing death anxiety, (2) extrinsic factors influencing death anxiety, (3) emotional struggles and coping, and (4) need for death education and psychological support. Gaps in palliative care education and death education need to be contextualized to increase the community palliative nurses' awareness and acceptance of death and enhance their death literacy in a multicultural setting.
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Li L, Lv J, Zhang L, Song Y, Zhou Y, Liu J. Association between attitude towards death and spiritual care competence of Chinese oncology nurses: a cross-sectional study. BMC Palliat Care 2021; 20:150. [PMID: 34587921 PMCID: PMC8480268 DOI: 10.1186/s12904-021-00846-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS An understanding of the oncology nurse spiritual care competence would help nurse managers recognize weakness in spiritual practice and improve the quality of spiritual care. But the relationship between attitude towards death and spiritual care competence is unknown. METHODS We recruited 326 nurses from hospitals in Guangzhou, China. The nurses completed the Chinese Spiritual Care Competence Scale and the Chinese Death Attitude Profile-Revised questionnaires. RESULTS The total score of spiritual care competence was 61.62 ± 16.10. And the lowest score of attitude towards death was for escape acceptance, 2.64 ± 0.82. Factors associated with nurse spiritual care competence were work department, whether trained in spiritual care, approaching acceptance, and escaping acceptance of attitude towards death. CONCLUSION Nurses need to perfect their spiritual care competence and establish positive attitudes towards death.
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Affiliation(s)
- Liujin Li
- School of Nursing, Guangzhou Medical University, 195 Dongfeng West Road, Yuexiu District, Guangzhou, P.R. China
| | - Jingmin Lv
- School of Nursing, Guangzhou Medical University, 195 Dongfeng West Road, Yuexiu District, Guangzhou, P.R. China
| | - Lingling Zhang
- Nursing Department, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Yalan Song
- Nursing Department, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Ying Zhou
- School of Nursing, Guangzhou Medical University, 195 Dongfeng West Road, Yuexiu District, Guangzhou, P.R. China
| | - Jiaxian Liu
- School of Nursing, Guangzhou Medical University, 195 Dongfeng West Road, Yuexiu District, Guangzhou, P.R. China.
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13
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Zaheer S, Ginsburg L, Wong HJ, Thomson K, Bain L, Wulffhart Z. Acute care nurses' perceptions of leadership, teamwork, turnover intention and patient safety - a mixed methods study. BMC Nurs 2021; 20:134. [PMID: 34330272 PMCID: PMC8323271 DOI: 10.1186/s12912-021-00652-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study contributes to a small but growing body of literature on how context influences perceptions of patient safety in healthcare settings. We examine the impact of senior leadership support for safety, supervisory leadership support for safety, teamwork, and turnover intention on overall patient safety grade. Interaction effects of predictors on perceptions of patient safety are also examined. METHODS In this mixed methods study, cross-sectional survey data (N = 185) were collected from nurses and non-physician healthcare professionals. Semi-structured interview data (N = 15) were collected from nurses. The study participants worked in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario. RESULTS Hierarchical regression analyses showed that staff perceptions of senior leadership (p < 0.001), teamwork (p < 0.01), and turnover intention (p < 0.01) were significantly associated with overall patient safety grade. The interactive effect of teamwork and turnover intention on overall patient safety grade was also found to be significant (p < 0.05). The qualitative findings corroborated the survey results but also helped expand the characteristics of the study's key concepts (e.g., teamwork within and across professional boundaries) and why certain statistical relationships were found to be non-significant (e.g., nurse interviewees perceived the safety specific responsibilities of frontline supervisors much more broadly compared to the narrower conceptualization of the construct in the survey). CONCLUSIONS The results of the current study suggest that senior leadership, teamwork, and turnover intention significantly impact nursing staff perceptions of patient safety. Leadership is a modifiable contextual factor and resources should be dedicated to strengthen relational competencies of healthcare leaders. Healthcare organizations must also proactively foster inter and intra-professional collaboration by providing teamwork educational workshops or other on-site learning opportunities (e.g., simulation training). Healthcare organizations would benefit by considering the interactive effect of contextual factors as another lever for patient safety improvement, e.g., lowering staff turnover intentions would maximize the positive impact of teamwork improvement initiatives on patient safety.
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Affiliation(s)
- Shahram Zaheer
- School of Health Policy and Management, York University, Toronto, Canada. .,Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | - Liane Ginsburg
- School of Health Policy and Management, York University, Toronto, Canada
| | - Hannah J Wong
- School of Health Policy and Management, York University, Toronto, Canada
| | - Kelly Thomson
- School of Administrative Studies, York University, Toronto, Canada
| | - Lorna Bain
- Interprofessional Collaboration and Education, Southlake Regional Health Centre, Newmarket, Canada.,University of Toronto, Toronto, Canada
| | - Zaev Wulffhart
- University of Toronto, Toronto, Canada.,Regional Cardiac Care Program, Southlake Regional Health Centre, Newmarket, Canada
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14
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Providing Palliative and Hospice Care to Children, Adolescents and Young Adults with Cancer. Semin Oncol Nurs 2021; 37:151166. [PMID: 34175165 DOI: 10.1016/j.soncn.2021.151166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To describe palliative, concurrent, and hospice care in pediatric oncology in the United States (US), we present a clinical scenario illustrating palliative and hospice care, including eligibility for concurrent care, insurance coverage and billing, barriers to accessing quality pediatric palliative and hospice care, and implications for oncology nursing practice. DATA SOURCES Peer-reviewed articles, clinical practice guidelines, professional organizations, and expert clinical opinion examining pediatric oncology, palliative care, and hospice care. CONCLUSION Understanding the goals of palliative and hospice care and the differences between them is important in providing holistic, goal-directed care. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses play a pivotal role in supporting the goals of pediatric palliative care and hospice care and in educating patients and their families. Nurses form trusting relationships with pediatric oncology patients and their families and are in a position to advocate for best palliative care practices as disease progresses to end of life, including when appropriate concurrent care or hospice.
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15
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Farmer N, Cotter EW. Well-Being and Cooking Behavior: Using the Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment (PERMA) Model as a Theoretical Framework. Front Psychol 2021; 12:560578. [PMID: 33912092 PMCID: PMC8071848 DOI: 10.3389/fpsyg.2021.560578] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 03/18/2021] [Indexed: 01/02/2023] Open
Abstract
The prevalence of psychosocial distress is increasing in the United States. At the same time, the American default lifestyle has steadily displaced household food production with industrial food production, despite increased cultural interest in cooking. An important focus of cooking research to date has been on cooking's association with nutrition and dietary quality. Less focus has been placed on how cooking might foster the qualities that allow for mitigation of psychosocial distress and promote well-being. Rooted in its evolutionary role in the human experience, cooking requires skills and knowledge that have the capacity to encourage aspects of well-being as described by Seligman as flourishing. Evidence for a beneficial role of cooking in psychosocial health exists, but the exploration is limited, potentially due to lack of a theoretical context to explain these benefits. From this perspective, we review the current literature showing the application of Seligman's prominent well-being model, Positive emotion, Engagement, Relationships, Meaning, and Accomplishment (PERMA), to cooking, defined as the activity related to the preparation of food or a meal. We propose that the PERMA model as applied to cooking may function as a theoretical framework to explore psychosocial outcomes associated with cooking. Broader application of this approach may also help to further the application of positive psychology in the developing literature around psychosocial health and nutrition-related chronic diseases.
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Affiliation(s)
- Nicole Farmer
- National Institutes of Health, Clinical Center, Bethesda, MD, United States
| | - Elizabeth W Cotter
- Department of Health Studies, American University, Washington, DC, United States
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16
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Creese J, Byrne JP, Conway E, Barrett E, Prihodova L, Humphries N. "We All Really Need to just Take a Breath": Composite Narratives of Hospital Doctors' Well-Being during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2051. [PMID: 33669828 PMCID: PMC7921910 DOI: 10.3390/ijerph18042051] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/05/2021] [Accepted: 02/17/2021] [Indexed: 12/16/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic poses a challenge to the physical and mental well-being of doctors worldwide. Countries around the world introduced severe social restrictions, and significant changes to health service provision in the first wave of the pandemic to suppress the spread of the virus and prioritize healthcare for those who contracted it. This study interviewed 48 hospital doctors who worked in Ireland during the first wave of the pandemic and investigated their conceptualizations of their own well-being during that time (March-May 2020). Doctors were interviewed via Zoom™ or telephone. Interview transcripts were analyzed using structured thematic analysis. Five composite narratives are presented which have been crafted to illustrate themes and experiences emerging from the data. This study found that despite the risks of contracting COVID-19, many doctors saw some improvements to their physical well-being in the first wave of the pandemic. However, most also experienced a decline in their mental well-being due to anxiety, emotional exhaustion, guilt, isolation and poor support. These findings shed light on doctor well-being during COVID-19, and the ways in which they have been affected by the pandemic, both professionally and personally. The paper concludes by highlighting how doctors' work life and well-being can be better supported during and after the COVID-19 pandemic.
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Affiliation(s)
- Jennifer Creese
- Royal College of Physicians of Ireland, Dublin D02 X266, Ireland; (J.-P.B.); (L.P.); (N.H.)
| | - John-Paul Byrne
- Royal College of Physicians of Ireland, Dublin D02 X266, Ireland; (J.-P.B.); (L.P.); (N.H.)
| | - Edel Conway
- DCU Business School, Dublin City University, Dublin D09 V209, Ireland;
| | - Elizabeth Barrett
- School of Medicine, University College Dublin, Dublin D04 V1W8, Ireland;
- Children’s University Hospital Temple Street, Dublin D01 F772, Ireland
| | - Lucia Prihodova
- Royal College of Physicians of Ireland, Dublin D02 X266, Ireland; (J.-P.B.); (L.P.); (N.H.)
| | - Niamh Humphries
- Royal College of Physicians of Ireland, Dublin D02 X266, Ireland; (J.-P.B.); (L.P.); (N.H.)
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Isobel S, Wilson A, Gill K, Schelling K, Howe D. What is needed for Trauma Informed Mental Health Services in Australia? Perspectives of clinicians and managers. Int J Ment Health Nurs 2021; 30:72-82. [PMID: 33169478 DOI: 10.1111/inm.12811] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 01/21/2023]
Abstract
Trauma Informed Care is an approach to the delivery of mental health care that requires sensitivity to the prevalence and effects of trauma in the lives of people accessing services. While TIC is increasingly emphasized in mental health policy and frameworks in Australia, people working in mental health settings have reportedly struggled to translate the values and principles into their everyday practice. This qualitative study used an experience-based co-design methodology to explore the potential for implementation of Trauma Informed Care into mental health services in Australia. The experiences of consumers, carers, clinicians, and managers were gathered. This paper presents the perspectives of clinicians (n = 64) and senior managers (n = 9) from across three Local Health Districts in New South Wales in Australia. All data were analysed thematically to address the research question: What is needed for Trauma Informed Mental Health Services in Australia? To be trauma-informed, managers required: leadership at all levels, access to resource, relevant and accessible training, support for staff, resolution of wider systems issues, and clarification of the concept and actions of TIC. Clinicians identified that to be trauma-informed they required services to: be aware of staff well-being, support different ways of working, address workplace cultures and provide increased resources. The findings have implications for any service, team or individual seeking to implement TIC within mental health settings.
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Affiliation(s)
- Sophie Isobel
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Allyson Wilson
- Mental Health Services, Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Katherine Gill
- Consumer Led Research Network, University of Sydney, Sydney, New South Wales, Australia
| | - Kathleen Schelling
- Mental Health Services, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Deborah Howe
- NSW Agency for Clinical Innovation, North Ryde, New South Wales, Australia
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Kudubes AA, Akıl ZK, Bektas M, Bektas İ. Nurses' Attitudes Towards Death and Their Effects on Spirituality and Spiritual Care. JOURNAL OF RELIGION AND HEALTH 2021; 60:153-161. [PMID: 31598824 DOI: 10.1007/s10943-019-00927-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study aimed to determine the effect of nurses' attitudes towards death on spirituality and spiritual care. This is a descriptive and correlational study. There was a moderate correlation between the total score on the Spirituality and Spiritual Care Rating Scale and the total and subdimension scores on the Attitude Towards Death Scale. It was found that the scores on the subdimensions of objective acceptance, escaping/acceptance and fear of death explained 41.7% of nurses' perceptions of spirituality and spiritual care. For holistic nursing care, it is very important that nurses are aware of their patients' spiritual needs and are capable of providing supportive spiritual service without regard for their own attitudes towards or spiritual thoughts about death.
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Affiliation(s)
| | | | - Murat Bektas
- Faculty of Nursing, Dokuz Eylul University, Inciralti, 35340, Izmir, Turkey
| | - İlknur Bektas
- Faculty of Nursing, Dokuz Eylul University, Inciralti, 35340, Izmir, Turkey
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Beavis J, Davis L, McKenzie S. Clinical Supervision for Support Workers in Paediatric Palliative Care: A Literature Review. Clin Child Psychol Psychiatry 2021; 26:191-206. [PMID: 33050722 DOI: 10.1177/1359104520961431] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Providing home care to children with complex physical health needs is an emotionally challenging role. Extant literature and documents such as the Cavendish Review (2013) have reported that a large proportion of care for this population is carried out by non-registered staff (support workers). Provision of clinical supervision for nurses working in palliative care is increasing, however, supervision needs of support workers are commonly neglected. This paper sought to synthesise what is known about clinical supervision practices for support workers in paediatric palliative care (PPC). A literature review was conducted in accordance with integrative review guidelines. 315 papers were identified initially, 15 studies were included in this review. Four commonalities were identified: importance of team cohesion, varying degrees of formality, self-awareness and practicalities. Support workers received varying forms of supervision and some facilitators faced organisational difficulties involving staff in supervision. Support workers who received staff support generally appreciated it in recognition that their work is complex and emotionally difficult. This paper highlighted that further research should investigate the efficacy of clinical supervision as a method of reducing stress and burnout for support workers. Any implementation of supervision should involve a considered approach to training and supervision to ensure fidelity.
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Affiliation(s)
- Jonathan Beavis
- The Lifetime Psychology Service, Sirona Care & Health, Bristol, UK
| | - Lucy Davis
- The Lifetime Psychology Service, Sirona Care & Health, Bristol, UK
| | - Sian McKenzie
- The Lifetime Psychology Service, Sirona Care & Health, Bristol, UK
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20
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Ouellette RR, Goodman AC, Martinez-Pedraza F, Moses JO, Cromer K, Zhao X, Pierre J, Frazier SL. A Systematic Review of Organizational and Workforce Interventions to Improve the Culture and Climate of Youth-Service Settings. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:764-778. [PMID: 32303926 PMCID: PMC9872793 DOI: 10.1007/s10488-020-01037-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Both organizational culture and climate are associated with service quality and outcomes across youth-service settings. Increasing evidence indicates capacity of organizational interventions to promote a positive and effective culture and climate. Less is known about common intervention components across studies and service settings. The current systematic review reviewed 9223 citations and identified 31 studies, across six youth-service settings, measuring changes over time in organizational culture and climate following implementation of an organizational or workforce support intervention. Results highlight the promise of organizational interventions, a need for more comparison and randomized designs, and future directions for maximizing capacity of organizations to promote health for frontline providers and the children they serve.
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