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

Traumatic experiences, quality of life, and organizational commitment among midwives: A cross-sectional study

BACKGROUND

The work of midwives is emotionally challenging. Midwives share moments of joy, when a baby is born, and attend complex events of loss and trauma. Exposure to childbirth complications, emergencies, and loss can affect their professional quality of life and functioning. This aspect of midwives' practice has not been sufficiently researched.

AIM

To examine the associations between exposures to traumatic events, post-traumatic symptoms, and personal resilience with professional quality of life and organizational commitment among hospital midwives.

METHODS

Participants in this cross-sectional study conducted in 2020 included 131 midwives from three large hospitals in central Israel. Data were collected using a structured self-administered questionnaire that examined socio-demographic characteristics, exposure to traumatic events during childbirth, personal resilience, post-traumatic symptoms, professional quality of life, and organizational commitment.

RESULTS

The three most traumatic events for midwives were: neonatal death or feared death, maternal death or feared death, and stillbirth. The more frequent the exposure to traumatic events, the more numerous and intense the post-traumatic symptoms. The more numerous and intense the post-traumatic symptoms, the higher the level of professional burnout and compassion fatigue and the lower the compassion satisfaction. Higher compassion satisfaction and lower professional burnout were associated with higher organizational commitment. Personal resilience, country of birth, post-traumatic symptoms, and organizational commitment predicted compassion satisfaction.

CONCLUSIONS

Midwives' exposure to traumatic events is associated with the onset of post-traumatic symptoms, impaired professional quality of life, and reduced organizational commitment, and is accompanied by burnout and compassion fatigue. There is a need to address this issue in training programs and to develop organizational support and policies to improve midwives' well-being and quality of care.

Subjective rather than objective patient death experiences link with physicians' and nurses' professional quality of life

BACKGROUND

Patient deaths are impactful events for professional caregivers in both their professional and personal lives. The present study aims to explore how both subjective and objective patient death experiences are related to various aspects of professional quality of life (ProQOL) among physicians and nurses.

METHODS

Secondary analyses of cross-sectional data were conducted, and 306 Chinese physicians and nurses whose most recent patient death experience was more than one month prior were included. Objective and subjective patient death experiences were measured based on the number of past patient deaths and the Accumulated Global Changes (AGC) subscale of the Professional Bereavement Scale, respectively. ProQOL was measured with the Professional Quality of Life Scale. Regressions were run following bivariate analyses.

RESULTS

The number of past patient deaths was not significantly linked with any of the three ProQOL scores in either the bivariate analyses or regressions. Meanwhile, higher AGC scores were associated with higher burnout, secondary traumatic stress, and compassion satisfaction scores after participants' age, occupation (physician/nurse), department, work experience, job commitment, and sense of mission were controlled.

CONCLUSION

Subjective rather than objective past patient death experiences link significantly with all three aspects of physicians' and nurses' ProQOL. The more professional caregivers think that they have been changed by all past patient deaths in their career, the more they experience burnout and secondary traumatic stress, but, the more satisfied they are with their job and the helping itself.

Determinants of psychological injury among health and social care workers in community settings: A systematic review

BACKGROUND

Health and Social Care (HSC) workers face psychological health risks in the workplace. While many studies have described psychological injuries in HSC workers, few have examined the determinants. Previous research has primarily focused on hospitals, lacking systematic reviews of community-based settings.

OBJECTIVE

To systematically identify and appraise current evidence on the determinants of psychological injuries among HSC workers in community settings.

METHODS

Searches were conducted in three bibliographic databases, supplemented by citation searches. Included studies focused on community-based HSC workers, reporting statistical associations between psychological injury and personal, health, occupational, or organizational factors. Quantitative studies published in English between January 1, 2000 and August 15, 2023 were included. Quality appraisal was undertaken using the JBI critical appraisal checklist.

RESULTS

Sixty-six studies were included. Study quality was highly variable, and all studies were cross-sectional. Twenty-three studies linked psychological injury with occupational factors (e.g. low job control, high job demands and low job satisfaction). Thirteen studies observed an association between work environment and psychological injury, and a further eleven between workplace social support and psychological injury. Fewer studies have examined the relationship between psychological injury and personal/individual factors.

CONCLUSION

Occupational and organisational factors are significantly associated with psychological health among HSA workers, in community settings. These aspects of job design, work environment and workplace relationships are modifiable, suggesting an opportunity for work design interventions to improve workers' psychological health and reduce the prevalence of psychological injury in this sector.

Clinicians' perceptions of the emotional impact of providing palliative care: A qualitative interview study

OBJECTIVES

Many aspects of palliative care, such as managing (complicated) symptoms, conducting goals-of-care conversations, and repeated exposure to loss, can be stressful to clinicians. Previous research on the emotional impact of providing palliative care was mainly done in specialist settings. However, the majority of palliative care is provided by clinicians who are not specialized in palliative care, and can be supported by palliative care specialists only when needed. Therefore, this study aimed to gain insight into the emotional impact of providing palliative care on clinicians, both palliative care generalists and specialists.

METHODS

A qualitative interview study among 21 clinicians (11 doctors and 10 nurses) working in hospitals, home care, or nursing homes in the Netherlands was conducted. Between February and June 2019, 13 palliative care generalists and 8 specialists were interviewed. Interviews were thematically analyzed by two researchers.

RESULTS

All clinicians considered the emotional impact of providing palliative care to be substantial and experienced both positive and negative aspects of providing palliative care. Several aspects of providing palliative care can support or undermine emotional stability. These so-called facilitators and barriers, such as practicing self-care and complexity of palliative care, were found at three different levels: individual, team, and organization.

SIGNIFICANCE OF RESULTS

Although clinicians experience providing palliative care as meaningful and valuable, the emotional impact is considerable. Negative and positive aspects often co-exist. Further insight into the dynamics and magnitude of the emotional impact of providing palliative care is needed in order to create a healthy working environment and develop adequate interventions.

Work environmental factors associated with compassion satisfaction and end-of-life care quality among nurses in general wards, palliative care units, and home care settings: A cross-sectional survey

BACKGROUND

Nurses providing end-of-life care experience not only burnout and compassion fatigue, but also positive effects such as compassion satisfaction. Nurses' compassion satisfaction was shown to be related to job satisfaction, work engagement, and nurse caring. Studies in emergency departments, intensive care units, oncology wards, and general wards have identified work environmental factors associated with nurses' compassion satisfaction, but no similar studies have been conducted in palliative care units or home care settings. It is also unknown whether work environmental factors associated with compassion satisfaction contribute to end-of-life care quality.

OBJECTIVE

To explore work environmental factors associated with nurses' compassion satisfaction and end-of-life care quality in three types of workplaces: general wards, palliative care units, and home care settings.

DESIGN

A cross-sectional survey of nurses providing end-of-life care.

SETTINGS

Sixteen general wards, 14 palliative care units, and 25 home-visit nursing agencies in Japan.

PARTICIPANTS

There were 347 study participants: 95 nurses in general wards, 128 in palliative care units, and 124 in home care settings.

METHODS

Compassion satisfaction was assessed using the Professional Quality of Life Scale, and end-of-life care quality was rated on a 4-point scale. Work environments were assessed using the Areas of Worklife Survey, which measures the fit between an individual and their work environment in six areas: workload, control, reward, community, fairness, and values.

RESULTS

Compared to nurses in general wards and palliative care units, home care nurses scored statistically significantly higher on all work environmental factors except reward. Work environmental factors that were significantly positively associated with higher compassion satisfaction were values in general wards (β = 0.335, P = 0.007), reward and workload in palliative care units (β = 0.266, P = 0.009 and β = 0.179, P = 0.035), and community and control in home care settings (β = 0.325, P = 0.001 and β = 0.261, P = 0.004). In addition, higher scores for workload in general wards (odds ratio = 5.321; 95 % confidence interval, 1.688-16.775) and for community in palliative units (odds ratio = 2.872; 95 % confidence interval, 1.161-7.102) were associated with higher end-of-life care quality. No associated work environmental factors were found in home care settings.

CONCLUSIONS

Work environmental factors associated with nurses' compassion satisfaction and end-of-life care quality varied between workplaces. These results may contribute to creating work environments that are appropriate for each workplace type to maintain both nurses' compassion satisfaction and end-of-life care quality.

TWEETABLE ABSTRACT

Work environmental factors associated with nurses' compassion satisfaction and end-of-life care quality were identified in three workplaces.

The mediating effects of attitude toward death and meaning of life on the relationship between perception of death and coping with death competence among Chinese nurses: a cross-sectional study

Background

It is important to understand how the perception of death affects the competence to cope with death.

Objectives

To explore whether the perception of death has an indirect effect on competence to cope with death through the mediation of attitude toward death and meaning of life.

Methods

A total of 786 nurses from Hunan Province, China, selected by random sampling method and asked to complete an online electronic questionnaire between October and November 2021 were included in the study.

Results

The nurses’ scored 125.39 ± 23.88 on the competence to cope with death. There was a positive correlation among perception of death, competence to cope with death, the meaning of life, and attitude toward death. There were three mediating pathways: the separate mediating effect of natural acceptance and meaning of life, and the chain mediating effect of natural acceptance and meaning of life.

Conclusion

The nurses’ competence to cope with death was moderate. Perception of death could indirectly and positively predict nurses’ competence to cope with death by enhancing natural acceptance or sense of meaning in life. In addition, perception of death could improve natural acceptance and then enhance the sense of meaning in life to positively predict nurses’ competence to cope with death.

Frequency and Prediction of Burnout Among Physicians Who Completed Palliative Care Fellowship Training - A 10 Year Survey

CONTEXT

Palliative Care (PC) physicians are vulnerable to burnout given the nature of practice. Reports suggest that burnout frequency is variable across different countries.

OBJECTIVE

The main objective of our study was to determine knowledge, attitudes and frequency of burnout among Hospice and Palliative Medicine (HPM) Fellowship graduates trained at a comprehensive cancer center.

METHODS

We conducted a survey to determine the knowledge, attitudes, and frequency of burnout in former fellows, consisting of the Maslach Burnout Inventory (MBI) and 41 custom questions. Palliative care fellows who trained at a Comprehensive Cancer Center from 2008 to 2018 were included in the survey.

RESULTS

Eighty-four percent of the 52 eligible physicians completed surveys. Median age was 38 years, with 68% females. Seventy-seven percent practiced PC more than 50% of time. Median practice duration was four years, and 84% were board certified. Most common disease types treated were cancer (89%), cardiac (43%) and pulmonary (43%). Burnout rate was high at 52% (n=20). The median scores for emotional exhaustion were 25.5, depersonalization 9, and personal accomplishment 48. Female gender (P=0.07) and having administration as a component in the job description (P=0.044) were associated with risk of burnout. Clinical care setting, work hours/week, frequency of weekend calls, and size of team were not significantly associated with burnout.

CONCLUSION

Burnout among former fellows trained in HPM between 2008 and 2018 is high. More research is needed to develop strategies to better prevent and manage burnout among HPM fellowship trained PC physicians.

Resilience at Work, Burnout, Secondary Trauma, and Compassion Satisfaction of Social Workers Amidst the COVID-19 Pandemic

Social workers during the COVID-19 pandemic are at risk due to exposure to varied populations in need, which may impact their resilience, burnout, secondary trauma, and compassion satisfaction. The study assessed resilience at work, burnout, secondary trauma, and compassion satisfaction among social workers in Israel during the first wave of the COVID-19 pandemic (May to June 2020). A convenience sample of 332 social workers (291 women (87.6%)) filled out an online, structured questionnaire that included demographics, a professional quality of life scale (ProQOL) (including three subscales), and resilience at work (RAW) (including seven subscales). The overall mean of the RAW was medium (M = 71, SD ± 8.9) compared to standardized scores. The mean scores of two of the subscales of the RAW, maintaining perspective and staying healthy, were low. The mean scores of the sub-scales of ProQOL were: compassion satisfaction was close to the 50th percentile (M = 48.25); burnout (M = 30.18) and secondary trauma (M = 26.27) were below the 25th percentile. Significant low to medium positive associations were found between all the dependent variables, except for staying healthy. A negative association was identified between compassion satisfaction and burnout, as well as between compassion satisfaction and secondary trauma. High levels of compassion satisfaction and contentment, low levels of secondary trauma, and having a managerial position were predicted to be 40% of the RAW. Lower levels of maintaining perspective, secondary trauma, and being younger predicted 27% of burnout. Higher levels of finding your calling, living authentically, maintaining perspective, interacting cooperatively, being older, and not being a manager predicted 58% of compassion satisfaction. Lower levels of burnout, maintaining perspective, and being younger predicted 36% of secondary trauma. As the COVID-19 pandemic still challenges most societies, policymakers should consider ways to integrate mechanisms that will enhance social workers' resilience at work.

Quality of work life and working conditions among oncology nurses: A national online descriptive cross-sectional study

The aim of this study was to examine the quality of work life (QoWL) and working conditions of oncology nurses in Turkey. The study utilized a descriptive cross-sectional design. The data were collected via the introductory information form and Brooks' Quality of Nursing Work Life Survey. The study was completed with 138 nurses. The factors affecting QoWL were determined using stepwise multiple linear regression. Nurses had a moderate QoWL, and age, duration of working in nursing, the number of nurses, and the working style were significantly associated with QoWL. To improve the QoWL, the nurses' socio-demographic factors should be considered and working conditions should be improved. Furthermore, well-designed institutional policies should be developed to improve the patient-nurse ratio and provide a quality healthcare.What this paper adds?In the current study, Turkish oncology nurses had a moderate quality of work life.Age, duration of working in the nursing, the number of nurses in the unit and the working style were linked to work-related quality of life in oncology nurses.Well-designed institutional policies should be developed to improve the working conditions and to increase work-related quality of life in oncology nurses.

Quality of palliative nursing care: Meaning, death anxiety, and the mediating role of well-being

BACKGROUND

There is increasing concern regarding the quality of palliative nursing care. However, despite the growing number of studies identifying related variables, there is still a paucity of studies analyzing models of how these variables interrelate.

OBJECTIVE

The study aimed to identify the role played in the quality of palliative care of nursing professionals by the variables meaning and death anxiety and to investigate the mediating role of psychological well-being and engagement.

METHOD

176 palliative nursing professionals participated, selected by non-probabilistic convenience sampling using the snowball method. A simple mediation analysis and a multiple mediator model were performed in parallel, and data were collected using a paper and online questionnaire between January and May 2018.

RESULTS

Well-being mediated the impact of meaning (indirect effect = 0.096, SE = 0.044, 95% confidence interval (CI): 0.028, 0.213) and death anxiety (indirect effect = -0.032, SE = 0.013, 95% CI: -0.064, -0.010) on the quality of care. Engagement, on the other hand, only mediated the impact of meaning (indirect effect = 0.185, SE = 0.085, 95% CI: 0.035, 0.372), while the indirect effect of death anxiety with the quality of care through engagement was not statistically significant (indirect effect = 0.008, SE = 0.009, 95% CI: -0.004, 0.032).

SIGNIFICANCE OF RESULTS

Death anxiety is not directly related to the quality of care, but rather has an effect through psychological well-being, a variable acting as a mediator between the two. The effect of meaning on the quality of care is explained by the mediation of both engagement and psychological well-being, and its impact on the quality of care is thereby mediated by more variables than death anxiety.

A Japanese Nationwide Survey of Nutritional Counseling for Cancer Patients and Risk Factors of Burnout among Registered Dietitians

Purpose

Registered dietitians have played a key role in the nutritional management of cancer patients; however, no study has investigated the prevalence of burnout and associated factors among this population. The aim of this study was to investigate the following: (1) experiences, approaches, and perspectives during nutritional counseling, (2) the prevalence of burnout, and (3) burnout-associated factors among registered dietitians.

Methods

A nationwide survey with self-administered questionnaires was conducted for 1070 registered dietitians belonging to all 390 designated cancer hospitals in Japan. Nutrition counseling, the prevalence of burnout, and burnout-associated factors were analyzed.

Results

A total of 631 responses were analyzed. Half of the respondents recommended a consultation about treatment of symptoms or listened to their patients' distress and anxiety of death. Respondents with a severe level of burnout for emotional exhaustion, depersonalization, and personal accomplishment (PA) were 21.1%, 2.8%, and 71.9%, respectively. Burnout was associated with fewer years of clinical experience, more overtime hours, higher score of Patient Health Questionnaire-9, higher score of K-6, not so positive attitude about caring for dying patients, the approach of listening to the patients and family distress and anxiety about death, the uneasiness interacting with patients and families without an effective proposal, the difficulty of allocating staff without increasing medical costs, and the absence of feeling of a good contribution to patients and families.

Conclusions

The prevalence of burnout on PA was quite high. Registered dietitians who engaged in nutritional counseling for cancer patients and families might benefit from education to help protect against burnout.

Palliative Care Professionals' Inner Life: Exploring the Mediating Role of Self-Compassion in the Prediction of Compassion Satisfaction, Compassion Fatigue, Burnout and Wellbeing

CONTEXT

Palliative care professionals are exposed to suffering on a daily basis. Working in such an environment frequently raises existential issues, psychological challenges, and emotional distress, that can detract from compassionate care. Identifying factors that help professionals cope with frequent exposure to issues related to mortality, such as compassion, could enhance palliative care providers' and patients' quality of life and wellbeing.

OBJECTIVES

To improve our understanding of the factors associated with professionals' inner life studying the role of self-compassion as a mediating variable between self-care and awareness and professionals' quality of life, and quantifying the impact of compassionate care.

METHODS

A cross-sectional online survey of palliative care professionals was conducted through the Spanish Society of Palliative Care. 296 professionals answered the survey.

RESULTS

The model tested showed an adequate fit (χ²(212) = 476.688 (P < .001), CFI = .907, RMSEA = .066 [.058,.073], and SRMR = .068), and the hypotheses were supported. Self-care and awareness predicted coping with death and self-compassion, which in turn predicted professional quality of life. Self-compassion had the greatest predictive power. Professional quality of life showed a statistically significant and positive effect on personal wellbeing, explaining more than 50% of its variance (R² = .574; P < .001).

CONCLUSION

For palliative care professionals, the cultivation of self-compassion is equally needed as compassion for others. Professional quality of life and compassionate care are related to professionals' wellbeing: when professionals take care of themselves, this will lead in a more compassionate care, but also in healthier, happier professionals.

The effect of death anxiety in nurses on their approach to dying patients: A cross-sectional study

PURPOSE

This study was conducted to determine death anxiety levels in nurses and to examine its effect on their approach to dying patients.

DESIGN AND METHODS

The study was conducted with 240 nurses. Study data were collected by Personal Information Form, Thorson-Powell Death Anxiety Scale, and Approach to Death and Dying Patients Attitude Scale.

FINDINGS

According to the total scores of the nurses included in the study, it was determined that they experienced mild death anxiety and exhibited a moderate attitude of avoidance towards death and dying patients.

CONCLUSION

This study showed that as the death anxiety of nurses increased, their avoidance attitudes towards dying patients decreased.

The Impact of the COVID-19 Pandemic on ICU Healthcare Professionals: A Mixed Methods Study

The large numbers of patients admitted to intensive care units due to COVID-19 has had a major impact on healthcare professionals. The incidence of mental health disorders among these professionals has increased considerably and their professional quality of life has suffered during the pandemic. This study aims to explore the impact of the provision of COVID-19 patient care on ICU healthcare professionals. A mixed methods study with an exploratory concurrent design was conducted between June and November 2020 in the Balearic Islands, Spain. Data were collected using a self-report online survey (n = 122) based on three validated questionnaires, and individual semi-structured in-depth online interviews (n = 11). Respondents scored 2.5 out of 5 on the moral distress scale, moderate/high on the compassion satisfaction scale, and moderate on the burnout and compassion fatigue subscales. Age was significantly and negatively related to professional quality of life but was positively related to workload and unavailability of protective equipment. Three main groups of themes relating to the impact of the pandemic emerged from the in-depth interviews: (a) clinical, (b) professional, and (c) personal and family impacts in the two waves. ICU healthcare professionals should be viewed as second victims of the COVID-19 pandemic as they have suffered significant psychological, professional, and moral harm.

Healthcare Professionals' Work-Related Stress in Palliative Care: A Cross-Sectional Survey

CONTEXT

Providing palliative care can lead to work-related stress and ultimately to burnout. The need for palliative care will further increase due to population aging and people living longer with life-threatening diseases. Therefore, a healthy palliative care workforce is vital.

OBJECTIVES

This study aims to get insight into the experienced work-related stress among healthcare professionals providing palliative care in the Netherlands and their strategies and needs in relation to maintaining a healthy work-life balance.

METHODS

A cross-sectional online survey among members of the Dutch Association for Palliative Care Professionals was conducted between February and March 2020. Burnout was assessed by the validated Burnout Assessment Tool. Self-constructed questions assessed strategies and needs of healthcare professionals providing palliative care regarding work-related stress.

RESULTS

In total 179 eligible respondents responded (response rate 54%). Respondents were mostly female (79%) and older than 50 years (66%). Most respondents were nurses (47%) and physicians (39%). Two-thirds of respondents (69%) experienced a median level of burnout and 2% a (very) high level. Furthermore, 7% had been on sick leave due to burnout. Although healthcare professionals engage on average in 3.7 coping activities, a quarter (23%) felt that these activities were not sufficient to maintain balanced. Respondents feel a need for activities aimed at the team and organisation level such as feeling emotionally safe within their team.

CONCLUSION

Symptoms of burnout are quite prevalent among healthcare professionals providing palliative care in the Netherlands. Healthcare professionals have a need for team and organisation approaches to maintain a healthy work-life balance.

Compassion fatigue and compassion satisfaction among palliative care health providers: a scoping review

BACKGROUND

Palliative care can be demanding and stressful for providers. There is increasing recognition in the literature of the impact of caregiving in palliative care settings, including compassion fatigue and compassion satisfaction. However, to date this literature has not been systematically reviewed. The purpose of this scoping review was to map the literature on compassion fatigue and compassion satisfaction among palliative care health providers caring for adult patients.

METHODS

Scoping review method guided by Joanna Briggs Institute guidelines was conducted using four electronic databases to identify the relevant studies published with no time limit. Following the title and abstract review, two reviewers independently screened full-text articles, and extracted study data. A narrative approach to synthesizing the literature was used.

RESULTS

Twenty studies were included in the review. Five themes emerged from synthesis: conceptualisation of compassion fatigue and compassion satisfaction; measurement of compassion fatigue and compassion satisfaction; consequences of compassion fatigue or compassion satisfaction and providing care for patients with life-threatening conditions; predictors or associated factors of compassion fatigue and compassion satisfaction among palliative care health providers; and strategies or interventions to support palliative care health providers and reduce compassion fatigue.

CONCLUSIONS

Limited studies examined the effectiveness of specific interventions to improve compassion satisfaction and reduce compassion fatigue among palliative care health providers. Further investigation of the impacts of compassion fatigue and compassion satisfaction on palliative care health providers and their work is also needed.

Burnout and Compassion Satisfaction: Survey Findings of Healthcare Employee Wellness During COVID-19 Pandemic using ProQOL

Introduction

Healthcare systems are being bombarded during the COVID-19 pandemic. Understanding burnout, compassion fatigue, and potential protective factors, such as compassion satisfaction, will be important in supporting the vital healthcare workforce. The goal of the current study was to understand the key factors of burnout, compassion fatigue, and compassion satisfaction among healthcare employees during the pandemic within the U.S. in April 2020.

Methods

The authors conducted a single-center, cross-sectional online survey using the Professional Quality of Life (ProQOL) Questionnaire and three open-ended questions around stress and responses to stress during COVID-19 at a large Midwestern academic medical center with nearly 16,000 employees.

Results

Healthcare employees (613) representing over 25 professions or roles and 30 different departments within the health system were surveyed. Participants reported low levels of compassion fatigue and burnout, but moderate levels of compassion satisfaction. Compassion satisfaction was notably higher than prior literature. Key areas of stress outside of work included family, finances and housing, childcare and homeschooling, and personal health.

Conclusions

This was a cross-sectional survey, limiting causal analyses. Also, based on the qualitative responses, the ProQOL was somewhat insufficient in assessing the breadth of stressors, particularly outside of work, that healthcare employees faced due to the pandemic. Although compassion satisfaction was elevated during the initial phases of the pandemic, providing some possible protection against burnout, this may change as COVID-19 continues to surge. Healthcare systems are encouraged to assess and address the broad range of work and non-work-related stressors to best serve their vital workforce.

Empowering the Health and Well-Being of the Palliative Care Workforce: Evaluation of a Weekly Self-Care Checklist

BACKGROUND

Workplace interventions are needed to prevent burnout and support the well-being of the palliative care workforce.

MEASURES

We conducted a survey of all palliative care clinical staff to evaluate the usefulness and feasibility of checklist items and the checklist itself. We collected demographics, perceptions of professional satisfaction and burnout, and qualitative feedback aimed at improving the checklist.

INTERVENTION

We implemented a 13-item self-care checklist, included in a handbook on palliative care carried in the laboratory coat of all clinical personnel, to remind them to care of their own well-being.

OUTCOMES

Of 39 personnel contacted, 32 (82%) responded. Most (20; 62%) found the checklist useful. Exercise was the most highly ranked item, whereas watching visual arts was the lowest ranked item.

CONCLUSIONS/LESSONS LEARNED

Numerous opportunities were identified to improve the checklist and facilitate achievement of checklist items. Survey data will be used in the next checklist version.

Psychological well-being of palliative care professionals: Who cares?

BACKGROUND

Traditionally, the psychological well-being of healthcare workers has been taken for granted - it has even been considered a part of the requirements that were demanded of them. When these professionals have experienced suffering and psychological depletion, they have been held accountable for this suffering, adopting an individualistic and reductionist viewpoint focused only on the professional. This approach has become obsolete due to its proven ineffectiveness, especially from an ethics of responsibility and organization viewpoint.

CONTEXT

The psychological well-being of the healthcare worker (and its opposites: suffering, exhaustion, and disenchantment) is advantageous to the professional's commitment to the institution, to their work performance, and to their personal life.

OBJECTIVE

The objective of this paper is to reflect on the psychological suffering of the palliative care professional.

METHOD

We will reflect on the three levels of responsibility that influence such suffering (micro-meso-macro-ethical; worker-environment-institution).

RESULTS

We will propose a global strategy for the care of psychological well-being supported by scientific evidence and key references.

SIGNIFICANCE OF RESULTS

We conclude with some contributions on what we have learned and still have to learn on this topic.

Mindfulness-Based Compassion Training for Health Professionals Providing End-of-Life Care: Impact, Feasibility, and Acceptability

Background: Health professionals who care for patients and their families at the end of life (EOL) may experience gratitude, and enhanced spirituality and meaning in life, yet they are also at increased risk of psychological distress, compassion fatigue, and occupational burnout given the stressors they encounter in their work. Objectives: This research evaluated the feasibility and acceptability of a novel six-week mindfulness-based compassion training intervention, which was tailored to health professionals involved in EOL care ("MBCT4HP"), and explored its impact on levels of psychological distress, compassion fatigue, compassion satisfaction, occupational burnout, self-compassion, and mindfulness. Design: We adopted an observational, repeated measures pilot study. Setting/Subjects: Thirty-one health professionals participated. The intervention comprised six, weekly sessions (totaling seven hours) designed to foster compassion for self and others, including formal and informal compassion and mindfulness practices, daily home practice, and a reflective experiential pedagogy. Measurements: Validated outcome measures for anxiety, depression, and stress; compassion satisfaction, compassion fatigue (burnout, secondary traumatic stress); occupational burnout (emotional exhaustion, personal accomplishment, and depersonalization), self-compassion, and mindfulness were administered at baseline, end of intervention, and eight weeks postintervention. The feasibility and acceptability of the intervention was assessed using attendance records, home practice logs, and self-report satisfaction items. Descriptive statistics and Generalized Linear Mixed Models were used to analyze the data. Results: Participants reported that the sessions were useful, relevant, easy to understand, and that they gave them sufficient knowledge to implement the strategies learned. Levels of anxiety, compassion fatigue (burnout only), and emotional exhaustion decreased over time with some decay in effects at follow up, and levels of compassion satisfaction and self-compassion increased with time. Conclusions: The intervention was feasible and acceptable to health professionals involved in EOL care and had a positive impact on levels of anxiety, compassion fatigue (burnout), emotional exhaustion, compassion satisfaction, and self-compassion.

Palliative Care Professionals' Inner Lives: Cross-Cultural Application of the Awareness Model of Self-Care

Compassionate professional qualities traditionally have not received the most attention in either critical or end of life care. Constant exposure to death, time pressure and workload, inadequate coping with personal emotions, grieving, and depression urge the development of an inner curricula of competences to promote professional quality of life and compassionate care. The COVID-19 pandemic highlights the universality of these problems and the need to equip ourselves with rigorously validated measurement and monitoring approaches that allow for unbiased comparisons. The main objective of this study was to offer evidence on the generalizability of the awareness model of self-care across three care systems under particular idiosyncrasy. Regarding the sample, 817 palliative care professionals from Spain, Argentina, and Brazil participated in this cross-sectional study using a multigroup structural equation modeling strategy. The measures showed good reliability in the three countries. When testing the multigroup model against the configural and constrained models, the assumptions were fulfilled, and only two relationships of the model revealed differences among contexts. The hypotheses posited by the awareness model of self-care were supported and a similar predictive power on the professional quality of life dimensions was found. Self-care, awareness, and coping with death were competences that remained outstanding no matter the country, resulting in optimism about the possibility of acting with more integrative approaches and campaigns by international policy-makers with the consensus of world healthcare organizations.

Mediating effects of empathy on the association between nursing professional values and professional quality of life in Chinese female nurses: A cross-sectional survey

Aim

This study aimed to examine whether and to what extent, empathy mediates the association between nursing professional values and professional quality of life (ProQOL) in Chinese female nurses.

Design

Cross-sectional study design.

Methods

A convenience sample of 733 nurses from Xi'an, Shaanxi Province, China, was recruited. Each participant was invited to complete a self-administrated socio-demographic questionnaire, the Nursing Professional Values Scale, the Jefferson Scale of Empathy and the Professional Quality of Life Scale. Descriptive statistics, Pearson correlation analysis and the bootstrap method were employed to analyse data using SPSS 23.0 software.

Results

The participants reported a medium level of ProQOL. Nursing professional values were positively associated with compassion satisfaction but negatively associated with burnout. Empathy mediated 9.2% and 57.1% of the total observed effect of nursing professional values on compassion satisfaction and burnout, respectively.

Relationship Between Death Anxiety of Turkish Nurses and Their Attitudes Toward the Dying Patients

This study aims to investigate the relationship between death anxiety of the Turkish nurses and their attitudes toward the dying patient. This study involved 203 nurses who were working at a university hospital. The data were collected using "Nurse Information Form" (which was prepared by the authors of this research), "Thorson-Powell Death Anxiety Scale," and "Attitude Scale about Euthanasia, Death, and Dying Patient." There was a positive correlation between death anxiety and dying patient avoidance behavior and euthanasia score (p < .05). The findings showed that nurses, death anxiety, and death scores were high in the loss of a close relatives (p < .05). Our findings suggest that the situation of the dying patients and their families and also nurses should be improved. Thus, special psychological education/training should be given to the nurses to deal with death anxiety and their attitude to the dying patient.

Resilience in palliative healthcare professionals: a systematic review

Purpose

Exposure to end-of-life and chronic illness on a daily basis may put palliative healthcare professionals’ well-being at risk. Resilience may represent a protective factor against stressful and demanding challenges. Therefore, the aim is to systematically review the quantitative studies on resilience in healthcare professionals providing palliative care to adult patients.

Methods

A literature search on PubMed, Scopus, Web of Science and PsycINFO databases was performed. The review process has followed the international PRISMA statement guidelines.

Results

At the initial search, a total of 381 records were identified. Twelve articles were assessed for eligibility and, finally, 6 studies met all the inclusion criteria. Of these, four researches were observational and two interventional pilot studies. From the systematic synthesis, palliative care providers’ resilience revealed to be related to other psychological constructs, including secondary traumatic stress, vicarious posttraumatic growth, death anxiety, burnout, compassion satisfaction, hope and perspective taking.

Conclusions

The current systematic review reported informative data leading to consider resilience as a process modulator and facilitator among palliative care professionals. A model on palliative healthcare providers’ experience and the role of resilience was proposed. Further studies may lead to its validation and implementation in assessment and intervention contributing to foster palliative healthcare professionals’ well-being.

Understanding physician burnout

Physician well-being is associated with benefits for physicians, patients, and health care systems. Well-being encompasses many inter-related attributes, including but not limited to resilience, fulfillment, joy in work, and burnout. Among these, burnout has been studied most widely, and has been found to be more frequent among medical trainees and professionals than in the general population. Burnout has been associated with physician depression and suicidality, which are also more frequent among physicians than the general population. The negative effects of burnout include decreased patient satisfaction, increased medical errors, and increased costs. Physician burnout has been associated with both organization-level drivers that contribute to an imbalance between resources and workload for physicians, and individual-level drivers related to resilience practices and attitudes. This paper reviews the literature on the epidemiology, drivers, and implications of physician burnout.

Development and Validity of the Nursing Care Scale and Nurse's Difficulty Scale in Caring for Dying Patients With Cancer and Their Families in General Hospitals in Japan

This study develops and examines the validity and reliability of 2 scales, respectively, for evaluating nursing care and the experience of difficulties providing nursing care for dying patients with cancer and their families. A cross-sectional anonymous questionnaire was administered to nursing staff caring for dying patients with cancer and their families in 4 general hospitals and a university hospital in Japan. The instruments assessed were the Nursing Care Scale for Dying Patients and Their Families (NCD) and the Nurse’s Difficulty Scale for Dying Patients and Their Families (NDD). Of the 497 questionnaires sent to nurses, 401 responses (80%) were analyzed. Factor analyses revealed that the NCD and NDD consisted of 12 items with 4 subscales: “symptom management,” “reassessment of current treatment and nursing care,” “explanation to family,” and “respect for the patient and family’s dignity before and after death.” These scales had sufficient convergent and discriminative validity, sufficient internal consistency (α of subscales: NCD, 0.71-0.87; NDD, 0.74-0.93), and sufficient test-retest reliability (intraclass correlation coefficient of subscales: NCD, 0.59-0.81; NDD, 0.67-0.82) to be used as self-assessments and evaluation tools in education programs to improve the quality of nursing care for the dying patients and their families.