Meaning in bone marrow transplant nurses' work: experiences before and after a "meaning-centered" intervention

Describing compassion fatigue from the perspective of oncology nurses in Durban, South Africa

Background

Caring for cancer patients can take a toll on the emotional health of oncology nurses, which may lead to compassion fatigue, resulting in decreased quality of nursing care, absenteeism and decreased retention of staff.

Aim

The aim of this study was to describe compassion fatigue from the perspective of oncology nurses. This study is part of a larger mixed-methods action research study to develop an in-facility intervention to manage compassion fatigue in oncology nurses.

Setting

This study was conducted at Durban, KwaZulu-Natal, South Africa.

Methods

The research setting comprised one state hospital (with oncology clinics and wards), a private hospital (with oncology wards) and a hospice in Durban, KwaZulu-Natal, South Africa. Semi-structured individual interviews (guided by Figley’s Compassion Fatigue Process, 2005) were conducted with eight participants. Data were analysed using manifest content analysis.

Results

Five categories emerged from the data, namely, emotional connection, emotional fatigue, emotional loss, blurring boundaries and acceptance.

Conclusion

The findings revealed that oncology nurses are affected emotionally in caring for their patients, thus making them prone to compassion fatigue. Oncology nurses need to acknowledge compassion fatigue and be able to self-reflect on how they are managing (both positively and negatively) with the stressors encountered in the oncology wards or units.

The Relationship Between Hope, Meaning in Work, Secondary Traumatic Stress, and Burnout Among Child Abuse Pediatric Clinicians

INTRODUCTION

Child abuse pediatricians continuously encounter trauma experienced by abused children, putting them at risk of secondary traumatic stress (STS), a syndrome with symptoms similar to those of posttraumatic stress disorder.

OBJECTIVE

To examine the relationship between secondary trauma, hope, meaningful work, and burnout in child abuse pediatric clinicians.

METHODS

Participants were solicited from the Helfer and Special Interest Group on Child Abuse for Medical Professionals listservs. They were sent a link to a Web-based survey consisting of the Oldenburg Burnout Inventory, the STS Scale, the Dispositional Hope Scale, and the Work as Meaning Inventory.

RESULTS

A total of 151 participants completed the survey. Correlational analyses showed strong positive associations between the STS score and burnout (R² = 0.47; F^3,140 = 40.64; p < 0.001). Hope and meaning in work demonstrated negatively moderate associations with STS and burnout (ΔR² = 0.07, p < 0.001).

CONCLUSION

A national sample of child abuse pediatric clinicians shows that STS is associated with burnout. Meaning in work and hope can mitigate these effects.

Family Visitation in the Postanesthesia Care Unit: Implementation of a Nurse Liaison Role

The purpose of this article was to report on the nurse liaison role developed at a 400-bed community hospital in response to a previously published best practice project on the effect of family visitation in the PACU on family member anxiety. The evidence resulted in the development of the nurse liaison role, which changed nursing practice and involved each area of perioperative services as we embarked on family-centered care (FCC). The nurse liaison program has served as a model for other hospital departments as well as area hospitals. Guidelines for implementation of the program, which included FCC, are discussed as well as job guidelines, job descriptions, challenges, and outcomes.

Burnout, Moral Distress, Work-Life Balance, and Career Satisfaction among Hematopoietic Cell Transplantation Professionals

A projected shortage of hematopoietic cell transplantation (HCT) health professionals was identified as a major issue during the National Marrow Donor Program/Be The Match System Capacity Initiative. Work-related distress and work-life balance were noted to be potential barriers to recruitment/retention. This study examined these barriers and their association with career satisfaction across HCT disciplines. A cross-sectional, 90-item, web-based survey was administered to advanced practice providers, nurses, physicians, pharmacists, and social workers in 2015. Participants were recruited from membership lists of 6 professional groups. Burnout (measured with the Maslach Burnout Inventory subscales of emotional exhaustion and depersonalization) and moral distress (measured by Moral Distress Scale-Revised) were examined to identify work-related distress. Additional questions addressed demographics, work-life balance, and career satisfaction. Of 5759 HCT providers who received an individualized invitation to participate, 914 (16%) responded; 627 additional participants responded to an open link survey. Significant differences in demographic and practice characteristics existed across disciplines (P < .05). The prevalence of burnout differed across disciplines (P < .05) with an overall prevalence of 40%. Over one-half of pharmacists had burnout, whereas social workers had the lowest prevalence at less than one-third. Moral distress scores ranged from 0 to 336 and varied by discipline (P < .05); pharmacists had the highest mean score (62.9 ± 34.8) and social workers the lowest (42.7 ± 24.4). In multivariate and univariate analyses, variables contributing to burnout varied by discipline; however, moral distress was a significant contributing factor for all providers. Those with burnout were more likely to report inadequate work-life balance and a low level of career satisfaction; however, overall there was a high level of career satisfaction across disciplines. Burnout, moral distress, and inadequate work-life balance existed at a variable rate in all HCT disciplines, yet career satisfaction was high. These results suggest specific areas to address in the work environment for HCT health professionals, especially the need for relief of moral distress and a greater degree of personal time. As the creation of healthy work environments is increasingly emphasized to improve quality care and decrease costs, these findings should be used by HCT leadership to develop interventions that mitigate work-related distress and in turn foster recruitment and retention of HCT providers.

The Practices and Meanings of Care for Nurses Working on a Pediatric Bone Marrow Transplant Unit

Bone marrow transplant (BMT) units are stressful work environments with high staff burnout, anxiety, and turnover. A qualitative study was undertaken to better understand care for nurses within the context of their clinical practice on a pediatric BMT unit. Understanding care practices for BMT nurses will allow us to design interventions and provide appropriate support for this subspecialty of nurses. Focus groups were held with 24 nurses as key participants, and 2 focus groups with general participants: unit management (N = 2) and caregivers of inpatients (N = 7). Data were analyzed using a thematic analysis. Data were transcribed verbatim and coded to consensus by members of the research team. Five themes emerged from the data: ( a) experiencing stressful situations that impede care, ( b) growing and developing personally and professionally, ( c) providing trustworthy and respectful care, ( d) acquiring meaningful coping skills, and ( e) sharing with others versus isolation. Stress management, professional development, and interdisciplinary communication were areas that emerged for potential intervention.

Relationships between personal attitudes about death and communication with terminally ill patients: How oncology clinicians grapple with mortality

OBJECTIVE

Clinician discomfort with death may affect care of patients but has not been well-studied. This study explores oncology clinicians' attitudes surrounding their own death and how these attitudes both affect and are affected by their care of dying patients and their communication with them.

METHODS

Qualitative interviews with physicians (n=25), nurse practitioners (n=7), and physician assistants (n=1) in medical or hematologic oncology clinical practices about communication styles, care of terminally ill patients, and personal perspectives about mortality.

RESULTS

Clinicians described three communication styles used with patients about death and dying: direct, indirect, or selectively direct. Most reported an acceptance of their mortality that was "conditional," meaning that that they could not fully know how they would respond if actually terminally ill. For many clinicians, caring for dying patients affected their outlook on life and death, and their own perspectives on life and death affected their approach to caring for dying patients.

CONCLUSION

An awareness of personal mortality may help clinicians to discuss death more openly with patients and to provide better care.

PRACTICE IMPLICATIONS

Efforts to promote self-awareness and communication training are key to facilitating clear communication with and compassionate care of terminally ill patients.

Existential distress among healthcare providers caring for patients at the end of life

PURPOSE OF REVIEW

Existential distress is well documented among patients at end of life (EOL) and increasingly recognized among informal caregivers. However, less information is known about existential concerns among healthcare providers working with patients at EOL, and the impact that such concerns may have on professionals.

RECENT FINDINGS

Recent literature documents five key existential themes for professionals working in EOL care: (1) opportunity for introspection; (2) death anxiety and potential to compromise patient care; (3) risk factors and negative impact of existential distress; (4) positive effects such as enhanced meaning and personal growth; and (5) the importance of interventions and self-care.

SUMMARY

EOL work can be taxing, yet also highly rewarding. It is critical for healthcare providers to make time for reflection and prioritize self-care in order to effectively cope with the emotional, physical, and existential demands that EOL care precipitates.

IMPAD-22: a checklist for authors of qualitative nursing research manuscripts

OBJECTIVE

The aim of this paper is to develop a checklist for authors preparing qualitative nursing research manuscripts, specifically focusing on the method section.

DESIGN

Literature review.

DATA SOURCES

15 articles were purposefully selected from three different nursing journals.

REVIEW METHODS

Evans' four step process was used to synthesize the method sections of the included articles.

RESULTS

Four main categories were identified 1) Ingress and Methodology, 2) Participants, 3) Approval, and 4) DATA: Collection and Management. Based on the categories and sub-categories, a 22-item checklist was developed.

DISCUSSION AND CONCLUSIONS

Earlier guidelines for formal reporting were developed for qualitative research in general. The main advantage and contribution of IMPAD is that it provides a 22-item checklist specifically aimed towards the method section, and furthermore, it was developed specifically for authors within the field of nursing research.