Predicting nurses’ well-being from job demands and resources: a cross-sectional study of emotional labour

The relationship between teacher emotional labor and work/family conflict: The mediating role of teacher-colleague relations

Teaching, as a high-pressure profession, encompasses significant emotional labor that inevitably spills over into teachers' personal lives. It is imperative to acknowledge and address the influence of emotional labor in the workplace on teachers' work/family conflict. Using the conservation of resources theory, this research engaged 690 primary and secondary teachers, employing Teacher Emotional Labor Strategies Scale, Teacher-colleague Relations Scale, and Work/family Scale (work-family conflict, and family-work conflict) to examine how teacher emotional labor influence their work/family conflict and the mediating role of teacher-colleague relations. The results of structural equation modeling showed that (1) surface acting was a significant predictor of work/family conflict, but deep acting and the expression of naturally felt emotion were not. (2) teacher-colleague relations mediated the relationship between surface acting and work/family conflict. These findings highlight the role of teachers' emotional labor strategies and teacher-colleague relations in reducing teachers' work/family conflict and promoting teachers' well-being. Implications for the improvement of teacher regulation ability and school environment are identified.

The Relationship Between Commuting Stress and Nurses' Well-Being: Considering Gender Differences

Aim: This research explores how and why commuting stress influences Chinese nurses' well-being. Background: A daily work commute may result in a significant psychological risk factor that can lead to harmful physiological and mental health consequences. Emerging research indicates that nurses experience long-lasting negative effects on their mental health, including burnout, due to the stress of a daily work commute. Methods: The study employed a cross-sectional design involving 380 registered nurses from state-owned hospitals in southern China. Hypotheses were tested using the PROCESS macro developed by Hayes [1]. Results: The stress of commuting indirectly influences nurses' well-being through increased emotional exhaustion. There is an interaction between commuting stress and nurses' gender such that the indirect effect of commuting stress on well-being is stronger for female nurses. Conclusions: The spillover effect of commuting stress in the nursing profession is often underestimated. However, this study underscores its significant impact on nurses' emotional exhaustion and well-being. The research findings emphasize that commuting stress contributes to emotional exhaustion and a decline in nurses' well-being. Implications for Nursing Management: Healthcare organizations should leverage these findings to reinforce the importance of self-care for nurses and to provide nurses with resources to help decrease the potential negative outcomes of commuting stress. The study also shows that female nurses may experience a more pronounced association between commuting stress and emotional exhaustion. As such, healthcare organizations should develop gender-specific interventions and support systems that address the unique challenges faced by female nurses in relation to commuting stress.

The Level and Outcomes of Emotional Labor in Nurses: A Scoping Review

Aims: This scoping review aims to examine the level and outcomes of emotional labor in nurses. Background: Nursing is a highly emotional profession that requires nurses to experience a wide range of emotions and control their emotional expressions in nursing practice. Chronic emotional labor and emotional burden not only impact nurses' individual well-being and professional performance but also their job satisfaction and turnover intention. Evaluation: This scoping review was guided by a five-stage scoping review framework and the PRISMA-ScR checklist. Eight databases were searched and 41 studies were reviewed. Key Issues: The Emotional Labor Scale and the Emotional Labor Scale for Nurses were the most commonly used instruments. Significant associations were found between emotional labor and 52 outcomes, which were categorized into two main themes: nurses' personal well-being and organizational well-being. There were 19 mediators and 12 moderators between nurses' emotional labor and 26 different outcomes. Conclusions: While the level of emotional labor among nurses remains uncertain, its consequences are plentiful and intricate. Studies have shown an important relationship between nurses' emotional labor and individual and organizational well-being, which is crucial for nurse managers. There is a need to explore the positive effects of nurses' emotional labor and its impact on patients. Additionally, validation studies of the instruments used to measure nurses' emotional labor are necessary. Implications for Nursing Management: The insights gained from this scoping review provided a more comprehensive understanding of emotional labor for nurse managers. This knowledge can be utilized to design training programs on emotional management and to explore different interventions aimed at alleviating the adverse impacts of nurses' emotional labor.

Compassion fatigue in palliative care: Exploring Its comprehensive impact on geriatric nursing well-being and care quality in end-of-life

BACKGROUND

This study examines the experiences of geriatric nurses in palliative care. It aims to understand how these experiences influence their well-being and the quality of care.

METHODS

Conducted in the Alahsa region of Saudi Arabia, the study employs qualitative methods, utilizing in-depth interviews with 12 geriatric nurses. The analysis employs a thematic approach, enriched by iterative reflections within a multidisciplinary research team.

RESULTS

The analysis reveals main themes: 1) the deep emotional connections between nurses and their patients; 2) the challenges faced, including compassion fatigue, high patient mortality, and communication hurdles; 3) the impact of these challenges on the quality of care, highlighting issues like diminished empathy; 4) the coping strategies used by nurses, such as self-care practices and continuous education.

CONCLUSIONS

The study concludes that coping strategies, including self-care and ongoing professional development, are vital for sustaining the nurses' well-being and ensuring the continued provision of high-quality care to Older Adults patients.

Relationship between tutor support, caring self-efficacy and intention to leave of nursing students: the roles of self-compassion as mediator and moderator

OBJECTIVES

Analyze the mediating e moderating roles of self-compassion in the relationship between tutor support and both students' caring efficacy and intention to leave.

METHODS

A cross-sectional study using an online questionnaire was conducted.

RESULTS

Self-compassion mediates the relationship between tutor support and students' caring efficacy. Tutor support play a role on all the facets of self-compassion, but only two dimensions of this variable (mindfulness vs. over-identification) are significantly associated with both the dimensions of caring self-efficacy, with inverse effects. Self-compassion moderates the relationship between tutor support and intention to leave.

CONCLUSIONS

Tutor support can improve students' caring efficacy by helping them to be mindful of their experiences in a nonjudgmental way. Supportive tutor can mitigate intention to leave by increasing self-compassion ability. Implications for International Audience Nursing education programs should implement workshops and briefings to develop students' self-compassion ability. This can foster perceived caring efficacy in students and reduce intention to leave.

The moderating role of age and seniority on nurses' emotional dissonance and perceived health

This study aims to investigate the weight of surface acting (a condition in which subjects must display an emotional state that does not correspond to their real feelings) in the relationship between the emotional load of nursing work and the perception of health, and to evaluate the moderating effect of age and length of service. A moderated mediation analysis was conducted on a sample of 359 Italian nurses. The results confirmed the mediation role of surface acting and showed that both age and seniority have moderating effects so that in conditions of high emotional load, older and more experienced nurses show higher levels of surface acting, and in conditions of high surface acting, younger and less experienced nurses show lower levels of perceived health. In conclusion, surface acting seems a stressor for younger nurses, not yet used to the weight of faking emotions, while the perceived emotional load seems a stressor for older and more experienced nurses. Each result highlights the importance of providing emotional regulation skills training and support to reduce the psychological impact of emotional demands on nurses.

"Zero to Hero": Conceptualising Time as a Moderator of Nurses' Emotional Labour on the Front Line

Aim

We aimed to conceptualise how environmental, institutional, and organisational dynamics of the ED underpin and "moderate" nurses' emotional labour.

Background

Around the globe, EDs are struggling to meet rising patient demand including both UK health systems and public services in the US. In spite of these challenges and the intense and distinctive nature of EDs, an exploration of emotional labour is largely missing from current understanding. This is important, in part because emotional labour is established as an indicator of wellbeing including intention to leave, burnout, and compassion fatigue. We understand little of how the environment moderates emotional labour, and our study addressed this problem in the ED. Understanding the moderators of emotional labour, organisational perspective also offers theoretical development.

Methods

Ethnography enabled immersion in the ED setting, gathering the lived experiences and narratives of the ED nursing team. This included 200 hours of observation at one District General Hospital and one Major Trauma Centre in the English NHS with 35 semistructured concurrent formal interviews.

Results

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Conclusions

The ED calls for an extensive spectrum of emotional labour from staff, influenced and moderated by the restrictions on resources, particularly time. We argue that, despite the often short nature of interactions undertaken in ED, the labour required is effortful and gruelling for staff. Understanding the relevance of environmental elements, namely, time, to the emotional labour offers tangible opportunities for improvement. These new understandings can underpin solutions to negative consequences of this work. Suggested measures and interventions to alleviate the impact of emotional labour should be prioritised by policy makers and those tasked with managing, designing, and leading the delivery of care in ED. Implications for Profession and/or Patient Care. The more "sped up" a service is required to be, the higher the likelihood of emotional labour is. In light of the challenges facing healthcare services around the world and the increased throughput through services, particularly in ED, this is important. This is also critical when considering that there are well-established relationships between emotional labour and wellbeing in nursing. Understanding the relevance of the healthcare environment to staff members' experiences of emotional labour is critical in designing solutions which counterbalance the potentially negative consequences of this work.

Middle Eastern nurses' views/experiences of work and well-being with the support measures during past disease outbreaks and COVID-19: a qualitative systematic review

BACKGROUND

The potential psychological health impact of pandemics on nurses has been increasingly widely recognised, as have recommendations to establish support measures for nurses' well-being. Despite the availability of support measures significant number of nurses still experienced burnout and mental distress during Covid-19. Few efforts have been made in the wider literature to understand how nurses experience well-being support or how they perceive it affects their well-being during pandemics. In the Middle East, understanding and exploring well-being support measures during pandemics from nurses' perspectives has not received significant attention.

OBJECTIVE

To investigate nurses' perspectives and experiences of well-being support measures during prior pandemics and the Covid-19 pandemic in the Middle East.

METHODS

A systematic qualitative review was undertaken utilising the JBI model as a framework. Searches were carried out in databases comprised CINAHL, MEDLINE, NUsearch Library of Nottingham University and Google Scholar. Moreover, a manual search through reference lists for relevant studies were carried out.

DATA EXTRACTION AND SYNTHESIS

Eleven studies were included in the review. The findings from the included qualitative studies were extracted using the JBI-QARI data extraction tool for qualitative research. The results were synthesised using a meta-synthesis in line with the JBI approach.

RESULTS

The included studies yielded an aggregate of 111 findings and were categorised into 14 categories, followed by four synthesised findings. These were: [1] nurses experienced challenges during MERS, yet different strategies were implemented by leaders and nurses to manage these challenges; [2] some well-being support measures were unfulfilled during Covid-19; [3] additional aspects compounded negatively on nurses' well- being; and [4] nurses showed maturity during Covid-19.

CONCLUSION

In comparison to prior health emergencies, well-being support measures during Covid-19 were not sufficiently adopted. Nurse policymakers and managers should consider these support measures to correspond with nurses' needs and explore the contextual factors that affect their implementation.

TRIAL REGISTRATION

PROSPERO (CRD42022344005).

Differential Effects of Work and Family Support on the Relationship Between Surface Acting and Wellbeing: A Self-Determination Theory Approach

Surface acting-the management of emotional displays as part of a nurse's work role-is increasingly getting scholars' attention in organizational behavior. Previous research focused on the relationship between surface acting and outcomes (such as psychological well-being) on the basis of resource-centric theories, ignoring the subjective stance of surface acting provider. According to self-determination theory, surface acting affects an individual's well-being through stimulating autonomous or controlled work motivation. Taking nurses as the subjects, the current study proposed that surface acting would affect job satisfaction and further psychological well-being through nurses' controlled work motivation, and work and family support would moderate the above relationships in diverse directions. An online survey of n = 342 nurses working at a hospital in central China was conducted, evaluating surface acting, job satisfaction, psychological well-being, workplace support, and family support. Results indicated that surface acting negatively influenced nurses' psychological well-being through job satisfaction. In addition, the results highlighted the two-faced aspect of social support, in which work support positively moderated the relationships between surface acting, job satisfaction, and psychological well-being, while family support intensified the abovementioned relationships negatively. These findings have important implications for surface acting, social support research, and managerial practices.

Role of affective commitment in the relationship between emotional labor and life satisfaction in nurses

PURPOSE

This study investigated relationships between hospice nurses' emotional labor, life satisfaction, and affective commitment (moderator). We started with the assumption that displaying real emotions rather than faking them may increase life satisfaction.

DESIGN AND METHODS

The study utilized a cross-sectional survey data analysis. A total of 322 nurses participated in the study. Hayes' process examined the moderation relationship predicting emotional labor and life satisfaction.

FINDINGS

The results showed that emotional labor partially affected life satisfaction. However, those effects varied at different levels of affective commitment and interestingly diminished at a high level.

PRACTICE IMPLICATIONS

Nurse leaders should understand and transform the surface emotional setting of nurses to more profound acting emotions and then to natural emotional responses, which otherwise can generate emotional conflict causing unsatisfactory life.

Job Demands, Resources and Burnout Among Polish Nurses During the Late Wave of COVID-19 Pandemic: The Mediating Role of Emotional Labor

Objective

Burnout has been recognized as a serious health problem. Nurses as a professional group are at a high risk of burnout occurrence, especially when facing burden associated with the COVID-19 pandemic. Despite evidence that higher job demands lead to burnout, there is less known about the indirect effect of job demands and resources on burnout via surface acting. Using the JD-R framework, this study examined how job demands and resources affected burnout among Polish nurses and whether these relationships are mediated by surface acting and moderated by coping with the workload.

Materials and Methods

A sample of 270 nurses from the biggest hospital in Southern Poland filled out an online questionnaire at the time between the fourth and the fifth wave of the COVID-19 pandemic in Poland. The Polish adaptations of Oldenburg Burnout Inventory (OLBI), Organizational Constraints Scale (OCS), Interpersonal Conflict at Work Scale (ICAWS), Areas of Worklife Survey (AWS), and Emotional Labor Scale (ELS) were used. Mediation and moderation analyses were carried out in the SPSS macro-PROCESS.

Results

Surface acting partially mediated the positive association between organizational constraints and interpersonal conflict at work and burnout, as well as the negative association between the perceived organizational support and burnout. Coping with workload moderated the direct effect of organizational constraints on burnout via surface acting.

Conclusion

The findings enrich the knowledge of the mediating and moderating mechanisms to explain the association between job demands, resources and burnout among nurses. There have been proposed interventions concerning increasing organizational support, effective emotional regulation of management education and psychological training regarding adequate coping strategies which could help reduce or prevent the occurrence of burnout in this professional group.

The Moderator Effect of Communicative Rational Action in the Relationship between Emotional Labor and Job Satisfaction

The aim of this study was to determine whether emotional labor behavior has an effect on job satisfaction, and if there is an effect, to reveal whether communicative rational action has a moderator effect. This research was carried out in the banking sector. The sample group consisted of administrators of foreign capital bank managers (427) at all levels in Turkey. The collected data were analyzed with the IBM SPSS 21 program. Multiple regression analysis and SPSS PROCESS v3.5 (model1) methods were used in the analysis. According to the analysis, the three sub-dimensions of communicative rational action (practical-rational action, rational communication, and rational action) have a moderator role in the effect of emotional labor and job satisfaction. The other two sub dimensions (value–rational–action and firm family) do not have a moderator role in this effect. In the analysis made according to the total score of communicative rational action, the moderator role of communicative rational action in the effect of emotional labor and job satisfaction was determined. As a result of the research and analysis, it was determined that emotional labor has a positive effect on the phenomenon of job satisfaction.

Nurses’ Work Environment during the COVID-19 Pandemic in a Person-Centred Practice—A Systematic Review

The work environment and especially the psychosocial work environment influence the mental and physical well-being of employees. The aim of this study was to identify and analyse the state of knowledge regarding nurses’ work situation, health, and person-centred work during the COVID-19 pandemic through a systematic review. Methods: Systematic Review, nine included articles. The theoretical swAge model was used as the framework in a deductive content analysis. Results: The result was presented in the nine determinate areas from the swAge model and showed that all nine determinate areas of the swAge model were of importance to both the nurses’ sustainable work situation during the COVID-19 pandemic and to person-centred care. The COVID-19 pandemic has had a negative effect on nurses’ health, both physically but especially psychologically, with high levels of depression, anxiety, and burnout. Nurses experienced a lack of control and support from organizations. They had to work with limited resources and sometimes care for patients beyond their expertise. Conclusion: There is a further need for more studies that address person-centredness from an organisational perspective with the intention to develop strategies and measure activities on how to make the nurses’ work situation more sustainable, and to increase their ability to give more person-centred care.

Job experience as a buffer against incivility: a daily diary study

Purpose

Incivility is pervasive in organisational settings, particularly in healthcare, and is associated with negative employee outcomes. The aim of this study was to analyse the relationships between experienced incivility, sleep quality and emotional outcomes, positioning sleep quality as a mediator. Additionally, the protective role of tenure and the unique effects of incivility from different sources were examined.

Design/methodology/approach

This study used a daily diary longitudinal design using self-report questionnaires with 92 nurses of varying tenure.

Findings

This research demonstrates that experiencing incivility negatively impacts sleep quality, which, in turn, increases surface acting and emotional exhaustion. Furthermore, the negative relationship between incivility and sleep quality is attenuated among nurses who have longer tenure.

Practical implications

These findings are helpful in developing targeted practical practices, such as incivility interventions and mentorship programs to reduce the incidence and impact of incivility.

Originality/value

This study draws upon theories of self-regulation and emotion regulation to examine how incivility diminishes self-control resources, leading to negative outcomes. This study also positions job tenure as a buffer against incivility and examines the differential impact of different sources of incivility.

Nursing students' emotional work and its consequences following encounters with e-patients who present reliable or unreliable information; a scenario based cross sectional survey

BACKGROUND

Hochschild's theory of emotional work explains how people evoke or suppress emotions in order to adhere to social norms. An encounter with an e-patient who presents potentially unreliable medical information from the internet can lead to caregivers undergoing emotional work. This may have a negative impact on caregivers, such as mental exhaustion or professional dissatisfaction.

OBJECTIVES

To examine nursing students' emotional work and its consequences following an encounter with e-patients who present new information from reliable or unreliable internet websites.

DESIGN

A cross sectional study.

SETTINGS

A large university in the center of Israel.

PARTICIPANTS

376 nursing students (230 Jewish, 146 Arab) of a 4-year BA program.

METHODS

The study was scenario based describing an e-patient that presents information from a reliable/unreliable website. The students were asked about the emotions the situation evokes in them based on the Emotional Work Questionnaire. In addition, the questionnaire examined the emotional work techniques (surface versus deep acting) and the impact of emotional work on the students.

RESULTS

Deep acting emotional work was the most used emotional work technique. Arab students performed more deep acting emotional work compared to Jewish students (F(1,360) = 12.57, p < 0.001). Deep acting emotion work mediated the relationship between ethnicity and the impact of emotion work ((LLCI (-0.1018), ULCI (-0.0199)).

CONCLUSIONS

The training of nursing students should allow and encourage students' legitimacy to feel and express various emotions, even when they are contrary to expectations. Sharing others' (students', clinical instructors') feelings that arise in clinical situations is an essential aspect of clinical training. This training may lead to effective emotional management in different situations and allow students to receive help and support that will enable them to develop good coping skills during their studies which will benefit them later in their professional career.

Exploring factors which contribute to the resilience of nurses working in the neonatal care unit: A grounded theory study

OBJECTIVES

This study aimed to produce a theoretical model to understand factors which affect the resilience of neonatal nurses. Nurses experience high levels of burnout due to the occupational stress they are exposed to. Burnout negatively affects both staff and patient outcomes, and in this population would likely affect the establishment of crucial early caregiver-infant relationships in the neonatal unit. Research suggests that increasing nurses' resilience can protect them against burnout, thus understanding factors that affect resilience in this population is critical.

RESEARCH METHODOLOGY

The study adopted a constructivist grounded theory design.

SETTING AND PARTICIPANTS

All participants were qualified registered nurses employed on a permanent basis in a Level 3 neonatal unit. Thirteen registered nurses attended one individual semi-structured interview. A constructivist grounded theory approach was used to analyse the subsequent verbatim transcripts.

FINDINGS

The resulting model identified that individuals working as nurses in the neonatal unit function within different systemic contexts: the nursing team; the family unit; the broader neonatal team; the National Health Service and their world outside the unit. Each context presents different practical, emotional and ethical challenges. These challenges are navigated through a combination of contextual, interpersonal and intrapersonal strategies.

CONCLUSIONS

The model is contextually embedded and extends existing literature pertaining to resilience of healthcare staff in other contexts. Suggestions are made in terms of adaptations to the organisational, social and individual contexts to benefit nursing resilience. Implications of the findings are also considered within the context of the ongoing Covid-19 pandemic.

Work Environment Characteristics and Emotional Intelligence as Correlates of Nurses' Compassion Satisfaction and Compassion Fatigue: A Cross-Sectional Survey Study

This cross-sectional survey study examined the relationship between Canadian nurses' work environment characteristics, emotional intelligence, compassion fatigue and compassion satisfaction (n = 1271). Psychological demands, decision latitude, supervisor and coworker support, and emotional intelligence (EI) were significantly correlated with nurses' compassion satisfaction and compassion fatigue, except for two EI subscales. Furthermore, these relationships were stronger for compassion satisfaction than compassion fatigue, suggesting that they are influenced by different factors. Our results highlight the importance of creating reasonable psychological demands, empowering nurses to make decisions in their jobs, supportive relationships at work, and fostering the development of nurses' EI.

The Emotional Labor of the Transplant Coordinator: An Inherent Predicament

Although extensive scholarship has been dedicated to the emotional experiences of transplant patients, little is known about the emotional experiences of transplant coordinators. The present article aims to illuminate the phenomenon of emotional labor invested by transplant coordinators. The transplant coordinator is a key person in the process of obtaining consent for organs for transplantation from deceased or living donors. One of the most taxing phenomena among nurses is emotional labor. Emotional labor is a term that denotes the investment of emotional effort to reach a consonance between one's inner authentic feelings and outward expression of one's emotions. Thirteen experienced transplant coordinators were interviewed for the purpose of unveiling their work-related feelings and emotions. Analysis of their narratives revealed 3 types of emotional labor based on the taxonomy proposed by Theodosius: therapeutic, instrumental, and collegial. Findings show that much emotional labor is invested by these nurses. Emotional labor is usually stressful and has an adverse effect on nurses' psychological well-being and health, especially when emotions that are not genuinely felt have to be conveyed. Transplant coordinators must fake their emotional expressions to excel in their job. Their job is psychologically taxing, leading in most cases to regret over choosing this job. Implications for research, policy, and practice include a recommendation that transplant unit managers act to help transplant coordinators avoid the painful emotions that accompany the experience of emotional labor. We provide several useful recommendations about how to alleviate and prevent these negative emotions.

Perceived organizational support and emotional labour among police communicators: what can organizational context tell us about posttraumatic stress?

OBJECTIVE

As central members of the emergency response system, communicators are regularly exposed to potentially traumatic events and experience some of the highest rates of posttraumatic stress. Given elevated rates of distress, they are regularly called upon to manage emotions-their own and others'-during high-risk and high-stress situations, within a highly controlled organizational context. Emotional labour (EL) theory suggests that many individuals faced with this challenge utilize a strategy in which emotions are suppressed or faked (surface acting-SA) in keeping with organizational expectations.

METHODS

This study was designed to examine the relationships among reported EL, perceived organizational support, job stress, and severity of posttraumatic stress among a population of communicators.

RESULTS

Job pressure and perceived lack of organizational support were positively associated with posttraumatic stress. Although the highest reported levels of SA occurred when interacting with members of the public, this SA was not associated with posttraumatic stress, unlike SA with co-workers and supervisors. SA with co-workers and supervisors was further related to perceptions of lack of organizational support.

CONCLUSION

Thus, an organization perceived as unsupportive may create a culture in which individuals are dissuaded from expressing true emotions with colleagues and supervisors, potentially magnifying the traumatic effects of exposure to critical incidents.

The Importance of Contextualized Psychosocial Risk Indicators in Workplace Stress Assessment: Evidence from the Healthcare Sector

The routine assessment of workplace stress is mostly based on standardized self-report tools, including generic psychosocial risk indicators (G-PRIs) designed to fit very heterogeneous occupational sectors. However, the use "by default" of such indicators might be inadequate when they fail to characterize the specificity of the work environment; hence, the inclusion of more contextualized indicators (C-PRIs) has been recommended. We aimed at evaluating the additional contribution of three C-PRIs (Work-Family Conflict, Emotional Demands, and Excessive Demands from Patients) in predicting individual outcomes (Emotional Exhaustion, Turnover Intentions) compared to commonly used G-PRIs (e.g., Demand, Control, Support), in a sample of 787 healthcare workers involved in a routine workplace stress assessment. Multilevel hierarchical regression supported the additional contributions of C-PRIs in predicting both outcomes over G-PRIs, sex, age and shift work. More robust and consistent evidence emerged for Emotional Exhaustion, which was significantly predicted by all C-PRIs, whereas Turnover Intentions was only predicted by the C-PRI Emotional Demands. Importantly, not all G-PRIs showed a relationship with the two outcomes. Taken together, our results support the importance of including C-PRIs in workplace stress assessment carried out by organizations, which should be selected based on literature search and discussion with the stakeholders.

Collegial surface acting emotional labour, burnout and intention to leave in novice and pre-retirement nurses in the United Kingdom: A cross-sectional study

Aim

To investigate the relationship between surface and deep acting in nurses' patient-focused and collegial emotional labour, with emotional exhaustion, depersonalization and personal accomplishment and intention to leave.

Design

A cross-sectional descriptive study using the Emotional Labour Scale, the Maslach Burnout Inventory and intention to leave Yes/No questions with 118 Registered Nurses to measure patient-focused and collegial emotional labour, burnout and intention to leave.

Results

Surface acting in patient-focused and collegial emotional labour was found to have positive associations with burnout and intention to leave their current job. Only surface acting in patient-focused emotional labour was positively associated with intention to leave the organization and/or the profession. The novice nurses carried out more deep acting collegial emotional labour than the pre-retirement nurses.

Conclusions

Collegial emotional labour is significant to nurses' intention to leave their current job but not their intention to leave the organization and/or the profession.

Perceived Stress and Life Satisfaction Among Chinese Clinical Nursing Teachers: A Moderated Mediation Model of Burnout and Emotion Regulation

Our previous study indicated that clinical teaching nurses in China suffered high levels of perceived stress and burnout, mainly because they were taking double responsibilities of nursing and teaching at the same time. The study aimed to investigate the underlying mechanisms of how and when perceived stress increased the risk of burnout and decreased life satisfaction among clinical teaching nurses. Questionnaires about perceived stress, burnout, emotion regulation, and life satisfaction were self-administered to 1,372 teaching nurses from eight tertiary military hospitals in China. Correlation and hierarchical multiple regressions were employed for data analysis. The results revealed that perceived stress had direct and indirect impacts on life satisfaction, with the principal element of burnout-emotional exhaustion-acting as a mediator. Moreover, the association between perceived stress and emotional exhaustion was moderated by emotion suppression-a key emotion regulation strategy. The negative impact of perceived stress on burnout was stronger among teaching nurses with high emotion suppression than among those with low emotion suppression. The present study contributed to a deeper understanding of the relationship between perceived stress and life satisfaction and also suggested further research into emotion regulation interventions to alleviate or eliminate the impact of perceived stress on burnout and eventually improve the life satisfaction for Chinese clinical nursing teachers.

Fake it or make it: employee well-being in emotional work settings

Purpose

The objective of the present study is to measure the well-being of employees who are engaged in frontline roles and actively engrossed in frequent regulation and management of emotions while performing interpersonal interactions. The study has conceptualised the comprehensive model to measure employee well-being with three work-related dimensions, namely work engagement, burnout and job satisfaction in emotional work settings.

Design/methodology/approach

The study has been conducted on employees of the civil aviation industry in North India working on various frontline profiles. Data have been collected from 600 employees through a pretested questionnaire, and structural equation modelling (SEM) has been performed to test the hypothesis.

Findings

The findings of the study have revealed that all three dimensions, namely work engagement, burnout and job satisfaction are statistically significant measures of employee well-being in emotional work settings. Also, the study has determined that employees are highly satisfied and engaged at work despite having a feeling of burnout.

Research limitations/implications

The study has enriched the literature by presenting and analysing a comprehensive model of employee well-being in emotional work settings of the civil aviation industry.

Practical implications

The study will aid the various service industries in the framing of the intervention and training programs, which would help in promoting the well-being of employees who are specifically engaged in emotional work.

Social implications

The study is very substantial in offering various parameters over which national well-being policies for individuals can be framed.

Originality/value

Priorly, very few studies have attempted to recognise the role of the aforementioned variables in emotional work settings in a comprehensive manner. Further, the study has emphasised the unrecognised role of job satisfaction and work engagement where burnout is prevailing due to the presence of high emotional job demands.

Empowering Nurses to Provide Humanized Care in Canadian Hospital Care Units: A Qualitative Study

Previous studies have reported a conflict between nurses' motivation to provide humanized care and practical requirements impeding them from doing so. This exploratory descriptive qualitative study aimed to explore nurses' perspectives on humanized care, the challenges they face, and, most importantly, their recommendations to overcome these barriers. Semistructured individual interviews were conducted with 17 auxiliary and registered nurses working in various health care units in a Canadian hospital. Participants demonstrated a good understanding of what humanized care covers and entails. They also described it as the very core of their profession and main source of job satisfaction. However, nurses reported that they are confronted with organizational barriers, mainly a lack of staff, the burden of administrative tasks, unsuitable physical environments or equipment, and little managerial support. Nurses stressed the need for a cultural change in managerial practices in order to be able to improve their provision of humanized care. Based on the findings, 4 structuring recommendations were identified: adopting an institutional policy promoting the implementation of humanized care, incorporating humanized care in nurses' tasks and procedures, improving participatory management, and ensuring adequate staffing.

The effect of job demands on health and work outcomes: A longitudinal study among Malaysian employees

The purpose of the current study was to investigate the impact of job demands on health and work outcomes among Malaysian workers. We hypothesized that job demands (i.e., emotional demands and physical demands) would predict future work-related burnout and work engagement, in turn affecting sleep problems and job performance (in-role, extra-role). A longitudinal two-wave survey was conducted among Malaysian workers and valid data from 345 participants were analyzed using structural equation modeling. The results revealed that work-related burnout predicts sleep problems while work engagement increased employees' job performance over time. Overall, the current study highlights the importance of specific job demands (i.e., emotional demands and physical demands) that specifically affect health-related behavior and work-related behavior among workers.

"Difficult patients" in the advanced stages of cancer as experienced by nursing staff: A descriptive qualitative study

PURPOSES

"Difficult patients", as labelled by staff members, have been studied for their peculiarities in primary care, family and internal medicine, physiotherapy, psychiatry, dermatology, and dentistry. However, no data has been documented on "difficult patients" in hospice care settings. The aim of the study was to address the following research questions: (a) When do nursing staff label a patient suffering from advanced cancer as "difficult" in a hospice care setting? (b) What are the problems that the nursing staff face in dealing with them, and (c) What are the specific strategies that nursing staff adopt in their daily practice to overcome issues and improve their relationship with "difficult patients"?

METHODS

A qualitative descriptive study design was performed in 2018 and reported according to the COnsolidated criteria for REporting Qualitative research. Three focus groups were conducted in three hospice settings in Northern Italy by involving 10 nurses and six nurses' aides. Three trained researchers performed interviews based on a set of open questions. Qualitative content analysis of the data collected was then performed by the same researchers.

RESULTS

Participants were labelled "difficult patients" according to three main themes: (1) "Feeling rejected"; (2) "Feeling uncomfortable with the life story experienced by the patient" and (3) "Experiencing the limits of the profession". Participants reported feeling "Frustrated", "Exhausted", "Powerless", "Overwhelmed" or "Embarrassed" when dealing with "difficult patients". Strategies to overcome these issues emerged.

CONCLUSIONS

As in other settings, hospice care nursing staff perceive some patients as "difficult". However, differently from other contexts, "difficult patients" are perceived as such also due to their relatives, who are perceived, in some cases, as being even more "difficult" than the patients themselves. Nursing staff should be aware of their personal attitudes and emotions in caring for patients perceived as "difficult" in order to identify and timely apply strategies to overcome issues that may compromise the therapeutic relationship and quality of care.

Patient-related stressful situations and stress-related outcomes in emergency nurses: A cross-sectional study on the role of work factors and recovery during leisure time

BACKGROUND

Emergency nurses are frequently exposed to patient-related stressful situations, making them susceptible to emotional exhaustion and symptoms of post-traumatic stress disorder. The current study aims to assess differential effects of patient-related stressful situations (emotionally demanding situations, aggression/conflict situations, and critical events) on stress-related outcomes in emergency nurses, and to identify moderating factors based on the Job Demands-Resources model and the Effort-Recovery model (job demands, job resources, and recovery experiences during leisure time).

METHOD

A cross-sectional study was carried out among nurses working in the emergency departments of 19 hospitals in the Netherlands (N = 692, response rate 73%). Data were collected by means of an online survey. Multiple hierarchical regression analyses were performed, controlling for sociodemographic variables.

RESULTS

The frequency of exposure to patient-related stressful situations was positively related to stress-related outcomes, with emotionally demanding situations and aggression/conflict situations mainly explaining variance in emotional exhaustion (β = 0.16, p < .01, ∆R² = 0.08, and β = 0.22, p < .01, ∆R² = 0.13), whereas critical events mainly explained variance in post-traumatic stress symptoms (β = 0.29, p < .01, ∆R² = 0.11). Moderating effects were found for within worktime recovery and recovery during leisure time. Work-time demands, autonomy and social support from the supervisor were predictive of stress-related outcomes irrespectively of exposure to patient-related stressful situations.

CONCLUSION

As patient-related stressful situations are difficult if not impossible to reduce in an emergency department setting, the findings suggest it would be worthwhile to stimulate within worktime recovery as well as recovery experiences during leisure time, to protect emergency nurses from emotional exhaustion and symptoms of post-traumatic stress. Furthermore, this study underscores the importance of reducing work-time demands and enhancing job resources to address stress-related outcomes in emergency nurses. Practical implications, strengths and limitations are discussed.

A survey on the training needs of caregivers in five European countries

AIM

This survey explored caregivers' perceived training needs in 5 European countries (United Kingdom, Greece, Bulgaria, Poland and Italy).

BACKGROUND

Training can enhance the professional capacity of caregivers; however, caregivers' training needs within Europe have not been examined recently.

METHODS

A survey conducted in 2015 captured data from 550 caregivers using a convenience sampling strategy, through a structured questionnaire and additional open-ended items and by conducting statistical and content analysis.

RESULTS

The results indicated basic nursing skills and specialization, as well as training in psychology-related skills like time management, emotion regulation, communication and advanced health care systems as the emerging training needs. There were some country differences in specific training need areas.

CONCLUSIONS

It was concluded that training in basic nursing skills and specialization in nursing specific conditions, in advanced health care systems and in psychology-related skills could add to the professional capacity of European caregivers employed in health and social care.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings inform about employed caregivers' training needs in Europe, which may contribute in the provision of quality care and organisational efficiency in health and social care.

Emotionally intelligent strategies students use to manage challenging interactions with patients and families: A qualitative inquiry

Healthcare students experience elevated stress associated with the interpersonal work of clinical practice. Emotional labour involves clinicians' use of intra- and inter-personal skills to manage their emotional states and promote patient and family emotional wellbeing. Effective emotional labour requires emotionally-intelligent skills. Learning to use these skills is critical to students' effective interpersonal management of stressful practice situations however, understanding of emotionally-intelligent strategies used by students on clinical placement is limited. To address this gap in knowledge, a qualitative study was conducted to investigate challenging interpersonal situations with patients and family experienced by pre-registration nursing and pharmacy students during clinical placement, and to identify how they used emotionally intelligent behaviours to manage those situations. Twenty final-year students from an Australian university were interviewed. Interpersonal situations experienced as challenging, involved patients or family members who were angry and aggressive, distressed, or embarrassed. Students used a broad range of cognitive, emotional, relational, and behavioural (CERB) emotionally-intelligent strategies to manage their own and others' emotions and behaviours during these encounters. The CERB framework, derived from analysis of student strategies, is a useful resource for healthcare curricula to support emotional intelligence education for interpersonal skill development and building of empathy and resilience for clinical practice.

Job Demand, Job Control, and Impaired Mental Health in the Experience of Workplace Bullying Behavior: A Two-Wave Study

Workplace bullying is an extreme social stressor at work leading to a severe deterioration of health amongst its targets. Research has revealed two important orders of factors that may trigger workplace bullying: Poor working conditions and individual factors such as impaired mental health that determine a personal psychological vulnerability to bullying. However, research has rarely investigated their role simultaneously. In response, we investigated whether the relationship between poor working conditions (i.e., high job demand) at time 1 (T1) and the experience of bullying at time 2 (T2) is strengthened by experiencing symptoms of impaired mental health at T1. We also tested whether job control—which contributes to better working conditions—at T1 moderates the relationship between job demand at T1 and bullying at T2. Participants (N = 235) were workers in the health sector. The time lag between T1 and T2 was one year. Cross-lagged path analysis revealed that the relationship between job demand at T1 and the experience of bullying behavior at T2 was strengthened by T1 impaired mental health. This suggests that considering both working conditions and individual factors together may be important for reaching a better understanding of the development of bullying.

Nurses’ emotions, emotional labor, and job satisfaction

Purpose

The purpose of this paper is to examine the relationships between emotional labor, emotions, and job satisfaction among nurses, and explore the mediating role of emotions in the relationship between emotional labor and job satisfaction.

Design/methodology/approach

A cross-sectional study was designed with 168 nurses in Korea. Structural equation modeling and path analysis were performed to analyze data.

Findings

Surface acting correlated positively with anxiety and frustration. Deep acting correlated positively with enjoyment and pride but correlated negatively with anxiety, anger and frustration. Enjoyment and pride correlated positively with job satisfaction; anger correlated negatively with job satisfaction. Deep acting correlated positively with job satisfaction, while surface acting did not show a significant relationship. Enjoyment, pride and anger mediated the relationship between deep acting and job satisfaction.

Research limitations/implications

This research expands empirical findings on nurses’ emotional experiences, by considering their discrete emotions rather than general affect. It is the first study to empirically examine the relationships between emotional labor, discrete emotions and job satisfaction, as well as the mediating role of emotions in the relationship between emotional labor and job satisfaction in the nursing field. The mediating role of emotions suggests that not only nurses and nurse managers but also hospital administrators should take nurses’ emotions into account to increase nurses’ well-being and their job satisfaction. Finally, differential influences of surface acting and deep acting on nurses’ emotional experiences and job satisfaction highlight the need for practical interventions to promote the use of deep acting among nurses.

Originality/value

This study confirms the mediating role of emotions in the relationship between emotional labor and job satisfaction in the nursing field. It encourages future research to pay greater attention to nurses’ emotions themselves along with emotional labor. Findings add an interdisciplinary aspect to research on nursing by assimilating psychological perspectives of emotion and emotion management research to this field.

Do emotional labour strategies influence emotional exhaustion and professional identity or vice versa? Evidence from new nurses

AIMS

The aim was to examine the reciprocal relationships of emotional labour strategies with emotional exhaustion and professional identity.

DESIGN

This study adopted a four-wave cross-lagged panel design.

METHODS

Survey data were collected in 2018 from a sample of 171 newly hired nurses from 58 hospitals in 11 provinces of China. Nurses' emotional labour (i.e., deep acting and surface acting), emotional exhaustion and professional identity were repeatedly measured. Cross-lagged panel analyses were conducted to examine the reciprocal relationships we hypothesized.

RESULTS

We found that emotional exhaustion was positively related to surface acting (but not vice versa); deep acting was negatively related to emotional exhaustion (but not vice versa); professional identity was positively related to deep acting (but not vice versa).

CONCLUSION

Our findings suggest that deep acting and professional identity may decrease the level of emotional exhaustion, whereas emotionally exhausted nurses are more likely to employ surface acting strategies.

IMPACT

This research finding will have an impact on the nursing management. Healthcare managers may consider workshops or training and development programs that promote nurses' professional identify to promote nurses' use of deep acting and consequently reduce their level of emotional exhaustion, which has been associated with a variety of negative consequences, such as low quality of patient service, high medical accidents, and turnover rate.

Emotional Labor Strategies, Stress, and Burnout Among Hospital Nurses: A Path Analysis

PURPOSE

This study aimed to examine the associations among emotional labor strategies, stress from emotional labor, and burnout in nurses.

DESIGN

We employed a descriptive cross-sectional design. Data were collected from May to November 2018 in South Korea using structured questionnaires. Participants were 303 nurses from 27 hospitals, who were recruited by convenience sampling.

METHODS

Emotional labor strategies (surface acting, deep acting, and expression of naturally felt emotions), stress, and burnout were self-reported. A path analysis using structural equation modeling was performed to examine the associations among the study variables.

FINDINGS

Bivariate analyses revealed that surface acting was positively correlated with stress and burnout, deep acting was negatively correlated with burnout, and naturally felt emotions were negatively correlated with stress and burnout. The path analysis revealed that surface acting was positively associated with stress, naturally felt emotions were negatively associated with burnout, and the stress from emotional labor was positively associated with burnout. Although surface acting was not directly associated with burnout, it was indirectly associated through stress.

CONCLUSIONS

Surface acting involves regulation and suppression of one's felt emotions. The findings of this study suggest that hospitals need to reduce expectations for surface acting to reduce nurses' stress and burnout. Organizational efforts to provide interventions that improve nurses' ability to manage their emotions in interactions with patients might effectively foster nurses' well-being.

CLINICAL RELEVANCE

Surface acting might contribute to nurses' burnout, and naturally felt emotions might reduce nurses' burnout. Nurse managers should thus provide opportunities to discuss the utilized emotional labor strategies and encourage appropriate responses depending on the patient context. Programs that promote emotional competence may reduce the adverse effects associated with nurses' emotional labor and foster effective coping strategies.

The relationship between emotional labour and job satisfaction in nursing

AIM

To investigate the relationship between emotional labour strategies and job satisfaction among nurses in Turkey.

BACKGROUND

Nursing is one of the professions in which emotional labour is heavily used. The relationship between emotional labour strategies and job satisfaction has many different consequences in nursing.

INTRODUCTION

Although studies have focused on the relationship between emotional labour and job satisfaction among nurses abroad, no studies on the subject have been found in Turkey.

METHODS

A cross-sectional descriptive design was employed. The study was conducted with 281 nurses working in a university hospital and three public hospitals in Manisa, Turkey. Research data were collected using the Personal Information Form, Emotional Labour Scale and Minnesota Satisfaction Questionnaire. Descriptive statistics and Pearson correlation analysis were used in data evaluation.

RESULTS

Analyses showed that the type of emotional labour strategy most frequently exhibited by nurses was surface acting. In surface acting, behaviours do not reflect employees' true feelings. Job satisfaction of nurses was higher than the medium level. A negative correlation was found between deep acting and job satisfaction. In deep acting, employees try to feel the emotions appropriate to the behaviour expected of them.

DISCUSSION

Nurses' emotional labour may cause some undesirable consequences.

CONCLUSION

Nurses' emotional labour strategies are related to their job satisfaction levels.

IMPLICATIONS FOR NURSING POLICY

Managers should be aware of the emotional labour of nurses and its possible negative consequences. Management strategies that target the negative consequences of emotional labour are important not only for the well-being of nurses but also for the quality of patient care.

Caring efficacy: nurses' perceptions and relationships with work-related factors

BACKGROUND AND AIM OF THE WORK

Caring nursing practice is central aspect of quality of services. It is important to assess nurses' caring experience in terms of perceived caring efficacy to make them aware of their outcomes and improve their strategies. The aims of the study was to analyze: (1) the caring efficacy level, (2) differences between the caring efficacy levels concerning  positive and negative work attitudes, (3) individual and organizational predictors of perceived caring efficacy.

METHODS

200 nurses were recruited from a University Hospital in Southern Italy. A self-reported questionnaire was administered. T-test was performed to analyze differences between caring efficacy levels concerning outcomes variables. Regression analysis was carried out to examine how some work factors were related to perceived caring efficacy.

RESULTS

Participants referred high confidence to care (CC) for 55%, and low doubts and concerns (DC) for 72.9%. Nurses who had low DC had lower emotional exhaustion than nurses with moderate DC. Nurses with low DC had higher job satisfaction than nurses with high DC. Regarding CC levels, there were no differences between mean values for both attitudes at work. The emotional dissonance significantly predicted DC and CC. The supervisor support had a negative link with emotional dissonance, which in turn was negatively related to CC.

CONCLUSIONS

Education and training should be addressed to reduce doubts and concerns to care and improve the ability to manage emotions. A work environment that value caring and give support in managing emotions can reduce emotional dissonance and improve caring self-efficacy.

Nurse Telephone Counseling Services as a "Gatekeeper" in an Internet-Based Digital Doctor Reception: A Mixed Questionnaire Survey

Objective: A large number of different types of digital innovations for health and medical care have been developed in Sweden under the concept of eHealth. Employees’ interest is of great importance in determining the success of different new digital interventions and technologies. Purpose: In this study, we aimed to elucidate the nurses’ experiences as a first “gatekeeper” in an Internet-based Digital Doctor Reception (DDR) concept. Methods: Our 16 informants were recruited among nurses who participated in a DDR pilot project that was completed in April 2019. A mixed questionnaire survey was used to elucidate the nurses’ experiences of collaboration & challenges, technical functionality, and DDR as an activity. The results were descriptively summarized with index values (IVs, 0-1.0), supplemented with a 10-point Likert-type scale that estimated satisfaction and views regarding personal experiences. Results: Collaboration and challenges were experienced as fairly good (IV, 0.58), and technical functionality was experienced as good (IV, 0.80). The experience of DDR as an activity was described positively with an IV of 0.75. The overall experience of the concept (IV, 0.68), corresponds well to the median satisfaction value of 6.5 (interquartile range, 6-9). Content analysis identified 2 main categories: “Facilitators in using DDR experienced by nurses” and “Barriers in using DDR experienced by nurses.” Nurses generally felt positive about participating in the development of an eHealth service. However, they suggested that DDR triaging should take place at the health care center level. The nurses also observed that certain patient groups were excluded from the DDR concept, and sometimes experienced this new way of triaging as less challenging. Conclusion: The informants in our study generally described satisfaction and an overall good experience with the DDR concept. However, some informants felt that the concept was sometimes more stressful and less challenging compared with normal working methods.

Nurses' perspectives on their communication with patients in busy oncology wards: A qualitative study

BACKGROUND

Despite an increase in emphasis on psychosocial care in cancer nursing, time constraints and nurses' lack of knowledge in skilled communication continue to be challenges.

AIMS

To examine how cancer care nurses view their communication with patients and how they deal with the psychosocial needs of patients in busy wards.

DESIGN

A qualitative interview study.

METHODS

Focus groups and individual interviews were conducted with eleven hospital-based cancer nurses in Hong Kong from July 2, 2017 to January 2, 2018.

RESULTS

A qualitative thematic analysis of the data identified three themes: 1. Intentional and unintentional psychosocial care that is secondary in focus; 2. Managing an emotionally challenged environment; 3. Mentoring and learning.

CONCLUSION

Oncology settings are time-constrained, emotionally charged environments for nurses, and providing psychosocial care for patients is a secondary concern. While proactive strategies can be used to avert patient complaints, being open and attending to the individual needs of patients is equally important to avoid blocking in nurse-patient communication. Despite emotional entanglement and tensions, the positive follow-up strategies used by nurses to manage the patients' emotions and provide psychosocial care reflect good practices. Leadership and support are needed to deal with the nurses' perception that their communication training has been ineffective and their ability to manage strong emotions deficient. Communication skills, honed by making continuous opportunities to communicate available, as well as an understanding of emotional labour, need to be integrated with mindfulness in the nurses' care of themselves and their patients. Notwithstanding the importance of experience in oncology care for junior nurses, it is necessary for both junior and senior nurses to learn about and reflect upon the different forms of emotional labour if value-based care is to be provided. In addition, it is essential for junior nurses to receive continuous coaching and mentoring, and to engage in reflective learning from each clinical encounter with oncology patients.

[Psychosocial Well-Being of Clinical Nurses Performing Emotional Labor: A Path Analytic Model Approach]

PURPOSE

This study was conducted to investigate the influence of emotional expressivity, emotional intelligence, affectivity, job autonomy, social support, and emotional labor on clinical nurses' individual well-being and to provide guidelines for interventions and strategies for its improvement.

METHODS

The sample consisted of 207 nurses recruited from a general hospital in Korea. The participants completed a structured self-report questionnaire comprising measures of emotional expressivity, emotional intelligence, positive affectivity, negative affectivity, job autonomy, supervisor support, coworker support, deep acting, surface acting, emotional exhaustion, and job satisfaction. Data were analyzed using SPSS statistics 22.0 and AMOS 22.0.

RESULTS

The final model was a good fit for the data based on the model fit indices. In the path analysis, surface acting, negative affectivity, supervisor support, and coworker support had statistically significant effects on emotional exhaustion, explaining 29.0% of the variance. Deep acting, emotional exhaustion, positive affectivity, and emotional intelligence had statistically significant effects on job satisfaction, explaining 43.0% of the variance.

CONCLUSION

Effective strategies to improve clinical nurses' individual well-being should focus on surface acting, deep acting, affectivity, social support, and emotional intelligence. The results of this study can be utilized as base data to manage emotional labor and improve clinical nurses' individual well-being.

Prevention of Occupational Strain: Can Psychological Empowerment and Organizational Commitment Decrease Dissatisfaction and Intention to Quit?

In the present study, the demands-control-support model has served as the basis for the assessment of occupational strain. This model has been used as a predictor of health problems. It has also been associated with organizational outcomes and behaviors. The purpose of this study is to relate job demands and resources with job satisfaction and intention to quit the union. We intend to test a multiple mediation model with psychological empowerment and union commitment as mediator variables. The investigation was carried out with 953 delegates of a Spanish trade union (healthcare professionals). We collected 401 questionnaires. Multiple mediation analyses were performed with bootstrapping techniques using the SPSS PROCESS macro. The results underlined the effects of multiple mediation of empowerment and commitment in the relation between resources and job satisfaction. This mediation was also observed in the relation between resources and intention to quit. The lack of relation between demands and satisfaction or intention to quit is of interest. In the presence of adequate resources, delegates are empowered and committed to their union, which leads to lower dissatisfaction and lower rates of quitting. This study advises organizations to give greater importance to motivational and attitudinal factors to attenuate occupational strain.

Learning lessons from the analysis of patient complaints relating to staff attitudes, behaviour and communication, using the concept of emotional labour

AIMS AND OBJECTIVES

This article explores the content of letters of complaint by patients and carers about the behaviour, attitudes and communication of healthcare staff.

BACKGROUND

The most common focus of patient complaints in the UK and other high-income countries is staff attitudes, behaviour and communication. There is a move to learn lessons from patient complaints, which can be used to improve patient care and experience.

METHODS

Fifty letters of complaint made by patients and carers relating to the behaviour, attitudes and communication of healthcare staff were analysed.

RESULTS

Poor attitudes, behaviours and communication have significant negative impact on the emotional well-being of patients and carers. Many patients and carers have heightened sensitivities due to both health-related stresses and also other factors. The healthcare role is expected to include compassion and kindness. The concept of emotional labour is useful in explaining the skills and effort required of staff in this often invisible and undervalued aspect of health care.

CONCLUSIONS

Given the increasing focus on patient experience, it is important that the importance of good staff attitudes, behaviours and communication is understood and that the emotional labour associated with this is recognised.

RELEVANCE TO CLINICAL PRACTICE

An understanding of emotional intelligence can protect staff from burnout and other negative outcomes which those in a caring role can experience.

The Impact of Workaholism on Nurses’ Burnout and Disillusion

Background:

The literature has shown that workaholism acts at the root of burnout, but research regarding these constructs in the nursing profession is scant. Similarly, little attention has been paid to the impact of workaholism on disillusion, which is a dimension of burnout linked to professional vocation.

Objectives:

Contribute to the ongoing research on the relationship between workaholism and burnout among nurses. Moreover, this study considers disillusion as a dimension to be considered when investigating the relationship between workaholism and burnout, since nursing entails professional vocation.

Method:

The study followed a cross-sectional design. 614 nurses of six hospitals in South Italy have compiled two Self-report questionnaires: the Dutch Utrecht WorkAholism Scale (workaholism - Italian version) and the Link Burnout Questionnaire (burnout). Part of the group of subjects was diagnosed with both syndromes or considered at risk of developing them. The impact of workaholism on burnout was examined using Structural Equation Models for each variable.

Results:

More than 26% of the nurses are affected by burnout whereas 21% are workaholics. Working excessively proved to be a good predictor of both psychophysical exhaustion and disillusion.

Conclusions:

Nurses are at risk of workaholism and burnout. The study shows that workaholism is a predictor of nurses’ burnout, in particular working excessively (a dimension of workaholism) affects their psychophysical well-being and professional vocation.

Knowledge management, health information technology and nurses' work engagement

BACKGROUND

Knowledge management (KM) extends the health information technology (HIT) literature by addressing its impact on creating knowledge by sharing and using the knowledge of health care professionals in hospitals.

PURPOSE

The aim of the study was to provide insight into how HIT affects nurses' explicit and tacit knowledge of their ongoing work processes and work engagement.

METHODOLOGY

Data were collected from 74 nurses in four wards of a Dutch hospital via a paper-and-pencil survey using validated measurement instruments. In a quasiexperimental research design, HIT was introduced in the two experimental wards in contrast to the two control wards. At the time of the HIT introduction, a pretest was administered in all four wards and was followed by a posttest after 3 months. Data were analyzed via partial least squares modeling.

RESULTS

Generally, nurses' tacit knowledge (i.e., their insight into and their capacity to make sense of the work processes) appears to be a significant and strong predictor of their work engagement. In contrast, nurses' explicit knowledge (i.e., information feedback about patients and tasks) only indirectly affects work engagement via its effect on tacit knowledge. Its effect on work engagement therefore depends on the mediating role of tacit knowledge. Interestingly, introducing HIT significantly affects only nurses' explicit knowledge, not their tacit knowledge or work engagement.

PRACTICE IMPLICATIONS

Nurses' tacit and explicit knowledge needs to be systematically distinguished when implementing HIT/KM programs to increase work engagement in the workplace. Tacit knowledge (insight into work processes) appears to be pivotal, whereas efforts aimed only at improving available information will not lead to a higher level of work engagement in nurses' work environments.

International Nursing: Research on the Correlation Between Empathy and China's Big Five Personality Theory: Implications for Nursing Leaders

To investigate the characteristics of nurses' empathy and explore the correlation between nurses' empathy and personality, a cross-sectional study with 250 nurses from a general hospital in China was conducted using the Chinese Big Five Personality Inventory (CBF-PI) and the Jefferson Scale of Empathy-Health Professionals (JSE-HP). The total score of the JSE-HP was 110.60 (SD = 11.71). Employment forms and child-rearing situations were the significant predictors of the JSE-HP score. Multiple hierarchical regression analysis indicated that the JSE-HP score was positively correlated with conscientiousness and agreeableness and the contribution of CBF-PI to JSE-HP scale variances was 15.1%. The results demonstrated that nurses' empathy is on the high level. The Big Five Personality model is a significant predictor of nurses' empathy. The findings of the study provide reference for nurses' humanistic care training and education. In addition, training programs emphasizing emotions, psychology, humanistic quality, and healthy personality should be strengthened to promote nurses' empathy.

Nurses' resilience and the emotional labour of nursing work: An integrative review of empirical literature

BACKGROUND

The emotional labour of nursing work involves managing the emotional demands of relating with patients, families and colleagues. Building nurses' resilience is an important strategy in mitigating the stress and burnout that may be caused by ongoing exposure to these demands. Understandings of resilience in the context of emotional labour in nursing, however, are limited.

OBJECTIVES

To investigate the state of knowledge on resilience in the context of emotional labour in nursing.

DESIGN

Integrative literature review.

DATA SOURCES

CINAHL, Medline, Scopus, and PsycINFO electronic databases were searched for abstracts published between 2005 and 2015 and written in English. Reference lists were hand searched.

REVIEW METHODS

Whittemore and Knafl's integrative review method was used to guide this review. The constant comparative method was used to analyze and synthesize data from 27 peer-reviewed quantitative and qualitative articles. Methodological quality of included studies was assessed using the Mixed Methods Assessment Tool.

RESULTS

Emotional labour is a facet of all aspects of nursing work and nurse-patient/family/collegial interactions. Emotional dissonance arising from surface acting in emotional labour can lead to stress and burnout. Resilience can be a protective process for the negative effects of emotional labour. Several resilience interventions have been designed to strengthen nurses' individual resources and reduce the negative effects of workplace stress; however they do not specifically address emotional labour. Inclusion of emotional labour-mitigating strategies is recommended for future resilience interventions.

CONCLUSION

Resilience is a significant intervention that can build nurses' resources and address the effects of emotional dissonance in nursing work. There is a need for further investigation of the relationship between resilience and emotional labour in nursing, and robust evaluation of the impact of resilience interventions that address emotional labour.

Emotional Labour and Wellbeing: What Protects Nurses?

Although compassionate care has wide-ranging benefits for patients, it can be emotionally demanding for healthcare staff. This may be a particular problem for those with little experience in a caring role. This study utilises the job demands-resources model to examine links between “emotional labour” and emotional exhaustion in student nurses. In line with the triple-match principle—whereby interactive effects are more likely when job demands, resources, and outcomes are within the same qualitative domain—the protective role of emotional support and emotion-focused coping (i.e., emotional venting) in the relationship between emotional labour and exhaustion is also explored. An online questionnaire was completed by 351 student nurses with experience working in healthcare settings. A strong positive relationship was found between emotional labour and emotional exhaustion, and some support was found for the moderating effects of emotional support and emotion-focused coping. Ways to help student and qualified nurses develop the emotional resilience required to protect their wellbeing, while providing high-quality compassionate care to patients are considered.