Does self-compassion mitigate the relationship between burnout and barriers to compassion? A cross-sectional quantitative study of 799 nurses

BackgroundBurnout has numerous negative consequences for nurses, potentially impairing their ability to deliver compassionate patient care. However, the association between burnout and compassion and, more specifically, barriers to compassion in medicine is unclear. This article evaluates the associations between burnout and barriers to compassion and examines whether dispositional self-compassion might mitigate this association.HypothesisConsistent with prior work, the authors expected greater burnout to predict greater barriers to compassion. We also expected self-compassion – the ability to be kind to the self during times of distress – to weaken the association between burnout and barriers to compassion among nurses.MethodsRegistered nurses working in New Zealand medical contexts were recruited using non-random convenience sampling. Following consent, 799 valid participants completed a cross-sectional survey including the Copenhagen Burnout Inventory, the Barriers to Physician Compassion scale, and a measure of dispositional self-compassion.ResultsAs expected, greater burnout predicted greater barriers to compassion while self-compassion predicted fewer barriers. However, self-compassion mitigated the association between burnout and burnout related barriers to compassion (but not other barriers). The interaction suggested that suggested that the association was stronger (rather than weaker) among those with greater self-compassion.DiscussionUnderstanding the lack of compassion and the effects of burnout in patient care are priorities in health. This report extends evidence on the association between burnout and compassion-fatigue to show that burnout also predicts the experience of specific barriers to compassion. While self-compassion predicted lower burnout and barriers, it may not necessarily reduce the extent to which burnout contributes to the experience of barriers to compassion in medicine. Implications for understanding how burnout manifests in barriers to clinical compassion, interventions and professional training, and future directions in nursing are discussed.     

Physicians’ and nurses’ perceptions of patient safety risks in the emergency department

The emergency department has been described as a high-risk area for errors. It is also known that working conditions such as a high workload and shortage off staff in the healthcare field are common factors that negatively affect patient safety. A limited amount of research has been conducted with regard to patient safety in Swedish emergency departments. Additionally, there is a lack of knowledge about clinicians’ perceptions of patient safety risks. Therefore, the purpose of this study was to describe emergency department clinicians’ experiences with regard to patient safety risks.MethodSemi-structured interviews were conducted with 10 physicians and 10 registered nurses from two emergency departments. Interviews were analysed by inductive content analysis.ResultsThe experiences reflect the complexities involved in the daily operation of a professional practice, and the perception of risks due to a high workload, lack of control, communication and organizational failures.ConclusionThe results reflect a complex system in which high workload was perceived as a risk for patient safety and that, in a combination with other risks, was thought to further jeopardize patient safety. Emergency department staff should be involved in the development of patient safety procedures in order to increase knowledge regarding risk factors as well as identify strategies which can facilitate the maintenance of patient safety during periods in which the workload is high.     

What puts the adverse in ‘adverse events’? Patients’ perceptions of post-treatment experiences in osteopathy – A qualitative study using focus groups

Patients commonly report mild to moderate effects following all forms of manual therapy. These are often regarded as adverse events by practitioners but there is limited evidence on how patients view their post-treatment experiences, and what meaning they ascribe to them. This qualitative study used three focus group discussions (19 participants) to explore osteopathic patients' perspectives; a framework approach was used to analyse the data. There were four emergent themes (and 23 sub-themes). Interpretative (level two) analysis of the data led to a conceptual model of meaning with four inter-related components: Expectations; Personal investment; Osteopathic encounter; Clinical change, under an overarching construct, the 'global osteopathic experience'. These four components, designated EPOC, can have a profound impact on a patient's post-treatment experiences and their perception of what is adverse. This model suggests there is disparity between patient perceptions and clinical definitions of adverse events; awareness by practitioners of this disparity is essential for effective clinical management.     

Nurses’, physicians’ and radiographers’ perceptions of the safety of a nurse prescribing of ionising radiation initiative: A cross-sectional survey

BackgroundA new initiative was introduced in Ireland following legislative changes that allowed nurses with special training to prescribe ionising radiation (X-ray) for the first time. A small number of studies on nurse prescribing of ionising radiation in other contexts have found it to be broadly as safe as ionising radiation prescribing by physicians. Sociological literature on perceptions of safety indicates that these tend to be shaped by the ideological position of the professional rather than based on objective evidence.ObjectivesTo describe, compare and analyse perceptions of the safety of a nurse prescribing of ionising radiation initiative across three occupational groups: nursing, radiography and medicine.DesignA cross-sectional survey design.SettingsParticipants were drawn from a range of clinical settings in Ireland.ParticipantsRespondents were 167 health professionals comprised of 49 nurses, 91 radiographers, and 27 physicians out of a total of 300 who were invited to participate. Non-probability sampling was employed and the survey was targeted specifically at health professionals with a specific interest in, or involvement with, the development of the nurse prescribing of ionising radiation initiative in Ireland.MethodsComparisons of perspectives on the safety of nurse prescribing of ionising radiation across the three occupational groups captured by questionnaire were analysed using the Kruskal–Wallis H test. Pairwise post hoc tests were conducted using the Mann–Whitney U test.ResultsWhile the majority of respondents from all three groups perceived nurse prescribing of ionising radiation to be safe, the extent to which this view was held varied. A higher proportion of nurses was found to display confidence in the safety of nurse prescribing of ionising radiation compared to physicians and radiographers with differences between nurses’ perceptions and those of the other two groups being statistically significant.ConclusionThat an occupational patterning emerged suggests that perceptions about safety and risk of nurse prescribing of ionising radiation are socially constructed according to the vantage point of the professional and may not reflect objective measures of safety. These findings need to be considered more broadly in the context of ideological barriers to expanding the role of nurses.     

A framework to support preceptors’ evaluation and development of new nurses’ clinical judgment

In today’s complex, fast-paced world of hospital nursing, new graduate nurses do not have well-developed clinical judgment skills. Nurse preceptors are charged with bridging the gap between new graduates’ learning in school and their autonomous practice as RNs. In one large, urban medical center in the U.S., a clinical judgment model and rubric were used as a framework for a new evaluation and orientation process. Preceptors of new graduate nurses who had used the former and new processes described their experiences using the framework. The findings indicated that having a structured framework provided objective ways to evaluate and help develop new graduate nurses’ clinical judgment. It is hypothesized that academic clinical supervisors may find such a framework useful to prepare students for transition to practice.     

A cross-sectional study of clinical emergency department nurses’ occupational stress,job involvement and team resilience

IntroductionThe occupational stress of clinical nurses has drawn increasing attention. It has been proven that occupational stress is related to job involvement, and job involvement affects team resilience. However, research on the relationship between emergency nurses’ occupational stress, job involvement and team resilience is lacking.AimTo explore relationships between occupational stress, job involvement, and team resilience among a sample of emergency nurses and determined significant influencing factors of occupational stress in emergency departments.MethodsIn four hospitals in Shandong, China, 187 emergency room nurses participated in a study. The Utrecht Work Engagement Scale, the Chinese version of the Stressors Scale for Emergency Nurses, and a scale for evaluating the team resilience of medical professionals were used to collect data.ResultsThe overall occupational stress score of nurses working in the emergency departments in Shandong province was 81.07 ± 25.80. The results of Single-factor analysis demonstrated that the scores indicating the occupational stress for emergency nurses differed significantly with respect to age, education level, marital status, children, professional title, work experience and work shift (P < 0.05). Additionally, there is a negative correlation between job involvement and team resilience and occupational stress. Multiple linear regression results showed that the job involvement, team resilience and work shift were statistically significant influencing factors of the level of occupational stress (change R² = 17.5 %, F = 5.386, P < 0.001).ConclusionsStronger team resilience and more active job involvement resulted in lower occupational stress levels experienced by emergency nurses.     

Barriers to the provision of optimal care to dying patients in hospital: An international cross-sectional comparison study of nurses’ perceptions

BackgroundNurses play an important role in caring for patients who are dying in hospital, so it is important to understand their perceptions of the factors that may influence the quality of that care. Much of the existing literature is focused on end-of-life care provision in western settings. Little is known about how nurses’ perceptions of end-of-life care provision may differ across Asian and Western locations. Understanding the similarities and differences between the perceptions of nurses in Asian and Western locations about the barriers to the provision of high-quality end-of-life care may help guide education and policy initiatives to improve end-of-life care in each location.AimTo compare the perceptions of nurses from Australia, South Korea, and Hong Kong regarding barriers to high-quality end-of-life care provision for people dying in hospitals.MethodsA cross-sectional study of hospital-based nurses from Australia (n = 153), South Korea (n = 241), and Hong Kong (n = 188) completed a survey between December 2016 and June 2018. Nurses indicated the extent to which they perceived 40 items across five domains to be a barrier to high-quality end-of-life care provision.FindingsSignificant variation between the perceptions of nurses in each location was found in two-thirds of the survey items. The greatest difference was seen in the item doctors continue life-sustaining medical interventions for too long, which was considered a significant barrier by 60.1% of Australian nurses, 32.9% of South Korean nurses and 13.8% of Hong Kong nurses. The greatest cross-location agreement related to differences in religious beliefs and languages. These items were considered a significant barrier by fewer than one-quarter of nurses.ConclusionNurses in Hong Kong, South Korea and Australia perceived a range of challenges to the provision of optimal end-of-life care. The significant differences observed in two-thirds of response items support the hypothesis that strategies to improve the quality of end-of-life care in one location may not be effective in another. For interventions to be effective they must be tailored to the unique nature of care-provision in each location. Gaining an understanding of the potential reasons for these differences may highlight potential targets for interventions that address the unique factors associated with care provision in each location.     

Tube placement using ‘IRIS’: A pilot assessment of its utility and safety

IntroductionMost critically ill patients have a feeding tube placed blindly, but 0.5% result in a major lung complication because misplacement is only detected at the end of procedure. Real-time guided tube placement may pre-empt such complications. This clinical effectiveness study examined the ability to visualise anatomy using Kangaroo™ feeding tubes with IRIS technology (‘IRIS’ tube).MethodsIn a single centre, gastric or intestinal integrated real-time imaging system (IRIS) tubes were prospectively placed in critically ill patients noting the anatomical visualisation.ResultsOf 15 placements, 13 were successful gastric placements and used for feeding but one gastric and one intestinal placement failed because of signal loss and inability to find the pylorus, respectively; both tubes were removed. Air insufflation and fluid aspiration were possible with all tubes. Respiratory misplacement was clearly differentiated, prior to reaching the main carina, from gastrointestinal (GI) anatomical markers, permitting removal before causing trauma. Furthermore, non-traumatic placement was visualised in high-risk cases including during advancement through a nostril with a base of skull fracture and into a stomach with a recently haemorrhaging gastric polyp. Individually assessed, direct vision may offer greater safety. X-ray or pH of aspirated fluid confirmed the position of GI tube placements. One adverse event occurred during placement, reversible bradycardia, in a patient previously having bradycardia. Vision was intermittently obscured by bile, mucus or impaction with mucosa.Conclusion‘IRIS’ tubes offer real-time guidance regarding anatomical position. Larger studies are needed to establish the best techniques of deploying this equipment and over-coming the difficulties observed.     

Knowledge of,and participation in,advance care planning: A cross-sectional study of acute and critical care nurses’ perceptions

BackgroundNurses have a core role in facilitating discussions and enacting decisions about end-of-life issues for patients in hospitals. Nurses’ own knowledge and attitudes may influence whether they engage in meaningful end-of-life conversations with patients.AimsTo determine in a sample of nurses working in acute and critical care hospital wards:1) their knowledge of advance care planning, including the authority of substitute decision-makers and legal validity of advance directives;2) their own participation in advance care planning decision-making practices; and3) associations between nurses’ socio-demographic characteristics; clinical expertise; and knowledge and behaviour in relation to advance care planning practices.DesignQuestionnaire-based, cross-sectional study.Setting and participantsThe study was conducted with 181 registered and enrolled nurses employed in acute and critical care wards of three metropolitan hospitals in Australia.ResultsNurses were least knowledgeable about items relating to the authority of medical (56%) and financial (42%) substitute decision-makers. Few nurses had prepared advance directives (10%) or appointed medical (23%) or financial (27%) decision-makers, when compared to discussing end-of-life wishes (53%) or organ donation (75%). Overall, 15% of nurses had not engaged in any advance care planning practices. Nurses who had cared for 11–30 dying patients in the last six months were more likely to have an increased knowledge score. Older nurses were more likely to participate in a greater number of advance care planning practices and an increase in shifts worked per week led to a significant decrease in nurses’ participation.ConclusionNurses have a key role in providing advice and engaging dying patients and their families in advance care planning practices. Nurses’ own knowledge and rates of participation are low. Further education and support is needed to ensure that nurses have an accurate knowledge of advance care planning practices, including how, when and with whom wishes should be discussed and can be enacted.     

Emergency nurses’ perceptions of the health care system and how it impacts provision of care to people who self-harm

BackgroundSelf-harm is a deliberate act to cause physical harm to oneself. People who self-harm are at greater risk for suicide than people who do not self-harm. Emergency nurses are first responders to many people who present to the emergency department (ED) with self-harm. The care they provide can influence future presentations to the emergency department and long-term outcomes.AimThe aim was to explore ED nurses’ experiences of working with people who self-harm.MethodsSemi-structured interviews were conducted with 18 emergency nurses from different locations in Australia in 2019. Elo and Kyngäs’ inductive content analysis research method guided all stages of the research.ResultsThe category “health care system” emerged from the data. It comprised five subcategories: (i) Complexity of the work environment; (ii) ED staff attitudes and care provision; (iii) the mental health patient; (iv) facilitators and barriers to providing care to people who self-harm; and (v) lack of community resources.DiscussionThis study found there were several factors influencing ED nurses’ knowledge, skills and confidence in caring for people who self-harm and several factors influenced their experience.ConclusionWhile participants felt confident to manage the physical injuries associated with self-harm, they were less confident to engage with the person about their self-harm. The article provides guidance for ED nurses to assess and intervene with people who present with self-harm.     

A study of the relationship between nurses’ experience,structural empowerment,and attitudes toward computer use

ObjectiveThis study examined the relationship between structural empowerment and nurses’ experience and attitudes toward computer use.MethodsThis study was conducted using a cross-sectional quantitative design. A total of 184 registered nurses from four hospitals in Jordan participated in the current study. Data were collected using a demographics questionnaire, the Conditions for Work Effectiveness Questionnaire-II (CWEQ-II), and the Pretest for Attitudes toward Computers in Healthcare (PATCH).ResultsThe median of experience in years among nurses was 5.0, ranging from one to 26 years. The mean score for the attitudes toward computer use was 61.90 ± 11.38. Almost half of the participants, 45.11%, were in the category of “feel comfortable using user-friendly computers.” The participants’ mean average of the total structural empowerment was 12.40 ± 2.43, and the values for its four subscales were: opportunity 3.57 ± 0.87, resources 2.83 ± 0.85, information 3.06 ± 0.79, and support 2.95 ± 0.86. The frequencies analysis revealed that most participants had a moderate level of empowerment (n = 127, 69.02%). The bivariate correlation between nurses’ experience and attitudes toward computer use was significant (r = −0.17, P < 0.05). The relationship between the total structural empowerment score and attitudes toward computer use was positive but weak (r = 0.20, P < 0.01).ConclusionThe results indicated that more experienced nurses are more reluctant toward computer use. However, creating an empowering work environment can facilitate nurses’ attitudes toward computer use.     

Moderating effect of organizational climate on the relationship between research motivation and learning engagement among nurses taking part-time master’s program: A cross-sectional study

AimsTo investigate the moderating effects of perceived organizational climate on the relationship between research motivation and learning engagement in research among nurses pursuing a part-time master’s degree.BackgroundResearch motivation positively affects learning engagement in research. However, the role of perceived organizational climate has not been explored in nurses taking part-time master’s program in China. This study examined the relationships between various types of research motivation and learning engagement in research and whether the perceived organizational climate moderates the relationship between the other variables.MethodsThis cross-sectional one-center study was performed on 230 nurses by assessing learning engagement in research, research motivation and perceived organizational climate.ResultsThe mean age of participants was 31.3 ± 3.5 years and 91.3% were female. Participants who had been assigned a supervisor showed higher learning engagement in research than those without a supervisor (3.65 ± 0.60 vs. 3.48 ± 0.61; P < 0.001). Participants who had experience conducting research reported higher learning engagement in research than those with no experience (3.30 ± 0.71 vs. 3.14 ± 0.83; P < 0.05). The mean score of learning engagement in research was 3.39 ± 0.63. The mean scores for intrinsic, extrinsic and failure-avoidance motivation were 3.72 ± 0.61, 3.71 ± 0.71 and 3.43 ± 0.70, respectively. As for perceived organizational climate, the mean score was 122.70 out of 148. Learning engagement in research was significantly positively correlated with intrinsic research motivation, extrinsic research motivation and perceived organizational climate scores (r = 0.441, 0.336, 0.307, p < 0.001, respectively). Perceived organizational climate moderated the correlation between intrinsic and extrinsic research motivation and learning engagement in research.ConclusionNurses taking the master’s program perceived a higher level of perceived organizational climate could strengthen the relationship between intrinsic and extrinsic research motivation and learning engagement in research. More organizational support can enhance learning engagement in research by reinforcing intrinsic and extrinsic research motivation.Implications for nursing managementUniversities can assign supervisors promptly. Universities and hospitals can provide education about the importance of research in nursing and reinforce their intrinsic and extrinsic research motivation. Hospitals can adjust policies based on the needs of nurses taking the master’s program to provide organizational support, to facilitate the research learning process.