Objective: Healthcare professionals who work in palliative care units face stressful life events on a daily basis, most notably death. For this reason, these professionals must be equipped with the necessary protective resources to help them cope with professional and personal burnout. Despite the well-recognized importance of the construct "meaning of work," the role of this construct and its relationship with other variables is not well-understood. Our objective is to develop and evaluate a model that examines the mediating role of the meaning of work in a multidisciplinary group of palliative care professionals. Using this model, we sought to assess the relationships between meaning of work, perceived stress, personal protective factors (optimism, self-esteem, life satisfaction, personal growth, subjective vitality), and sociodemographic variables.
Method: Professionals (n = 189) from a wide range of disciplines (physicians, psychologists, nurses, social workers, nursing assistants, physical therapists, and chaplains) working in palliative care units at hospitals in Madrid and the Balearic Islands were recruited. Sociodemographic variables were collected and recorded. The following questionnaires were administered: Meaning of Work Questionnaire, Perceived Stress Questionnaire, Life Orientation Test-Revised, Satisfaction with Life Scale, Subjective Vitality Scale, Rosenberg Self-Esteem Scale, and the Personal Growth Scale.
Result: The explanatory value of the model was high, explaining 49.5% of the variance of life satisfaction, 43% of subjective vitality, and 36% of personal growth. The main findings of this study were as follow: (1) meaning of work and perceived stress were negatively correlated; (2) optimism and self-esteem mediated the effect of stress on the meaning attached to work among palliative care professionals; (3) the meaning of work mediated the effect of stress on subjective vitality, personal growth, and life satisfaction; and (4) vitality and personal growth directly influenced life satisfaction.
Significance of results: The proposed model showed a high explanatory value for the meaning professionals give to their work and also for perceived stress, personal protective factors, and sociodemographic variables. Our findings could have highly relevant practical implications for designing programs to promote the psychological well-being of healthcare professionals.
Au Québec, le rôle des maisons de SP est central dans l'offre de soins en fin de vie. Avec l'évolution et le vieillissement de la société, des lois et du travail, qui se complexifient, les soignants et l'ensemble des intervenants se voient exposés à une demande émotionnelle croissante combinée à d'autres facteurs de stress. Pourtant, aucun programme visant à favoriser le bien-être au travail pour ce type d'intervenants ne semble disponible au Canada. S'inspirant d'écrits et d'expériences internationales, un processus novateur permettant l'élaboration et la mise en oeuvre d'un programme de bien-être pour intervenants en maison de soins palliatifs (SP) a été entrepris suivant l'influence de la recherche-action. L'article décrit cette démarche de coconstruction. Ce type d'innovation pourrait permettre l'amorce d'une transformation systémique reconnaissant l'importance de soutenir les acteurs den SP pour offrir des soins de fin de vie de qualité.
The average expected lifespan in Canadian long-term care (LTC) homes is now less than two years post-admission, making LTC a palliative care setting. As little is known about the readiness of LTC staff in Canada to embrace a palliative care mandate, the main objective of this study was to assess qualities relevant to palliative care, including personal emotional wellbeing, palliative care self-efficacy and person-centred practices (e.g. knowing the person, comfort care). A convenience sample of 228 professional and non-professional staff (e.g. nurses and nursing assistants) across four Canadian LTC homes participated in a survey. Burnout, secondary traumatic stress and poor job satisfaction were well below accepted thresholds, e.g. burnout: mean = 20.49 (standard deviation (SD) = 5.39) for professionals; mean = 22.09 (SD = 4.98) for non-professionals; cut score = 42. Furthermore, only 0â€“1 per cent of each group showed a score above cut-off for any of these variables. Reported self-efficacy was moderate, e.g. efficacy in delivery: mean = 18.63 (SD = 6.29) for professionals; mean = 15.33 (SD = 7.52) for non-professionals; maximum = 32. The same was true of self-reported person-centred care, e.g. knowing the person; mean = 22.05 (SD = 6.55) for professionals; mean = 22.91 (SD = 6.16) for non-professionals; maximum = 35. t-Tests showed that non-professional staff reported relatively higher levels of burnout, while professional staff reported greater job satisfaction and self-efficacy (p < 0.05). There was no difference in secondary traumatic stress or person-centred care (p > 0.05). Overall, these results suggest that the emotional wellbeing of the Canadian LTC workforce is unlikely to impede effective palliative care. However, palliative care self-efficacy and person-centred care can be further cultivated in this context.
OBJECTIVES: To explore how psychology trainee death concerns and ageist behavior relate to their willingness and desire to work with older adults.
METHOD: Trainees (N = 104; 80.8% women) completed the Death Thought-Accessibility Measure, Relating to Older People Evaluation (ROPE), Death Anxiety Scale-Extended (DASE), and Beck Anxiety Inventory (BAI) and rated their willingness and desire to work with older adults and their willingness to obtain training on how to work with older adults.
RESULTS: Pearson correlations showed that salience of death-related thoughts, death anxiety (but not general anxiety), and negative behaviors toward older adults were significantly negatively associated with trainees' willingness and desire to work with older adults. Regressions revealed that negative behaviors toward older adults was the strongest factor associated with willingness and desire to work with older adults, whereas positive behaviors toward older adults was the strongest factor associated with being willing to obtain training in working with older adults. Death anxiety and salience of death-related thoughts positively correlated with each other and were each positively associated with negative behaviors toward older adults.
CONCLUSION: Helping graduate trainees become more comfortable with mortality and changing negative behaviors toward older adults may increase their interest in gerontology and geriatrics.
BACKGROUND: Increased exposure to deaths in the intensive care unit (ICU) generate grief among ICU staff, which remains unresolved most of the time. Unresolved grief becomes cumulative and presents a risk factor for burnout. "sacred pause" is a ritual performed at patient's death to honor the lost life and recognize the efforts of the health-care team.
OBJECTIVE: To study the impact of the ritual of sacred pause on the attitudes and behaviors of the ICU physicians and nurses.
METHODS: Ten-question online anonymous survey was sent to ICU physicians and nurses in the medical ICU of a tertiary care hospital in July 2017.
RESULTS: Thirty-four ICU team members completed the survey including 12 physicians and 22 nurses. Seventy sacred pause rituals were performed from July 2016 to June 2017. Seventy-nine percent respondents believed that the ritual brought closure and helped them overcome the feelings of disappointment, grief, distress, and failure after the death of their patient in ICU. Seventy-three percent agreed that the ritual has instilled and encouraged a sense of team effort. Eighty-two percent responded that the ritual makes their efforts feel appreciated. Many felt that the ritual should be a universal phenomenon in all ICUs. Only 55% respondents felt that the practice has a potential to decrease ICU burnout, many of them (42%) were undecided.
CONCLUSION: Sacred pause brings closure, prevents cumulative grief and distress, builds resilience, promotes team effort, and improves professional satisfaction of ICU team. It may lower burnout syndrome in ICU, but further studies are warranted.
OBJECTIVE: Homecare workers play a pivotal role in palliative care, but research on their experiences is limited. The aim of this study was to describe how homecare workers in Sweden experience their work in palliative homecare.
METHOD: This qualitative study used open-ended interviews with a purposive sample of 15 homecare workers. The data was analysed by means of qualitative content analysis.
RESULTS: One main theme emerged from the analysis: upholding an ideal image of palliative work. This had four subthemes: doing good; doing their best work; feeling work satisfaction; and facing difficulties.
CONCLUSION:: Palliative care performed by homecare workers is demanding. Homecare workers need more practical support and would benefit from a care model that involves working with registered nurses, as a team, to provide humanistic care to dying patients and their relatives.
OBJECTIVE: The aim of this study was to translate into Spanish the Self Competence in Death Work Scale (SC-DWS) and to explore its psychometric properties of validity and reliability.
METHOD: Participants were 106 nursing professionals, who worked in units related to care at the end of life. Participants answered a questionnaire containing the Spanish forms of the Self-Competence in Death Work Scale (SC-DWS), Perceived Life Significance Scale (PLSS), Death Anxiety Inventory-Revised (DAI-R), Hospital Anxiety and Depression Scale (HADS) and General Self Efficacy Scale (GSE).
RESULTS: A Cronbach's alpha coefficient of .71 was obtained. The factorial analysis yielded five significant factors that accounted for 59.9% of the variance. The scores of the SC-DWS presented a positive and significant coefficient of correlation with Self-efficacy (GSE) and Meaning of life (PLSS) and negative with General anxiety and Depression (HADS) and Death anxiety (DAI-R).
DISCUSSION: The Spanish form of the SC-DWS has acceptable psychometric properties. This instrument could be used for evaluating competences of the professionals that work in environments related to the end of life. Likewise, it could be used to assess the efficiency of interventions directed to the acquisition of skills and coping strategies for suffering and death.
Lâ€™épuisement professionnel des soignants est particulièrement fréquent en cancérologie. Ses causes en sont plurifactorielles, car relevant quasiment toujours de lâ€™association de facteurs personnels et professionnels. Ceux liés au travail peuvent être séparés en cinq catégories : le type de travail, la charge de travail, les conflits interpersonnels, les facteurs organisationnels et les facteurs managériaux. La qualité de vie au travail est un concept plus récent qui sâ€™inscrit dans le champ de la psychologie positive. La démarche participative est un modèle organisationnel qui reposait initialement sur quatre composantes : la formation interne, les staffs pluriprofessionnels, le soutien aux équipes et la démarche projet. Récemment nous avons rajouté une cinquième composante devant le constat de la nécessité dâ€™espaces dâ€™échanges entre les médecins et les cadres de santé des services pour que le modèle marche. Ce modèle est un critère prioritaire HAS dâ€™accréditation des établissements depuis la V 2010 pour la prise en charge des patients en soins palliatifs dans tous les services de soins. Dans la dernière partie de cet article nous verrons lâ€™impact des facteurs managériaux et organisationnels mais également du modèle organisationnel de la démarche participative sur la qualité de vie au travail des soignants et sur la qualité des soins offerts aux patients et à leurs proches.
Fatal work incidents result in an array of government responses, and in countries such as the United Kingdom and Australia, this may include the holding of coronial inquests. A common theme from the scant literature is that family members have a strong need to know how and why their loved one died. The inquisitorial nature of inquests suggests potential in uncovering this information, although little is known about families' experiences with these proceedings. Interviews with 40 bereaved relatives explored their views and experiences of inquests. Findings suggest that families, often frustrated with other investigative processes, want inquests to provide a better understanding of how and why the death occurred, uncover any failings/responsibilities, and thereby move closer to a sense of justice being obtained for the deceased. Families identified problems perceived to impair the process and where improvements could be made to secure a more effective and meaningful institutional response to the fatality.
Terror management theory suggests that following culturally derived scripts for valued behaviour protects people from death concerns, and conversely, not meeting standards for cultural value can weaken this protection, heightening mortality concerns. Using this conceptual framework, we examine (1) how considerations of loss of employment, a source of cultural value for many, relates to the accessibility of death-related cognition, and (2) the moderating role of job market health, and (3) involvement in close relationships. Study 1 found that writing about being unemployed (vs. a control topic) led to greater mortality-related cognition. Study 2 found that considering unemployment heightened death cognition, but only when participants were led to perceive the job market as unhealthy. Finally, Study 3 found that considering unemployment led to greater death cognition, but not for those involved in a close relationship. Findings offer insight into a previously overlooked consequence of unemployment, and factors that may serve a protective function.
People bereaved by suicide are at an increased risk of suicide and of dropping out of education or work. Explanations for these associations are unclear, and more research is needed to understand how improving support in educational or work settings for people bereaved by suicide might contribute to reducing suicide risk. Our objective was to explore the impact of suicide on occupational functioning. We conducted a cross-sectional online study of bereaved adults aged 18-40, recruited from staff and students of British higher educational institutions in 2010. We used thematic analysis to analyse free text responses to two questions probing the impact of suicide bereavement on work and education. Our analysis of responses from 460 adults bereaved by suicide identified three main themes: (i) specific aspects of grief that impacted on work performance, cognitive and emotional domains, and social confidence; (ii) structural challenges in work or educational settings including a lack of institutional support, the impact of taking time off, and changes to caring roles; and (iii) new perspectives on the role of work, including determination to achieve. Institutional support should be tailored to take account of the difficulties and experiences described.
From 1969 until the signing of the Belfast (Good Friday) Agreement in 1998, more than 3,600 people were killed as a result of violence in Northern Ireland. Brendan O’Hara describes a study that examined whether the Northern Ireland Troubles have impacted those working in palliative care, and whether any such impact has implications for the treatment patients receive.
It is crucial that palliative care nurses feel competent to practice their profession in accordance with ethical principles, to personalize care, to remain sensitive, to ensure respect, and to communicate effectively. The aim of this study was to verify that higher levels of perceived professional competency predict better individual and organizational outcomes, such as job satisfaction and organizational citizenship behavior. An online cross-sectional survey was conducted with 107 Italian palliative care nurses. Structural equation modeling technique was used for data analysis. The model fitted the data well. Professional competency was positively associated with both job satisfaction (ß = 0.39) and organizational citizenship behavior (ß = 0.53). The more confidence palliative care nurses have in their professional competency, the more they are satisfied with their job and engage in organizational citizenship behavior. Fostering professional competency in palliative nursing can help not only patients and their families but also the nurses themselves, the organization, and their coworkers.
OBJECTIVE: To examine experiences with suicide exposure and bereavement among women firefighters.
METHODS: Women firefighters (N = 266, Mage = 37.64y) completed self-report measures assessing their experiences with suicide exposure, history of suicidality, current psychiatric symptoms, and suicide risk.
RESULTS: Three-fourths (74.4%) of participants reported knowing someone who had died by suicide; of these participants, 31.3% reported losing a fellow firefighter to suicide. Exposure to suicide during one's firefighting career was associated with more severe psychiatric symptoms and suicide risk. Greater impact of a suicide death was significantly associated with more severe current suicide risk, even after controlling for prior suicidality and other psychiatric symptoms.
CONCLUSIONS: Women firefighters exposed to suicide during their careers may experience more severe psychiatric symptoms and increased suicide risk as compared to their counterparts without this exposure. In particular, women firefighters who are more severely impacted by a suicide loss may be at increased suicide risk.
BACKGROUND: Futile or potentially inappropriate care (futile/PIC) has been suggested as a factor contributing to clinician well-being; however, little is known about this association.
OBJECTIVE: To determine whether futile/PIC provision is associated with measures of clinician well-being.
DESIGN: Cross-sectional, self-administered, online questionnaire.
SETTING: Two New York City Hospitals.
PARTICIPANTS: Attending physicians, residents, nurses, and physician assistants in the fields of internal medicine, surgery, neurology, or intensive care. Exposure(s): Provision of perceived futile/PIC.
MEASUREMENTS: Main outcomes included (1) clinician burnout, measured using the Physician Worklife Study screen; (2) clinician depression, measured using the Patient Health Questionnaire; and (3) intention to quit, measured using questions assessing thoughts of quitting and how seriously it is being considered.
RESULTS: Of 1784 clinicians who received surveys, 349 participated. Across all clinicians, 91% reported that they either had or had possibly provided futile/PIC to a patient. Overall, 43.4% of clinicians screened positive for burnout syndrome, 7.8% screened positive for depression, and 35.5% reported thoughts of leaving their job as a result of futile/PIC. The amount of perceived futile/PIC provided was associated with burnout (odds ratio [OR] 3.8 [16-30 patients vs 1-2 patients]; 95% confidence interval [CI]: 1.1-12.8) and having thoughts of quitting (OR, 7.4 [16-30 patients vs 1-2 patients]; 95% CI: 2.0-27), independent of depression, position, department, and the number of dying patients cared for.
CONCLUSIONS: A large majority of clinicians report providing futile/PIC, and such care is associated with measures of clinician well-being, including burnout and intention to quit.
8,3 millions de personnes aident un proche en perte d'autonomie. La moitié occupe en même temps un emploi. Les salariés aidants représentant, en effet, un actif sur six, un sur quatre dans dix ans. Au même titre que les pouvoirs publics, les entreprises doivent être sensibilisées à une problématique qui touche de plus en plus leurs collaborateurs. C'est pourquoi France Alzheimer et maladies apparentées, avec le soutien du groupe Humanis, publie une étude qualitative, dans laquelle elle a notamment recueilli les attentes des aidants vis-à-vis de leurs employeurs.
Origine : BDSP. Notice produite par MSSH-EHESP EGJ9sR0x. Diffusion soumise à autorisation
Palliative care (PC) is a medical specialty that strives to fulfill the physical, psychosocial, emotional, practical, and spiritual needs of individuals at end of life or in tandem with curative treatment. Although exponentially rising in use and beneficial to patient well-being at end of life, the purpose of PC is often misunderstood and those providing its services frequently report resistance from organizational members. Such resistance can be attributed to tensions between traditional biomedical models of medicine that privilege curative treatment and biosocial models of medicine that holistically care for patients. Thus, this study addresses what tensions PC providers experience in their institutions and what communicative strategies they use at the interpersonal level in managing those tensions. Using structuration theory in tandem with relational dialectics theory, we inductively analyzed semistructured interviews with 24 Circle of Life award-winning PC providers. Findings indicate two dialectics experienced by PC providers in their institutions: the living-dying dialectic and the practicing-advocating dialectic. We conclude that these interpersonal dialectics emerge through interaction in competing medical meaning systems and found that storytelling was a particularly salient form of communication that participants used for management.
BACKGROUND/AIM: Occupational therapists who work in palliative care are frequently exposed to the experience of death and dying. Previous occupational therapy research has offered insight into factors that influence feelings relating to death and dying and associated coping strategies. However, existing literature is dated and has not specifically examined the concept of grief. This study addresses this gap in knowledge by exploring the lived experience of professional grief among occupational therapists working in palliative care settings.
METHODS: Semi-structured interviews were conducted with six Australian palliative care occupational therapists. The data were collected and analysed using an interpretive phenomenological approach.
RESULTS: Four interrelated themes were identified as core to the lived experience of professional grief among participants. These included; 'knowledge of self', 'giving permission for connections and feelings', 'filtering experience' and 'being present at work and at home'.
CONCLUSION: Considered in combination, these themes offer a guide for therapists to explore their own experience of and responses to professional grief and, in doing so, foster the development of personalised management strategies.
PURPOSE: The aim of this study was to explore the impact of extended cancer survival on broader aspects of life and wellbeing such as occupational, financial and family life for patients with advanced cancer and their nominated informal caregivers.
METHODS: In-depth qualitative interviews were transcribed verbatim. A thematic framework was developed from an initial process of open coding and tested iteratively as new data were collected.
RESULTS: Twenty-four patient-caregiver dyads with advanced ovarian (9), melanoma (9) or lung cancer (6). Patients were aged 39-84 (median 62 years) and caregivers 19-85 (median 54 years). Caregivers were the partners/spouses (15), children (5), siblings (2) and friends (2) of patients. One particular theme, 'uncertainty', encompassed many issues such as planning for the future, providing for one's family, employment and finances. Uncertainties were related to the timescale and trajectory of the disease and lack of control or ability to make plans. There were marked age effects. Accounts from within the same dyad often differed and patients and caregivers rarely discussed concerns with each other.
CONCLUSIONS: Both patients and their informal caregivers were challenged by the uncertainties around living with advanced cancer and the lack of a defined trajectory. This impacted many diverse areas of life. Although distressing, dyads seldom discussed these concerns with each other.
IMPLICATIONS FOR CANCER SURVIVORS: Uncertainty is a recurrent issue for cancer survivors and their families impacting broad aspects of their lives and their ability to move forward; however, patients and caregivers in this study rarely discussed these concerns together. Uncertainty should be discussed periodically, together, and healthcare professionals could facilitate these discussions. The use of one or more 'trigger questions' in clinic appointments may provide an opportunity to start these dialogues.
Recent data on the inequities in mortality, health, and access to health services experienced by the Traveller community in Ireland show higher rates of death by suicide and other sudden causes among members of this marginalized minority group than in the general population. Psychological literature on bereavement suggests that traumatic deaths and multiple deaths within a close network may be more likely to lead to complicated grief reactions. The aim of this study is to add to our understanding of the effects of the differential mortality rate by exploring how grief is experienced within the Traveller community in the context of bereavement from multiple deaths or sudden deaths (including suicide). Data from three semistructured focus group interviews with a total of 10 Traveller Community Health Worker participants (nine female and one male) were analyzed using Interpretative Phenomenological Analysis. Two master themes organized the salient phenomenological aspects of the grief experience: Living with Tragic Loss and Communicating Tragic Loss. A picture emerged of individual and community-level loss that is extensive, profound, and enduring. The sequelae of deaths by suicide include difficulties in coping, a search for meaning, and a pervasive sense of fear. Silence, the embodied act of giving voice to tragic loss, and strategies for managing disclosure of tragic deaths with children were all strong themes which emerged from the analysis. This study uses interpretative phenomenological analysis to generate a vivid picture of the lived psychological experience of grief as it is experienced by members of a minority group with above average rates of sudden and early deaths. This contributes to understanding the burden of health inequality in an underresearched population. Findings in relation to challenges in communicating with children about tragic deaths can be integrated into bereavement support resources.