Is there any association among depressive symptoms, job satisfaction and self-assessed empathy? A correlational study in Greek Psychiatric/Mental Health Nurses.

A descriptive correlational design was applied to explore association among self-assessed depressive symptoms, job satisfaction and self-assessed empathy in 206 Greek Psychiatric-Mental Health Nursing Personnel (PMHNP). Depressive symptom intensity was associated with satisfaction from performed tasks (r = -0.157, p = 0.033), professional prestige (r = -0.255, p < 0.0001), relations with colleagues (r = -0.263, p < 0.0001) and empathy (r = -0.183, p = 0.013). In a regression model, only satisfaction from relations and workload remained significant depressive symptom predictors after controlling for important covariates. The quality of relations with colleagues and workload are important predictors of PMHNPs self-perceived mental health well-being, independently of clinicians' self-assessed empathy or overall professional satisfaction.

The effectiveness of systematic pain assessment on critically ill patient outcomes: A randomised controlled trial.

BACKGROUND: Evidence suggests that critically ill patients' pain may still be underestimated. Systematic approaches to pain assessment are of paramount importance for improving patients' outcomes. OBJECTIVES: To investigate the effectiveness of a systematic approach to pain assessment on the incidence and intensity of pain and related clinical outcomes in critically ill patients. METHODS: Randomized controlled study with consecutive critically ill patients allocated to either a standard care only or a systematic pain assessment group. The Behavioral Pain Scale (BPS) and the Critical Pain Observation Tool (C-POT) were completed twice daily for all participants. In the intervention group, clinicians were notified of pain scores. Linear Mixed Models (LMM) for the longitudinal effect of the intervention were employed. RESULTS: A total of 117 patients were included (control: n=61; intervention: n2=56). The incidence of pain (C-POT >2) in the intervention group was significantly lower compared to the control group (p < .001). The intervention had a statistically significant effect on pain intensity (BPS, p = 0.01). The average total morphine equivalent dose in the intervention group was higher than in the control group (p = 0.045), as well as the average total dose of propofol (p = 0.027). There were no statistically significant differences in ICU mortality (23.4% vs 19.3%, p=0.38, odds ratio 0.82 [0.337-1.997]) and length of ICU stay (13.5, SD 11.1 vs 13.9, SD 9.5 days, p= 0.47). CONCLUSION: Systematic pain assessment may be associated with a decrease in the intensity and incidence of pain and influence the pharmacological management of pain and sedation of critically ill patients.

The experience of Greek-Cypriot individuals living with mental illness: preliminary results of a phenomenological study.

BACKGROUND: Research evidence shows that healthcare professionals do not fully comprehend the difficulty involved in problems faced by people living with severe mental illness (SMI). As a result, mental health service consumers do not show confidence in the healthcare system and healthcare professionals, a problem related to the phenomenon of adherence to therapy. Moreover, the issue of unmet needs in treating individuals living with SMI is relared to their quality of life in a negative way. METHODS: A qualitative methodological approach based on the methodology of van Manen phenomenology was employed through a purposive sampling of ten people living with SMI. The aim was to explore their perceptions and interpretations regarding: a) their illness, b) their self-image throughout the illness, c) the social implications following their illness, and d) the quality of the therapeutic relationship with mental health nurses. Participants were recruited from a community mental health service in a Greek-Cypriot urban city. Data were collected through personal, semi-structured interviews. RESULTS: Several main themes were identified through the narratives of all ten participants. Main themes included: a) The meaning of mental illness, b) The different phases of the illness in time, c) The perception of the self during the illness, d) Perceptions about the effectiveness of pharmacotherapy, e) Social and personal consequences for participants following the diagnosis of mental illness, f) Participants' perceptions regarding mental health professionals and services and g) The therapeutic effect of the research interview on the participants. CONCLUSIONS: The present study provides data for the enhancement of the empathic understanding of healthcare professionals regarding the concerns and particular needs of individuals living with SMI, as well as the formation of targeted psychosocial interventions based on these needs. Overall, the present data illuminate the necessity for the reconstruction of the provided mental healthcare in Cyprus into a more recovery- oriented approach in order to address personal identity and self-determination issues and the way these are related to management of pharmacotherapy. Qualitative studies aiming to further explore issues of self-identity during ill health and its association with adherence to therapy, resilience and self-determination, are also proposed.

Determinants of procedural pain intensity in the intensive care unit. The Europain® study.

RATIONALE: Intensive care unit (ICU) patients undergo several diagnostic and therapeutic procedures every day. The prevalence, intensity, and risk factors of pain related to these procedures are not well known. OBJECTIVES: To assess self-reported procedural pain intensity versus baseline pain, examine pain intensity differences across procedures, and identify risk factors for procedural pain intensity. METHODS: Prospective, cross-sectional, multicenter, multinational study of pain intensity associated with 12 procedures. Data were obtained from 3,851 patients who underwent 4,812 procedures in 192 ICUs in 28 countries. MEASUREMENTS AND MAIN RESULTS: Pain intensity on a 0-10 numeric rating scale increased significantly from baseline pain during all procedures (P < 0.001). Chest tube removal, wound drain removal, and arterial line insertion were the three most painful procedures, with median pain scores of 5 (3-7), 4.5 (2-7), and 4 (2-6), respectively. By multivariate analysis, risk factors independently associated with greater procedural pain intensity were the specific procedure; opioid administration specifically for the procedure; preprocedural pain intensity; preprocedural pain distress; intensity of the worst pain on the same day, before the procedure; and procedure not performed by a nurse. A significant ICU effect was observed, with no visible effect of country because of its absorption by the ICU effect. Some of the risk factors became nonsignificant when each procedure was examined separately. CONCLUSIONS: Knowledge of risk factors for greater procedural pain intensity identified in this study may help clinicians select interventions that are needed to minimize procedural pain. Clinical trial registered with www.clinicaltrials.gov (NCT 01070082).

Measuring professional satisfaction in Greek nurses: combination of qualitative and quantitative investigation to evaluate the validity and reliability of the Index of Work Satisfaction.

PURPOSE: The Index of Work Satisfaction (IWS) is a comprehensive scale assessing nurses' professional satisfaction. The aim of the present study was to explore: a) the applicability, reliability and validity of the Greek version of the IWS and b) contrasts among the factors addressed by IWS against the main themes emerging from a qualitative phenomenological investigation of nurses' professional experiences. METHODS: A descriptive correlational design was applied using a sample of 246 emergency and critical care nurses. Internal consistency and test-retest reliability were tested. Construct and content validity were assessed by factor analysis, and through qualitative phenomenological analysis with a purposive sample of 12 nurses. Scale factors were contrasted to qualitative themes to assure that IWS embraces all aspects of Greek nurses' professional satisfaction. RESULTS: The internal consistency (α = 0.81) and test-retest (tau = 1, p < 0.0001) reliability were adequate. Following appropriate modifications, factor analysis confirmed the construct validity of the scale and subscales. The qualitative data partially clarified the low reliability of one subscale. CONCLUSIONS: The Greek version of the IWS scale is supported for use in acute care. The mixed methods approach constitutes a powerful tool for transferring scales to different cultures and healthcare systems.

"An ongoing struggle with the self and illness": α meta-synthesis of the studies of the lived experience of severe mental illness.

The diverse experiences of severely mentally ill persons, most of the times, have not been taken into account, or integrated to the treatment procedures. This meta-synthesis aimed to examine what is like to live with severe mental illness narratives by employing a meta-ethnographic synthesis of seventeen published peer reviewed qualitative studies. Third order analysis revealed as core theme "An ongoing struggle for reconciliation with the self and the illness". Other themes included amongst others: loss of identity, pain of having had one's life stolen, being an outcast. The identification of the importance of the alterations of self-identity throughout the continuum of the severe mental disorder may be the focus of targeted psychosocial interventions.

Dysfunctional psychological responses among Intensive Care Unit nurses: a systematic review of the literature.

OBJECTIVE: To systematically review evidence on dysfunctional psychological responses of Intensive Care Units nurses (ICUNs), with focus on anxiety and depressive symptoms and related factors. METHOD: A literature search was performed in CINAHL, PubMed and Scopus databases, from 1999 to present, along with a critical appraisal and synthesis of all relevant data. The following key words, separately and in combination, were used: "mental status" "depressive symptoms" "anxiety" "ICU nurses" "PTSD" "burnout" "compassion fatigue" "psychological distress". RESULTS: Thirteen quantitative studies in English and Greek were included. The results suggested increased psychological burden in ICUNs compared to other nursing specialties, as well as to the general population. CONCLUSIONS: Studies investigating psychological responses of ICUNs are limited, internationally. Future longitudinal and intervention studies will contribute to a better understanding of the phenomenon.

Moral distress, autonomy and nurse-physician collaboration among intensive care unit nurses in Italy.

AIM: To explore the level of moral distress and potential associations between moral distress indices and (1) nurse-physician collaboration, (2) autonomy, (3) professional satisfaction, (4) intention to resign, and (5) workload among Italian intensive care unit nurses. BACKGROUND: Poor nurse-physician collaboration and low autonomy may limit intensive care unit nurses' ability to act on their moral decisions. METHODS: A cross-sectional correlational design with a sample of 566 Italian intensive care unit nurses. RESULTS: The intensity of moral distress was 57.9 ± 15.6 (mean, standard deviation) (scale range: 0-84) and the frequency of occurrence was 28.4 ± 12.3 (scale range: 0-84). The mean score of the severity of moral distress was 88.0 ± 44 (scale range: 0-336). The severity of moral distress was associated with (1) nurse-physician collaboration and dissatisfaction on care decisions (r = -0.215, P < 0.001); and (2) intention to resign (r = 0.244, P < 0.0001). The frequency of occurrence of moral distress was associated with the intention of nurses to resign (r = -0. 209, P < 0.0001). CONCLUSION: Moral distress seems to be associated with the intention to resign, whereas poor nurse-physician collaboration appears to be a pivotal factor accounting for nurses' moral distress. IMPLICATIONS FOR NURSING MANAGEMENT: Enhancement of nurse-physician collaboration and nurses' participation in end-of-life decisions seems to be a managerial task that could lead to the alleviation of nurses' moral distress and their retention in the profession.

Anxiety levels and related symptoms in emergency nursing personnel in Greece.

INTRODUCTION: Several studies provide evidence for the association between work stress and mild psychiatric morbidity among emergency nurses. These symptoms have not been explored in Greek nursing personnel employed in emergency departments. The aim of this descriptive correlational study was to investigate the presence of anxiety and stress symptoms among emergency nursing personnel in Greece. METHODS: The sample was composed of nursing personnel employed in emergency departments of 8 adult General hospitals in Greece (N = 213). The Hamilton Anxiety Scale was applied for the quantitative assessment of anxiety symptoms, along with demographic, vocational, and educational data. Descriptive statistics were explored, and nonparametric comparisons, as well as correlational tests, were performed. RESULTS: Anxiety levels were found to be mild (1.102 ± 0.53), with women (P = .021, Mann-Whitney U test) and nursing personnel employed in public sector hospitals (P = .029, Mann-Whitney U test) having higher anxiety level scores. In addition, a statistically significant mild correlation was observed between work experience in the emergency department and anxiety states (τ = 0.178, P = .011). The most commonly reported manifestations of mild psychiatric symptomatology were sleep disturbances (2.32 ± 1.2), anxious mood (1.57 ± 1.1), and depressed mood (2.38 ± 1.2), with 24.8% of the participants reporting very severe sleep disturbance, 23.9% reporting very severe depressive mood, and 10.7% reporting very severe anxious mood. DISCUSSION: Hospital administrators need to be aware of the extent of workplace stress and subsequent anxiety symptoms that exist in emergency nurses. Staff counseling, continuing professional education, and empowerment strategies may need to be implemented to prevent psychiatric morbidity, as well as job dissatisfaction and resignations.

'The patient is my space': hermeneutic investigation of the nurse-patient relationship in critical care.

BACKGROUND: The nurse-patient relationship has been postulated to lie at the core of nursing care. However, it is unclear how this concept applies in critical care, as a great majority of critically ill patients are unable to communicate. AIMS: Through a phenomenological hermeneutical perspective, we aimed to explore intensive care nurses' perceptions and meanings regarding their interpersonal relationship with critically ill individuals. METHODS: A Heideggerian hermeneutical approach was used to design the study and analyse the data, which were collected through repetitive interviews with 12 intensive care nurses. RESULTS: Critical care nurses report to experience deep relationships with patients, which seem to be mediated by the ongoing contact with patients' bodies. These relationships evoke intense feelings of love, empathy and care and affect how nurses perceive and make sense of their role and their world. The identified core theme of their experience is entitled 'syncytium', which describes a network of closely connected cells. According to participants' perceptions, nurse and patient affect each other reciprocally and are mutually dependent upon each other. In Heideggerian terms patients provide nurses with opportunities to experience 'authentic care' and they participate in their 'being-in-the-world', thus they are central in nurses' meanings about their role and existence. Other elicited themes that account for the perceived nurse-patient relationship include the spatiality/temporality of the relationship, nurses' perceptions and meanings attributed to their role and nurses' perceptions of death. CONCLUSIONS: Critical care nurses appear to experience their relationships with patients intensely. These relationships are invested with meanings and elicit powerful feelings over a shared course with patients. Patients are central in nurses' meaning-making process and role perception. RELEVANCE TO CLINICAL PRACTICE: These findings have implications for the educational preparation of critical care nurses and their psychological support.

A critical review of the evidence for nurses as information providers to cancer patients.

AIMS: To review evidence on the role of oncology nurses in the provision of information to cancer patients and to delineate evidence-based implications for clinical practice and research. BACKGROUND: Provision of information is central for the empowerment of patients to participate in their care. There is not enough evidence regarding the nursing role in the information delivery process in cancer patients. DESIGN: Descriptive literature review. METHODS: From January 1990-2008, databases searched included Medline, CINAHL, PubMed, CancerLit and the Cochrane Library. Original research articles addressing the role of nurses in information delivery were included. We explored evidence on: (1) the effectiveness of nurses as information providers, (2) the way patients evaluate nurses' input to information delivery, (3) the extent to which nurses contribute to information delivery to cancer patients and (4) the types of information provided by nurses. RESULTS: The most important findings were: (1) nurses' role as information providers for cancer patients is prominent, especially after the initiation of treatment, (2) specialist nurses are very effective in providing information, (3) no clear evidence exists on how nurses compare with other health-care professionals as information providers and (4) some evidence exists that patients may prefer nurses as information providers at specific times in their treatment and especially in regards to symptom management. CONCLUSION: Well-designed studies provide some evidence that nurses are effective as information providers to cancer patients. Specifically, oncology nurses are able to provide information of both high quality and of appropriate quantity and to assist individuals to interpret information provided by others. RELEVANCE TO CLINICAL PRACTICE: Oncology nurses should be specifically educated and prepared to offer explicit, practical and timely information and they should be trained in interpersonal communication skills, which will increase their ability to comprehend patient information needs.

Psychological support and outcomes for ICU patients.

AIMS AND OBJECTIVES: To critically review evidence on the effects of psychological support during intensive care unit (ICU) treatment on adult ICU patients' psychological and physiological outcomes. Evidence from intervention studies on imagery and relaxation has been included, as well. BACKGROUND: Stress and negative emotions may have both immediate, as well as long-term effects on ICU patients' psychological and physical well-being, and they are linked to delayed physical recovery. DESIGN, METHODS: A narrative critical review methodology was employed. Databases searched included Medline, CINAHL, PubMed, PsychInfo and the Cochrane Library. Experimental, quasi-experimental or pretest-posttest peer-reviewed intervention studies published since 1970 were included. RESULTS: Fourteen studies: seven on nurse led relaxation, three on guided imagery, one on nurse-patient interaction, two on physician-patient interaction and one correlational study on perceived social support were included. The results suggest significant improvements in patients' outcomes: improved vital signs, decrease in pain ratings, anxiety, rate of complications and length of stay, and improved sleep and patient satisfaction. Eight studies employed randomized experimental, four quasi-experimental and two descriptive correlational designs. Two studies explored effects on patients' sleep, and two on procedure-related pain. CONCLUSIONS: The literature is limited in exploring the effects of nurse-patient interactions. The amount and quality of psychosocial support in the ICU, as well as imagery and relaxation techniques, are linked to short-term and long-term patients' outcomes. RELEVANCE TO CLINICAL PRACTICE: ICU nurses need to engage in psychological support in a systematic way, and to acknowledge the high priority of support interventions.

Potential effects of stress in critical illness through the role of stress neuropeptides.

AIMS AND OBJECTIVES: To critically review evidence on the hypothesis that the multitude of cognitive and psychological stressors perceived by critically ill individuals may contribute to the development of pathophysiologic sequlae through modulation of the levels of stress neuropeptides. BACKGROUND: Critically ill individuals experience high levels of stress and intense adverse emotions. Although psychological stress has long been recognized as a factor in disease, and despite the nursing tenet on the importance of patients' psychological responses, in critical care, the potential physiologic effects of stress have received little attention. DESIGN, METHODS: Narrative critical review. Databases searched included Medline, CINAHL, PubMed and the Cochrane Library. Evidence on the role of stress neuropeptides and pertinent findings in critically ill individuals are reviewed. RESULTS: Limbic and extra-limbic brain structures along with specific stress neuropeptides [corticotrophin releasing hormone (CRH), adrenocorticotropin hormone (ACTH), neuropeptide Y , vasopressin, prolactin, oxytocin, substance P, cholecystokinin, endorphins, enkephalins, somatostatin, noradrenaline, melatonin] are involved in emotional and stress responses. Research evidence indicates that stress neuropeptide levels may be altered in critical illness. Moreover, they mediate processes such as immunity, endothelial response and oxidative stress. A framework for future research and practice is presented. CONCLUSIONS: It is probable that, in critical illness, psychological stress accentuates pathophysiological sequlae, through release of neuropeptides. The role of neuropeptides is suggested as an important field of investigation for critical care nursing. However, currently available data are insufficient to draw firm conclusions. Focussed studies on the physiologic correlates of psychological stress in the critically ill are needed. RELEVANCE TO CLINICAL PRACTICE: If this hypothesis is corroborated, bedside quantification of selected neuropeptides may contribute to the assessment of stress and of the effectiveness of psychological support interventions in the future. Moreover, psychosocial and, probably, pharmacological support interventions may be effective adjuncts to the care of the critically ill.

Association Between Workplace Bullying Occurrence and Trauma Symptoms Among Healthcare Professionals in Cyprus.

Workplace bullying/mobbing is an extreme work-related stressor, but also a severe hazard for physical, mental and psychological health in healthcare employees, including nurses. A range of trauma-related symptoms has been linked with bullying victimization. The aim of the study was the investigation of workplace bullying/mobbing-related trauma symptoms in Greek-Cypriot nurses working in emergency and critical care settings, as well as of potential correlations with demographic and occupational variables. A descriptive, cross-sectional correlational study was performed in a convenience sample of 113 nurses. A modified version of the Part B.CII of The Workplace Violence in the Health Sector-Country Case Studies Research Instrument (WVHS-CCSRI Part C.II-M) and the modified Secondary Traumatic Stress Scale (STSS-M) were used for the assessment of bullying/mobbing frequency and workplace bullying/mobbing-related trauma symptoms, respectively. A total of 46.9% of the sample reported experiences of both bullying/mobbing victimization and witnessing of bullying/mobbing to others (VWB subgroup), 21.2% reported solely bullying/mobbing victimization (SVB subgroup) and 10.6% reported witnessing of bullying/mobbing to others (SWB subgroup). A total of 22.3% did not experience or witness any bullying/mobbing at the workplace. Trauma symptoms intensity (STSS-M total score) was more severe in the participants a) with a high frequency of workplace bullying/mobbing experiences compared to those with a moderate frequency of such experiences (p = 0.018), b) of the VWB subgroup compared to those of the SWB subgroup (p = 0.019), c) employed in Emergency Departments compared to those employed in ICUs (p = 0.03), d) who had considered resigning due to bullying/mobbing experiences compared to those who had never considered resigning (p = 0.008), e) who had been punished for reporting a bullying/mobbing incident compared to those who had not (p = 0.001), and f) who considered the incident unimportant to be reported compared to those who avoided reporting due to other causes (p = 0.048). This data highlights the need to establish effective and safe procedures for bullying/mobbing reporting, aiming to support bulling/mobbing victims and witnesses, and further to protect their legal rights. Both victims and witnesses of workplace bullying/mobbing need to be assessed by mental health professionals for PTSD symptoms in order to have access to effective treatment.

Interpersonal touch interventions for patients in intensive care: A design-oriented realist review.

AIM: To develop a theoretical framework to inform the design of interpersonal touch interventions intended to reduce stress in adult intensive care unit patients. DESIGN: Realist review with an intervention design-oriented approach. METHODS: We searched CINAHL, MEDLINE, EMBASE, CENTRAL, Web of Science and grey literature sources without date restrictions. Subject experts suggested additional articles. Evidence synthesis drew on diverse sources of literature and was conducted iteratively with theory testing. We consulted stakeholders to focus the review. We performed systematic searches to corroborate our developing theoretical framework. RESULTS: We present a theoretical framework based around six intervention construction principles. Theory testing provided some evidence in favour of treatment repetition, dynamic over static touch and lightening sedation. A lack of empirical evidence was identified for construction principles relating to intensity and positive/negative evaluation of emotional experience, moderate pressure touch for sedated patients and intervention delivery by relatives versus healthcare practitioners.

Relaxation for Critically ill Patient Outcomes and Stress-coping Enhancement (REPOSE): a protocol for a pilot randomised trial of an integrative intervention to improve critically ill patients' delirium and related outcomes.

INTRODUCTION: Delirium is a common complication of critical illness, associated with negative patient outcomes. Preventive or therapeutic interventions are mostly ineffective. Although relaxation-inducing approaches may benefit critically ill patients, no well-designed studies target delirium prevention as a primary outcome. The objective of this study is to assess feasibility and treatment effect estimates of a multimodal integrative intervention incorporating relaxation, guided imagery and moderate pressure touch massage for prevention of critical illness delirium and for related outcomes. METHODS AND ANALYSIS: Randomised, controlled, single-blinded trial with two parallel groups (1:1 allocation: intervention and standard care) and stratified randomisation (age (18-64 years and ≥65 years) and presence of trauma) with blocking, involving 104 patients with Intensive Care Delirium Screening Checklist (ICDSC): 0-3 recruited from two academic intensive care units (ICUs). Intervention group participants receive the intervention in addition to standard care for up to five consecutive days (or until transfer/discharge); control group participants receive standard care and a sham intervention. We will assess predefined feasibility outcomes, that is, recruitment rates and protocol adherence. The primary clinical outcome is incidence of delirium (ICDSC ≥4). Secondary outcomes include pain scores, inflammatory biomarkers, heart rate variability, stress and quality of life (6 weeks and 4 months) post-ICU discharge. Feasibility measures will be analysed descriptively, and outcomes will be analysed longitudinally. Estimates of effects will be calculated. ETHICS AND DISSEMINATION: The study has received approval from the Human Research Ethics Board, University of Alberta. Results will inform the design of a future multicentre trial. TRIAL REGISTRATION NUMBER: NCT02905812; Pre-results.

Multiple organ dysfunction syndrome pathogenesis and care: a complex systems' theory perspective.

AIMS AND OBJECTIVES: To discuss multiple organ dysfunction syndrome (MODS) from a complex systems' theory perspective and to delineate a conceptual framework for the development and care of MODS. BACKGROUND: MODS is an intricate and devastating manifestation of critical illness characterized by widespread aberrant molecular, cellular and systemic responses. DESIGN AND METHODS: Narrative literature review (MEDLINE, CINAHL databases) and knowledge synthesis with the theoretical assertions of chaos and complex systems' theory. Cellular and systemic response paradoxes in MODS (including cellular hypoxia, cell death and signalling) are reviewed. RESULTS: The diseased person is depicted as a complex adaptive system. The relevancy of some of the principles of complex chaotic systems' theory to the proposed model is illustrated, including sensitive dependence on initial conditions, emergence, attractors, self-organization, self-organized criticality and emerging order. The transition from life-supporting to death-related organismic responses is illustrated as a critical event in MODS and care implications are drawn. CONCLUSIONS: Patient responses in MODS appear to conform to the principles of chaotic systems. Death is illustrated not as a consequence of homeostatic failure but as a 'deliberate' self-organized phenomenon entailing multiple dynamically evolving mechanisms. RELEVANCE TO CLINICAL PRACTICE: Some of the principles of chaotic complex systems may need to be taken into account to advance care in MODS. An alternative theoretical perspective may support nurses to conceptualize both MODS and their role in a way that will help them to cope better with this devastating syndrome and develop practice.

A Phenomenological Investigation of the Interplay Among Professional Worth Appraisal, Self-Esteem and Self-Perception in Nurses: The Revelation of an Internal and External Criteria System.

Nurses' professional self-concept is strongly associated with professional worth appraisal, which encompasses their feelings and perceptions regarding their task efficacy and value of input to clinical outcomes. Professional self-concept and professional worth appraisal are incorporated in one's overall professional role perception. Data show that the way nurses think and feel about themselves personally and professionally, is associated with their well-being, the quality of provided patient care, their job satisfaction and retention. Although researchers indicate that professional self-concept is a different entity from personal self-concept, however, a clear differentiation and possible interaction between these constructs has not been yet adequately described in nursing literature. Personal self-concept mirrors the way people interpret them-selves, incorporating their self-awareness and personal effectiveness. Following purposeful sampling and informed consent, a phenomenological approach based on Munhall's methodology was employed to explore the living experience of professional role perception in 16 critical and emergency nurses, with special focus on their perceptions and feelings about personal and professional-role worth appraisal. Data and theoretical saturation criteria were implemented, along with all nine Munhall's criteria for the rigor and trustworthiness of phenomenological studies. The participants' narratives suggested a possible interaction between professional attitude and personality traits, illuminating as the core theme an interplay among self-perception, personal and professional worth appraisal process. Additionally, the present study emphasized the way self-evaluation criteria system may be associated with the personal and professional self-concept in nurses. In particular, it was highlighted that the way nurses think and feel about themselves is associated with the way they experience their professional role and vice versa, and that professional role-based self-concept and professional worth perception can be linked with their well-being. Furthermore, positive feelings about the self and personal competencies seemed to enhance the perception of effectiveness in clinical settings and adequacy of professional skills, resulting in empowered professional identity and vice versa. Overall, the present findings are discussed in relation to nurses' experience of work-related stressors and relevant interventions. Further exploration of the effectiveness of interventions for facilitating adaptive personal and professional self-appraisal are suggested.