Prevalence and predictors of compassion satisfaction, secondary traumatic stress, and burnout among Chinese hospice nurses: A cross-sectional study.

AIM: To explore the prevalence and predictors of compassion satisfaction, secondary traumatic stress, and burnout among Chinese hospice nurses. BACKGROUND: Because of prolonged and continual contact with suffering, deaths, and grief, hospice nurses may be vulnerable to emotional burdens and have difficulty maintaining their professional quality of life. METHODS: A cross-sectional study was conducted. A total of 478 hospice nurses were selected from 24 medical institutions in Sichuan province. Demographic, work-related information and work-related trauma questionnaire, the Chinese version of the Interpersonal Reactivity Index, the Chinese version of the Emotion Regulation Questionnaire, and the Chinese version of the Professional Quality of Life Scale for Nurses were used for collecting data. RESULTS: The mean scores of compassion satisfaction, secondary traumatic stress, and burnout were 34.89 ± 6.21, 26.35 ± 5.24, and 24.49 ± 5.01, respectively. Job satisfaction, perspective-taking, empathic concern, working in tertiary hospitals, and adopting cognitive reappraisal strategy were positively associated with compassion satisfaction, while personal distress was a negative factor, all variables explaining 50.7 % of the variance. Higher burnout was found among nurse who had higher personal distress, worked in secondary or primary hospitals, worked >8 h per day and caring for >10 dying patients last month. In addition, job satisfaction, social support, perspective-taking, empathic concern, and cognitive reappraisal were identified as significant protectors, explaining 50.1 % of the variance. We also found that lower job satisfaction, higher personal distress, higher expressive suppression, lack of social support, senior nurses, and cared for >10 dying patients last month, were positively related to secondary traumatic stress. However, cognitive reappraisal had negative associations. These seven factors explained 32.0 % of the variance. CONCLUSIONS: Hospice care has specific characteristics and hospice nurses may suffer from more work-related stressors compared with other nurses. Our study may provide clues to help nursing administrators identify hospice nurses who are at higher risk of compassion fatigue and design targeted interventions focused on potential risk factors and protectors to improve hospice nurses' compassion satisfaction, while reducing compassion fatigue.

Grief as a mediator of the relationship between empathy and compassion fatigue.

OBJECTIVE: Oncology nurses are at high risk of developing compassion fatigue (CF) because of the persistent exposure to patients' suffering and death. Empathy is a prerequisite cognitive reaction for CF. Nurses with greater empathy levels are more prone to develop an emotional connection with patients. However, it is this kind of close bonds that led nurses to experience a deep sense of grief. Cumulative grief may eventually develop into CF. This study examined the levels of grief, empathy and CF, evaluated the correlation among empathy, grief and CF, and verified the role grief as a mediator of the relationship between empathy and CF. METHODS: Participants were 794 Chinese oncology nurses in a cross-sectional study. We measures consisted a demographic questionnaire, the Interpersonal Reactivity Index, the Texas Revised Inventory of Grief-Present, and the Professional Quality of Life Scale. RESULTS: Oncology nurses showed moderate levels of empathy and grief, moderate to high levels of CF. Perspective taking was negatively related to grief and secondary traumatic stress (STS). Empathic concern was negatively related to burnout (BO). Personal distress was positively related to grief, STS and BO. Grief was positively related to STS and BO. Grief played a partial mediating role between empathy and STS. CONCLUSIONS: Oncology nurses commonly experience CF. There is a need to provide interventions and effective supports for oncology nurses to improve their empathy ability, and help them cope with grief and CF.

Knowledge and attitudes toward end-of-life care among community health care providers and its influencing factors in China: A cross-sectional study.

A majority of nurses struggled with a negative emotion of anger, doubt, fear, or anxious, uncomfortable in the face of death and dying. However, little was known about community health care providers' in China. Therefore, we conducted a study to investigate their knowledge and attitudes toward end-of-life care and analyze its influencing factors. To provide reference for developing effective strategies to promote end-of-life care in China.A total of 132 community health care providers of 10 community health care centers in Changzhi city were investigated by a Questionnaire of Knowledge and Attitudes toward Caring for the Dying from May, 2017 to December, 2017, and data was analyzed by SPSS 22.0 software.Of the 132 community health care providers who were under investigation, 70 knew about hospice care, but they rated their overall content on end-of-life care as inadequacy, especially in communication skills and knowledge of pain management. The average score of attitudes was 3.47 (SD = 0.44), the lowest score was in the subscale of nurse-patient communication, which was 2.91 (SD = 0.65). Health care providers who had worked for more than 11 years, who had experiences of the death of relatives or friends, and who had previous experiences of caring for terminal patients had more positive attitudes toward caring for the dying (P < .05 for all). There was a significant relationship between community health care providers' attitudes toward death and their attitudes toward end-of-life care (r = -0.282, P < .01). The significant predictors of attitudes toward end-of-life care were attitudes toward death (ß = -0.342), experiences of the death of relatives (ß=-0.207), experiences of caring for the dying (ß = 0.185), and working experience (ß = 0.171).Community health care providers had positive attitudes toward end-of-life care, but they lacked systematic and professional knowledge and skills of caring for the terminal patients. Education is the top priority. It is imperative to set up palliative care courses and life-death education courses, establish an indigenous end-of-life care model, and improve policies, systems, and laws to promote end-of-life care.

Systematic profiling of substrate binding response to multidrug-resistant mutations in HIV-1 protease: Implication for combating drug resistance.

Human immunodeficiency virus 1 (HIV-1) protease (PR) represents one of the primary targets for developing antiviral agents for the treatment of HIV-infected patients. However, a number of multidrug-resistant mutations in the enzyme have been observed over the past decades, largely limiting the application of PR inhibitors in antiviral therapy. A systematic investigation of the intermolecular interaction between the multidrug-resistant mutants of HIV-1 PR and its substrates would help to establish a complete profile of substrate response to PR mutations and to design new antiviral agents combating drug resistance. Here, we describe an integrative method to profile 6 clinical multidrug-resistant PR mutants against a panel of 16 substrate octapeptides that flank 12 distinct PR cleavage sites in viral precursor polyproteins. It is found that most multidrug-resistant mutations have only a modest or moderate effect on substrate peptide binding, although these mutations would cause a large free energy loss in PR inhibitor binding. Structural analysis reveals that the substrate peptides are loosely bound within PR active pocket to form a wide contact interface between them, and thus mutation of just single or few residues seems not to influence PR-substrate binding considerably. In addition, peptides derived from variable cleavage sites are generally more sensitive to the mutations as compared to those derived from conserved sites, supporting the co-evaluation mechanism of HIV-1 PR and its substrates under drug suppression. We also identify 12 functionally conserved key residues around the enzyme's active site, which play crucial role in substrate recognition. In vitro fluorescence anisotropy assays confirm that wild-type PR can bind substrate peptides ARVL/AEAM and NLAF/PQGE with a moderately high affinity (KD=2 and 16µM, respectively). In contrast, the key residue mutations N25D/D29N can completely eliminate (KD=n.d.) or largely reduce (KD=32 and 120µM, respectively) the binding capability of the two peptides, suggesting that these PR residues could be the potential target sites for developing resistance-free anti-HIV agents.