Pleasure and suffering among hospital nurses / Placer y sufrir entre enfermeras hospitalarias / Prazer e sofrimento entre enfermeiros do contexto hospitalar

ABSTRACT Objectives: to associate pleasure and suffering indicators with aspects related to nursing work in hospitals. Methods: This is a cross-sectional quantitative study conducted with 152 nurses from a university hospital in the city of João Pessoa, Paraíba State, Brazil. Data were collected through interviews, using a tool to obtain sociodemographic data, work characteristics and the Pleasure and Suffering Indicators at Work Scale. Results: pleasure living and its domains were rated as satisfactory, while suffering factors and their domains were critically assessed. Statistically significant associations were observed among pleasure and suffering indicators, and some characteristics of nurses' work. Conclusions: it was evidenced that nurses had critical levels of suffering at work associated with their work practice characteristics.

RESUMEN Objetivos: asociar indicadores de placer y sufrimiento con aspectos relacionados con el trabajo de enfermería en el hospital. Métodos: este es un estudio transversal y cuantitativo, realizado con 152 enfermeras de un hospital universitario en la ciudad de João Pessoa, estado de Paraíba, Brasil. Los datos fueron recolectados a través de entrevistas, utilizando un instrumento para obtener datos sociodemográficos, características del trabajo y la Escala de Indicadores de Placer y Sufrimiento en el Trabajo. Resultados: la experiencia del placer y sus dominios se clasificaron como satisfactorios, mientras que los factores de sufrimiento y sus dominios obtuvieron una evaluación crítica. Se observaron asociaciones estadísticamente significativas entre los indicadores de placer y sufrimiento, y algunas características del trabajo de las enfermeras. Conclusiones: se evidenció que las enfermeras tenían niveles críticos de sufrimiento en el trabajo, asociado con las características de su práctica laboral.

RESUMO Objetivos: associar os indicadores de prazer e sofrimento com os aspectos relacionados ao trabalho de enfermagem no contexto hospitalar. Métodos: trata-se de um estudo transversal, com abordagem quantitativa, realizado com 152 enfermeiros de um hospital universitário em João Pessoa, Paraíba, Brasil. Os dados foram coletados por meio de entrevistas, mediante a utilização de um instrumento para obtenção dos dados sociodemográficos, e características do trabalho e da Escala de Indicadores de Prazer e Sofrimento no Trabalho. Resultados: a vivência de prazer e os seus domínios foram classificados como satisfatórios, enquanto os fatores de sofrimento e seus domínios obtiveram avaliação crítica. Foram observadas associações estatisticamente significativas entre os indicadores de prazer e sofrimento, e algumas características do trabalho dos enfermeiros. Conclusões: foi evidenciado que os enfermeiros apresentavam níveis críticos de sofrimento no trabalho, associados às características de sua prática laboral.

Reflections on the Emotional Hazards of Pediatric Oncology Nursing: Four Decades of Perspectives and Potential.

THEORETICAL PRINCIPLES: Pediatric oncology nurses are particularly vulnerable to emotional distress. Responsible for the oversight of a child's care, these nurses sustain close interactions with multiple patients and families over time, many of whom are coping with life-limiting diagnoses. The world of pediatric oncology nurses is one where tragedy is routinely witnessed thus demanding self-care and healing across a continuum. PHENOMENON ADDRESSED: The aim of this article is to outline and review the emotional sequelae of pediatric oncology nurses' work and to suggest interventions to support well-being in light of prolonged caregiving. Three major categories that are addressed include the aspects of clinical practice that influence caregiving, the risks of burnout, compassion fatigue, moral distress and grief, and interventions to counteract these phenomena. RESEARCH LINKAGES: Future-nursing research should focus upon the development of validated, psychometrically sound measurement tools to assess nurse-specific variants of burnout, compassion fatigue, moral distress, and nurse grief. Qualitative research should investigate the relationship between personal variables, workplace and team characteristics, age and experience, and their influence on the predominance of burnout, compassion fatigue, moral distress, and nurse grief. Lastly, the phenomena of resiliency demands further study.

Standardising fast-track surgical nursing care in Denmark.

Considerable variations in procedures, hospital stay and rates of recovery have been recorded within specific surgical procedures at Danish hospitals. The aim of this paper is to report on a national initiative in Denmark to improve the quality of surgical care by implementation of clinical guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN) in 2004. The unit was responsible for guideline construction and implementation using the 'workshop practice method': establishing a website, creating a knowledge centre, coordinating implementation agents, and arranging national workshops and conferences. The UPN has promoted implementation of fast-track regimes in all surgical departments in Denmark. We recommend the workshop-practice method for implementation of new procedures in other areas of patient care.

Enablers and barriers to implementing bedside reporting: insights from nurses.

As part of efforts to improve patient safety, quality of care and patient- and family-centred care, there is a growing interest in moving away from traditional taped nursing reports or reporting at the nursing station to reporting at the bedside. Although a body of knowledge exists regarding what nurses view as benefits and challenges experienced in nurse-to-nurse bedside reporting, less is known about the perceptions of nurses who have experienced this change in reporting practice on their unit. In this context, a qualitative study using semi-structured interviews was undertaken to explore nurses' perceptions of a newly implemented nurse-to-nurse bedside reporting practice at one acute care hospital. A total of 43 interviews were conducted on four units with seven nurses from respirology, 10 from obstetrics and gynecology, 10 from nephrology and 16 from general surgery. Data were analyzed using a directed content analysis approach. Three themes emerged that captured nurses' perceptions of the implementation of nurse-to-nurse bedside reporting: (a) being supported to change and embrace bedside reporting, (b) maintaining confidentiality and respecting patients' preferences and (c) experiencing challenges with bedside reporting. Our findings provide insight for other organizations in their efforts to change reporting practices. Specifically, there is a need for multi-pronged initiatives including leadership support, educational opportunities and ongoing monitoring and feedback mechanisms. Future research is required to examine how enablers can be leveraged and barriers mitigated or removed to ensure successful implementation and sustainability of nurse-to-nurse bedside reporting.

Hospital variation and temporal trends in palliative and end-of-life care in the ICU.

OBJECTIVES: Although studies have shown regional and interhospital variability in the intensity of end-of-life care, few data are available assessing variability in specific aspects of palliative care in the ICU across hospitals or interhospital variability in family and nurse ratings of this care. Recently, relatively high family satisfaction with ICU end-of-life care has prompted speculation that ICU palliative care has improved over time, but temporal trends have not been documented. DESIGN/SETTING: Retrospective cohort study of consecutive patients dying in the ICU in 13 Seattle-Tacoma-area hospitals between 2003 and 2008. MEASUREMENTS: We examined variability over time and among hospitals in satisfaction and quality of dying assessed by family, quality of dying assessed by nurses, and chart-based indicators of palliative care. We used regression analyses adjusting for patient, family, and nurse characteristics. MAIN RESULTS: Medical charts were abstracted for 3,065 of 3,246 eligible patients over a 55-month period. There were significant differences between hospitals for all chart-based indicators (p < 0.001), family satisfaction (p < 0.001), family-rated quality of dying (p = 0.03), and nurse-rated quality of dying (p = 0.003). There were few significant changes in these measures over time, although we found a significant increase in pain assessments in the last 24 hours of life (p < 0.001) as well as decreased documentation of family conferences (p < 0.001) and discussion of prognosis (p = 0.020) in the first 72 hours in the ICU. CONCLUSIONS: We found significant interhospital variation in ratings and delivery of palliative care, consistent with prior studies showing variation in intensity of care at the end of life. We did not find evidence of temporal changes in most aspects of palliative care, family satisfaction, or nurse/family ratings of the quality of dying. With the possible exception of pain assessment, there is little evidence that the quality of palliative care has improved over the time period studied.