The measurement of compassionate leadership: Adaptation and Spanish validation of the compassionate leadership self-reported scale.

BACKGROUND: A culture of shared leadership is widespread among palliative care teams based on a commitment to valuing and including all people equally. As compassion is a core value for end-of-life care work, compassionate leadership may be the best way to lead in palliative care. AIMS: The aims of this study were twofold: (1) to adapt and validate the Compassionate Leadership Self-reported Scale in a sample of palliative care professionals; and (2) to study the relation between compassionate leadership and associated concepts of self-compassion, awareness and self-care. METHODS: A cross-sectional survey of 296 Spanish end-of-life care professionals was conducted. Analyses included descriptive statistics, a confirmatory factor analysis (CFA) with four-correlated factors, reliability estimates and a structural model. RESULTS: Results suggested there were medium to high levels of compassionate leadership in the sample. The CFA showed an adequate overall fit: χ2 (98) = 277.595 (p < 0.001); CFI = 0.986; SRMR = 0.047; RMSEA = 0.088 [0.076, 0.100]. Reliability estimates for four subscales of compassionate leadership (attending, understanding, empathising and helping) were also adequate, ranging from 0.72 to 0.96. Finally, the structural model predicting compassionate leadership suggested that the dimensions of attending and understanding were most highly related to positive self-compassion and awareness; empathising, to self-care and awareness; and helping, to positive self-compassion and self-care. CONCLUSION: The Compassionate Leadership Scale has adequate psychometric properties when used to assess compassionate leadership in the context of end-of-life care. Our results indicate that self-compassion, awareness and self-care are important correlates of such compassionate leadership.

Using latent profile analysis to understand palliative care professionals' quality of life during the COVID-19 pandemic.

Healthcare workers' professional quality of life has been increasingly under the spotlight, even more so during the COVID-19 pandemic, which has posed a genuine challenge for them. This study aims to describe the professional quality of life profiles of a sample of Spanish palliative care professionals during the COVID-19 pandemic, encompassing aspects such as work satisfaction, burnout, compassion fatigue, and compassion satisfaction; while studying the relationships between these profiles and sociodemographic variables, clinical situations experienced during the pandemic, protectors of professional quality of life, the quality of care delivered, and the professionals' wellbeing. Data from a survey of Spanish palliative care professionals were used. The variables measured were professional quality of life, sociodemographic characteristics, COVID-19-related experiences, protectors of professional quality of life, wellbeing, and quality of care. Our research included latent profile analyses, along with chi-squared and t-tests. The results suggested two profiles of professional quality of life, namely low (32.78%) and high (67.22%). The following profile displayed a higher likelihood of having a low professional quality of life: younger professionals, registered nurses, with a decrease in their teamwork, without specific training in palliative care, in coping with death and stress or emotional training and with lower levels of self-care and self-compassion, whose patients were unable to die a dignified death. Similarly, a low professional quality of life profile was associated with reduced wellbeing and poorer quality of care offered. In conclusion, providing professionals with education and training to improve their ability to handle end-of-life care and stress, maintaining cohesive teams and promoting self-care and self-compassion are pivotal to maintaining the quality of life and wellbeing of palliative care professionals and the quality of care that they provide.

Development and validation of the Short Professional Quality of Life Scale based on versions IV and V of the Professional Quality of Life Scale.

BACKGROUND: This research presents a short version of the Professional Quality of Life (ProQOL) scale, one of the most frequently used questionnaires in the arena of applied healthcare investigation. It measures burnout (BO), compassion fatigue (CF), and compassion satisfaction (CS). METHODS: A 9-item version of the ProQOL was developed. In Study 1, this short version, which used items from version IV of the ProQOL, was administered to 817 palliative care professionals from Spain, Argentina, and Brazil. In Study 2, the same nine items, but this time from version V of the ProQOL, were administered to 296 Spanish palliative care professionals. RESULTS: Study 1: The Short ProQOL showed an adequate internal structure, and invariance across the countries studied (χ2(106) = 185.620 (p < 0.001), CFI = .929, RMSEA = 0.058 [0.044, 0.072], SRMR = 0.081). Argentinians showed higher levels of BO (mean difference = 0.172, p = 0.042, Cohen's d = 0.168), whereas Brazilians showed higher levels of CF (Mean difference = 0.384, p = 0.002, Cohen's d = 0.352). Study 2: the Short ProQOL again showed adequate internal structure and reliability (χ2(24) = 134.504 (p < 0.001); CFI = 0.953; RMSEA = 0.126 [0.106, 0.147]; SRMR = 0.063), and was related to coping with death, self-compassion, and self-care. CONCLUSIONS: The Short ProQOL could help facilitate the application of harmonizing measurements and its use for cross-cultural comparisons and occupational health monitoring was satisfactory.

Psychometric Properties of the Self-Compassion Scale-Short Form: Study of Its Role as a Protector of Spanish Nurses Professional Quality of Life and Well-Being during the COVID-19 Pandemic.

Self-compassion is a multifaceted construct that represents compassion turned inward and involves approaching one's failure and inadequacy with kindness. To measure these self-compassionate behaviors, the Self-Compassion Scale-Short Form (SCS-SF) is one of the most widely used and has been recurrently employed in the healthcare arena. Specifically, self-compassion has been pointed out as essential for providing compassionate care and maintaining healthcare workers balance. AIM: The aim of this study is twofold: (1) to provide evidence of the psychometric properties of the SCS-SF in a sample of Spanish nurses and (2) to study of its role as a protector of Spanish nurses professional quality of life and well-being during the COVID-19 pandemic. METHODS: A sample of 115 Spanish nurses was studied. Mean age was 43.79 years old (SD = 10.99); 84.3% were women. The factorial structure of the SCS-SF was studied with competitive confirmatory factor analysis (CFA). Finally, a full structural equation model was tested, in which positive and negative self-compassion predicted professional quality of life, and professional quality of life, in turn, predicted well-being. RESULTS: Three a priori structures were compared: one-factor, two-factor, and six-factor model. The two-factor solution, positive and negative self-compassion, was retained as the best structure to represent the data. Regarding the predictive model, the two poles of self-compassion predicted professional quality of life prediction, and professional quality of life positively predicted well-being, showing a strong relationship. CONCLUSION: Self-compassion can be an important resource for nurses' balance, promoting adequate professional quality of life and their well-being.

The Spanish Version of the State Self-Compassion Scale-Long Form (SSCS-L): A Study of Its Validity and Reliability in a Sample of Nursing Students.

BACKGROUND: In nurses, self-compassion mitigates the effects of stress, burnout and compassion fatigue, and enhances empathy, compassion and well-being and quality of life. The Self-Compassion Scale is the most-used instrument. The aim of this study is to validate the Spanish version of the new developed State Self-Compassion Scale-Long (SSCS-L). METHODS: Students of the first year of the Nursing Degree were surveyed online. Together with the SSCS-L, their levels of positive and negative affect was reported. Analyses included descriptive statistics, competitive confirmatory factor analysis, evidence on criterion-related validity and estimates of reliability. RESULTS: The best fitting model for the SSCS-L was the one hypothesizing six-correlated factors of self-compassion: self-kindness, common humanity, mindfulness, self-judgement, isolation, and over-identification. Positive relations between the positive dimensions of self-compassion and positive affect were found, whereas there were negative relations between the positive poles of self-compassion and negative affect. Estimates of reliability were adequate, except for the dimension of over-identification. CONCLUSIONS: Self-compassion has become a key competency for nurses. The SSCS-L is an appropriate tool to allow an adequate assessment of self-compassion in experimental contexts.

Palliative Care Professionals' Inner Life: Exploring the Mediating Role of Self-Compassion in the Prediction of Compassion Satisfaction, Compassion Fatigue, Burnout and Wellbeing.

CONTEXT: Palliative care professionals are exposed to suffering on a daily basis. Working in such an environment frequently raises existential issues, psychological challenges, and emotional distress, that can detract from compassionate care. Identifying factors that help professionals cope with frequent exposure to issues related to mortality, such as compassion, could enhance palliative care providers' and patients' quality of life and wellbeing. OBJECTIVES: To improve our understanding of the factors associated with professionals' inner life studying the role of self-compassion as a mediating variable between self-care and awareness and professionals' quality of life, and quantifying the impact of compassionate care. METHODS: A cross-sectional online survey of palliative care professionals was conducted through the Spanish Society of Palliative Care. 296 professionals answered the survey. RESULTS: The model tested showed an adequate fit (χ2(212) = 476.688 (P < .001), CFI = .907, RMSEA = .066 [.058,.073], and SRMR = .068), and the hypotheses were supported. Self-care and awareness predicted coping with death and self-compassion, which in turn predicted professional quality of life. Self-compassion had the greatest predictive power. Professional quality of life showed a statistically significant and positive effect on personal wellbeing, explaining more than 50% of its variance (R2 = .574; P < .001). CONCLUSION: For palliative care professionals, the cultivation of self-compassion is equally needed as compassion for others. Professional quality of life and compassionate care are related to professionals' wellbeing: when professionals take care of themselves, this will lead in a more compassionate care, but also in healthier, happier professionals.

Development and Validation of the Brief Nursing Stress Scale (BNSS) in a Sample of End-of-Life Care Nurses.

Nursing has been identified as a very stressful profession. Specifically in end-of-life care, nurses frequently experience stressful situations related to death and dying. This study aims to develop and validate a short scale of stress in nurses, the Brief Nursing Stress Scale. A cross-sectional survey of Spanish end-of-life care professionals was conducted; 129 nurses participated. Analyses included a confirmatory factor analysis of the Brief Nursing Stress Scale, estimation of reliability, relation with sex, age and working place, and the estimation of a structural equation model in which BNSS predicted burnout and work satisfaction The confirmatory factor analysis showed an adequate fit: χ2(9) = 20.241 (p = 0.017); CFI = 0.924; SRMR = 0.062; RMSEA = 0.098 [0.040,0.156]. Reliability was 0.712. Women and men showed no differences in stress. Younger nurses and those working in hospital compared to homecare showed higher levels of stress. A structural equation model showed nursing stress positively predicted burnout, which in turn negatively predicted work satisfaction. Nursing stress also had an indirect, negative effect on work satisfaction. The Brief Nursing Stress Scale showed adequate estimates of validity, reliability, and predictive power in a sample of end-of-life care nurses. This is a short, easy-to-use measure that could be employed in major batteries assessing quality of healthcare institutions.

Development and Psychometric Validation of the Brief Nurses' Practice Environment Scale and Its Relation to Burnout Syndrome and Job Satisfaction: A Study in Spanish Nurses.

Introduction: Nursing environment is a vast concept that traditionally has included a wide range of job characteristics and has been related to burnout and job satisfaction. For its measurement, the Practice Environment Scale of the Nursing Work Index (PESNWI) stands out. However, shorter instruments are needed. The purpose of the study is to develop and test the Brief Nurses' Practice Environment (BNPE) Scale. Methods: The BNPE Scale was developed and tested in a sample of 210 Spanish nurses (data collection 2018). Results: Cronbach's alpha was 0.702. The confirmatory factor analysis (CFA), with an excellent fit, offered evidence of internal validity. Regarding validity, the BNPE Scale predicted both burnout and job satisfaction. Finally, evidence pointed out a cutoff score of <12 for low levels of practice environment and a cutoff score of >15 for higher levels in practice environment. Conclusions: The BNPE Scale is a short, easy-to-use measure that could be employed in major batteries assessing the quality of healthcare institutions.

The Personal Wellbeing Index in Spanish Palliative Care Professionals: A Cross-Sectional Study of Wellbeing.

Health professionals are especially exposed to stress, with consequences on professionals' health and wellbeing. However, palliative care professionals' wellbeing has been the subject of very little research. The aim of this work is to study the Personal Wellbeing Index (PWI) in a sample of Spanish palliative care professionals, as well as to study their levels of wellbeing and the relationships of wellbeing with variables such as gender, age, marital status, profession, and professional quality of life. A cross-sectional survey of Spanish palliative care professionals was conducted. The Spanish version of the PWI and the Short version of the Professional Quality of Life Scale were used. Here, 296 palliative care professionals attending patients at the end of life participated in the study. They showed medium to high levels of wellbeing. The PWI showed an adequate internal structure [χ 2 (20) = 116.130 (p < 0.001)]; Comparative Fit Index (CFI) = 0.970; standardized root mean square residual (SRMR) = 0.041; root mean square error of approximation (RMSEA) = 0.140 (0.116, 0.166)] and excellent estimates of reliability [α = 0.879 and Composite Reliability Index (CRI) = 0.923]. Wellbeing was higher for married compared to single and showed no relation with age, gender, and profession. Additionally, a structural equation model was estimated, in which a positive relation was found between wellbeing and compassion satisfaction and a negative one with burnout. The PWI is adequate to measure personal wellbeing in Spanish palliative care professionals.

Predicting Professional Quality of Life and Life Satisfaction in Spanish Nurses: A Cross-Sectional Study.

Background: Dealing with suffering, grief, and death on a daily basis, together with the particular working conditions, may produce high levels of burnout in nurses, and hinder their well-being. The purpose of this research is to study the effect of self-care and self-compassion on nurses' professional quality of life and well-being. Methods: The research had a cross-sectional design, used correlational methodology and a structural equation model was hypothesized. Along the study, 210 nurses from the Healthcare Public System of the Balearic Islands, participated. The study took place from June to September 2018. Results: The hypothesized model showed an overall adequate fit. Practice environment predicted both self-care and self-compassion, whereas nursing stress did not. Self-care and self-compassion predicted nurses' professional quality of life, whereas the practice environment and nursing stress were not predictors. Finally, professional quality of life showed a positive relationship with life satisfaction. Conclusions: The study presents a comprehensive structural equation model in which self-care and self-compassion are the best predictors of nurses' professional quality of life. A direct relation of professional quality of life and nurses' well-being has also been found, while controlling for the effects of nurses' practice environment and stress.

Quality of work life and self-care in nursing staff with high emotional demand. / Calidad de vida laboral y autocuidado en enfermeras asistenciales con alta demanda emocional.

OBJECTIVE: To explore the variables related to the quality of work life and the self-care of nursing professionals working with high emotional demand. METHOD: Qualitative, according to the constructivist paradigm. It combines the phenomenological-hermeneutic/interpretative method with the use of semi-structured interviews. Information was analyzed with Maxqda 11. Interviews included professionals from the Valencian healthcare system, with typical profiles of nurses working in surgical units, emergencies, oncology, home care, and cooperation. RESULTS: Organizational factors were reported as a barrier to self-care, affecting healthcare activity. Working with patients was highlighted as a protective factor, based on the satisfaction derived from helping in situations of serious illness and suffering. The quality of work life manifested was assessed as not being what they would desire and deficient. The factors that affected the professionals most were the type of working day and work schedules (shifts, nights, holidays, on call...). The physical, mental and social dimensions of self-care can attenuate the negative effects of this situation. CONCLUSIONS: It is necessary to examine in depth the construct of self-care, to counteract emotionally stressful problems and situations, to propose intervention strategies, training plans and greater involvement of health institutions in the improvement of nurses' quality of work life.

Interpretación de las puntuaciones obtenidas con la escala breve de calidad de vida profesional / Interpretation of the scores obtained with the short professional quality of life scale

Introducción: La Escala de Calidad de Vida Profesional, conocida por sus siglas en inglés (Pro- QOL), es una de las más utilizada en el contexto de los profesionales sanitarios para evaluar la calidad de vida profesional. Recientemente se ha presentado una versión breve de dicha escala, la Escala Breve de Calidad de Vida Profesional. El objetivo de este trabajo es ofrecer una guía para la interpretación de las puntuaciones obtenidas con la mencionada escala. Material y métodos: Se llevó a cabo un estudio transversal en el que participaron profesionales de cuidados paliativos españoles. Se evaluó calidad de vida profesional, mindfulness, autocom- pasión y bienestar personal. Se calcularon estadísticos descriptivos, incluyendo percentiles para la interpretación de la Escala Breve de Calidad de Vida Profesional, y análisis de varianza, para estudiar la bondad de los puntos de corte establecidos. Resultados: La satisfacción con la compasión puede considerarse baja con puntuaciones de 10 o menores, media con puntuaciones entre 11 y 13, y alta con puntuaciones de 14 o superiores. El burnout puede considerarse bajo con puntuaciones de 6 o menores, medio con puntuaciones en- tre 7 y 8, y alto con puntuaciones de 9 o superiores. La fatiga por compasión puede considerarse baja con puntuaciones de 4 o inferiores, media con puntuaciones de 5, y alta con puntuaciones de 6 o superiores. Así establecidas, las puntuaciones se relacionaron de la forma esperada con mindfulness, autocompasión y bienestar personal. Discusión: Los puntos de corte identificados para las puntuaciones de la Escala Breve de Calidad de Vida Profesional son útiles y coherentes para utilizar dicha escala. (AU)

Background: The Professional Quality of Life scale, known by its acronym in English, ProQOL, is one of the most widely used tools by health professionals to assess professional quality of life. Recently, a short version of this scale has been presented, the Short Professional Quality of Life scale. The aim of this work is to offer a guideline for the interpretation of the scores obtained with this scale. Materials and methods: A cross-sectional study was carried out in Spanish palliative care profes- sionals. Professional quality of life, mindfulness, self-compassion, and personal well-being were evaluated. Descriptive statistics were calculated, including percentiles for the interpretation of the Short Professional Quality of Life scale, and an analysis of variance was performed to study the validity of the established cut-off points. Results: Satisfaction with compassion can be considered low with scores of 10 or lower, medium with scores between 11 and 13, and high with scores of 14 or higher. Burnout can be considered low with scores of 6 or lower, medium with scores between 7 and 8, and high with scores of 9 or higher. Compassion fatigue can be considered low with scores of 4 or lower, medium with scores of 5, and high with scores of 6 or higher. The established cut-off point for these scores were correlated in the expected direction with mindfulness, self-compassion, and personal well-being. Discussion: The cut-off points identified for the Short Professional Quality of Life scale scores are useful and adequate for scale use. (AU)

Estudio descriptivo del impacto de la pandemia por COVID-19 sobre las condiciones de trabajo, el cuidado de los pacientes y la calidad de vida profesional de una muestra de profesionales de cuidados paliativos españoles / Descriptive study of the impact of the COVID-19 pandemic on the working conditions, patient care, and professional quality of life in a sample of spanish palliative care professionals

Antecedentes y objetivo: La pandemia por COVID-19 ha supuesto un importante reto para nuestros profesionales de cuidados paliativos. El objetivo del presente estudio es describir cómo ha afectado esta pandemia a las condiciones de trabajo, el cuidado de los pacientes y la calidad de vida profesional de una muestra de profesionales de cuidados paliativos.Materiales y métodos: Se llevó a cabo un estudio transversal en el que se contactó a 338 profesionales de cuidados paliativos. Se preguntó por datos sociodemográfi cos, condiciones de trabajo, cuidado de los pacientes, calidad de vida profesional y variables relacionadas.Resultados: Doscientos setenta y ocho profesionales contestaron la encuesta online. La edad media fue de 45,34 años. El 77,2 % fueron mujeres. Un 32,0 % informó no haber contado con los recursos materiales necesarios. Más de la mitad apuntaron que su carga de trabajo había aumentado considerablemente, siendo excesiva. La mayoría de quienes cuidaron a pacientes COVID-19 que fallecieron señalaron que el paciente no había sido acompañado por un familiar ni de forma adecuada por el propio profesional, no teniendo una muerte digna. Un 46,5 % sufría alto burnout y el 77,6 % alta fatiga por compasión, pero también alta satisfacción con la compasión (68,9 %). Muchos de ellos habían recibido formación previa y tenían altos niveles de compasión, autocompasión, autocuidado y competencia en afrontamiento de la muerte.(AU)

Background and objective: The COVID-19 pandemic has been a major challenge for palliative care professionals. The objective of this study was to describe how this pandemic affected the working conditions, patient care, and professional quality of life in a national sample of palliative care professionals.Materials and methods: A cross-sectional study was carried out in which 338 palliative care professionals were contacted. Data on sociodemographics, working conditions, patient care, professional quality of life, and related variables were gathered.Results: Two hundred and seventy-eight professionals answered the online survey. Mean age was 45.34 years; 77.2 % were women; 32.0 % reported not having had the necessary material resources. More than half indicated that their workload had increased considerably, being excessive. Most of those who cared for COVID-19 patients who died indicated that these patients had not been accompanied by a family member or adequately by the professional him/herself, thus not having a dignified death. In all, 46.5 % suffered from high burnout and 77.6 % from high compassion fatigue, but also experienced high satisfaction with compassion (68.9 %). Many of them had received previous training and had high levels of compassion, self-compassion, selfcare and competence in coping with death. (AU)

Calidad de vida laboral y autocuidado en enfermeras asistenciales con alta demanda emocional / Quality of work life and self-care in nursing staff with high emotional demand

Objetivo: Explorar las variables relacionadas con la calidad de vida laboral y el autocuidado de profesionales de enfermería en situaciones estresantes y con alta demanda emocional. Método: Cualitativo, según el paradigma constructivista, combinando el método fenomenológico-hermenéutico/interpretativo mediante el uso de entrevistas semiestructuradas. La información fue analizada con Maxqda 11. Las entrevistas se realizaron a profesionales de centros sanitarios y servicios de Valencia con perfiles característicos de enfermería en unidades médico-quirúrgicas, urgencias, oncología, atención domiciliaria, y de ayuda humanitaria. Resultados: Los factores organizativos se expresaron como barrera para el autocuidado, afectando a la actividad asistencial. Como factor protector, se señala el trato con pacientes, basado en la satisfacción que genera la relación de ayuda en situaciones de gravedad, y sufrimiento. La valoración de la calidad de vida laboral manifestada no fue la deseada y resulta deficiente. Los factores que más afectan se refieren al tipo de jornada laboral y los horarios de trabajo (turnos rodados, noches, festivos, guardias...). Las dimensiones física, psíquica y social del autocuidado, pueden atenuar los efectos negativos de esta situación. Conclusiones: Es necesario profundizar en el constructo del autocuidado, para contrarrestar los problemas y situaciones emocionalmente estresantes, plantear estrategias de intervención, planes formativos y una mayor implicación de las instituciones sanitarias en la mejora de la calidad de vida laboral de enfermería

Objective: To explore the variables related to the quality of work life and the self-care of nursing professionals working with high emotional demand. Method: Qualitative, according to the constructivist paradigm. It combines the phenomenological-hermeneutic/interpretative method with the use of semi-structured interviews. Information was analyzed with Maxqda 11. Interviews included professionals from the Valencian healthcare system, with typical profiles of nurses working in surgical units, emergencies, oncology, home care, and cooperation. Results: Organizational factors were reported as a barrier to self-care, affecting healthcare activity. Working with patients was highlighted as a protective factor, based on the satisfaction derived from helping in situations of serious illness and suffering. The quality of work life manifested was assessed as not being what they would desire and deficient. The factors that affected the professionals most were the type of working day and work schedules (shifts, nights, holidays, on call...). The physical, mental and social dimensions of self-care can attenuate the negative effects of this situation. Conclusions: It is necessary to examine in depth the construct of self-care, to counteract emotionally stressful problems and situations, to propose intervention strategies, training plans and greater involvement of health institutions in the improvement of nurses' quality of work life