Moral Distress (MD) and burnout in mental health nurses: a multicenter survey.

INTRODUCTION: Moral Distress (MD) is a common experience among nurses and if it is not recognised and treated, it may lead to serious consequences on nurses' health and quality of care. MD has been studied in several healthcare contexts. However, there are only few studies on MD in psychiatry and in Italy there are no data in this field.  Objective: To assess the presence of MD among mental health nurses in Italy and verify whether there is a relationship between MD and burnout. METHODS: We conducted a multicentre survey among nurses of Mental Health services of four hospitals in Milan. The MD Scale for Psychiatric NursesItalianrevised (MDS-PItarev) and the Maslach Burnout Inventory (MBI) were used for data collection. Factor analysis and calculation of content validity index (CVI) and Cronbach's alpha were performed on the Italian version of the MDS-PIta. Three items of the old version of the scale were removed, because judged not relevant in the Italian context. The revised scale maintained excellent CVI (0.89) and Cronbach's alpha (0.93). RESULTS: Of 285 questionnaires distributed, 228 (80%) were returned. The median of MD was 2 (scale range 0-6); MD is correlated with two burnout dimensions: emotional exhaustion (rho(ρ)=0.28, p<0,001) and depersonalization (ρ=0.20, p<0,001). CONCLUSIONS: This is the first study about MD among psychiatric nurses in Italy. We found a medium-low level of MD among nurses who participated in the survey. We also found a modest but significant correlation between MD and two dimensions of MBI. Further studies are needed to confirm these results.

[Organizational features influencing health worker's fulfillment in an Alzheimer center and in a nursing home]. / Le caratteristiche organizzative che influenzano il benessere lavorativo degli operatori di un Centro Alzheimer e di una RSA.

OBJECTIVES: The pursuit of the best working conditions and of a rewarding job are pivotal elements in care process cause working satisfaction plays a main role to further the positive treatments outcome. METHODS: Anonymous questionnaires were administered to 59 subjects (10 nurses and 49 health workers) operating in two different institutions, an Alzheimer centre and a nursing home, in order to describe their personal sensation about work's gratification. RESULTS: Our research shows up, in both institutions, a satisfying perception about working conditions, learning and educational opportunities, teamwork and individual skills recognition. CONCLUSIONS: Patients' behavioural disorders and hard relationship with families are source of strain and stress for both groups. The rest home staff complain about the unsuitable environmental conditions which make difficult the managing of particular minor behavioural disorders like wonderings, escapes and falls. Elements as salary and balance between work and free time are relevant for both groups but not adequate to fulfill their expectations if work recognition and individual daily efforts appreciation are lacking.

[Therapeutic education for carers, an innovative concept to prevent burnout]. / ETP de l'aidant, un concept innovant pour prévenir l'épuisement.

Some hospital teams have chosen to use therapeutic education with carers in order to prevent their burnout. Nurses trained in therapeutic patient education perform a particularly innovative role by helping to relieve the carer's 'burden'.

Nurses' Job satisfaction: an Italian study.

BACKGROUND: The aim of the work presented was to assess job satisfaction of a number of nurses from different departments working in public hospitals in Italy. The assessment was carried out through the combined use of questionnaires, which measured different aspects of job satisfaction, such as coping abilities, stress level and optimism/pessimism. The literature supports the fact that nurses' job dissatisfaction is closely connected with high levels of stress, burnout and physical and mental exhaustion, together with high workload levels and the complexity of care. The growing interest in measuring the levels of nurses' job satisfaction is attributable to a number of problems that have been raised worldwide, two of which are becoming ever so important: turnover and shortage of nurses. The research question is: Which are the main motivating factors of Italian nurses' job satisfaction/dissatisfaction? METHODS: The study used a convenience (non probability) sample of 1,304 nurses from 15 different wards working in Italian public hospitals from a number of cities in northern, central and southern Italy. The survey instrument was a questionnaire consisting of 205 items which included 5 different questionnaires combined together. RESULTS: The results show a low level of job satisfaction (IWS= 11.5, JSS=126.4). However, the participants were overall happy about their job and considered autonomy and salary important factors for job satisfaction. CONCLUSION: Research has shown that the nurses' level of satisfaction in Italian hospitals is low. The results revealed dissatisfaction with task requirements, organizational policies and advance in career. Nurses interviewed did not feel stressed and showed to be optimistic overall. New research on the subject should be conducted by focusing on ward differences, North and South of Italy and on gender differences.

[Nurses helping nurses with psychological disorders in Barcelona]. / À Barcelone, des infirmières aident des infirmières souffrant de troubles psychologiques.

In Barcelona, in Spain, the Retorn programme is breaking a taboo. It has been especially designed to help practising nurses suffering from addiction or psychological disorders. The care and follow-up are provided by a multi-disciplinary team in a clinic which caters for all types of health professionals, in complete confidentiality.

Regulating the Flow of Change to Reduce Fontline Nurse Stress and Burnout.

The nursing workforce is at the center of many changes associated with care delivery transformation. To achieve this transformation, frontline nursing staff must be engaged in their work, committed to their organization's mission, and capable of delivering high-quality care. To identify top opportunities for driving nursing engagement, researchers from The Advisory Board Company analyzed engagement survey responses from more than 343 000 employees at 575 healthcare organizations. In this article, the authors describe 3 strategies for addressing 1 of the greatest opportunities for improving nurse engagement: ensuring nurses feel their organization helps them reduce stress and burnout.

Relationship of adverse events and support to RN burnout.

Registered nurse (RN) "second victims" are RNs who are harmed from their involvement in medical errors. This study used the conceptual model nurse experience of medical errors and found a relationship between RN involvement in preventable adverse events and 2 domains of burnout: emotional exhaustion (P = .009) and depersonalization (P = .030). Support to RNs involved in preventable adverse events was inversely related to RN emotional exhaustion (P < .001) and depersonalization (P = .003) and positively related to personal accomplishment (P = .002).

Investigating burnout situations, nurses' stress perception and effect of a post-graduate education program in health care organizations of northern Italy: a multicenter study.

BACKGROUND: Burnout (BO) is increasingly considered a public health problem: it is not only harmful to the individual, but also for the organization. Therefore, in recent years, research has given particular attention to the study of the phenomenon and its antecedents among the nursing profession. In the last ten years, the literature shows the prevalence of BO in different clinical settings, but there are few recent data describing the phenomenon and its relationship with educational preventive programs. OBJECTIVES: The aims of this study are: a) to describe the prevalence of nurses' risk of BO in the northern Italy area b) to describe nurses' coping and their perception of the BO antecedents. c) to describe the effects of education on the nurses' coping and their recognition of BO antecedents. METHODS: The study is structured into two main parts. The first was cross-sectional, the second was prospective. Burnout Potential Inventory (BPI) questionnaire was used in the cross-sectional part to survey risk of BO in three big hospitals in Northern Italy. The Health Profession Stress and Coping Scale (HPSCS) was used in the prospective part to survey the nurses' stress perception and their coping mechanisms in a post-graduate educational program. RESULTS: Nurses' BO risk is within the normal range, although the BPI highlighted three borderline subscales: poor team work, work overload and poor feedback. Post-graduate education had a positive effect on the stress perception, but it is not sufficient to improve coping mechanisms. CONCLUSIONS: The study revealed the more stressful work situations and the effect of post-graduate education to prevent the effects of stress. This topic needs further investigation in the light of the result of this study.

[The model of Human Caring: results of a pre- and post-intervention study with a control group]. / Il modello assistenziale dello Human Caring: risultati di uno studio pre e post intervento con gruppo di controllo.

INTRODUCTION: The "Human Caring" model is a philosophy of care based on individual centrality and which, although developed within nursing discipline, could be used by all professionals who take care of individuals. Nurses who work within the field of Mental Health, is subjected to a considerable emotional burden and it is believed that the introduction of this model can have a positive impact. OBJECTIVE: To evaluate the effects of the introduction of the model Human Caring in the Department of Mental Health Asl Cuneo 1, in order to improve health care professionals' well-being and patients' perception with respect to care and assistance. METHOD: A pre and post intervention design approach with control group where variables were measured before (T0) and after (T1) the implementation of the model of care Human Caring. RESULTS: 80 health care professionals and 125 clients were observed. Results show a non statistically significant difference between the pre and post test both for health care professionals and clients. CONCLUSIONS: Human Caring model does not seem to have a positive impact in the short term. However, it is arguably a protective action for health care professionals that further studies should deeply explore with longer period of follow-up.

[Operational fatigue: debriefing from Kapisa, Afghanistan]. / La fatigue opérationnelle : retour d'expérience Afghanistan/Kapisa.

The concept of operational fatigue, a term first used during the Second World War, was subsequently extended to encompass a vague series of psychological disorders. This article looks back at an overseas operation in Afghanistan, during the summer of 2011, where the tense background situation, casualties and fatalities resulted in some members of the commando parachute units suffering from such conditions.

Burnout in psychiatric nursing: examining the interplay of autonomy, leadership style, and depressive symptoms.

It is important to consider ways in which nurses can be protected from experiencing the effects of burnout. This study examined the relationships between leadership style of psychiatric nurse supervisors, work role autonomy, and psychological distress in relation to psychiatric nurse burnout. Eighty-nine psychiatric nurses from Montana and New York hospitals completed an online survey that assessed their work-related experiences. Overall, results of this study indicate that the participants were experiencing high levels of emotional exhaustion and depersonalization when compared to a normative sample of mental health workers. Results also showed that leadership style and work role autonomy are likely to be environmental factors that protect against burnout in nurses. Finally, it was shown that the relationship between depressive symptoms and the burnout component of personal accomplishment may be influenced by nurses' perceptions of the leadership style in their work environment. These findings are important because nurse supervisor leadership styles and amount of autonomy are characteristics of the work environment that may be amenable to change through training and intervention.

Compassion fatigue in military healthcare teams.

Since the onset of the Iraq war and Afghanistan conflicts, military healthcare teams have had increasing exposure to the traumatic effects of caring for wounded warriors, leading to a phenomenon termed compassion fatigue. The purpose of this integrative review was to develop a proposed definition for compassion fatigue in support of these teams. There is no current standardized formal definition, and this lack of clarity can inhibit intervention. Seven main themes evolved from the literature review and were integrated with the core elements of the Bandura Social Cognitive Theory Model as the first step in developing a uniformed definition.

Resilience and professional quality of life among military healthcare providers.

The retention of qualified military healthcare providers is a top priority for Department of Defense (DoD) leaders. The purpose of this study is to examine the relationship between resilience and professional quality of life and to explore differences among providers who had been deployed and those who had never been deployed. Results indicated high resilience scores among all providers, and significant relationships between dimensions of professional quality of life and resilience. There were significant differences in professional quality of life based on deployment. Recommendations for future research are included, particularly as retention is an important issue for the DoD.

'Violence is not part of our job': a thematic analysis of psychiatric mental health nurses' experiences of patient assaults from a New Zealand perspective.

This paper describes psychiatric mental health nurses' (PMHN) experiences of patient assaults within mental healthcare settings using a thematic analytical approach. The aim of the study was to explore and describe psychiatric mental health nurses' experiences of patient assaults. The major findings of the study related to the nature and impact of assaults and supportive strategies associated with violence perpetrated by patients against psychiatric mental health nurses. Perpetrator risk factors for patients include mental health disorders, alcohol and drug use and the inability to deal with situational crises. The injuries sustained by nurses in the context of the study include lacerations, head injuries, dislocations and bruises. Psychological harm has also occurred, including quite severe mental health problems, such as post-traumatic stress disorder. Protective strategies for combating negative consequences of workplace violence include practice of self-defence, social support and a supportive and consultative workplace culture with access to counselling services and assistance in all aspects, including finances. The paper concludes that while healthcare employers need to provide better support services to the healthcare professionals who are assaulted, the legal system also needs to acknowledge that assaults against nurses are a violation of human rights and violence should not to be tolerated as part of working in mental healthcare settings.

The moderating effects of locus of control and job level on the relationship between workload and coping behaviour among Finnish nurses.

AIM: This study examined a two-fold moderating effect of the locus of control (LOC) and the nurses' job level on the stress-coping relationship. BACKGROUND: The literature on stress lacks studies examining whether control, either as a personality trait or job characteristic, would overtake coping efforts. METHODS: A three-way interaction effect (workload × LOC × job level) was applied to test the moderation model. Participants were hospital staff nurses and nurse managers (n = 934) in Finnish hospitals. They responded to an electronic-questionnaire that sought their work loads, coping behaviours and LOC. RESULTS: The results provided support for the moderation model. Staff nurses with external LOC exerted more coping behaviours when experiencing a high workload. Job level significantly altered the moderating effect of LOC; staff nurses with an internal LOC and nurse managers with an external LOC disregarded coping efforts. CONCLUSION: Extrinsic control inherent in higher job levels appeared to undertake the lacking disposition of control among externals diminishing coping efforts. IMPLICATIONS FOR NURSING MANAGEMENT: Job level interacts with LOC on the perception of control in hospitals. Staff nurses with internal LOC and nurse managers with external LOC could make a greater balance between personal and job resources effectively to deal with role overload.

[Counterproductive behaviors and moral disengagement of nurses as potential consequences of stress-related work: validity and reliability of measurement scales]. / I comportamenti controproduttivi e il disimpegno morale degli infermieri quali possibili conseguenze dello stress lavoro correlate: validità e affidabilità delle relative scale di misura.

BACKGROUND: Several studies, but no one in the nursing, have shown that work stress can facilitate the adoption of specific behaviors that the literature identifies as Counterproductive Work Behaviors (CWB). Individuals, however, not giving up to their moral principles, may transgress social, organizational, moral and ethical norms, through the adoption of moral disengagement (MD). OBJECTIVES: The purpose of this study is to validate two specific scales of deviant behaviors and MD in nursing: the Nursing Counterproductive Work Behaviours Scale (Nursing CWBS) and Nursing Moral Disengagement Scale (Nursing MDS). METHOD: 460 nurses participated in the study. After the adaptation of the Counterproductive Work Behavior Checklist by Spector and Fox to Nursing context (Nursing CWBS) and the ex novo development of the Nursing MDS, the psychometric properties of the two scales were tested. Also, the two scales were correlated. RESULTS: Through a cross-validation approach and based on the results of exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), we have shown that the scales have good psychometric properties. Furthermore, the results, attest that the nurse with high levels of MD implements more CWB in the workplace. CONCLUSIONS: The Nursing CWBS and Nursing MDS represent a valid starting point for the study of such phenomena in this specific context where stress among nursing staff is sometimes of considerable extent, especially in specific contexts of clinical care.

Exploration of the burnout syndrome occurrence among mental health nurses in Cyprus.

Nurses' work-related stress might be associated with psychiatric symptoms, leading to altered professional attitudes. The aim of this study was to explore the levels of burnout and associations with anxiety and depressive symptoms among Greek-Cypriot psychiatric-mental health nurses (PMHNs). A descriptive correlational design with cross-sectional comparisons was applied. A sample of 226 PMHNs was used. Participants reported low levels of burnout. However, 10% of them manifested clinically significant anxiety and depressive symptoms. Emotional exhaustion and depersonalization were associated with depressive (r=0.562, p<0.0001, and r=0.616, p<0.0001, respectively) and anxiety (r=0.394, p<0.0001, and r=0.448, p<0.0001, respectively) symptoms. Further research investigating the biological aetiopathology of these psychological alterations is warranted.

Getting in and getting out whole: nurse-patient connections in the psychiatric setting.

As a strong component in patient healing, interpersonal connection in the psychiatric/mental health setting can threaten nurses' health. Participant observation on four behavioral health and addiction units revealed a process of connecting with patients' emotional pain, delineating strategies applicable to nurses' multiple world views and practice styles. Findings from 12 nurses highlighted connectedness as a process and personal decision that, with self-awareness and individualized self-protective/self-separating strategies, can enhance patient healing as well as nurse satisfaction and growth. The evolved model may help nurses ease emotional labor, combat compassion fatigue, enhance performance, and preserve their self in today's complex acute care setting.

Phoenix nurses: a path to renewal.

Sometimes being on the front lines involves caring for our colleagues. "Assisting nurses to nurture and heal themselves" is a defined role of holistic nursing practice (AHNA & ANA, 2013, p. 8). Nothing can be more catastrophic for a nurse's career than the loss of her/his license to practice. In this dark hour a nurse will often need extra support and someone to walk alongside her/him in the healing process. This article describes a holistic nurse in North Carolina who is helping nurses in her region find the courage to rise up from the ashes and start anew.