Work environmental factors associated with compassion satisfaction and end-of-life care quality among nurses in general wards, palliative care units, and home care settings: A cross-sectional survey.

BACKGROUND: Nurses providing end-of-life care experience not only burnout and compassion fatigue, but also positive effects such as compassion satisfaction. Nurses' compassion satisfaction was shown to be related to job satisfaction, work engagement, and nurse caring. Studies in emergency departments, intensive care units, oncology wards, and general wards have identified work environmental factors associated with nurses' compassion satisfaction, but no similar studies have been conducted in palliative care units or home care settings. It is also unknown whether work environmental factors associated with compassion satisfaction contribute to end-of-life care quality. OBJECTIVE: To explore work environmental factors associated with nurses' compassion satisfaction and end-of-life care quality in three types of workplaces: general wards, palliative care units, and home care settings. DESIGN: A cross-sectional survey of nurses providing end-of-life care. SETTINGS: Sixteen general wards, 14 palliative care units, and 25 home-visit nursing agencies in Japan. PARTICIPANTS: There were 347 study participants: 95 nurses in general wards, 128 in palliative care units, and 124 in home care settings. METHODS: Compassion satisfaction was assessed using the Professional Quality of Life Scale, and end-of-life care quality was rated on a 4-point scale. Work environments were assessed using the Areas of Worklife Survey, which measures the fit between an individual and their work environment in six areas: workload, control, reward, community, fairness, and values. RESULTS: Compared to nurses in general wards and palliative care units, home care nurses scored statistically significantly higher on all work environmental factors except reward. Work environmental factors that were significantly positively associated with higher compassion satisfaction were values in general wards (ß = 0.335, P = 0.007), reward and workload in palliative care units (ß = 0.266, P = 0.009 and ß = 0.179, P = 0.035), and community and control in home care settings (ß = 0.325, P = 0.001 and ß = 0.261, P = 0.004). In addition, higher scores for workload in general wards (odds ratio = 5.321; 95 % confidence interval, 1.688-16.775) and for community in palliative units (odds ratio = 2.872; 95 % confidence interval, 1.161-7.102) were associated with higher end-of-life care quality. No associated work environmental factors were found in home care settings. CONCLUSIONS: Work environmental factors associated with nurses' compassion satisfaction and end-of-life care quality varied between workplaces. These results may contribute to creating work environments that are appropriate for each workplace type to maintain both nurses' compassion satisfaction and end-of-life care quality. TWEETABLE ABSTRACT: Work environmental factors associated with nurses' compassion satisfaction and end-of-life care quality were identified in three workplaces.

Development of an Instrument for Evaluating Nurses' Knowledge and Attitude Toward End-of-Life Care: End-of-Life Nursing Education Consortium-Japan Core Quiz.

This study aimed to develop a scale focusing on knowledge and attitudes toward palliative care and end-of-life care for nurses and to confirm the scale's validity and reliability. We conducted a self-administered questionnaire survey with 1745 nurses of 10 hospitals all over Japan. We also examined the test-retest reliability of items for 205 of the nurses, 2 weeks after the first survey was completed. We used item-response theory, factor analysis, and intraclass correlation coefficients. The response rate was 44.5% (n = 762). Ninety items in 9 domains about knowledge of palliative care and end-of-life care were selected by using item-response theory. For knowledge items, Kuder-Richardson-20 was 0.85, and intraclass correlation coefficient was 0.84 in all domains. Ten items in 3 domains about attitudes toward palliative care and end-of-life care were selected by using exploratory factor analysis. For attitude items, Cronbach's α coefficient was .90, and intraclass correlation coefficient was 0.80 in all domains. The developed scale, named the End-of-Life Nursing Education Consortium-Japan Core Quiz, has sufficient validity and reliability. This scale may contribute to assessing the effectiveness of the End-of-Life Nursing Education Consortium-Japan Core Curriculum Nursing Education Program in Japan.