Emotional labour in nursing research: A bibliometric analysis.

AIM: This study aims to conduct a comprehensive bibliometric analysis to explore the trajectory and thematic developments of emotional labour research in nursing. DESIGN: Utilizing descriptive and bibliometric analysis techniques. METHODS: The data analysis and graphical presentation were conducted using the Bibliometrix Package in R software. DATA SOURCES: The Web of Science Core Collection (WoSCC) database was searched on October 20, 2023. RESULTS: From 1992 to 2023, 842 authors published relevant articles, yielding 779 author keywords. There has been a general upward trend in the number of articles published over the past 30 years, with an annual growth rate of 11.71%. Keyword co-occurrence cluster analysis revealed the main focus areas of research on emotional labour antecedents and consequences, regulatory modalities, training and education, as well as research methods and application scenarios. CONCLUSION: Emotional labour significantly influences nursing staff's well-being and patient care outcomes. Effective management and education regarding emotional labour are crucial for enhancing nursing staff performance and patient care quality. Future research should focus on long-term effects, training efficacy, regulatory strategies across clinical settings, and innovative approaches to address current challenges. IMPACT: This study provides valuable insights into the unique trajectory and thematic developments of emotional labour research in nursing. The findings underscore the importance of addressing emotional labour in nursing practice and education to improve patient care outcomes and nursing staff well-being. REPORTING METHOD: Adherence to recognized bibliometric reporting methods, following relevant EQUATOR guidelines. NO PATIENT OR PUBLIC CONTRIBUTION: This study is based solely on existing literature and did not involve patients or the public in its design, conduct, analysis, interpretation, or preparation.

An exploration of managing emotional labour and maintaining professional integrity in children's hospice nursing.

BACKGROUND: Research exploring nurse-parent relationships in children's hospices is rare. AIM: To investigate how children's hospice nurses manage emotional labour and professional integrity in their long-term relationships with parents. METHODS: A purposive sample of six children's nurses, from hospices across England, recorded audio diaries and participated in telephone interviews. Narratives were thematically analysed. FINDINGS: Three overarching, cross-cutting themes were identified-purposeful positioning; balancing personability and professionalism; coping with and counterbalancing emotional labour. All themes were indicative of and/or built upon emotional intelligence constructs, such as self-awareness, self-regulation, appropriate (managed) empathy, social skills and intrinsic motivation. Innate features of children's hospice work were important for perpetuating intrinsic motivation and satisfaction. CONCLUSION: This study provided an insight into the management of emotional labour and professional integrity by experienced children's hospice nurses. The identification of emotional intelligence skills merits further exploration in this environment, as well as other children's palliative care settings.

Hospitality Work as Social Reproduction: Embodied and Emotional Labour during COVID-19.

This article focuses on how the imaginary of a 'safe' environment was visualised and conveyed within the hospitality sector during the COVID-19 pandemic, drawing on diaries and interviews with 21 workers in the UK. Our findings show increased workloads for hospitality staff, compounded by anxieties of risk and individualised COVID-19 regulation work. This includes workers' negotiations of corporeal boundaries and distancing from customers, the visible cleaning of communal areas and recuperation and care work for their own bodies and others in shared living spaces. We draw on conceptualisations of embodied and emotional labour to understand these experiences, reflecting on the importance of the actions performed by workers in maintaining community spaces and creating customer confidence in safely enjoying a 'hospitable' environment. This article contributes to social science scholarship of embodied and emotional labour, hospitality and social reproduction.

Emotion in public involvement: A conceptual review.

BACKGROUND: Experiential knowledge can aid in designing research by highlighting what an idea looks like from a patient and carer perspective. Experiential knowledge can be emotional, and this can create challenges at formal research meetings. OBJECTIVE: The aim of this study was to consider the role of emotions in public involvement. METHODS: This is a conceptual review informed by relevant literature and reflection within the author team. A structured Scopus search was conducted in November 2021 and December 2022, identifying 18 articles that presented findings from patient and public involvement (PPI) research related to 'emotion'. We complemented the search with theory-generating articles related to the role of emotion and emotional labour in human life. FINDINGS: Study findings from the structured search were tabulated to identify recurring themes; these were as follows: emotional connections to the research topic can cause stressful as well as cathartic experiences of PPI, 'emotional work' is part of PPI when people are contributing with their experiential knowledge and the emotional aspect of 'lived experience' needs to be recognised in how PPI is planned and facilitated. These points were considered in relation to theoretical works and experiences within the author team. DISCUSSION: 'Emotion work' is often required of public collaborators when they contribute to research. They are asked to contribute to research alongside researchers, with knowledge that often contains emotions or feelings. This can be both upsetting and cathartic, and the environment of the research study can make the experience worse or better. CONCLUSIONS: The emotional component of experiential knowledge can be challenging to those invited to share this knowledge. It is imperative that researchers, research institutions and health and care professionals adjust research meeting spaces to show an awareness of the emotional labour that is involved in PPI. PATIENT OR PUBLIC CONTRIBUTION: This review was initiated after a meeting between carers and family members of residents in care homes and researchers. The review is co-written by a group of three researchers and three carers and family members. Regular online meetings were held during the draft stages to incorporate people's views and ideas. Data extracted from the review were presented to the group of public collaborators in a variety of formats (e.g., posters, slideshows, text and verbally) to facilitate shared sense-making and synthesis of the literature.

Reframing the public/private debate on healthcare services: Tracking boundaries in the National Health Service.

This paper intervenes in the dichotomous debate on the 'privatisation' of the UK's National Health Service (NHS). Whilst research suggests that involving private-sector actors and principles deviates from the founding aims of the NHS to deliver equitable healthcare for all, the opposing argument to 'keep our NHS public' also limits understanding and alternative possibilities. Through focusing on maintaining overarching structures, these campaigns fail to address everyday medical practices that have long been critiqued by those allied with the sociology of health and illness. This paper draws on feminist critiques of public/private to expand the structural economic lens of mainstream political debates and explore how multiple forms of economic, social, cultural, and symbolic capital, operate in everyday healthcare practices. Through an historically-informed ethnographic exploration of routine hip replacements, I find that capital itself emerges through relations between people and things, and that public/private boundaries play an integral role in forming these relations to instil value on particular patients and forms of labour, demarcating what kind of healthcare is given to whom. I therefore suggest future action should focus on assembling healthcare relations beyond the dualism of public/private categories, to create multiple safe places and relations for all.

Emotional labour and turnover intention among nurses in China: Mediating effects of nurse-patient relationship and self-rated health.

AIM: This study tested the mediating role of the nurse-patient relationship and self-rated health in the effect of emotional labour on turnover intention among nurses in China. BACKGROUND: The underlying mechanism behind the effect of emotional labour on turnover intention remains inadequately understood. INTRODUCTION: Nurses with a high level of emotional labour are predisposed to experiencing poor health and tension in their relationships with patients, which may increase turnover intention. METHODS: A cross-sectional survey of 527 nurses in a public tertiary hospital in Qiqihar, located in China's Heilongjiang province, was conducted. Emotional labour and turnover intention were assessed using existing validated scales containing multiple items, while the nurse-patient relationship and self-rated health were assessed using single items, respectively. Baron and Kenny's causal steps and the Karlson/Holm/Breen method were adopted to test the mediating effects of the nurse-patient relationship and self-rated health in the association between emotional labour and turnover intention after adjusting for variations in sociodemographic and job characteristics. RESULTS: Emotional labour was positively associated with turnover intention. Self-rated poor health and a disharmonious nurse-patient relationship partially mediated the positive effect of emotional labour on turnover intention. CONCLUSIONS: Emotional labour significantly affects the turnover intention of nurses working in public tertiary hospitals in China, and this effect is partially mediated by self-rated health and the nurse-patient relationship. IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY: Giving more attention to nurses' negative emotions and work attitudes is crucial. Developing comprehensive strategies for enhancing nurses' emotional management ability, promoting their physical and psychological well-being, and improving nurse-patient relationship to reduce nurses' turnover.

Leaders' emotional labour and abusive supervision: The moderating role of mindfulness.

In this study, we examine how leaders' emotional labour strategies (surface acting and deep acting) deplete leaders' self-control resources to predict abusive supervision, in addition to the moderating role of leader mindfulness. Integrating ego-depletion theory and emotion regulation theory, we hypothesise that deep acting and surface acting predict higher levels of abusive supervision, which is mediated by reduced self-control. Furthermore, we predict that leaders' trait mindfulness moderates the relationship between emotional labour and self-control on abusive supervision. Results from a three-wave study of leader-follower dyads supported mediation hypotheses; both deep and surface acting predicted abusive supervision, which is mediated by reduced self-control. Our moderated mediation hypotheses were supported for deep acting but not surface acting. This research contributes to the literature by demonstrating the depleting nature of emotional labour in leadership and the importance of leader mindfulness as a boundary condition that can make deep acting less harmful for leader behaviour.

Competence in managing workplace violence among nursing interns: Application of latent class analysis.

AIM: To identify subtypes of competence in managing workplace violence (WPV) among nursing interns and to assess between-group differences. BACKGROUND: Nursing interns are reported to be a vulnerable population for experiencing workplace violence during their clinical placement. Although WPV could have a negative impact on nursing interns' health and attitudes towards the nursing profession, little is known about nursing interns' competence in workplace violence management or its influencing factors. DESIGN: A cross-sectional study. METHODS: Between March to April 2023, nursing interns at three tertiary general hospitals in Anhui Province, China, completed questionnaires including a general information questionnaire, the Management of Workplace Violence Competence Scale (MWVCS), the Utrecht Work Engagement Scale (UWES-9), the Emotional Labour Scale for Nurses (ELSN) and were classified into subtypes by latent class analysis. Subsequently, univariate analysis and multivariate logistic regression were performed to identify the influencing factors by subtypes. RESULTS: A total of 264 questionnaires were valid and the overall mean age of the participants was 21.06 ±1.41 years. Four classes were identified: low competency group (15.5%), low cognition-low coping competency group (18.2%), low cognition-medium to high competency group (21.6%) and high competency group (44.7%). The results of multinomial logistic regression analysis showed that placement hospitals with a WPV management department, emotional control effort in profession dimension and emotional pretense by norms dimension in the Emotional Labour Scale for Nurses, pursuing further education and vigour dimension in the Utrecht Work Engagement Scale were influencing factors of the potential categories of WPV management competence. CONCLUSIONS: Four classes were identified and there was competence variability among nursing interns. More attention should be given to nursing interns who did not receive WPV-related training in their school or placement hospital.

Leaving it at the gate: A phenomenological exploration of resilience in mental health nursing staff in a high-secure personality disorder unit.

AIMS AND DESIGN: This study reports a qualitative phenomenological investigation of resilience in nursing staff working in a high-secure personality disorder service. METHOD: Interviews were carried out with six nursing staff, and these captured the richness and complexity of the lived experience of nursing staff. RESULTS: Four superordinate themes emerged from the analysis: Management of emotions: participants showed an awareness that their job is about giving care to patients who may present with very challenging behaviours. The care that they offered was conceptualized as something that needed to be provided in a measured way, with boundaries. A clear distinction was drawn between 'caring personally' for patients, and 'providing care'. Teamwork: teamwork was cited as a major influencing factor by all participants. This was seen as directly impacting the smooth running of the ward, and therefore on the well-being of nursing staff, but also of patients. Understanding: nursing staff were acutely aware that they were working in an environment where everyday interactions would be open to intense scrutiny and possible misinterpretation by patients. Work-life balance: All the participants spoke of making a conscious effort to have a separate work and home life, which was influenced by a number of factors. CONCLUSION: The article has discussed the themes of managing emotion, team understanding and work-life balance, illustrating how each contributes to the resilience of nursing staff in this challenging environment. New insights - applicable in both national and international contexts - have been produced. IMPACT: In secure environments, mental health nursing staff need organizational support and assistance to develop ways of managing difficult experiences with patients, systems that promote recovery, and educational and supervisory support to help understand and process the effects on them. This article provides evidence to support the work of managers and clinicians in these environments. No Patient or Public Contribution.

The effect of organizational justice on young nurses' turnover intention: The mediating roles of organizational climate and emotional labour.

AIM: This study aims to explore the effect of organizational justice on young nurses' turnover intention and the roles of organizational climate and emotional labour in this relationship. BACKGROUND: The shortage of nursing resources has become a growing problem in countries worldwide. As the main representatives of the nursing force, young nurses have high turnover intentions, which aggravates the possibility of nursing shortages. As an important variable affecting the turnover intention of young nurses, the mechanism underlying the impact of organizational justice should be studied in depth. DESIGN: A descriptive cross-sectional design was employed. METHODS: From November to December 2022, an online questionnaire survey was conducted among 1160 young clinical nurses from 5 hospitals in Henan Province, China. The scales used in this study include the organizational justice scale, the turnover intention scale, the organizational climate scale and the emotional labour scale. AMOS 26.0 was used for model drawing and mediation path testing, and SPSS 25.0 was used for data analysis. This study complies with the STROBE Statement of Observational Studies. RESULTS: In general, the young nurses surveyed had high turnover intentions (14.82+/-4.44). Organizational justice has a negative predictive effect on young nurses' turnover intention (r = -0.465, P＜0.01). Organizational climate and emotional labour play a chain mediating role in the relationship between organizational justice and young nurses' turnover intention (ß = -0.051). CONCLUSIONS: Organizational justice is significantly related to the turnover intention of young nurses, and organizational climate and emotional labour play a chain mediating role in the relationship between organizational justice and turnover intention. Therefore, nursing managers should pay attention not only to organizational justice but also to the influence of organizational climate and emotional labour on the turnover intention of young nurses.

Frontstage nursing and backstage growth: The emotional labour of student nurses in Dutch nursing homes.

The complex emotional work of nurses calls for more recognition of emotional labour and the incorporation of emotional labour in nursing education. Based on participant observation and semistructured interviews, we describe the experiences of student nurses in two nursing homes for elderly people with dementia in the Netherlands. We analyse their interactions using Goffman's dramaturgical view on the front and backstage behaviour and the distinction between surface acting and deep acting. The study reveals the complexity of emotional labour, as nurses swiftly adapt their communication styles and behavioural strategies between settings, patients, and even between moments within one interaction sequence, which shows that the theoretical binaries fail to fully capture their skills. Although student nurses take pride in their emotionally taxing work, the societal undervaluation of the nursing profession negatively impacts their self-image and ambitions. More explicit recognition of these complexities would enhance their self-appreciation. This calls for a professional 'backstage area' that allows nurses to articulate and strengthen their emotional labour skills. Educational institutions should provide this backstage for nurses-in-training to strengthen these skills as part of the professional skill set.

A meta-ethnography on the experience and psychosocial implications of providing abortion care.

RATIONALE: Challenges unique to abortion care have negative implications for access to safe abortion and the psychosocial well-being of healthcare providers. A deeper understanding of the experience of providing abortion care can inform responsive interventions toward supporting abortion providers and strengthening health systems. OBJECTIVE: A meta-ethnography was conducted to describe the experiences of providing abortion care and offer broad conceptual implications of abortion providers' experiences on their psychosocial coping and well-being. METHODS: International grey and published research reported in English between 2000 and 2020 was identified via Web of Science Core Collection, PsycInfo, PubMed, Science Direct and Africa-Wide. Studies conducted in contexts where elective abortion is legally permitted were included. Study samples included nurses, physicians, counsellors, administrative staff and other healthcare providers involved in abortion care. Qualitative studies and qualitative data from mixed designs were included. The Critical Appraisal Skills Programme tool was used for appraisal and data was analysed using a meta-ethnographic approach. FINDINGS: The review included 47 articles. Five themes arose from the data including the emotional challenges of providing clinical and psychological care, organisational and structural challenges, experiences characterised by stigma, pro-choice narratives, and coping with challenges. Outcomes ranged from moral and emotional alignment, resistance to abortion stigma, and job satisfaction to moral distress, emotional suppression, internalised stigma, selective participation and discontinuation of abortion care. Outcomes were dependent on the nature of interpersonal relationships, working conditions, the internalization of positive or negative messages about abortion, personal history and individual coping styles. CONCLUSIONS: Despite facing significant challenges in their work, the presence of positive outcomes among abortion providers and the moderating role of external and individual-level factors on well-being have encouraging implications for supporting psychosocial wellness among abortion providers.

The status of emotional labour and its influence on job burnout among village doctors during the COVID-19 pandemic in China: a cross-sectional study.

BACKGROUND: Village doctors in China are not only the gatekeepers of rural residents' health but also the net bottom of the medical security system. However, emotional labour is increasingly threatening the stability of the rural primary medical system. In addition, the ongoing coronavirus disease 2019 (COVID-19) pandemic has further exposed the vulnerability of human resources in China's rural health system. This study aims to evaluate the current situation of emotional labour among village doctors and explore the impact of emotional labour on job burnout during the COVID-19 pandemic in China. METHODS: A cross-sectional survey was conducted in December 2021 in Shandong Province. We used structured questionnaires to collect data, including sociodemographic characteristics, emotional labour, and job burnout. Data were analysed by t test, analysis of variance (ANOVA), Pearson correlation analysis, and hierarchical multiple linear regression. RESULTS: A total of 1,093 village doctors from Shandong Province participated in the study. More than half of the participants were male (62.40%) and were between 41 and 50 years old (53.43%). The total mean score of emotional labour was 3.17 ± 0.67, of which the surface acting (SA) score was 2.28 ± 0.90, and the deep acting (DA) score was 3.91 ± 0.93. There were significant differences in SA according to gender and work content (P < 0.05) and in DA according to gender, age, education level, and work content (P < 0.05). Pearson correlation analysis showed that SA was positively correlated with job burnout (P < 0.001), and DA was negatively correlated with job burnout (P < 0.001). Hierarchical multiple linear regression analysis revealed that 29% of the variance in job burnout is attributable to SA (ß = 0.530, P < 0.001) and DA (ß = -0.154, P < 0.001). CONCLUSION: Village doctors in Shandong Province performed moderate levels of emotional labour during the COVID-19 pandemic. SA had a significant positive effect on job burnout, while DA had a significant negative effect on job burnout among village doctors. Administrators should enhance training on emotional labour for village doctors to play a positive role in alleviating their job burnout.

Impact of nurses' emotional labour on job stress and emotional exhaustion amid COVID-19: The role of instrumental support and coaching leadership as moderators.

AIM: This study examines Pakistan nurses' emotional labour and stress in health care emergencies, specifically their emotional exhaustion and availability of support of organization and management to alleviate the effects. BACKGROUND: As COVID-19 pandemic has been declared a global outbreak and many countries have enacted medical emergencies, this has increased job demands and expected desired emotional expressions from frontline workers. Such high levels of job demand contribute to various stress reactions among employees. METHODS: Authors applied a longitudinal design, using an experimental approach, to collect data from 319 nurses serving in 107 government hospitals in Pakistan. The authors surveyed nurses at two time points with the interval of 3 months by using an online questionnaire tool. At one time, they asked nurses to report on emotional labour, stress and exhaustion. In the second phase, after providing supports (during interval phase) at different levels, the authors repeated the same scales from same participants in addition to instrumental support and coaching leadership. Data were processed using SPSS-Amos for elementary analysis and SPSS-process macro software for robustness and hypotheses testing. RESULTS: The findings indicate that job stress fully mediates the relationship between surface acting and emotional exhaustion in controlled phase and partially mediates in intervention phase. Furthermore, in intervention phase, instrumental support moderates and alleviates positive effects of emotional labour on job stress, and coaching leadership moderates and lessens positive effects of job stress on emotional exhaustion. CONCLUSION: This research concludes that health care organizations can alleviate emotional exhaustion caused by emotional labour and job stress amid emergencies by providing support at different levels: organizational and managerial. However, the effectiveness of these supports depends on high to low levels. IMPLICATIONS FOR NURSING MANAGEMENT: This study demonstrates that to handle and support emotional labour and job stress to avoid emotional exhaustion in health care emergencies, organizational supports matter. Support at organizational level can include instrumental support. At managerial level, holding a coaching leadership style can foster external facets of management while uplifting the internal support qualities of confidence and self-awareness that improve the individuals' ability to lead; work with paradox and uncertainty.

Mental health nurses' resilience in the context of emotional labour: An interpretive qualitative study.

Strengthening mental health nurses' (MHNs) resilience may help mitigate the negative effects of the emotional labour (EL) of their work. There is no prior evidence on MHNs' experiences of resilience in the context of EL. This interpretive qualitative study sought to explore how MHNs build and maintain their resilience in the face of high levels of EL. Semi-structured interviews were conducted with 11 MHNs. Reflexive thematic analysis was used to analyse the data. Four main themes were constructed. The first three; Being attuned to self and others, Having a positive mindset grounded in purpose, and Maintaining psychological equilibrium through proactive self-care, describe how MHNs build and maintain their resilience. The fourth theme, Running on emotionally empty, describes what impedes MHNs' resilience. MHNs engaged in internal self-regulatory processes to manage their mental and emotional state. They maintained intra- and inter-personal boundaries and proactively used self-care strategies to maintain their well-being. Through this, they were able to replenish and sustain the energy required to maintain a state of equilibrium between themselves, their interpersonal practice, and their working environment, and to positively adapt to EL. However, lack of organizational support and high workplace demands can negatively impact MHNs' equilibrium and adaptive ability. There is a need for organizations to proactively work to reduce workplace stressors, and support MHNs' professional well-being and practice. Education and support strategies focused on strengthening MHNs' resilience, well-being, and mental health practice capabilities, including the provision of clinical supervision, and clear role expectations within MHNs' scope of practice are recommended.

A light touch intervention with a heavy lift - gender, space and risk in a global vaccination programme.

Frontline workers (FLWs) in the Global Polio Eradication Initiative go door-to-door delivering polio vaccine to children. They have played a pivotal role in eliminating wild polio from most countries on earth; at the same time, they face significant bodily risk. STRIPE, an international consortium, conducted a mixed-methods study exploring the knowledge and experiences of polio staff in seven countries (Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia, India, Indonesia and Nigeria). We surveyed 826 polio FLWs and conducted semi-structured interviews with 22 of them. We used a body work framework to guide analysis. Polio workers perform a different kind of body work than many other FLWs. Delivering a few drops of oral vaccine takes a light touch, but gendered spaces can make the work physically dangerous. Polio's FLWs must bend or break gendered space norms as they move from house-to-house. Navigating male spaces carries risk for women, including lethal risk, particularly in conflict settings. Workers manoeuvre between skeptical community members and the demands of supervisors which generates emotional labour. Providing FLWs with more power to make operational decisions and providing them with robust teams and remuneration would improve the likelihood that they could act to improve their working conditions.

When closeness is effortful: Teachers' physiological activation undermines positive effects of their closeness on student emotions.

BACKGROUND: Student perceptions of teachers' interpersonal closeness positively affect their emotions. If closeness is, however, effortful for the teacher (i.e., emotional labour, signalling less genuine closeness), this may undermine these positive effects. We tested this assumption by using student reports and external observations of teacher closeness and ambulant measures of teacher heart rate, to gauge teachers' physiological effort connected to being close during class. AIMS: We investigated the association between teachers' physiological effort connected to closeness and students' lesson-focused emotions. SAMPLE: 75 teachers and their students (N = 1645) participated during one real-life lesson. METHODS: Teacher interpersonal closeness was continuously coded based on a video recording and teachers' heart rate was measured continuously as an indicator of physiological effort. Students reported their emotions and perception of teacher closeness at the end of the lesson. RESULTS: Multilevel models with student emotions as DVs and students' perceptions of teacher warmth (L1 predictor) and teachers' physiological effort when being close (i.e., an intra-individual cross-correlation, L2 predictor) were tested. As expected, students reported more positive and less negative emotions when they perceived more teacher closeness. The physiological effort connected to being close was not directly associated with student emotions; however, such effort moderated the effect of perceived closeness, especially with regard to negative student emotions (i.e., cross-level interactions). The more effortful teacher closeness was, the less closeness protected students from negative emotions. CONCLUSIONS: In line with extant research on faking enjoyment and emotional labour, students seemed to be affected when teacher closeness was physiologically effortful, and overall positive effects of teacher closeness were undermined.

Professional identity and emotional labour affect the relationship between perceived organisational justice and job performance among Chinese hospital nurses.

AIM: To investigate the influence of perceived organisational justice, professional identity and emotional labour on nurses' job performance. BACKGROUND: Previous studies have not explored the impact of professional identity and emotional labour on the relationship between perceived organisational justice and job performance. However, how to mobilize the enthusiasm of nurses and improve their job performance is the key for nursing managers to realize the sustainable development of hospitals. METHODS: A cross-sectional survey design was conducted. A total of 951 nurses from public hospitals in China participated in the survey from March-June 2021. The descriptive statistical approach, Pearson's correlation analysis and the PROCESS Macro Model 4 and 14 in regression analysis were used to analyse the available data. RESULTS: The results showed that nurses' perceived organisational justice, professional identity, emotional labour and job performance were significantly positive correlations between every two variables, with coefficients ranging between .24 and .75. Professional identity played a whole mediating role in perceived organisational justice and job performance, accounting for 98.04% of the total effect; meanwhile, this process was moderated by emotional labour. CONCLUSIONS: Perceived organisational justice positively predicted nurses' job performance; as a mediating mechanism with moderating, professional identity and emotional labour further explained how perceived organisational justice promoted the job performance of nurses. IMPLICATIONS FOR NURSING MANAGEMENT: This study highlighted the moderated mediation role of professional identity and emotional labour between nurses' perceived organisational justice and job performance. Understanding this mechanism has guiding significance for nursing managers to improve nurses' job performance.

Tensions in the therapeutic relationship: emotional labour in the response to child abuse and neglect in primary healthcare.

BACKGROUND: Child abuse and neglect (child abuse) is a prevalent public health issue linked to survivors experiencing a higher risk of health issues such as obesity, heart disease and major depression. Given the significant impact of child abuse on health, general practitioners (GPs) and primary care nurses (nurses) are well-placed to respond to child abuse. However, research shows that responding to child abuse is difficult for health practitioners, especially the act of reporting child abuse. The present study aimed to understand how GPs and nurses experience the response to child abuse in primary healthcare. METHODS: This study employed qualitative methods. Twenty-six in-depth individual and group interviews were conducted with 30 GPs and nurses. The interviews were audio recorded with consent, transcribed verbatim and thematically analysed. RESULTS: The participants were mostly metropolitan-based female GPs. Participants were sampled from two settings: private general practice and community health; and Doctors in Secondary Schools, a program that places GPs and nurses in high schools. Thematic analysis generated four themes: blowing trust out of the water; riding the reaction wave; opening a hornet's nest; and battling emotions. Participants felt that, in considering child abuse, they were betraying the trust of the therapeutic relationship and thus, had to manage their patients' reactions to preserve the therapeutic relationship. They used strategies that created shifts in perception in both themselves and their patients to help maintain the therapeutic relationship. Participants often felt that they had to compromise their professional code of ethics to fulfil their mandatory reporting obligations. Thus, they experienced internal emotional battles when responding which led to some experiencing burnout or vicarious trauma and others resilience. This complex interplay of relationship and emotional management was placed in the context of emotional labour theory. We contend that our participants undertook emotional labour across three levels: internal, organisational and systemic. CONCLUSIONS: We conclude that the emotional labour exerted in the response to child abuse can be diminished by: developing strategies for therapeutic relationship management; undertaking an internal, organisational and systemic values assessment; and facilitating communication between health professionals and the child protection system.

'Using humanity to change systems' - understanding the work of online feedback moderation: A case study of Care Opinion Scotland.

OBJECTIVE: To gain a deeper understanding of online patient feedback moderation through the organisation of Care Opinion in Scotland. METHODS: An ethnographic study, initially using in-person participant observations, switching to remote methods due to the pandemic. This involved the use of remote observations and interviews. Interviews were carried out with the whole Scottish team (n = 8). RESULTS: Our results identify three major themes of work found in online patient feedback moderation. The first is process work, where moderators make decisions on how to edit and publish stories. The second is emotional labour from working with healthcare experiences and with NHS staff. The third is the brokering/mediation role of Care Opinion, where they must manage the relationships between authors, subscribing healthcare providers and Scottish Government. Our results also capture that these different themes are not independent and can at times influence the others. CONCLUSION: Our results build on previous literature on Care Opinion and provide novel insights into the emotional and brokering/mediation work they undertake. Care Opinion holds a unique position, where they must balance the interests of the key stakeholders. Care Opinion holds the power to amplify authors' voices but the power to make changes to services lies with NHS staff and services. Online moderation work is complex, and moderators require support to carry out their work especially given the emotional impact. Further research is planned to understand how patient stories are used by NHS Scotland, and the emotional labour involved with stories, from both the author and NHS staff perspective.