Compassion Satisfaction and Compassion Fatigue Among Critical Care Nurses.

BACKGROUND: Although critical care nurses gain satisfaction from providing compassionate care to patients and patients' families, the nurses are also at risk for fatigue. The balance between satisfaction and fatigue is considered professional quality of life. OBJECTIVES: To establish the prevalence of compassion satisfaction and compassion fatigue in adult, pediatric, and neonatal critical care nurses and to describe potential contributing demographic, unit, and organizational characteristics. METHODS: In a cross-sectional design, nurses were surveyed by using a demographic questionnaire and the Professional Quality of Life Scale to measure levels of compassion fatigue and compassion satisfaction. RESULTS: Nurses (n = 221) reported significant differences in compassion satisfaction and compassion fatigue on the basis of sex, age, educational level, unit, acuity, change in nursing management, and major systems change. CONCLUSIONS: Understanding the elements of professional quality of life can have a positive effect on work environment. The relationship between professional quality of life and the standards for a healthy work environment requires further investigation. Once this relationship is fully understood, interventions to improve this balance can be developed and tested.

Nursing job satisfaction, certification and healthcare-associated infections in critical care.

OBJECTIVE: The purpose of this study was to examine the relationship between nursing job satisfaction and healthcare-associated infections (HAIs) in adult critical care. METHODS: Multilevel modelling was used to examine the relationship between nursing job satisfaction and two HAIs, ventilator-associated pneumonia (VAP) and central-line associated bloodstream infections (CLABSI). RESULTS: Units with nurses that reported satisfaction with organisational policies were associated with a 6.08 decrease in VAP (p=0.013) and units with nurses reporting favourable perception of task requirements were associated with a 7.02 decrease in VAP (.014). Positive perception of organisational policies was associated with lower rates of CLABSI (p=0.002). Unexpected findings include a positive relationship between perception of pay and autonomy and CLABSI as well as perception of interactions and VAP. Units with a higher proportion of Critical Care Registered Nurse (CCRN) certified nurses were associated with lower rates of both CLABSI (p<0.001) and VAP (p=0.037). CONCLUSION: This study provides preliminary evidence to support the relationship between nursing job satisfaction and HAIs in critical care, although some relationships were counterintuitive. A secondary finding included significant relationships between CCRN certified nurses and HAIs.

Effect of concord grape juice on chemotherapy-induced nausea and vomiting: results of a pilot study.

PURPOSE/OBJECTIVES: To determine the feasibility of administering a flavonoid-rich adjunctive treatment (Concord grape juice) for the management of chemotherapy-induced nausea and vomiting (CINV); to evaluate the usefulness of existing measures for assessing CINV frequency and severity, quality of life, control over life events, and psychological state; to identify any actual or potential adverse events associated with frequent grape juice intake; and to provide preliminary data concerning the effect of Concord grape juice on CINV, quality of life, perceived control over life events, and psychological state. DESIGN: Double-blind, randomized clinical trial. SETTING: A cancer center in an academic health science center in the northeastern United States. SAMPLE: 77 adult patients with cancer receiving moderately or highly emetogenic chemotherapy agents. METHODS: Participants drank 4 oz. of grape juice or placebo prior to meals for one week following each of four chemotherapy treatment cycles. They recorded frequency, duration, and distress of nausea, vomiting, and retching daily, beginning the evening of chemotherapy administration and continuing for seven days. Data were analyzed with generalized estimating equations methodology to model differences between groups over time. MAIN RESEARCH VARIABLES: Nausea and vomiting frequency, duration, and distress; quality of life; control over decision making; and psychological state. FINDINGS: Nausea and vomiting frequency, duration, and distress were lower for experimental group members, although a high attrition rate (50%) resulted in insufficient power to detect statistically significant differences over time. Greater levels of anxiety, depression, and hostility at baseline were related to nausea and vomiting, quality of life, and perceived control over decision making. CONCLUSIONS: The effect of grape juice flavonoids on CINV should be investigated further with a larger sample to determine whether preliminary findings are supported. Alterations to the study protocol will be necessary to decrease attrition. IMPLICATIONS FOR NURSING: Flavonoid-rich fruits and vegetables may provide additional protection against CINV. If the compounds work, they would offer a low-cost, readily available adjunctive treatment for the management of CINV.

Meeting Magnet research evidence-based practice expectations through hospital-based research centers.

Hospital-based nursing research centers can create the structures and processes needed to promote and sustain research and evidence-based practice (EBP) and assist in the monitoring of care delivery outcomes. At the University of Rochester Medical Center, New York, a highly successful nursing research center has succeeded in creating a Magnet environment that incorporates research and EBP into strategic planning, individual employee performance review, and organizational processes. Support of a hospital-based research center can provide the foundation for an infrastructure that supports achievement of Magnet designation research and EBP criteria. The costs pertain primarily to the staff required to develop and manage the center and the educational programs offered through it. Based on the experience at this center, administrators should plan 3-5 years before significant impact is seen in terms of numbers of consultations performed and tangible increases in staff and leadership participation in research and EBP initiatives.

Project (inverted exclamation mark)EXITO!: success through diversity and universality for outcomes improvement among Hispanic home care patients.

The National Health Disparities Report notes that Hispanics have poorer quality of care in 23 of 38 core measures. The result of this disparity is great personal and health system costs, which could be reduced. Prior studies have focused on access and language. We studied outcomes improvement. The purpose of this project was to develop a replicable theory-based outcomes improvement model for delivery of nursing care to Hispanic patients. The Leininger Sunrise Enabler approach was used to design a program specific to the cultural needs of a home care population. Outcome and Assessment Information Set (OASIS) data from 125 unduplicated home care patients were tracked. Nursing care delivery was analyzed using ethnographic research techniques. Delivery of nursing care using a culturally congruent approach reduced acute hospitalization and emergent care visits. Medication management and customer and nursing satisfaction also improved. National standards for culturally and linguistically appropriate services in health care help reduce healthcare disparities, but improving Hispanic outcomes requires moving beyond symptoms and symptom management to transcultural care. The estimated savings to the health care system are significant.

Recruiting, retaining, and advancing careers for employees from underrepresented groups.

In response to the need to increase the number of persons from underrepresented groups working in acute care settings, 2 hospitals in upstate New York implemented a multidimensional workforce development project targeting existing and new employees meeting federally defined poverty levels. The authors describe the project and its outcomes, which surpassed original expectations.

Using organizational mission, vision, and values to guide professional practice model development and measurement of nurse performance.

An organization's mission, vision, and values statements are the guiding forces behind the institution's administrative strategic planning and performance assessment activities. Linking nursing professional practice model components and performance evaluation criteria with each of these foundational documents assures that their values, beliefs, and intentions are evident in daily work life.

Assessing pain control in nonverbal critically ill adults.

The accurate assessment of pain in nonverbal patients is difficult, with nurses often relying on a variety of methods to determine medication impact. Much of the evidence to date suggests that commonly used indicators of pain may not effectively measure the true extent of distress in patients unable to verbalize their level of discomfort. A recent pilot study of an existing and newly developed pain assessment scale reinforces this concern.

Nurses' job satisfaction, organizational commitment, and career intent.

OBJECTIVE: The objective of this survey was to define the characteristics of the nursing work force of a mixed urban/rural region of New York state and to determine the nurses' level of job satisfaction and commitment to the work setting. BACKGROUND: Recent investigations suggest nurses are highly dissatisfied with the demands of the healthcare environment and are expressing increased likelihood of leaving the work setting. These factors, in combination with the increasing age of the current nursing work force, are contributing to serious concerns about the future of patient care. METHODS: A random sample survey was mailed to registered nurses in the Finger Lakes Region of New York State in June 2000. Items in the questionnaire addressed nurse characteristics, reasons for leaving or staying with an employing agency, one- and five-year career intent, and level of job satisfaction and organizational commitment. RESULTS: Forty-six percent of the nurses returned completed questionnaires. Within this sample, most of the nurses were older, European American, and female. Personal and organizational characteristics contributed to differences in levels of job satisfaction, organizational commitment, and 1- and 5-year intent. In addition, many of the most satisfied and committed nurses reported their intent to leave nursing within the next 5 years. CONCLUSIONS: Findings of this investigation suggest the organizational environment, educational preparation, and personal characteristics of currently employed registered nurses affect their current job satisfaction, organizational commitment, and plans for continuing as a nurse.