The emotional labour of quality improvement work in end of life care : a qualitative study of Patient and Family Centred Care in England

Abstract: Background: There is a growing emphasis on understanding patient experience in order to inform efforts to support improvement. This paper reports findings from an implementation study of an evidence-based intervention called Patient and Family Centred Care (PFCC) designed to tap into patient experiences as a basis for improvement. In this study the PFCC intervention was spread to a new service area (end of life care) and delivered at scale in England. The findings presented here focus specifically on one key aspect of the intervention: staff shadowing of patients, and the experiences of staff carrying out shadowing for the purposes of service improvements. Methods: The study methods were ethnographic observations of key events, semi-structured interviews with members of participating teams and the programme implementation support team and managers, and a review of the documents used in the set up and running of the programme. Results: One of the key strengths of the PFCC approach is to encourage staff through shadowing to engage with patient experience of services. Many staff described the process of shadowing as a transformative experience that alerted them to immediate areas where their services could be improved. However, engaging with patient experience of end of life care services also had unintended consequences for some staff in the form of emotional labour. Furthermore, we observed difficulties encountered by staff that are not accounted for in the existing PFCC literature relating to how care service structures may unevenly distribute the amount of ‘emotional labour’ that staff members need to invest in implementing the programme. Conclusions: Connecting with patient experience is a crucial aspect of a number of quality improvement interventions that aim to help staff to engage with the lived experience of their services and reconnect their motivations for working in the health care system. However, there may be unintended consequences for health care service staff, particularly in sensitive areas of service delivery such as end of life care. The ‘emotional labour’ for staff of engaging in quality improvement work informed by patient experience should be considered in planning and supporting patient experience led quality improvement

Reconceptualizing Profit-Orientation in Management: A Karmic View on "Return on Investment" Calculations

From the perspective of the present day, Puritan-inspired capitalism seems to have succeeded globally, including in India. Connected to this, short-term profit-orientation in management seems to constrain the scope of different management approaches in a tight ideological corset. This article discusses the possibility of replacing this Puritan doctrine with the crucial elements of Indian philosophy: Karma and samsara. In doing so, the possibility of revising the guiding principles in capitalist management becomes conceivable, namely the monetary focus of profit-orientation and its short-term orientation. This perspective allows a detachment of the concept of profit from the realm of money, as the seemingly only objectifiable measure of profit. Furthermore it allows a removal of the expectation that every "investment" has to directly "pay off". A karmic view offers management a possible facility for being more caring about the needs and fates of other stakeholders, as profit-orientation would no longer be attached as a factual constraint to merely accumulate money. (author's abstract

Psychosocial working conditions and the risk of depression and anxiety disorders in the Danish workforce

<p>Abstract</p> <p>Background</p> <p>To examine the risk of depressive and anxiety disorders according to psychosocial working conditions in a large population-based sample.</p> <p>Methods</p> <p>Job Exposure Matrix was applied to assess psychosocial working conditions in a population-based nested case-control study of 14,166 psychiatric patients, diagnosed with depressive or anxiety disorders during 1995–1998 selected from The Danish Psychiatric Central Research Register, compared with 58,060 controls drawn from Statistics Denmark's Integrated Database for Labour Market Research.</p> <p>Results</p> <p>Low job control was associated with an increased risk of anxiety disorders in men (IRR 1.40, 95% CI 1.24–1.58).</p> <p>In women an elevated risk of depression was related to high emotional demands (IRR 1.39, 95%CI 1.22–1.58) and to working with people (IRR 1.15, 95% CI 1.01–1.30). In both sexes high demands were associated with a decreased risk of anxiety disorders. There was a weak association between job strain and anxiety disorders in men (IRR 1.13, 95%, CI 1.02–1.25)</p> <p>Conclusion</p> <p>Psychosocial work exposures related to the risk of depressive and anxiety disorders differ as between the sexes. The pattern of risks is inconsistent. The results give rise to rethinking both study designs and possible causal links between work exposures and mental health.</p

Can empathy lead to emotional exhaustion in teachers? The mediating role of emotional labor

Objectives: The present study was designed to examine the links between empathy, emotional labor (both surface and deep acting), and emotional exhaustion as well as determine if emotional labor mediates the relationship between empathy and emotional exhaustion in teachers. It was assumed that emotional labor can take two opposite directions (positive mood induction and negative mood induction). Thus, the additional aim of the study was to analyze the mediating role of mood regulation strategies in the relationship between empathy and emotional exhaustion. Materials and Methods: A sample of 168 teachers from Łódź and its surroundings completed a set of questionnaires: Emotional Labor Scale; Mood Regulation Scales, Maslach Burnout Inventory, and Empathic Sensitivity Scale. Results: The results provided mixed support for the hypotheses indicating that both types of emotional labor, negative mood induction and emotional exhaustion were positively intercorrelated. Moreover, deep acting was a significant mediator in the relationship between empathy and emotional exhaustion. The analyzed link was also mediated by negative mood induction, whereas positive mood induction did not emerge as a significant mediator. Conclusions: The study provided insight into the role of empathy and emotional labor in the development of teacher burnout. It also confirmed that deep acting and negative mood induction mediate the relationship between empathy and emotional exhaustion in teachers

Energy Management of People in Organizations: A Review and Research Agenda

Although energy is a concept that is implied in many motivational theories, is hardly ever explicitly mentioned or researched. The current article first relates theories and research findings that were thus far not explicitly related to energy. We describe theories such as flow, subjective well-being, engagement and burn-out, and make the link with energy more explicit. Also, we make a first link between personality characteristics and energy, and describe the role of leadership in unleashing followers’ energy. Following, we identify how the topic of energy management can be profitably incorporated in research from a scientific as well as a practitioner viewpoint. Finally, we describe several interventions to enhance energy in individuals and organizations

Emotional intelligence training intervention among trainee teachers: a quasi-experimental study

Background: Emotional intelligence (EI) has often been linked to improvements in professional performance. Indeed, generic competencies related to EI have been included in university curricula. However, learning EI involves significant time and effort on the part of students, and this may hinder the acquisition of specific content for each degree. In this study, an intervention to develop EI in higher education students is described and evaluated. Methods: The intervention consisted of eight group sessions performed in a regular course aiming to increase EI. The sessions included strategies and training on perceiving and understanding one’s own emotions and others’ emotions, identifying and understanding the impact one’s own feelings in adopting decisions, expressing one’s own emotions and the stress experienced, and managing both one’s own emotions and emotions of others. Participants were 192 students studying for a Master of Primary Education degree. A quasi-experimental nonequivalent control group pretest-posttest design was adopted. The effectiveness of the intervention was evaluated using multi-level analyses. Results: The results showed a significant improvement in the EI of students in the experimental group compared with the control group. Conclusions: This research demonstrates that it is possible to develop EI in higher education students, without hindering the acquisition of specific content competencies and, therefore, without interfering with their academic performance and without overburdening students with work outside the classroom. Trial registration: The experiment has been registered in the Initial Deposit of the Spanish Center for Sociological Research (CIS). 7/6/2015. http://www.cis.es/cis/opencms/ES/index.html.This research was supported by the Spanish Ministry of Economy and Competitiveness under Grant number EDU2015-64562-R

Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme