Work and personal well-being of nurses in Queensland: Does rurality make a difference?

Objective: This study aims to ascertain if differences exist in the perception of the professional practice environment and personal well-being of nurses across different geographical areas in Queensland. Design: This paper was performed on a prospective, self-report cross-sectional on-line survey. Setting: The study was conducted among the nurses employed in public and private health care settings: acute hospitals, community health and aged care in Queensland, Australia. Participants: Participants of this study were 1608 registered and enrolled nurses and assistants in nursing, current members of the Queensland Nurses Union in 2013 and who provided a workplace postcode. One thousand eight of these participants worked in major cities, while 382 in rural locations and 238 in remote areas. Interventions: None. Main outcome measures: Scores of well-being as determined by the following scales: the Depression, Anxiety and Stress Scale, the Professional Quality of Life Scale version 5, the Connor–Davidson Resilience Scale and of the Professional Practice Environment using the Practice Environment Scale – Nursing Work Index Revised. Results: Nurses employed in major cities perceived ‘nursing foundations for quality care’ more favourably than those from other settings. Remote area nurses had lower levels of secondary traumatic stress than nurses in major cities and rural areas. There was no difference between nurses across their geographical locations for stress, anxiety, depression, compassion satisfaction, burnout, resilience and the four other measures of the Practice Environment Scale. Conclusions: The study findings provide new data suggesting that, with the exception of secondary traumatic stress, the personal well-being of nurses does not differ across geographical settings. Similarly, with the exception of the subscale of ‘nursing foundations for quality care’ there was no difference in perceptions of the professional practice environment. As secondary traumatic stress is associated with burnout, this finding needs to be investigated further

Enhancing students’ preparedness to care for older people: A mixed methods analysis

Background: Nursing students’ positive attitudes towards ageing and older people are central to developing person-centred care. Perceptions about older people are influenced by social and generational values and beliefs, including a general understanding that older people need to be cared for. Nursing students often undertake early clinical placements in aged care settings, where residents’ needs are complex, yet the nursing experience is often considered ‘basic’ care. Illustrating that older people have rich personal histories and are valuable contributors to society can balance students’ perceptions and expectations and outcomes of clinical placements. Educational interventions using photo-elicitation and in-depth dialogue may surface students’ assumptions and challenge their misperceptions of older people before the first clinical placement. Aim: To examine the impact of the innovative Depth of Field: Exploring Ageing © (DOF) resource as preparation for nursing students’ clinical placement in residential aged care facilities. Methods: Mixed methods, block randomised controlled study with first year students. Students attending clinical laboratory groups received either usual preparation (control, n = 108) or DOF plus usual preparation (intervention, n = 99). Pre/post surveys included: Geriatric Attitudes Scale (GAS) and demographics. Eight students from the intervention group participated in focus groups post-clinical. Findings: Groups were similar at baseline. There were statistically significant changes following the intervention (p ≤. 05) for 9/13 individual GAS items and difference in overall mean scores (intervention group: M = 0.26; SD = 0.27; control group: M = 0.01; SD = 0.27). Focus group themes included: preconceptions toward older people; feelings of being emotionally unprepared; and perceptions of the DOF intervention in preparing students to connect with the older person. Discussion: The DOF vignette provided opportunity for students to preflect on ageing. Translation to practice was evidenced with students seeing beyond residents’ physical care requirements to the value of connecting with the older person's story to facilitate person-centred care. Conclusions: The DOF intervention assisted students to adopt positive attitudes and a broader perspective of older people, as preparation for placement in residential aged care facilities

Enhancing students’ preparedness to care for older people: A mixed methods analysis

Background Nursing students’ positive attitudes towards ageing and older people are central to developing person-centred care. Perceptions about older people are influenced by social and generational values and beliefs, including a general understanding that older people need to be cared for. Nursing students often undertake early clinical placements in aged care settings, where residents’ needs are complex, yet the nursing experience is often considered ‘basic’ care. Illustrating that older people have rich personal histories and are valuable contributors to society can balance students’ perceptions and expectations and outcomes of clinical placements. Educational interventions using photo-elicitation and in-depth dialogue may surface students’ assumptions and challenge their misperceptions of older people before the first clinical placement. Aim To examine the impact of the innovative Depth of Field: Exploring Ageing © (DOF) resource as preparation for nursing students’ clinical placement in residential aged care facilities. Methods Mixed methods, block randomised controlled study with first year students. Students attending clinical laboratory groups received either usual preparation (control, n = 108) or DOF plus usual preparation (intervention, n = 99). Pre/post surveys included: Geriatric Attitudes Scale (GAS) and demographics. Eight students from the intervention group participated in focus groups post-clinical. Findings Groups were similar at baseline. There were statistically significant changes following the intervention (p ≤ .05) for 9/13 individual GAS items and difference in overall mean scores (intervention group: M = 0.26; SD = 0.27; control group: M = 0.01; SD = 0.27). Focus group themes included: preconceptions toward older people; feelings of being emotionally unprepared; and perceptions of the DOF intervention in preparing students to connect with the older person. Discussion The DOF vignette provided opportunity for students to preflect on ageing. Translation to practice was evidenced with students seeing beyond residents’ physical care requirements to the value of connecting with the older person’s story to facilitate person-centred care. Conclusions The DOF intervention assisted students to adopt positive attitudes and a broader perspective of older people, as preparation for placement in residential aged care facilities

Individual and environmental determinants of burnout among nurses

Objective Burnout is a significant problem affecting the nursing workforce and is associated with significant personal suffering and high rates of nurse turnover. Efforts to further understand the variables that explain burnout are needed. The aim of this cross-sectional study was to examine both environmental and individual factors that may explain burnout among nurses. Method We recruited 1848 Australian nurses to complete several online questionnaires measuring the practice environment (Practice Environment Scale of the Nursing Work Index), burnout (Professional Quality of Life Scale), trait negative affect (Spielberger State-Trait Anxiety Inventory form Y2) and resilience (Connor Davidson Resilience Scale). Correlational analysis as well as hierarchical regression was used to determine the relative importance of variables in explaining burnout scores. Results All of the practice environment scales were significantly related to burnout in the negative direction, and these relationships were above .3 for all except the relationship scale (r = –.256) and the participation in hospital affairs scale (r = –.285). Overall, the regression model accounted for 62% of the variance in nurse burnout scores. Trait negative affect, resilience and two aspects of practice environment (Manager sub-scale and Staffing sub-scale) all explained significant variance in burnout scores. The largest contribution came from the two individual variables (resilience and trait negative affect) that together explained 55% of the variance in burnout scores. Conclusions Findings suggest that health service administrators should provide nursing staff with education and support to build individual resilience. Workplaces that attend to staffing and resource issues and have managers who provide high levels of support to their staff appear to be essential strategies to help prevent nurse burnout

Outcomes for family carers of a nurse-delivered hospital discharge intervention for older people (the Further Enabling Care at Home Program): Single blind randomised controlled trial

Background: Hospital discharge of older people receiving care at home offers a salient opportunity to identify and address their family caregivers’ self-identified support needs. Objectives: This study tested the hypothesis that the extent to which family caregivers of older people discharged home from hospital felt prepared to provide care at home would be positively influenced by their inclusion in the new Further Enabling Care at Home program. Design: This single-blind randomised controlled trial compared outcomes from usual care alone with those from usual care plus the new program. The program, delivered by a specially trained nurse over the telephone, included: support to facilitate understanding of the patient's discharge letter; caregiver support needs assessment; caregiver prioritisation of urgent needs; and collaborative guidance, from the nurse, regarding accessing supports. Setting and participants: Dyads were recruited from the medical assessment unit of a Western Australian metropolitan public hospital. Each dyad comprised a patient aged 70 years or older plus an English speaking family caregiver. Methods: The primary outcome was the caregiver's self-reported preparedness to provide care for the patient. Data collection time points were designated as: Time 1, within four days of discharge; Time 2, 15–21 days after discharge; Time 3, six weeks after discharge. Other measures included caregivers’ ratings of: their health, patients’ symptoms and independence, caregiver strain, family well-being, caregiver stress, and positive appraisals of caregiving. Data were collected by telephone.Results: Complete data sets were obtained from 62 intervention group caregivers and 79 controls. Groups were equivalent at baseline. Needs prioritised most often by caregivers were: to know whom to contact and what to expect in the future and to access practical help at home. Support guidance included how to: access help, information, and resources; develop crisis plans; obtain referrals and services; and organise legal requirements. Compared to controls, preparedness to care improved in the intervention group from Time 1 to Time 2 (effect size = 0.52; p = 0.006) and from Time 1 to Time 3 (effect size = 0.43; p = 0.019). These improvements corresponded to a change of approximately 2 points on the Preparedness for Caregiving instrument. Small but significant positive impacts were also observed in other outcomes, including caregiver strain. Conclusions: These unequivocal findings provide a basis for considering the Furthering Enabling Care at Home program's implementation in this and other similar settings. Further testing is required to determine the generalisability of results

The contribution of individual psychological resilience in determining the professional quality of life of Australian nurses

Research Topic: The aim of this study was to determine the relative contribution of trait negative affect and individual psychological resilience in explaining the professional quality of life of nurses. Materials and Methods: One thousand, seven hundred and forty-three Australian nurses from the public, private, and aged care sectors completed an online Qualtrics survey. The survey collected demographic data as well as measures of depression, anxiety and stress, trait negative affect, resilience, and professional quality of life. Results: Significant positive relationships were observed between anxiety, depression and stress, trait negative affectivity, burnout, and secondary traumatic stress (compassion fatigue). Significant negative relationships were observed between each of the aforementioned variables and resilience and compassion satisfaction (CS). Results of mediated regression analysis indicated that resilience partially mediates the relationship between trait negative affect and CS. Conclusion: Results confirm the importance of both trait negative affect and resilience in explaining positive aspects of professional quality of life. Importantly, resilience was confirmed as a key variable impacting levels of CS and thus a potentially important variable to target in interventions aimed at improving nurse's professional quality of life. © 2015 Hegney, Rees, Eley, Osseiran-Moisson and Francis

The Influence of Trait-Negative Affect and Compassion Satisfaction on Compassion Fatigue in Australian Nurses

For this study, we examined the nature of the unique relationships trait-negative affect and compassion satisfaction had with compassion fatigue and its components of secondary traumatic stress and burnout in 273 nurses from 1 metropolitan tertiary acute hospital in Western Australia. Participants completed the Professional Quality of Life Scale (Stamm, 2010), Depression Anxiety Stress Scale (Lovibond & Lovibond, 2004), and the State-Trait Anxiety Inventory (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983). Bivariate correlation and hierarchical regression analyses were performed to examine and investigate 4 hypotheses. The results demonstrate a clear differential pattern of relationships with secondary traumatic stress and burnout for both trait-negative affect and compassion satisfaction. Trait-negative affect was clearly the more important factor in terms of its contribution to overall compassion fatigue and secondary traumatic stress. In contrast, compassion satisfaction's unique protective relationship only related to burnout, and not secondary traumatic stress. The results are therefore consistent with the view that compassion satisfaction may be an important internal resource that protects against burnout, but is not directly influential in protecting against secondary traumatic stress for nurses working in an acute-care hospital environment. With the projected nursing workforce shortages in Australia, it is apparent that a further understanding is warranted of how such personal variables may work as protective and risk factors. (PsycINFO Database Record (c) 2016 APA, all rights reserved

Promoting Mental Health in New Zealand: Building Resilience in Teenage Children

There has been concerns about the increasing incidence of youth depression and anxiety, with school teachers seeking out ways to better equip youth with skills to help them deal with daily life. A resilience training programme for youth was implemented in one region of New Zealand. It aimed to enhance resilience through the instruction of problem-focused cognitive strategies, managing stressful situations, and making difficult conversations easier. This study was then evaluated to find out what was important in implementing such a training programme. A composite questionnaire consisting of resilience measure questions taken from the State Trait Assessment of Resilience Scale (STARS) and Child and Youth Resilience Measure (CYRM)-12 questionnaires, along with resilience knowledge recall questions, was administered at the commencement and completion of the programme. Seven schools completed the survey. The implementation of the training programme improved the overall resilience and knowledge scores of the students. There was a significant increase in both the STARS Trait and CYRM-12 resilience scores and the resilience knowledge recall scores. However, an overall decrease in the mean STARS State (right now) resilience score could reflect increasing stress as the school year progresses. By empowering children to be more resilient, the incidence of clinically identified mental health maladaptation in adulthood may be minimised, and therefore supports better utilisation of health care resources