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Reflective practice groups: Are they useful for liaison psychiatry nurses working within the Emergency Department?
Abstract
Background: Liaison psychiatry nurses in Emergency Departments assess and plan onward treatment for individuals, often following self-harm or suicide attempts. These nurses are at high risk of occupational stress. Reflective practice groups may be beneficial, but there is currently no research evaluating this. Aim: We explored nurses’ experiences of attending psychology-led reflective practice groups. Method: Thematic analysis of semi-structured interviews with 13 nurses was undertaken. Results: Four themes emerged from the data: (i) Sharing and learning; participants discussed how the group provided a platform to share common experiences, express emotions and learn from each other. (ii) Grounding and perspective; participants said the group encouraged reflection on the impact of their work, with a sense of valuing their skills and the difference they make. (iii) Space; participants spoke about the group being a protected, structured and safe space. (iv) Relationships; participants said the group allowed them to support each other and have conversations in a sensitive and non-threatening way. Discussions in the group increased some participants’ confidence and self-esteem. Discussion: Some nurses perceive a range of benefits from participating in reflective practice groups. Implications for practice: For some mental health nurses reflective practice groups are an acceptable and valued intervention which may reduce burnout.
... Previous research has indicated some positive outcomes for nurses attending RPGs; including improved work group cohesiveness, decreased anxiety, increased CS, 5 normative shared learning, 17,18 increased job confidence, 19,20 and stress management. 10 Previous findings also indicate that the group processes involved in RPGs, when enhanced by effective facilitation, can help participants to feel validated and empowered, 8,19 increase job resources of self-efficacy, autonomy and skill discretion, and provide social support to buffer against job demands. ...
... 8 Social support and group cohesion are significant job resources that promote a positive work environment for nurses. 4,23,27 Consistent with previous research, 6,7,19,27,38 this study supports that effective facilitation of group processes is essential for enhancing cohesion, promoting the sharing of resources 5,18 and creating a supportive space for issues to be addressed in RPG, 6,8,10 In order of significance, barriers to RPG attendance were workload, rostering, discomfortable sharing in a group, time constraints. Thes findings support the findings of Platzer and colleagues 26 and can be noted to primarily be logistical and organisational. ...
... The issue of burnout in the emergency department context was raised by practitioners, who were at risk of burnout because of exposure to distressed individuals, pressure to discharge people within a set time frame and little continuity with patients after discharge. 22 This was coupled with little support and supervision for emergency department practitioners. ...
... 30 To date there is no standard model of staff training for those regularly treating selfharm 20 yet this would be a positive step towards challenging stigmatising attitudes that continue to be experienced by patientsparticularly for nurse practitioners who assess the majority of patients presenting to the emergency department with self-harm. Regular supervision for staff is indicated, as practitioner well-being is Experiences of care for self-harm in the emergency department associated with patient satisfaction and safety 22 and evidence suggests that supervision is associated with greater job satisfaction and lower levels of stress. 31 Research is needed to develop the evidence base for such interventions delivered in the emergency department, such as the Attempted Suicide Short Intervention Program, that emphasises how building a human connection can give patients hope at a time when life does not feel worth living. ...
Background
Each year, 220 000 episodes of self-harm are managed by emergency departments in England, providing support to people at risk of suicide.
Aims
To explore treatment of self-harm in emergency departments, comparing perspectives of patients, carers and practitioners.
Method
Focus groups and semi-structured interviews with 79 people explored experiences of receiving/delivering care. Participants were patients (7 young people, 12 adults), 8 carers, 15 generalist emergency department practitioners and 37 liaison psychiatry practitioners. Data were analysed using framework analysis.
Results
We identified four themes. One was common across stakeholder groups: (a) the wider system is failing people who self-harm: they often only access crisis support as they are frequently excluded from services, leading to unhelpful cycles of attending the emergency department. Carers felt over-relied upon and ill-equipped to keep the person safe. Three themes reflected different perspectives across stakeholders: (b) practitioners feel powerless and become hardened towards patients, with patients feeling judged for seeking help which exacerbates their distress; (c) patients need a human connection to offer hope when life feels hopeless, yet practitioners underestimate the therapeutic potential of interactions; and (d) practitioners are fearful of blame if someone takes their life: formulaic question-and-answer risk assessments help make staff feel safer but patients feel this is not a valid way of assessing risk or addressing their needs.
Conclusions
Emergency department practitioners should seek to build a human connection and validate patients’ distress, which offers hope when life feels hopeless. Patients consider this a therapeutic intervention in its own right. Investment in self-harm treatment is indicated.
... Self-reflective practices have the capacity to change behaviors in a way that leads to realizing new perspectives (O'Neill et al., 2019). Additionally, nurses who reflect use imagination and learn creative ways to develop insight and expertise in their professional roles (Gustafsson & Fagerberg, 2004;Walker, 2008). ...
... experiences of attending psychology-led reflective practice groups.O'Neill et al. (2019) concluded a psychology-led group reflective practice can be useful for expressing commonalities, sharing emotions, and learning from those experiences in the context of liaison psychiatry nursing. reflective practice and discussing difficult topics. Similar to O'Neill et al.(2019), participants in this study reported sharing feelings wi ...
Pediatric oncology nurses can develop hazardous feelings of burnout over decades of clinical practice (Boyle & Bush, 2018). Interventions that help decrease burnout and improve professional development are reflective practices (Caldwell & Grobbel, 2013). Currently, there is a paucity of information on pediatric oncology nurses with 10 or more years of experience and how they use self-reflection to cope with workplace stressors. The purpose of this study was to explore how expert-level pediatric oncology nurses describe their experiences using self-reflective practices in the clinical setting. An interview-based exploration of the lived experiences of participants was necessary to understand the unique self-reflective practices currently used among nurses. Descriptive phenomenological methods were used, and data were organized and analyzed using the modified Stevick-Colaizzi-Keen method (Moustakas, 1994). Convenience and snowball sampling procedures were used. Six nurses fit the inclusion criteria and consented to participate in this study. Each participant completed three interviews. Results of the study were arranged in two categories: (a) the experience of using self-reflective practices in the clinical setting and (b) the experience of using self-reflective practices away from the clinical setting. In the clinical setting, experienced pediatric oncology nurses used self-reflection to develop better ways of interacting with patients, families, and colleagues. Using self-reflection to cope with stress and burnout occurred less in the clinical setting and more when experienced nurses reflected with other nurses, had moments of solitude, or when they were driving home from work. These results have implications for current nursing educators and nurses looking to develop skillsets to help reduce the harmful effects of stress and burnout in the clinical setting and maintain a productive career.
... Reflective practice groups, as a form of reflective practice, have been developed and evaluated in the context of mental health nursing (Dawber, 2013a(Dawber, , 2013bDawber & O'Brien, 2014;O'Neill, Johnson, & Mandela, 2019). They have been reported to promote self-awareness, clinical insight, and quality of care (Dawber, 2013b: Dawber & O'Brien, 2014 and to facilitate stress management and team building (Dawber, 2013b;O'Neill et al., 2019). ...
... Reflective practice groups, as a form of reflective practice, have been developed and evaluated in the context of mental health nursing (Dawber, 2013a(Dawber, , 2013bDawber & O'Brien, 2014;O'Neill, Johnson, & Mandela, 2019). They have been reported to promote self-awareness, clinical insight, and quality of care (Dawber, 2013b: Dawber & O'Brien, 2014 and to facilitate stress management and team building (Dawber, 2013b;O'Neill et al., 2019). Dawber (2013a) described reflective practice groups as facilitated group supervision promoting reflection focusing on the interpersonal aspects of care delivery, allowing participants to share insights relevant to nursing practice in a supportive environment. ...
The recovery-oriented reflective practice group (RORPG) is a staff-directed intervention aimed at achieving the recovery-focused transformation of mental health settings. This discussion paper aims to outline and reflect on the conceptual framework and group structure of recovery-oriented reflective practice groups. RORPGs build on conceptualizations of reflective practice, personal recovery, mental health nursing as a relational and reflective practice, and abductive reasoning. Dewey’s phases of reflection, together with an understanding of nursing practice as a dynamic process of care, provide a structure for group sessions in which abductive reasoning can be considered a core activity. This paper outlines a sound theoretical foundation and suggests that RORPGs might prove useful for providing a space for learning in practice, informed by both theoretical and practical knowledge.
... The review also highlighted the necessity of further qualitative evaluations of the effects and impacts of clinical supervision, although the existing literature reports "overwhelmingly positive" findings (Cutcliffe et al., 2018(Cutcliffe et al., , p. 1360. Reflective practice groups, as a form of reflective practice, have been developed and evaluated in the context of mental health nursing (Dawber, 2013a(Dawber, , 2013bDawber & O'Brien, 2014;O'Neill et al., 2019). They have been reported to promote self-awareness, clinical insight, and quality of care (Dawber, 2013b: Dawber & O'Brien, 2014 and to facilitate stress management and team building (Dawber, 2013b;O'Neill et al., 2019). ...
... Reflective practice groups, as a form of reflective practice, have been developed and evaluated in the context of mental health nursing (Dawber, 2013a(Dawber, , 2013bDawber & O'Brien, 2014;O'Neill et al., 2019). They have been reported to promote self-awareness, clinical insight, and quality of care (Dawber, 2013b: Dawber & O'Brien, 2014 and to facilitate stress management and team building (Dawber, 2013b;O'Neill et al., 2019). ...
The recovery-oriented reflective practice group (RORPG) is a staff-directed intervention aimed at achieving the recovery-focused transformation of mental health settings. This discussion paper aims to outline and reflect on the conceptual framework and group structure of recovery-oriented reflective practice groups. RORPGs build on conceptualizations of reflective practice, personal recovery, mental health nursing as a relational and reflective practice, and abductive reasoning. Dewey's phases of reflection, together with an understanding of nursing practice as a dynamic process of care, provide a structure for group sessions in which abductive reasoning can be considered a core activity. This paper outlines a sound theoretical foundation and suggests that RORPGs might prove useful for providing a space for learning in practice, informed by both theoretical and practical knowledge.
... Reflecting on past experiences leads to deeper learning and better performance [11]. Reflection leads to "transformational learning" and learners gain an understanding of their responsibility in providing health care [4]; moreover, it promotes self-awareness, clinical insight, and quality of care [12,13], stress management and teamwork [12,14], and empathy and professionalism [15], and it helps clinicians make difficult or ethical decisions when faced with complex cases in clinical practice [16]. ...
Background
Developing reflective capacity and critical thinking is one of the prerequisites of education in health professions, especially medicine. This study aimed to determine the reflective capacity of medical students and its role in their critical thinking disposition.
Methods
In this cross-sectional descriptive research, conducted in 2022, a total of 240 medical intern students were selected using the convenient sampling method. Data were collected using a reflective capacity questionnaire and critical thinking disposition questionnaire and analyzed with descriptive and inferential statistics using SPSS20.
Results
The mean reflective capacity was 4.53 ± 0.50, and mean critical thinking disposition was 127.52 ± 10.85. Among the dimensions of reflection, “active self-appraisal (SA)” and “reflective with others (RO)” had the highest and lowest means, respectively. The dimensions of critical thinking disposition with the highest and lowest means were related to innovation and intellectual maturity, respectively. Reflective capacity and its dimensions were found to have a direct and statistically significant relationship with critical thinking disposition and its dimensions. Regression analysis results showed that reflective capacity accounts for 28% of students’ critical thinking disposition.
Conclusion
The relationship between students’ reflective capacity and their critical thinking disposition has rendered reflection as one of the necessary components of medical education. Thus, determining the learning activities by considering the reflection process and models will be very effective in creating and strengthening critical thinking disposition.
... In psychiatric care, various forms of support for reflection have been considered a significant tool for supporting nursing (Ejneborn-Looi, 2015). For example, reflective practice groups are developed and evaluated in the context of mental health nursing and reported to improve reflective thinking, promote team cohesion, and provide support for nursing staff working in clinical settings (Dawber, 2013a(Dawber, , 2013bDawber & O'Brien, 2013), including general emergency departments (O'Neill et al., 2019). Recovery-oriented reflective practice groups can facilitate recovery-focused transformation of services (Gabrielsson & Looi, 2019). ...
While people with mental ill-health report unsatisfying experiences and poor treatment in general emergency departments, nursing staff report a lack of adequate knowledge and training. This study describes nursing staff's experiences caring for people with mental ill-health in general emergency departments. A qualitative descriptive design was used and 14 interviews were subjected to qualitative content analysis. Results show that nursing staff are dealing with uncertainty and competing priorities when caring for people with mental ill-health. Nursing staff must both take and be given the opportunity to maintain and develop confidence and independence and need support in promoting mental health recovery.
... Conversation, which is a verbal method for reflective practice, is essential and allows us to deal more deeply with reflections made through writing and gain broader insight [19]. Nurses have the advantage of feeling emotional stability and improving personal insight through insights of other people by recognizing their problems through reflective practices at the group level [22]. Educational strategies, such as role-playing, films, and videos for preceptors' reflection practice training, are helpful for improving the relationship between preceptors and new nurses; however, they are rarely used in preceptor education [23]. ...
Studies on methods to share nursing and learning experiences with preceptors are lacking. This study was conducted to determine the preliminary effects of developing and applying a reflective practice program for preceptor nurses who experience stressful situations to convert negative emotions into positive ones. This study was conducted over 12 weeks from March to May 2022 on 47 participant nurses in South Korea. Preceptor Reflective Practice Program (PRPP) was conducted in parallel with writing a reflective journal and a reflective practice workshop. Data collection was integrated through quantitative and qualitative approaches. Quantitative data were collected through questionnaires on stress coping, the burden of preceptors, social support, and emotional intelligence, and analyzed by SPSS WIN 26.0 program. The questionnaire data were analyzed after the preceptor nurses had written a reflective journal. Stress coping, social support, and emotional intelligence significantly increased in preceptor nurses after participating in the PRPP. This study found that the PRPP helped nurses improve their emotional intelligence through reflective practice and convert stress into a more positive direction. Therefore, at the organizational and national levels, a reasonable compensation system to provide support workforce and to the work of preceptor nurses should be established.
... Penelitian ini juga sejalan dengan penelitian yang dilakukan Ardian & Hariyati (2017) yang menyatakan bahwa DRK memiliki banyak manfaat dalam meningkatkan pengetahuan, kemampuan berpikir kritis, melatih kemampuan berbicara di depan umum, berpikir terbuka serta meningkatkan kemampuan memahami artikel ilmiah. Manfaat lainya adalah meningkatkan kesadaran diri, wawasan klinis dan kualitas pelayanan keperawatan serta meningkatkan kepercayaan diri (O'Neill et al., 2019;Karnick, 2017). Banyak sekali manfaat dari DRK, untuk itu institusi kesehatan seperti rumah sakit perlu menerapkan DRK untuk meningkatkan pengetahuan dan profesionalisme perawat. ...
This study aims to improve the ability to evaluate the results of reforming agents in implementing the Case Reflection Discussion program. The method used is a pilot study method using a problem-solving approach—the results of the problem identification need to be optimized for the implementation of CRD. Problem-solving begins with the preparation of guidelines and SOPs on CRD. The performance of CRD was piloted in 4 rooms; the results of the progress evaluation obtained after participating in CRD were nurses stated that CRD helped increase knowledge, critical thinking skills, spurring work according to standards and as a solution in solving problems in service. In conclusion, the implementation of CRD requires support from hospital management in the form of structuring the system and providing motivation and facilities. The performance of CRD needs to be supported and carried out through tiered supervision from the team leader, head of the room to the head of the nursing field. Keywords: Case Reflection Discussion (CRD), Continuing Nursing Education (CNE)
... The existing literature has suggested positive effects of clinical supervision, although further research is needed to evaluate its impact (Cutcliffe et al., 2018). Clinical supervision in the form of reflective practice groups has been reported to promote self-awareness, clinical insight, and quality of care (Dawber, 2013;Dawber & O'Brien, 2014) and to facilitate stress management and team-building (Dawber, 2013;O'Neill et al., 2019). In addition, written narratives have been suggested as a strategy to enhance nurses' reflective practices (Choperena et al., 2019). ...
This study aimed to describe self-rated reflective capacity in students enrolled in post-registration specialist nursing education at the advanced level. We applied a non-experimental and cross-sectional design. A survey of 156 specialist nursing students at two universities in Northern Sweden was conducted. Data were collected in 2019 using a web-based questionnaire assessing self-rated reflective capacity through the Reflective Capacity Scale of the Reflective Practice Questionnaire. Data were analyzed descriptively using frequencies and proportions. Correlations were analyzed using Spearman's rho. Results show that students specializing in psychiatric care and oncological care report a higher reflective capacity than students specializing in other areas. We found no significant correlations between reflective capacity and gender, and reflective capacity in total did not correlate with age or work experience. We conclude that reflective capacity might vary between nursing students in different areas of specialization. Further research is needed to understand causes and impacts of variations in nursing students' reflective capacities.
... For example, reflective practice groups are often embedded in clinical practice, enabling staff to discuss the emotional impact of their work and receive support within their teams. 10 Similarly, Schwartz rounds allow staff to share emotional experiences with others from across the organisation and have been widely adopted by NHS trusts. 11 One review of these interventions including 41 studies found that staff reported improved wellbeing and coping, job satisfaction, teamwork and empathy for colleagues as a result of these spaces. ...
Background:
The COVID-19 pandemic has highlighted the impact work can have on healthcare workers and the importance of staff support services. Rapid guidance was published to encourage preventive and responsive support for healthcare workers.
Aims:
To understand mental healthcare staff's help-seeking behaviours and access to support at work in response to the COVID-19 pandemic, to inform iterative improvements to provision of staff support.
Method:
We conducted a formative appraisal of access to support and support needs of staff in a National Health Service mental health trust. This involved 11 semi-structured individual interviews using a topic guide. Five virtual staff forums were additional sources of data. Reflexive thematic analysis was used to identify key themes.
Results:
Peer-based, within-team support was highly valued and sought after. However, access to support was negatively affected by work pressures, physical distancing and perceived cultural barriers.
Conclusions:
Healthcare organisations need to help colleagues to support each other by facilitating open, diverse workplace cultures and providing easily accessible, safe and reflective spaces. Future research should evaluate support in the evolving work contexts imposed by COVID-19 to inform interventions that account for differences across healthcare workforces.
... Mental health staff are also important for delivering staff support, something that became very obvious during the recent pandemic. Plenty of evidence exists for the benefits on staff wellbeing of reflective practice 18,19 , but this is rarely factored into commissioning agreements between acute providers and commissioners. ...
The distressing reality that mental healthcare for children and young people in acute trust settings in the UK is woefully underprovided is not news. But with acute trust debts being written off, hospital trusts and commissioners of services have a timely opportunity to address this age- and condition-based discrimination.
Delivering a just service for under-18s depends on attitude, resources and adequate knowledge of the tasks involved. This article aims to describe the current landscape, summarise the arguments for better integrating mental healthcare into physical healthcare settings, articulate the tasks involved and the challenges for commissioning and providing, and finally share examples of current service models across the country.
Ultimately, commissioning and provider choices will be constrained by resource pressures, but this article aims to underscore why commissioning and providing a portmanteau ‘no wrong door’ hospital service for children, young people and families is worth the headache of thinking outside old commissioning and provider boxes.
... While it can be argued that reflection cannot be reduced to a tool for learning (Ekebergh, 2007), research suggests that reflective thinking can be promoted with positive effects on learning and practice (Goulet et al., 2016;Mann et al., 2009). Reflective practice groups, for example, have been developed and evaluated in the nursing practice context suggesting that they might promote self-awareness, clinical insight and quality of care (Dawber, 2013;Dawber & O'Brien, 2014) and facilitate stress management and team building (Dawber, 2013;O'Neill et al., 2019). Also, a review of the literature reported that reflective writing can foster clinical decision-making skills, reflection-on-action and professional self-development in undergraduate nursing education (Bjerkvik & Hilli, 2019). ...
Aim
This study aimed to test the validity and reliability of the Swedish version of the Reflective Capacity Scale of the Reflective Practice Questionnaire in a nursing context.
Design
Non‐experimental and cross‐sectional.
Methods
The instrument was translated from English to Swedish using a translation and back‐translation procedure. Data for the validity and reliability analysis were collected from Registered Nurses in specialist education (n = 156) at two Swedish universities.
Results
The Swedish version of the Reflective Capacity Scale of the Reflective Practice Questionnaire is a valid and reliable instrument that assesses the reflective capacity of healthcare practitioners. Our findings suggest a unidimensional structure of the instrument, excellent internal consistency and good reliability.
Conclusion
The Swedish version of the Reflective Capacity Scale of the Reflective Practice Questionnaire has a degree of reliability and validity that is satisfactory, indicating that the instrument can be used as an assessment of reflective capacity in nurses.
... Reflective practice is also considered a vital professional skill in nursing practice (Asselin, 2011;O'Neill et al., 2019;Thompson & Burns, 2008). The importance of skill development in nursing education is vital as it promotes self-awareness and develops best practice (Dolphin, 2013;Vaughan, 2017;Waldo & Hermanns, 2009). ...
Reflective practice is a vital component of nursing education. It allows for the integration of core theoretical knowledge and the clinical experience. Despite a small and growing body of literature exploring the nursing students’ perceptions and experiences of this process, a review of the qualitative literature has not been published. The purpose of this meta-synthesis is to examine the qualitative data of nursing students’ perceptions and experiences of reflective practice. This meta-synthesis provides a model that suggests quality reflection results in an improvement in practice. Students perceive that quality reflection occurs when all facets of this model have been met. This encompasses an understanding of knowledge including, learning and the barriers and enablers to knowledge, as well as self-discovery including, facing emotions and personal growth. Understanding these experiences and perceptions will permit further understanding of the motivations and factors that influence the quality of reflective practice.
... Daily work with youth and families experiencing significant psychosocial stressors and mental health challenges requires a focus on workforce wellness (Fukui, Wu, & Salyers, 2019). Reflective supervision has been implemented with various health service professionals to support ongoing development and to help professionals manage the complexities of day-to-day work with youth and families (Dawber, 2013;Gilkerson, 2004;O'Neill, Johnson, & Mandela, 2019). Reflective supervision may help buffer providers from stress through supportive relationships with protected space to engage in self-reflection and build capacities around relationship-based practice and addressing diverse needs of youth and families impacted by stress and trauma. ...
Early identification and treatment of depression during adolescence can contribute to healthier outcomes across the lifespan, yet adolescent depression has been underidentified and undertreated. The American Academy of Pediatrics’ (AAP) Guidelines for Adolescent Depression in Primary Care (GLAD-PC) were created to enhance the identification and treatment of adolescent depression. Integrated psychologists in a pediatric primary care setting partnered with providers and clinic staff to implement an adolescent depression screening initiative and transform primary care practice around identification and management. From January 2017 through August 2018, 2107 adolescents between the ages of 11 and 18 were screened using the PHQ-9A. Eleven percent (n = 226) of adolescents had an elevated screen with a score of ≥ 10 and 7% (n = 151) screened positive for suicidal ideation. Identification of depressive symptoms led to increased integrated behavioral health services delivered by psychologists, psychiatrists, and psychology trainees. Psychologists integrated in primary care can support primary care practices to develop service delivery systems aligned with AAP’s GLAD-PC and address the diverse implementation barriers associated with incorporating clinical practice guidelines in real-world settings. Universal screening for adolescent depression and response protocols were successfully implemented in a pediatric primary care clinic under the leadership of psychologists and pediatrician partners.
Covid-19, the disease caused by severe acute respiratory syndrome coronavirus 2 is recognised as one of the most challenging global events of the twenty-first Century. The detrimental impact of the pandemic resulted in high rates of infection, morbidity, and mortality, with health-care workers firmly positioned on the frontline of this unparalleled international crisis. An emerging literature detailing the impact of COVID-19 on health-care practitioners identifies high levels of depression, anxiety, and distress. Accordingly, there are calls for the implementation of effective interventions to tackle the impending spectre of psychological morbidities and staff burnout. While it is important to explore new approaches, it is also valuable to examine how existing strategies, such as reflective practice, can be repurposed to specifically address practitioner well-being. This requires a reimagining of reflective practice and a reimagining of the reflective practice contexts in which reflective activity occurs. This paper presents The Reflective Practice Integrative Framework, which illustrates how reflective practice can be used to address the complex aims of supporting effective patient care, while also facilitating practitioner well-being. The Reflective Organisational Learning Framework is also presented which can be used to develop effective reflective practice environments through single, double, and/or triple loop learning.
Aim:
Worldwide, long-term care tends to shift from institutional care towards home care. In order to deliver high-quality and adequate care, the type, amount and cost of care is determined by a patient needs assessment. However, there are indications that this patient needs assessment varies between comparable patients. In the Netherlands, some home care organizations aim to improve patient needs assessments by implementing improvement measures to reduce this practice variation. The goal of this study was to explore the type and perceived impact of those implemented improvement measures.
Design:
A cross-sectional explorative survey study was conducted among Dutch home care organizations between January and April 2021.
Methods:
An online questionnaire with 26 items was developed by the research team, which was distributed through Dutch nationwide home care sector organizations, the Dutch nurses' association (V&VN) and the Dutch society for home care nursing (NWG).
Results:
The survey was completed by 184 respondents, including home care nurses, managers and staff who are responsible for training, policy and quality of care. Intervision and peer review for home care nurses were the most common reported improvement measures that were implemented in home care organizations. The experiences of those improvement measures have been perceived as creating greater uniformity in the patient needs assessment, making home care nurses feel more supported and secure performing their patient needs assessment and that the provided care is more in line with patients' demand. Our findings give insights into type and perceived impact of improvement measures that Dutch home care organizations implemented. Further research is needed to find out whether improvement measures actually improve patient needs assessments and reduce practice variation.
Purpose
There has been a rapid increase in the number of mental health interventions implemented in the workplace. The efficacy of these interventions has been mixed. The factors influencing implementation may offer insights to why some interventions fail to be effective.
Method
We conducted a meta-synthesis of qualitative research on the barriers and facilitators to implementing workplace mental health interventions. We evaluated the quality of evidence using CASP and CERQual and synthesised our data using thematic analysis.
Results
33 studies were included in the review. A broad range of interventions were reflected in the studies, a majority of which were implemented at the individual level and in health care settings. Facilitators included positive disclosure by line managers, completion of intervention in work time, scheduling flexibility and trainer credibility. Barriers included managers not prioritising interventions, lack of suitable training of facilitators, competing priorities, workload issues and staff shortages. No findings were judged to be very well supported (i.e., high confidence).
Conclusion
Evidence surrounding the implementation of mental health interventions in the workplace is weak, and studies are limited to high income countries, with a bias towards healthcare and public sector settings. We call for a taxonomy of implementation issues specifically for workplace mental health to advance knowledge and practice.
Introduction:
Protecting health-care provider (HCP) well-being is imperative to preserve health-care workforce capital, performance, and patient care quality. Limited evidence exists for the long-term effectiveness of HCP well-being programs, with less known about physiotherapists specifically.
Purpose:
To review and synthesize qualitative research describing experiences of HCP, generate lessons learned from the greater population of HCP participating in workplace well-being programs, and then to inform programs and policies for optimizing psychological well-being in an understudied population of physiotherapists.
Methods:
This qualitative meta-synthesis included a systematic literature search conducted in September 2020; critical appraisal of results; and data reduction, re-categorizing, and thematic extraction (reciprocal translation) with interpretive triangulation.
Results:
Twenty-five papers met the inclusion criteria. Participants included physicians, nurses, and allied health providers. All programs targeted the individual provider and included psychoeducational offerings, supervision groups, coaching, and complementary therapies. Four themes were constructed: 1) beneficial outcomes across a range of programs; 2) facilitators of program success; 3) barriers to program success; and 4) unmet needs driving recommendations.
Conclusions:
The findings enhance our understanding of diverse individual-level programs to address HCP well-being. Beneficial outcomes were achieved across program types with system-level support proving critical; however, HCP described barriers to program success (HCP characteristics, off-site programs, institutional culture) and remaining needs (resources, ethical dissonance) left unaddressed. Organizations should offer individual-level programs to support physiotherapists in the short term while pursuing long-term, system-level change to address drivers of well-being.
Rationale:
While professional values are seen as a fundamental part of element of shared decision-making, there is little research on how they are learnt within the paramedic profession.
Aims and objectives:
This study sought to understand how student paramedics developed their professional values within the ambulance practicum.
Method:
37 paramedic students and 5 paramedic educators submitted diary entries and took part in focus groups.
Results:
There was a general consensus between participants that the study of professional values was viewed as a scholarly activity within the university, and the practicum subsequently viewed as unacademic. Students identified that much of their learning replicated values of the environment they were in, and educators voiced their concerns that this may not always result in the understanding behind professional values.
Conclusion:
This study has highlighted that professional values would be worthy of being explored within the paramedic undergraduate curriculum, in an effort to enable students to understand and develop their values during their education and appreciate the importance of values within shared decision-making.
Rising levels of burnout and poor well-being in healthcare staff are an international concern for health systems. The need to improve well-being and reduce burnout has long been acknowledged, but few interventions target mental healthcare staff, and minimal improvements have been seen in services. This review aimed to examine the problem of burnout and well-being in mental healthcare staff and to present recommendations for future research and interventions. A discursive review was undertaken examining trends, causes, implications, and interventions in burnout and well-being in healthcare staff working in mental health services. Data were drawn from national surveys, reports, and peer-reviewed journal articles. These show that staff in mental healthcare report poorer well-being than staff in other healthcare sectors. Poorer well-being and higher burnout are associated with poorer quality and safety of patient care, higher absenteeism, and higher turnover rates. Interventions are effective, but effect sizes are small. The review concludes that grounding interventions in the research literature, emphasizing the positive aspects of interventions to staff, building stronger links between healthcare organizations and universities, and designing interventions targeting burnout and improved patient care together may improve the effectiveness and uptake of interventions by staff.
Abstract
Background
There is growing interest in the relationships between depressive symptoms and burnout in healthcare staff and the safety of patient care. Depressive symptoms are higher in healthcare staff than the general population and overlap conceptually with burnout. However, minimal research has investigated these variables in nurses. Given the conceptual overlap between depressive symptoms and burnout, there is also a need for an explanatory model outlining the relative contributions of these factors to patient safety.
Aims
To investigate the relationships between depressive symptoms, burnout and perceptions of patient safety. A mediation model was proposed whereby the association between symptoms of depression and patient safety perceptions was mediated by burnout.
Design
A cross-sectional questionnaire was distributed at three acute NHS Trusts.
Method
Three-hundred and twenty-three hospital nursing staff completed measures of depressive symptoms, burnout and patient safety perceptions (including measures at the level of the individual and the work area/unit) between December 2015 - February 2016.
Results
When tested in separate analyses, depressive symptoms and burnout facets were each associated with both patient safety measures. Furthermore, the proposed mediation model was supported, with associations between depressive symptoms and patient safety perceptions fully mediated by burnout.
Conclusion
These results suggest that symptoms of depression and burnout in hospital nurses may have implications for patient safety. However, interventions to improve patient safety may be best targeted at improving burnout in particular, with burnout interventions known to be most effective when focused at both the individual and the organisational level.
The purpose of the study is to investigate mental health nurses' experiences of recognizing and responding to suicidal behavior/self-harm and dealing with the emotional challenges in the care of potentially suicidal inpatients. Interview data of eight mental health nurses were analyzed by systematic text condensation. The participants reported alertness to patients' suicidal cues, relieving psychological pain and inspiring hope. Various emotions are evoked by suicidal behavior. Mental health nurses seem to regulate their emotions and emotional expressions, and balance involvement and distance to provide good care of patients and themselves. Mental health nurses have an important role and should receive sufficient formal support.
Background:
There is growing evidence that teamwork in hospitals is related to both patient outcomes and clinician occupational well-being. Furthermore, clinician well-being is associated with patient safety. Despite considerable research activity, few studies include all three concepts, and their interrelations have not yet been investigated systematically. To advance our understanding of these potentially complex interrelations we propose an integrative framework taking into account current evidence and research gaps identified in a systematic review.
Methods:
We conducted a literature search in six major databases (Medline, PsycArticles, PsycInfo, Psyndex, ScienceDirect, and Web of Knowledge). Inclusion criteria were: peer reviewed papers published between January 2000 and June 2015 investigating a statistical relationship between at least two of the three concepts; teamwork, patient safety, and clinician occupational well-being in hospital settings, including practicing nurses and physicians. We assessed methodological quality using a standardized rating system and qualitatively appraised and extracted relevant data, such as instruments, analyses and outcomes.
Results:
The 98 studies included in this review were highly diverse regarding quality, methodology and outcomes. We found support for the existence of independent associations between teamwork, clinician occupational well-being and patient safety. However, we identified several conceptual and methodological limitations. The main barrier to advancing our understanding of the causal relationships between teamwork, clinician well-being and patient safety is the lack of an integrative, theory-based, and methodologically thorough approach investigating the three concepts simultaneously and longitudinally. Based on psychological theory and our findings, we developed an integrative framework that addresses these limitations and proposes mechanisms by which these concepts might be linked.
Conclusion:
Knowledge about the mechanisms underlying the relationships between these concepts helps to identify avenues for future research, aimed at benefiting clinicians and patients by using the synergies between teamwork, clinician occupational well-being and patient safety.
Objective:
To determine whether there is an association between healthcare professionals' wellbeing and burnout, with patient safety.
Design:
Systematic research review.
Data sources:
PsychInfo (1806 to July 2015), Medline (1946 to July 2015), Embase (1947 to July 2015) and Scopus (1823 to July 2015) were searched, along with reference lists of eligible articles.
Eligibility criteria for selecting studies:
Quantitative, empirical studies that included i) either a measure of wellbeing or burnout, and ii) patient safety, in healthcare staff populations.
Results:
Forty-six studies were identified. Sixteen out of the 27 studies that measured wellbeing found a significant correlation between poor wellbeing and worse patient safety, with six additional studies finding an association with some but not all scales used, and one study finding a significant association but in the opposite direction to the majority of studies. Twenty-one out of the 30 studies that measured burnout found a significant association between burnout and patient safety, whilst a further four studies found an association between one or more (but not all) subscales of the burnout measures employed, and patient safety.
Conclusions:
Poor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors, however the lack of prospective studies reduces the ability to determine causality. Further prospective studies, research in primary care, conducted within the UK, and a clearer definition of healthcare staff wellbeing are needed.
Implications:
This review illustrates the need for healthcare organisations to consider improving employees' mental health as well as creating safer work environments when planning interventions to improve patient safety.
Systematic review registration:
PROSPERO registration number: CRD42015023340.
This paper was commissioned by The King's Fund to inform its review of leadership in the NHS. The views expressed are those of the authors and not of The King's Fund.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
abstract This paper highlights the importance of providing a regular space for teams of professionals, working in the mental health field and caring professions, to reflect on how the work impacts on the team dynamics and their own mental health. It explores the role of the group facilitator and how that role differs from working with patient and other groups. It considers the context of the current political environment within which mental health services operate and explores how this may impact on individual and team ego strength, leading to regression and reliance on primitive defence mechanisms as a means to coping and survival. Also considered is the issue of the challenges presented in working with teams where traits and features consistent with borderline personality disorder (DSM-4 Cluster B) manifest in the team. The authors propose a model called ‘Team Development and Reflective Practice Groups’, and suggest guidelines for providing an optimum facilitating environment for the professionals within these groups.
A scale designed to assess various aspects of the burnout syndrome was administered to a wide range of human services professionals. Three subscales emerged from the data analysis: emotional exhaustion, depersonalization, and personal accomplishment. Various psychometric analyses showed that the scale has both high reliability and validity as a measure of burnout. Since the publication of this article in 1981, more extensive research was done on the MBI, which resulted in some modifications of the original measure. The present article has been re-edited to reflect those modifications. However, it does not include other new additions (which are contained in the MBI Manual distributed by the publisher, Mind Garden).
The objective of this paper was to systematically review and critically evaluate all English language research papers reporting empirical studies of clinical supervision in psychiatric nursing. The first part of the search strategy was a combination of brief and building block strategies in the PubMed, CINAHL, and PsycINFO databases. The second part was a citation pearl growing strategy with reviews of 179 reference lists. In total, the search strategy demonstrated a low level of precision and a high level of recall. Thirty four articles met the criteria of the review and were systematically evaluated using three checklists. The findings were summarized by using a new checklist with nine overall questions regarding the studies' design, methods, findings, and limitations. The studies were categorized as: (i) effect studies; (ii) survey studies; (iii) interview studies; and (iv) case studies. In general, the studies were relatively small scale; they used relatively new and basic methods for data collection and analysis, and rarely included sufficient strategies for identifying confounding factors or how the researchers' preconceptions influenced the analyses. Empirical research of clinical supervision in psychiatric nursing was characterized by a basic lack of agreement about which models and instruments to use. Challenges and recommendations for future research are discussed. Clinical supervision in psychiatric nursing was commonly perceived as a good thing, but there was limited empirical evidence supporting this claim.
The aim of this study was to examine the influence of empowering work conditions and workplace incivility on nurses' experiences of burnout and important nurse retention factors identified in the literature.
A major cause of turnover among nurses is related to unsatisfying workplaces. Recently, there have been numerous anecdotal reports of uncivil behaviour in health care settings.
We examined the impact of workplace empowerment, supervisor and coworker incivility, and burnout on three employee retention outcomes: job satisfaction, organizational commitment, and turnover intentions in a sample of 612 Canadian staff nurses.
Hierarchical multiple linear regression analyses revealed that empowerment, workplace incivility, and burnout explained significant variance in all three retention factors: job satisfaction (R(2) = 0.46), organizational commitment (R(2) = 0.29) and turnover intentions (R(2) = 0.28). Empowerment, supervisor incivility, and cynicism most strongly predicted job dissatisfaction and low commitment (P < 0.001), whereas emotional exhaustion, cynicism, and supervisor incivility most strongly predicted turnover intentions.
In our study, nurses' perceptions of empowerment, supervisor incivility, and cynicism were strongly related to job satisfaction, organizational commitment, and turnover intentions.
Managerial strategies that empower nurses for professional practice may be helpful in preventing workplace incivility, and ultimately, burnout.
The role of the psychiatric consultation liaison nurse (PCLN) has increased substantially in popularity over the last few years. Despite the growth of this position, a paucity of literature regarding the role, functions and effectiveness of psychiatric consultation liaison nursing continues to exist. The current study was undertaken as part of the Victorian Nurse Practitioner Project. A significant aspect of this study concerned collection of data on the activities of the PCLN. This approach enabled an extensive and detailed profile of the PCLN to be formulated. The findings indicate that the PCLN provided a service to nursing, medicine and allied health in relation to patients experiencing mental health problems in the general hospital setting. Patients referred to the PCLN presented varied clinical features in terms of medical, surgical and mental health disorders. The PCLN performed a range of interventions. The results of this study make a significant contribution to address the current paucity of literature.
Few studies have focused on caring professionals and their emotional exhaustion from working with traumatized clients, referred to as compassion fatigue (CF). The present study had 2 goals: (a) to assess the psychometric properties of a CF scale, and (b) to examine the scale's predictive validity in a multivariate model. The data came from a survey of social workers living in New York City following the September 11, 2001, terrorist attacks on the World Trade Center. Factor analyses indicated that the CF scale measured multiple dimensions. After overlapping items were eliminated, the scale measured 2 key underlying dimensions--secondary trauma and job burnout. In a multivariate model, these dimensions were related to psychological distress, even after other risk factors were controlled. The authors discuss the results in light of increasing the ability of professional caregivers to meet the emotional needs of their clients within a stressful environment without experiencing CF.
Importance
Physician burnout has taken the form of an epidemic that may affect core domains of health care delivery, including patient safety, quality of care, and patient satisfaction. However, this evidence has not been systematically quantified.
Objective
To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction.
Data Sources
MEDLINE, EMBASE, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key terms physicians, burnout, and patient care. Detailed standardized searches with no language restriction were undertaken. The reference lists of eligible studies and other relevant systematic reviews were hand-searched.
Study Selection
Quantitative observational studies.
Data Extraction and Synthesis
Two independent reviewers were involved. The main meta-analysis was followed by subgroup and sensitivity analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (I²) and publication bias were performed.
Main Outcomes and Measures
The core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs.
Results
Of the 5234 records identified, 47 studies on 42 473 physicians (25 059 [59.0%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis. Physician burnout was associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59-2.40), poorer quality of care due to low professionalism (OR, 2.31; 95% CI, 1.87-2.85), and reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68). The heterogeneity was high and the study quality was low to moderate. The links between burnout and low professionalism were larger in residents and early-career (≤5 years post residency) physicians compared with middle- and late-career physicians (Cohen Q = 7.27; P = .003). The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (Cohen Q = 8.14; P = .007).
Conclusions and Relevance
This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe. Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations.
Burnout is prevalent among mental health providers and is associated with significant employee, consumer, and organizational costs. Over the past 35 years, numerous intervention studies have been conducted but have yet to be reviewed and synthesized using a quantitative approach. To fill this gap, we performed a meta-analysis on the effectiveness of burnout interventions for mental health workers. We completed a systematic literature search of burnout intervention studies that spanned more than 3 decades (1980 to 2015). Each eligible study was independently coded by 2 researchers, and data were analyzed using a random-effects model with effect sizes based on the Hedges' statistic. We computed an overall intervention effect size and performed moderator analyses. Twenty-seven unique samples were included in the meta-analysis, representing 1,894 mental health workers. Interventions had a small but positive effect on provider burnout (Hedges' = .13, = .006). Moderator analyses suggested that person-directed interventions were more effective than organization-directed interventions at reducing emotional exhaustion (between = 6.70, = .010) and that job training/education was the most effective organizational intervention subtype (between = 12.50, < .001). Lower baseline burnout levels were associated with smaller intervention effects and accounted for a significant proportion of effect size variability. The field has made limited progress in ameliorating mental health provider burnout. Based on our findings, we suggest that researchers implement a wider breadth of interventions that are tailored to address unique organizational and staff needs and that incorporate longer follow-up periods. (PsycINFO Database Record
In the present study, we outline the evolution of a process-focused reflective practice
group (RPG) model for nurses working in clinical settings. The groups were initiated at Redcliffe and
Caboolture hospitals by the consultation liaison psychiatry nurse and author. An associated article
provides an evaluation of these RPG. The literature review identifies the key themes and theories on
which the model is based, and the article outlines the process and practicalities of facilitating RPG in
critical care, midwifery, and oncology specialties over a 3-year period. The model proposes that the
effectiveness and sustainability of RPG arises from adequate preparation and engagement with
prospective participants. Group rules, based on principles of confidentially, supportiveness, and
diversity, were collaboratively developed for each group. Facilitation utilized a group-as-a-whole
approach to manage process and stimulate reflection. While the purpose of RPG was a reflection on
interpersonal aspects of nursing, contextual workplace issues were frequently raised in groups.
Acknowledgement and containment of such issues were necessary to maintain clinical focus. The
literature highlights facilitator credibility and style as crucial factors in the overall success of RPG, and
it is proposed that reflective practice as a process-focused model for groups succeeds when nurse
facilitators are trained in group process and receive concurrent supervision.
Aims
This paper reports a critical review of the literature examining burnout among nurses and physicians working in emergency departments. The objective was to draw together a diverse collection of literature to undertake an in-depth analyse of the issues raised by the review question.
Background
Burnout among nurses and physicians working in emergency departments has only been brought to the attention of researchers recently. It is thought that the highly stressful environment and unpredictable nature of the work puts nurses and physicians at risk of burnout.
Method
A literature review was undertaken using the electronic databases CINAHL and MEDLINE, Royal College of Nursing and British Medical Journal websites. The papers retrieved used quantitative and qualitative approaches and were scrutinised for relevance. Twelve articles met the inclusion criteria and corresponded to the aim of this review.
Conclusion
The findings of the review reinforce concerns about the adverse effects of burnout among nurses and physicians working in emergency departments. Future research in this field is recommended, particularly around the naturalistic paradigm, to gain a deeper insight into the lived experiences of emergency department nurses and physicians.
This paper outlines an evaluation of reflective practice groups (RPG) involving nurses and midwives from three clinical nursing specialties at Redcliffe and Caboolture Hospitals, Queensland, Australia. The groups were facilitated by the consultation liaison psychiatry nurse and author using a process-focused, whole-of-group approach to explore clinical narrative in a supportive group setting. This was a preliminary evaluation utilizing a recently-developed tool, the Clinical Supervision Evaluation Questionnaire, along with externally-facilitated focus groups. Nurses and midwives responded favourably to RPG, reporting a positive impact on clinical practice, self-awareness, and resilience. The majority of participants considered RPG had positive implications for team functioning. The focus groups identified the importance of facilitation style and the need to address aspects of workplace culture to enable group development and enhance the capacity for reflection. Evaluation of the data indicates this style of RPG can improve reflective thinking, promote team cohesion, and provide support for nurses and midwives working in clinical settings. Following on from this study, a second phase of research has commenced, providing more detailed, longitudinal evaluation across a larger, more diverse group of nurses.
Changes within the Australian health care system have led many people with mental health disorders to use emergency departments as the point of access to mental health services. Staff in emergency departments are not necessarily equipped to assess the needs of such clients. This paper briefly describes the development of a multidisciplinary mental health liaison team, within the emergency department of one hospital in Sydney, which was designed to assist both staff and clients. Available evidence suggests the implementation of the team has been a success, however, more research is required to confirm the effectiveness of this approach. Questions are raised about appropriate referral and follow-up for some clients. The study also found deficiencies in the method of routine data collection (Emergency Department Identification System), which makes formal auditing of the team and the services it provides a difficult task.
Clinical supervision is widely accepted as an essential prerequisite for high quality nursing care. This paper reports findings from a study that aims to identify the factors that may influence the effectiveness of clinical supervision for community mental health nurses (CMHNs) in Wales, UK. Two hundred and sixty (32%) CMHNs from an estimated total population of 817 completed the Manchester Clinical Supervision Scale (MCCS) and a demographic questionnaire. The MCCS is a 36-item questionnaire measuring the quality and effectiveness of the supervision received. Three-quarters of CMHNs reported having participated in six or more sessions of supervision in their current posts. Clinical supervision was more positively evaluated where sessions lasted for over one hour, and took place on at least a once-monthly basis. Perceived quality of supervision was also higher for those nurses who had chosen their supervisors, and where sessions took place away from the workplace. These findings have important implications for the organization and delivery of mental health nursing services.
Burnout is a phenomenon in which the cumulative effects of a stressful work environment gradually overwhelm the defenses of staff members, forcing them to withdraw psychologically. This study compared the levels of burnout among nurses in different nursing specialties. MATERIALS and
The sample of the study consisted of all the nurses working in all public hospitals in Shiraz, Iran who were graduates of either technological educational institutions or universities and had experienced clinical nursing practice for at least 1 year. Using Maslach Burnout Inventory and General Health Questionnaire (28-item version), we identified the psychiatric morbidity and burnout among nurses.
Study results indicated that nurses of psychiatry wards showed significantly higher levels of emotional exhaustion and depersonalization in comparison with nurses working in other wards, and burn wards nurses showed significantly higher levels of personal accomplishment. Also, nurses who were single were more emotionally exhausted.
Different clinical working environments appear to have an impact on the development of nurses' burnout.
This paper is a report of an interview study exploring psychiatric hospital nursing staff members' reflections on participating in supervision. Clinical supervision is a pedagogical process designed to direct, develop, and support clinical nurses. Participation rates in clinical supervision in psychiatric settings have been reported to be relatively low. Qualitative research indicates that staff members appreciate clinical supervision, but paradoxically, do not prioritize participation and find participation emotionally challenging. Little is known about these contradictory experiences and how they influence participation rates. Twenty-two psychiatric hospital nursing staff members were interviewed with a semistructured interview guide. Interview transcripts were interpreted by means of Ricoeur's hermeneutic method. The respondents understood clinical supervision to be beneficial, but with very limited impact on their clinical practice. Neither management nor the staff effectively prioritized clinical supervision, which added to a downward spiral where low levels of participation undermined the potential benefits of clinical supervision. The respondents embraced and used alternative forums for getting emotional support among peers, but maintained that formalized supervision was the only forum for reflection that could solve the most difficult situations.
This paper notes the dawning of reflective practice on the horizon of nursing practice and sets out to explore its value for nursing. Central to this value is the potential of reflective practice to enable practitioners to develop clinical expertise towards achieving desirable and effective practice and, through collaborative research, the development of a valid disciplinary knowledge grounded in practitioners' personal knowledge.
An evaluation of process and outcomes from learning through reflective practice groups on a post-registration nursing course
Small groups were set up purposefully on a part-time post-registration Diploma in Professional Studies in Nursing programme to enable students to reflect on and learn from experience. The use of these groups was qualitatively evaluated by the use of in-depth interviews. Although there were many barriers to such learning, some students made significant developments in their critical thinking ability and underwent perspective transformations that led to changes in attitudes and behaviour. These are identified as an increased professionalism, greater autonomy in decision making, more self-confidence to challenge the status quo and make their own judgements, and a less rule-bound approach to their practice. The processes by which these changes occurred are identified as support and challenge within the groups offered by both the facilitators and other group members.
This paper reports a study which aims (1) to investigate and compare levels of stressors and burnout of qualified and unqualified nursing staff in acute mental health settings; (2) to examine the relationships between stressors and burnout and (3) to assess the impact of social support on burnout and stressor-burnout relationships.
Several studies have noted that the work of mental health nurses can be highly stressful, but relatively few have focused specifically on staff working in acute inpatient settings. Although many of the pressures faced by this group are similar to those in other nursing specialties, a number of demands relate specifically to mental health settings, including the often intense nature of nurse-patient interaction and dealing with difficult and challenging patient behaviours on a regular basis.
A convenience sample of 93 nursing staff from 11 acute adult mental health wards completed the Mental Health Professionals Stress Scale, Maslach Burnout Inventory and House and Wells Social Support Scale.
Lack of adequate staffing was the main stressor reported by qualified staff, while dealing with physically threatening, difficult or demanding patients was the most stressful aspect for unqualified staff. Qualified nurses reported significantly higher workload stress than unqualified staff. Approximately half of all nursing staff showed signs of high burnout in terms of emotional exhaustion. A variety of stressors were positively correlated with emotional exhaustion and depersonalization. Higher levels of support from co-workers were related to lower levels of emotional exhaustion. Higher stressor scores were associated with higher levels of depersonalization for staff reporting high levels of social support, but not for those reporting low levels of support (a reverse buffering effect).
Qualified and unqualified nursing staff differed in terms of the prominence given to individual stressors in their work environment. The findings were consistent with the notion of burnout developing in response to job-related stressors. While staff support groups may be useful in alleviating feelings of burnout, the reverse buffering effect suggests that they should be structured in a way that minimizes negative communication and encourages staff to discuss their concerns in a constructive way.
Psychiatric staff report that the use of coercion towards patients in psychiatric care engenders feelings of discomfort and conflicts. The aim of this study was to describe psychiatric nurses' experiences of participating in reflection groups focused on the use of coercion, in relation to their views regarding systematic clinical supervision and staff support. Twenty-one nurses who had participated in reflection groups were interviewed retrospectively. The structured interview focused on: (i) their views of clinical supervision and support in general; (ii) their views of clinical supervision and support specifically concerning the use of coercion; and (iii) their experiences of participating in groups reflecting the use of coercion. Nurses were largely positive about participating in reflection groups, as expressed in the subthemes: having time for reflection; being confirmed; gaining new perspectives; sharing fellowship with colleagues; and relating more effectively to patients. Complications concerning participation in the reflection groups and other forms of clinical supervision as reported by nurses were: providing time for participation; having a common aim; being vulnerable in difficult situations; and assuming that the need for supervision and support could indicate that they were not coping with their job.
This paper presents the findings from a survey of Finnish mental health and psychiatric nurses. The aim of the study was to describe and evaluate the current state of clinical supervision, and ascertain the levels of burnout and job satisfaction experienced by these health care professionals. Clinical supervision was found beneficial for mental health and psychiatric health care professionals in terms of their job satisfaction and levels of stress. The findings seem to demonstrate that efficient clinical supervision is related to lower burnout, and inefficient supervision to increasing job dissatisfaction.
The aim of this study was to establish the degree to which clinical supervision might influence levels of reported burnout in community mental health nurses in Wales, UK.
The research instruments used were the Maslach Burnout Inventory and the Manchester Clinical Supervision Scale. At the time of the survey 817 community mental health nurses were reported to work within Wales. Two hundred and sixty (32%) community mental heath nurses working in 11 NHS Trusts responded to the survey.
One hundred and eighty-nine (73%) community mental heath nurses had experience of clinical supervision in their present posts and 105 (40%) in their previous posts. The findings from the Maslach Burnout Inventory indicated high levels of emotional exhaustion for 36%, high levels of depersonalization for 12% and low levels of personal accomplishment for 10% of the community mental heath nurses surveyed. Univariate analysis showed that those community mental heath nurses who were younger, male and who had not experienced six or more sessions of clinical supervision were more likely to report cold negative attitudes towards their clients as indicated by higher scores on the depersonalization subscale of the Maslach Burnout Inventory. One hundred and sixty-six community mental heath nurses had experienced six or more sessions of clinical supervision and had completed the Maslach Burnout Inventory. Higher scores on the Manchester Clinical Supervision Scale were also associated with lower levels of measured burnout, with significant negative correlations between the total Manchester Clinical Supervision Scale score and the emotional exhaustion subscale (r = -0.148, P = 0.050) and the depersonalization subscale (r = -0.220, P = 0.003) of the Maslach Burnout Inventory. These findings suggest that if clinical supervision is effective then community mental heath nurses are likely to report lower levels of emotional exhaustion and depersonalization.
The findings from this study suggest that if clinical supervision is effective then community mental heath nurses report lower levels of burnout. Further research is required to determine the long-term benefits of implementing clinical supervision and to determine which other factors have an influence on levels of burnout for this group of nurses. Health service organizations have a responsibility for ensuring that all individual practitioners have access to effective clinical supervision and the Nursing and Midwifery Council could extend the registered nurses personal accountability to include - to seek clinical supervision as and when necessary.
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