Nurses' resilience and the emotional labour of nursing work: An integrative review of empirical literature.
TL;DR: Resilience is a significant intervention that can build nurses' resources and address the effects of emotional dissonance in nursing work and robust evaluation of the impact of resilience interventions that address emotional labour is recommended.
About: This article is published in International Journal of Nursing Studies.The article was published on 2017-05-01. It has received 254 citations till now. The article focuses on the topics: Emotional exhaustion & Psychological resilience.
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TL;DR: Mental health outcomes were statistically positively correlated with skin lesion and negatively correlated with self-efficacy, resilience, social support, and frontline work willingness, and future interventions at the national and organisational levels are needed.
494 citations
Cites background from "Nurses' resilience and the emotiona..."
...Resilience can mitigate the negative impact of work related stress and prevent poor psychological health outcomes among nurse [27]....
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TL;DR: Understanding nurse resilience can proactively help nurses identify or prevent potential problems, thus fostering job resources and ultimately achieving personal and professional growth.
176 citations
TL;DR: At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare professionals receiving resilience training may report higher levels of resilience, and there was little or no evidence of any effect of resilience training on anxiety or stress perception.
Abstract: Background Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses, physicians, psychologists and social workers, are exposed to various work-related stressors (e.g. patient care, time pressure, administration) and are at increased risk of developing mental disorders. This population may benefit from resilience-promoting training programmes. Objectives To assess the effects of interventions to foster resilience in healthcare professionals, that is, healthcare staff delivering direct medical care (e.g. nurses, physicians, hospital personnel) and allied healthcare staff (e.g. social workers, psychologists). Search methods We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results. Selection criteria Randomised controlled trials (RCTs) in adults aged 18 years and older who are employed as healthcare professionals, comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, wait-list, usual care, active or attention control. Primary outcomes were resilience, anxiety, depression, stress or stress perception and well-being or quality of life. Secondary outcomes were resilience factors. Data collection and analysis Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only). Main results We included 44 RCTs (high-income countries: 36). Thirty-nine studies solely focused on healthcare professionals (6892 participants), including both healthcare staff delivering direct medical care and allied healthcare staff. Four studies investigated mixed samples (1000 participants) with healthcare professionals and participants working outside of the healthcare sector, and one study evaluated training for emergency personnel in general population volunteers (82 participants). The included studies were mainly conducted in a hospital setting and included physicians, nurses and different hospital personnel (37/44 studies). Participants mainly included women (68%) from young to middle adulthood (mean age range: 27 to 52.4 years). Most studies investigated group interventions (30 studies) of high training intensity (18 studies; > 12 hours/sessions), that were delivered face-to-face (29 studies). Of the included studies, 19 compared a resilience training based on combined theoretical foundation (e.g. mindfulness and cognitive-behavioural therapy) versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. hospitals, universities), or a combination of different sources. Fifteen studies did not specify the source of their funding, and one study received no funding support. Risk of bias was high or unclear for most studies in performance, detection, and attrition bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare professionals receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.45, 95% confidence interval (CI) 0.25 to 0.65; 12 studies, 690 participants), lower levels of depression (SMD -0.29, 95% CI -0.50 to -0.09; 14 studies, 788 participants), and lower levels of stress or stress perception (SMD -0.61, 95% CI -1.07 to -0.15; 17 studies, 997 participants). There was little or no evidence of any effect of resilience training on anxiety (SMD -0.06, 95% CI -0.35 to 0.23; 5 studies, 231 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.14, 95% CI -0.01 to 0.30; 13 studies, 1494 participants; very-low certainty evidence). Effect sizes were small except for resilience and stress reduction (moderate). Data on adverse effects were available for three studies, with none reporting any adverse effects occurring during the study (very-low certainty evidence). Authors' conclusions For healthcare professionals, there is very-low certainty evidence that, compared to control, resilience training may result in higher levels of resilience, lower levels of depression, stress or stress perception, and higher levels of certain resilience factors at post-intervention. The paucity of medium- or long-term data, heterogeneous interventions and restricted geographical distribution limit the generalisability of our results. Conclusions should therefore be drawn cautiously. The findings suggest positive effects of resilience training for healthcare professionals, but the evidence is very uncertain. There is a clear need for high-quality replications and improved study designs.
138 citations
TL;DR: The resources, measures, and information can be a protective factor facing nurses' psychosocial risks, especially during a pandemic.
Abstract: Context: COVID-19 pandemic is a serious health emergency that has affected countries all over the world. Health emergencies are a critical psychosocial risk factor for nurses. In general, psychosocial risks constitute serious problems as they impact workers' health, productivity, and efficiency. Despite their importance, few studies analyze nurses' psychosocial risks during a health emergency caused by a pandemic or analyze their perception of the emergency and its relation to such risks. Objectives: To analyze the perception of COVID-19 by nurses, especially about measures, resources, and impact on their daily work. Also, to analyze these professionals' psychosocial risks and the relationship between perception of COVID-19 and these risks. Methods: A descriptive correlational study was performed in a convenience sample of 92 nurses from two public hospitals in the Valencian Community (Spain), (74 women, 79.1%), aged 24-63 (M = 43.37, SD = 11.58). Data were collected via an online self-completed questionnaire during the rise of the pandemic from March 29 to April 8, when the number of infections went from 78,797 to 146,690. Results: The measures and resources available about COVID-19 are relatively low, and the impact on their work is high. Similarly, the most prominent psychosocial risks appear to be emotional work and workload. In contrast, nurses' work engagement is medium, and their satisfaction is high. Finally, there seems to be a negative and significant relationship between the information available to nurses, the measures implemented, and resources with some of their psychosocial risks, and a positive one with job satisfaction and work engagement. There is also a positive and significant relationship only between the impact of COVID-19 and their work inequality, but not for other risks. Conclusions: The resources, measures, and information can be a protective factor facing nurses' psychosocial risks, especially during a pandemic. Studying the relationships between psychosocial risk and perception of a health emergency would be relevant and fundamental to protecting and caring for nurses, health professionals, and society.
117 citations
TL;DR: A concept analysis was undertaken to examine nurse resilience using a priori selected analysis framework and key attributes of nurse resilience were social support, self-efficacy, work-life balance/self-care, humour, optimism, and being realistic.
Abstract: Nurse resilience is attracting increasing attention in research and practice. Possession of a high level of resilience is cited as being crucial for nurses to succeed professionally and manage workplace stressors. There is no agreed definition of nurse resilience. A concept analysis was undertaken to examine nurse resilience using a priori selected analysis framework. This concept analysis aims to systematically analyse resilience as it relates to nurses and establish a working definition of nurse resilience. Sixty-nine papers met the search criteria for inclusion. Key attributes of nurse resilience were social support, self-efficacy, work-life balance/self-care, humour, optimism, and being realistic. Resilience enables nurses to positively adapt to stressors and adversity. It is a complex and dynamic process which varies over time and context and embodies both individual attributes and external resources. Sustaining nurse resilience requires action and engagement from both individuals and organizations.
115 citations
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TL;DR: An Explanation and Elaboration of the PRISMA Statement is presented and updated guidelines for the reporting of systematic reviews and meta-analyses are presented.
Abstract: Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.
Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions.
The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
25,711 citations
TL;DR: Data analysis methods of qualitative research are proposed as strategies that enhance the rigour of combining diverse methodologies as well as empirical and theoretical sources in an integrative review.
Abstract: Aim. The aim of this paper is to distinguish the integrative review method from other review methods and to propose methodological strategies specific to the integrative review method to enhance the rigour of the process.
Background. Recent evidence-based practice initiatives have increased the need for and the production of all types of reviews of the literature (integrative reviews, systematic reviews, meta-analyses, and qualitative reviews). The integrative review method is the only approach that allows for the combination of diverse methodologies (for example, experimental and non-experimental research), and has the potential to play a greater role in evidence-based practice for nursing. With respect to the integrative review method, strategies to enhance data collection and extraction have been developed; however, methods of analysis, synthesis, and conclusion drawing remain poorly formulated.
Discussion. A modified framework for research reviews is presented to address issues specific to the integrative review method. Issues related to specifying the review purpose, searching the literature, evaluating data from primary sources, analysing data, and presenting the results are discussed. Data analysis methods of qualitative research are proposed as strategies that enhance the rigour of combining diverse methodologies as well as empirical and theoretical sources in an integrative review.
Conclusion. An updated integrative review method has the potential to allow for diverse primary research methods to become a greater part of evidence-based practice initiatives.
6,131 citations
TL;DR: In this article, Hochschild examined two groups of public contact workers: flight attendants and bill collectors, and found that roughly one-third of American men and one-half of American women hold jobs that call for substantial emotional labor.
Abstract: In private life, we try to induce or suppress love, envy, and anger through deep acting or "emotion work," just as we manage our outer expressions of feeling through surface acting In trying to bridge a gap between what we feel and what we "ought" to feel, we take guidance from "feeling rules" about what is owing to others in a given situation Based on our private mutual understandings of feeling rules, we make a "gift exchange" of acts of emotion management We bow to each other not simply from the waist, but from the heart But what occurs when emotion work, feeling rules, and the gift of exchange are introduced into the public world of work?In search of the answer, Arlie Hochschild closely examines two groups of public-contact workers: flight attendants and bill collectors The flight attendant's job is to deliver a service and create further demand for it, to enhance the status of the customer and be "nicer than natural" The bill collector's job is to collect on the service, and if necessary, to deflate the status of the customer by being "nastier than natural" Between these extremes, roughly one-third of American men and one-half of American women hold jobs that call for substantial emotional labor In many of these jobs, they are trained to accept feeling rules and techniques of emotion management that serve the company's commercial purpose Just as we have seldom recognized or understood emotional labor, we have not appreciated it cost to those who do it for a livingLike a physical laborer who becomes estranged from what he or she makes, an emotional laborer, such as a flight attendant, can become estranged not only from her own expressions of feeling (her smile is not "her" smile), but also from what she actually feels (her managed friendliness) This estrangement, though a valuable defense against stress, is also an important occupational hazard, because it is through our feelings that we are connected with those around us On the basis of this book, Hochschild was featured in "Key Sociological Thinkers", edited by Rob Stones This book was also the winner of the Charles Cooley Award in 1983, awarded by the American Sociological Association and received an honorable mention for the C Wright Mills Award
2,208 citations
TL;DR: In this paper, the authors review and critique the variety of definitions, concepts, and theories of psychological resilience and conclude that resilience is required in response to different adversities, ranging from ongoing daily hassles to major life events, and that positive adaptation must be conceptually appropriate to the adversity examined in terms of the domains assessed and the stringency of criteria used.
Abstract: The purpose of this paper is to review and critique the variety of definitions, concepts, and theories of psychological resilience. To this end, the narrative is divided into three main sections. The first considers how resilience has been defined in the psychology research literature. Despite the construct being operationalized in a variety of ways, most definitions are based around two core concepts: adversity and positive adaptation. A substantial body of evidence suggests that resilience is required in response to different adversities, ranging from ongoing daily hassles to major life events, and that positive adaptation must be conceptually appropriate to the adversity examined in terms of the domains assessed and the stringency of criteria used. The second section examines the conceptualization of resilience as either a trait or a process, and explores how it is distinct from a number of related terms. Resilience is conceptualized as the interactive influence of psychological characteristics within the context of the stress process. The final section reviews the theories of resilience and critically examines one theory in particular that is commonly cited in the resilience literature. Future theories in this area should take into account the multiple demands individuals encounter, the meta-cognitive and -emotive processes that affect the resilience-stress relationship, and the conceptual distinction between resilience and coping. The review concludes with implications for policy, practice, and research including the need to carefully manage individuals’ immediate environment, and to develop the protective and promotive factors that individuals can proactively use to build resilience.
1,428 citations
TL;DR: It is suggested that nurses can actively participate in the development and strengthening of their own personal resilience to reduce their vulnerability to workplace adversity and thus improve the overall healthcare setting.
Abstract: Title. Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: a literature review
Aim. This paper is a report of a literature review to explore the concept of personal resilience as a strategy for responding to workplace adversity and to identify strategies to enhance personal resilience in nurses.
Background. Workplace adversity in nursing is associated with excessive workloads, lack of autonomy, bullying and violence and organizational issues such as restructuring, and has been associated with problems retaining nurses in the workforce. However, despite these difficulties many nurses choose to remain in nursing, and survive and even thrive despite a climate of workplace adversity.
Data sources. The literature CINAHL, EBSCO, Medline and Pubmed databases were searched from 1996 to 2006 using the keywords ‘resilience’, ‘resilience in nursing’, and ‘workplace adversity’ together with ‘nursing’. Papers in English were included.
Findings. Resilience is the ability of an individual to positively adjust to adversity, and can be applied to building personal strengths in nurses through strategies such as: building positive and nurturing professional relationships; maintaining positivity; developing emotional insight; achieving life balance and spirituality; and, becoming more reflective.
Conclusion. Our findings suggest that nurses can actively participate in the development and strengthening of their own personal resilience to reduce their vulnerability to workplace adversity and thus improve the overall healthcare setting. We recommend that resilience-building be incorporated into nursing education and that professional support should be encouraged through mentorship programmes outside nurses’ immediate working environments.
964 citations