Insights on compassion and patient-centred nursing in intensive care: A constructivist grounded theory.

To explore patient-centred nursing, compassion satisfaction and compassion fatigue from intensive care nurses' perspectives. Compassion satisfaction and compassion fatigue can influence critical care nurses' decisions to either continue or leave the profession, and could impact the compassionate patient-centred nursing care patients receive during their ICU admission. This qualitative research design was informed by Charmaz's Grounded Theory Constructivist methodology. In-depth interviews were conducted with 21 critical care nurses of two ICUs in Australia during 2016. Interview data were analysed using grounded theory processes. Findings reflected positive and negative impacts on critical care nurses' ability to deal compassionately with their patients. Effects on patient-centred nursing and critical care nurses' own well-being were revealed. A core category of "Expectations" emerged, explaining the tension between critical care nurses' biomedical, clinical skills and knowledge versus compassionate, patient-centred nursing care. This tension was clarified and expanded in subcategories of "Life in the Balance," "Passion and Pressure," "Understanding and Advocacy" and "Tenacity and Fragility". Providing patient-centred nursing may enhance critical care nurses' experience of compassion satisfaction, in turn impacting delivery of compassionate patient-centred nursing to generate a virtuous circle. Critical care nurses who feel respected and supported by their management team and colleagues experience feelings of compassion satisfaction, leading to greater engagement and care towards their patient. Systematically addressing critical care nurses' needs to successfully balance biomedical with compassionate nursing care may lead to greater well-being in the critical care nursing workforce and improve patient experience of intensive care.

Jakimowicz S ，Perry L ，Lewis J 《-》

Compassion fatigue, moral distress, and work engagement in surgical intensive care unit trauma nurses: a pilot study.

Mason VM ，Leslie G ，Clark K ，Lyons P ，Walke E ，Butler C ，Griffin M ... -  《-》

Nurses' perceived and actual caregiving roles: identifying factors that can contribute to job satisfaction.

To compare nurses' caring expectations with their caregiving experiences and to identify factors that could potentially be included in a preliminary conceptual model of job satisfaction and compassion fatigue. Nurses often report emotional reward and satisfaction in their profession from compassionately caring for sick and injured patients. However, being in close proximity to trauma can eventually deplete a nurse's compassion and empathy for the patients they care for. This loss of compassion is further exacerbated by demanding work environments that involve administrative duties, attending to patients' psychosocial needs and interacting with patients' families. To date, the literature has tended to focus on pathology of compassion fatigue, rather than identifying its contributing factors. A grounded theory approach was used to identify emerging themes in nurses' accounts of their caregiving roles. Open-ended interviews were conducted with nurses (n = 9) who were employed by a maritime district health authority for a minimum of five years. Interviews focused on beliefs of how to provide care, perceived caregiving responsibilities and perceived challenges in the provision of care. Emerging from the data is a proposed model of job satisfaction. The concepts of monitoring and patient advocacy appeared to be key components in reported satisfaction or alienation. Discrepancies were found between care expectations outlined by management and nurses' perceptions of care provision. Additionally, type of nursing education was related to nurses' confidence in applying nursing skills. These findings have implications for training programmes, hospital management and quality of patient care. It is important to identify factors that could explain resilience to compassion fatigue because compassion fatigue has negative consequences not only for nurses themselves but for the patients in their care.

Morrison KB ，Korol SA 《-》

Delivering compassionate care in intensive care units: nurses' perceptions of enablers and barriers.

Compassion is core to nursing practice. Nurses' expression of compassion is a complex interaction informed by the nurse, the patient and the practice environment. The aim of this study was to identify personal, professional and organizational factors, intensive care nurses, in a major metropolitan facility in Australia, identified as enabling or disabling them to be compassionate. Intensive care nurses (n = 171) reflected on their experiences during 'compassion cafés' conducted in 2015. Qualitative, reflexive methods were used to explore ICU nurses' perceptions of enablers and barriers. Nurses documented their perceptions, which were thematically analysed. Meanings were subsequently verified with participants. The findings identified multiple factors both inside and outside the workplace that constrained or enabled nurses' ability to be compassionate. Two main factors inside the workplace were culture of the team, in particular, support from colleagues and congruency in work practices and decision-making, and connections with patients and families. Outside the workplace, nurses were influenced by their values about care and lifestyle factors such as family demands. Nurses capacity to be compassionate is a complex interplay between nursing knowledge and expectations, organizational structures and lifestyle factors. The responsibility for 'compassionate' care is a shared one. Nurses need to be cognizant of factors that are enabling or inhibiting their ability to be compassionate. Healthcare leaders have a responsibility to provide structural support (staffing, education and space) that assist nurses to deliver compassionate care and where appropriate cater for nurses needs so that they are better able to be compassionate.

Jones J ，Winch S ，Strube P ，Mitchell M ，Henderson A ... -  《-》

An integrative review of supports, facilitators and barriers to patient-centred nursing in the intensive care unit.

To systematically review the literature describing factors perceived by nurses as impacting the provision of patient-centred nursing in the intensive care unit. Patient-centred nursing in critical care differs from other healthcare areas, and the aggressive curative environment of the ICU has potential to compromise some of its elements. Understanding critical care, nurses' perceptions of promoting and deterrent factors may inform development of strategies to support effective patient-centred nursing and job satisfaction in this workforce. An integrative literature review. Whittemore and Knafl's method was used with "best-fit" framework synthesis. CINAHL, PsycINFO, Medline and EMBASE were searched for 2000-2016 literature using search terms drawn from the ICU patient-centred framework. In total, 3,079 papers were identified, with 23 retained after applying eligibility criteria. Five themes were identified: Nurse identity; Organisation; Communication; Relationships; and Ideology of ICU. Almost every theme and related categories referred to factors acting as barriers to patient-centred nursing in the ICU; only four referred to supports/facilitators. Findings showed that provision of patient-centred nursing may be compromised by some factors of the critical care environment, and illustrate the challenges and complexity of providing effective patient-centred nursing in this environment. Findings should be applied to address barriers and to enhance facilitators of effective patient-centred nursing in critical care. The emotional and physical demands of critical care nursing are major considerations; supporting these nurses to fulfil their challenging role may empower them in their professional quality of life and provide a basis for workforce retention as well as delivery of effective patient-centred nursing. Measures to enhance patient-centred nursing could promote critical care nurses' job satisfaction and workforce retention, and be applied more broadly and collaboratively to promote multidisciplinary patient-centred care.

Jakimowicz S ，Perry L ，Lewis J 《-》