Objectives. Many aspects of palliative care, such as managing (complicated) symptoms, conductinggoals-of-care conversations, and repeated exposure to loss, can be stressful to clinicians.Previous... Show moreObjectives. Many aspects of palliative care, such as managing (complicated) symptoms, conductinggoals-of-care conversations, and repeated exposure to loss, can be stressful to clinicians.Previous research on the emotional impact of providing palliative care was mainlydone in specialist settings. However, the majority of palliative care is provided by clinicianswho are not specialized in palliative care, and can be supported by palliative care specialistsonly when needed. Therefore, this study aimed to gain insight into the emotional impactof providing palliative care on clinicians, both palliative care generalists and specialists.Methods. A qualitative interview study among 21 clinicians (11 doctors and 10 nurses) workingin hospitals, home care, or nursing homes in the Netherlands was conducted. BetweenFebruary and June 2019, 13 palliative care generalists and 8 specialists were interviewed.Interviews were thematically analyzed by two researchers.Results. All clinicians considered the emotional impact of providing palliative care to be substantialand experienced both positive and negative aspects of providing palliative care. Severalaspects of providing palliative care can support or undermine emotional stability. These socalledfacilitators and barriers, such as practicing self-care and complexity of palliative care,were found at three different levels: individual, team, and organization.Significance of results. Although clinicians experience providing palliative care as meaningfuland valuable, the emotional impact is considerable. Negative and positive aspects often coexist.Further insight into the dynamics and magnitude of the emotional impact of providingpalliative care is needed in order to create a healthy working environment and develop adequateinterventions. Show less
The current dissertation aims to assess the well-being of Emergency Department (ED) nurses and identify (combinations of) job factors related to this. Second, it aims to evaluate the overall... Show moreThe current dissertation aims to assess the well-being of Emergency Department (ED) nurses and identify (combinations of) job factors related to this. Second, it aims to evaluate the overall effectiveness and effective elements of an intervention implementation project conducted in multiple EDs in the Netherlands. Findings show a high prevalence of stress-related outcomes in ED nurses, but also high levels of work engagement and job satisfaction. Worktime demands and aggression/conflict situations have the strongest relationship with exhaustion, whilst work engagement is mostly related to developmental opportunities. Recovery during and outside of work can buffer the impact of patient-related stressful situations. According to a literature review, interventions can effectively prevent/reduce stress-related outcomes in nurses, with person-directed interventions reaching greater short-term effects. Little is known about their longevity and only a limited number of organization-directed studies exist. The current 2,5-year (mostly organization-directed) intervention project, led to improved working conditions but not (yet) to better well-being. Greater effects were found in hospitals with more fitting interventions and were employees felt more informed about and involved in the project. Psychosocial safety climate was positively related to communication, participation and the fit of actions to the risk factors, and as such provides a good starting point for a successful intervention project. Show less
Huizinga, C.R.H.; Tummers, F.H.M.P.; Marang-van de Mheen, P.J.; Cohen, A.E.; Bogt, K.E.A. van der 2019
The need for data to study the relationship between fatigued healthcare professionals and performance outcomes is evident, however, it is unclear which methodology is most appropriate to provide... Show moreThe need for data to study the relationship between fatigued healthcare professionals and performance outcomes is evident, however, it is unclear which methodology is most appropriate to provide these insights. To address this issue, we performed a systematic review of relevant articles by searching the MEDLINE, EMBASE, Cochrane, Web of Science, and CINAHL databases. The literature search identified 2960 unique references, of which 82 were identified eligible. The impact on performance was studied on clinical outcomes, medical simulation, neurocognitive performance, sleep quantification and subjective assessment. In general results on performance are conflicting; impairment, no effect, and improvement were found. This review outlines the various methods currently available for assessing fatigue-impaired performance. The contrasting outcomes can be attributed to three main factors: differences in the operationalisation of fatigue, incomplete control data, and the wide variety in the methods used. We recommend the implementation of a clinically applicable tool that can provide uniform data. Until these data become available, caution should be used when developing regulations that can have implications for physicians, education, manpower planning, and - ultimately - patient care. (C) 2019 Elsevier Ltd. All rights reserved. Show less
