Work environmental factors associated with compassion satisfaction and end-of-life care quality among nurses in general wards, palliative care units, and home care settings: A cross-sectional survey.

BACKGROUND: Nurses providing end-of-life care experience not only burnout and compassion fatigue, but also positive effects such as compassion satisfaction. Nurses' compassion satisfaction was shown to be related to job satisfaction, work engagement, and nurse caring. Studies in emergency departments, intensive care units, oncology wards, and general wards have identified work environmental factors associated with nurses' compassion satisfaction, but no similar studies have been conducted in palliative care units or home care settings. It is also unknown whether work environmental factors associated with compassion satisfaction contribute to end-of-life care quality. OBJECTIVE: To explore work environmental factors associated with nurses' compassion satisfaction and end-of-life care quality in three types of workplaces: general wards, palliative care units, and home care settings. DESIGN: A cross-sectional survey of nurses providing end-of-life care. SETTINGS: Sixteen general wards, 14 palliative care units, and 25 home-visit nursing agencies in Japan. PARTICIPANTS: There were 347 study participants: 95 nurses in general wards, 128 in palliative care units, and 124 in home care settings. METHODS: Compassion satisfaction was assessed using the Professional Quality of Life Scale, and end-of-life care quality was rated on a 4-point scale. Work environments were assessed using the Areas of Worklife Survey, which measures the fit between an individual and their work environment in six areas: workload, control, reward, community, fairness, and values. RESULTS: Compared to nurses in general wards and palliative care units, home care nurses scored statistically significantly higher on all work environmental factors except reward. Work environmental factors that were significantly positively associated with higher compassion satisfaction were values in general wards (ß = 0.335, P = 0.007), reward and workload in palliative care units (ß = 0.266, P = 0.009 and ß = 0.179, P = 0.035), and community and control in home care settings (ß = 0.325, P = 0.001 and ß = 0.261, P = 0.004). In addition, higher scores for workload in general wards (odds ratio = 5.321; 95 % confidence interval, 1.688-16.775) and for community in palliative units (odds ratio = 2.872; 95 % confidence interval, 1.161-7.102) were associated with higher end-of-life care quality. No associated work environmental factors were found in home care settings. CONCLUSIONS: Work environmental factors associated with nurses' compassion satisfaction and end-of-life care quality varied between workplaces. These results may contribute to creating work environments that are appropriate for each workplace type to maintain both nurses' compassion satisfaction and end-of-life care quality. TWEETABLE ABSTRACT: Work environmental factors associated with nurses' compassion satisfaction and end-of-life care quality were identified in three workplaces.

Validation of the Japanese version of the 8-item Chronic Pain Acceptance Questionnaire (CPAQ-8).

This study aimed to examine the reliability and validity of the Japanese version of the Chronic Pain Acceptance Questionnaire (CPAQ-8J). A total of 108 outpatients with chronic pain completed the CPAQ-8 questionnaire, along with the Acceptance and Action Questionnaire-II, Hospital Anxiety and Depression Scale, Pain Disability Assessment Scale, Numerical Rating Scale, and EuroQol 5 dimensions 5-level. Confirmatory factor analyses examined the factor structure. Results indicated that the CPAQ-8J comprised a two-component factor structure. Correlations between the CPAQ-8J and each variable were as expected, except between the "pain willingness" subscale and other scales ; thus, the CPAQ-8J had a certain degree of convergent validity. Internal consistency and test-retest reliability suggest that the CPAQ-8J is reliable. The psychometric properties of the CPAQ-8J meet a certain standard ; meanwhile, some issues must be addressed for its practical application. Further research should consider the influence of cultural characteristics in practical application. J. Med. Invest. 70 : 88-93, February, 2023.

Expectations of respiratory physicians from psychologists in palliative care for patients with non-cancer respiratory diseases.

BACKGROUND: Psychological symptoms are common in patients with non-malignant respiratory disease (NMRD). Psychologists can likely play a role in NMRD palliative care. We aimed to explore the expectations of respiratory physicians from psychologists in NMRD palliative care. METHODS: An ad hoc questionnaire was developed based on a free-descriptive questionnaire survey among respiratory physicians from four hospitals in Japan. Using this questionnaire, we surveyed respiratory physicians from eight hospitals in Japan and assessed their expectations of psychologists' support and outcomes. Expectations were compared between physicians with and without experience of working with psychologists. RESULTS: The quantitative questionnaire was completed by 129 physicians. Data analysis from 108 participants revealed that the highly expected support included "getting early information on patients' psychological distress" (97.2%) and "counseling family members regarding anxiety caused by changes in patient's condition" (96.3%). Physicians also expected "relief in patient's psychological distress" (96.3%) and "providing the psychological support that families need" (95.4%) from psychologists. Compared to physicians with experience of working with psychologists, those without expected more in terms of "giving specific advice on the way of communication and psychological support" (p = 0.035) and "providing psychological support for difficult-to-handle patients and families on behalf of other medical staff" (p = 0.036). CONCLUSIONS: Respiratory physicians may expect relief of psychological distress experienced by patients and their families from psychologists by getting information about their distress and providing psychological support. These results may be useful for psychologists to provide palliative care for patients with NMRD in collaboration with respiratory physicians.

Psychometric properties of the Japanese version of the Geriatric Anxiety Inventory for community-dwelling older adults.

BACKGROUND: This study developed a Japanese version of the Geriatric Anxiety Inventory (GAI-J) and its short form (GAI-J-SF) to evaluate anxiety in older adults in Japan and assess these measures' psychometric properties with a cross-sectional design. METHODS: Participants (N = 400; mean age: 75 years) were community-dwelling older adults who answered a set of self-report questionnaires. They were recruited from a community centre for older persons in the Kanto region of Japan. Of the respondents, 100 participated in a follow-up survey to evaluate test-retest reliability. Item response theory was adopted to evaluate item parameters. RESULTS: Confirmatory factor analysis with categorical data suggested that, as with the original Geriatric Anxiety Inventory, the GAI-J/GAI-J-SF had a unifactor structure. Test-retest correlation and internal consistency analyses indicated that these scales had high reliability. Item response theory results showed that both measures' item parameters were acceptable. Correlations with the Penn State Worry Questionnaire, State Trait Anxiety Inventory-State Only, Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were mostly consistent with our hypotheses. This supports the high convergent validity of the GAI-J/GAI-J-SF. CONCLUSIONS: The findings indicate that the GAI-J and the GAI-J-SF have robust psychometric properties for assessing late-life anxiety in older Japanese adults. Future GAI-J studies in clinical groups are needed.

Pilot study of a basic individualized cognitive behavioral therapy program for chronic pain in Japan.

BACKGROUND: Chronic pain is a major health problem, and cognitive behavioral therapy (CBT) is its recommended treatment; however, efforts to develop CBT programs for chronic pain and assess their feasibility are remarkably delayed in Asia. Therefore, we conducted this pilot study to develop a basic individualized CBT for chronic pain (CBT-CP) and assessed its feasibility for use in Japan. METHODS: Our study was an open-labeled before-after trial without a control group conducted cooperatively in five Japanese tertiary care hospitals. Of 24 outpatients, 15, age 20-80, who experienced chronic pain for at least three months were eligible. They underwent an eight-session CBT-CP consisting of relaxation via a breathing method and progressive muscle relaxation, behavioral modification via activity pacing, and cognitive modification via cognitive reconstruction. The EuroQol five-dimensional questionnaire five level (EQ5D-5 L) assessment as the primary outcome and quality of life (QOL), pain severity, disability, catastrophizing, self-efficacy, and depressive symptoms as secondary outcomes were measured using self-administered questionnaires at baseline, post-treatment, and 3-month follow-up. Intention-to-treat analyses were conducted. RESULTS: Effect size for EQ5D-5 L score was medium from baseline to post-treatment (Hedge's g = - 0.72, 90% confidence interval = - 1.38 to - 0.05) and up to the 3-month follow-up (g = - 0.60, CI = - 1.22 to 0.02). Effect sizes for mental and role/social QOL, disability, catastrophizing, self-efficacy, and depressive symptoms were medium to large, although those for pain severity and physical QOL were small. The dropout rate was acceptably low at 14%. No severe adverse events occurred. CONCLUSION: The findings suggest that CBT-CP warrants a randomized controlled trial in Japan. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), UMIN000020880. Registered on 04 February 2016.

Traumatic Events Among Cancer Patients That Lead to Compassion Fatigue in Nurses: A Qualitative Study.

CONTEXT: Cancer care nurses are frequently exposed to patients' traumatic experiences and are at high risk of compassion fatigue. OBJECTIVES: To describe the components and frequencies of traumatic events experienced by patients with cancer, which give rise to nurse compassion fatigue. METHODS: This study is a supplementary analysis of data from a previous qualitative study. Semistructured interviews were conducted with 30 Japanese nurses, with at least two years of experience in cancer care and a history of compassion fatigue. Content analysis and constant comparison was used to identify relevant subcategories and categories. The frequencies of these subcategories and categories were then evaluated. RESULTS: Eleven subcategories and four categories were identified. The kappa coefficient of these subcategories, determined by two independent raters, was 0.89. Subcategories with the highest frequencies among participants were as follows: having symptoms of cancer progression (n = 20; 67%), suffering because of insufficient pain control (n = 11; 37%), and being informed about getting cancer (n = 10; 33%). The four categories were as follows: worsening of physical condition (n = 20; 67%), bad news from doctors (n = 19; 63%), difficulty in treatment (n = 18; 60%), and emotional conflict with family (n = 6; 20%). CONCLUSION: This study identified the components and frequencies of traumatic events among patients with cancer that lead to the onset of nurse compassion fatigue. Such information will aid in understanding the triggers of compassion fatigue, allowing for possible preparation to reduce the risk of this occupational hazard.

Factors related to the fatigue of relief workers in areas affected by the Great East Japan Earthquake: survey results 2.5 years after the disaster.

BACKGROUND: After the Great East Japan Earthquake (March 11, 2011), the fatigue of relief workers became a major problem in affected areas. In the present study, we conducted a questionnaire survey 2.5 years post-disaster identifying factors related to the fatigue of relief workers. METHODS: This survey was cross-sectional and participants (N = 119) were relief workers living in affected areas. We used a self-administered questionnaire which included participants' current problems, sources of strong feeling of loss, psychological distress and compassion fatigue. Based on answers (Yes/No) to the fatigue item, we created 2 groups; a Fatigue-group and a Non-fatigue group. We employed bivariate analysis on items with significant differences between the two groups and entered them into a multivariable logistic regression model. RESULTS: Fifty-seven (48%) reported that they were "very tired" and were assigned to the Fatigue group. The total score of the 6-item Kessler Psychological Distress Scale (K6) and each subscale score (burnout, secondary trauma, and compassion satisfaction) of the Professional Quality of Life measure (Pro-QOL) in the Fatigue group were significantly higher than those in the Non-fatigue group. There were significant differences between the two groups for 11 items relating to current problems and sources of strong feelings of loss, and the following items were extracted as factors related to the fatigue of relief workers: loss of trust in others (adjusted OR, 10.03: 95%CI, 2.30-43.79), no confidence to continue work (adjusted OR, 6.27: 95%CI, 1.72-22.83), loss of important person(s) (adjusted OR, 5.58: 95%CI, 2.05-15.19), and sleep disturbance (adjusted OR, 5.14: 95%CI, 1.93-13.67). CONCLUSION: Many relief workers who reported fatigue had experienced various losses and current problems. Adequate consideration and care systems for local relief workers with fatigue should be given for a long-period after a disaster and it is important for the workers themselves to continue accepting support from others and maintaining self-care habits.

Cognitive reactions of nurses exposed to cancer patients' traumatic experiences: A qualitative study to identify triggers of the onset of compassion fatigue.

OBJECTIVE: Nurses in cancer care are considered to be at risk for compassion fatigue because they are frequently exposed to patients' traumatic experiences. However, only a few effective empirical studies have been conducted in this field, and cognitive factors in particular have not been sufficiently studied. This study aims to describe the components of nurses' cognitive reactions from their exposure to cancer patients' traumatic experience to the onset of compassion fatigue. METHODS: In this qualitative study, 30 nurses in cancer care were purposively selected. Data were collected through semistructured interviews and analyzed by using content analysis and the constant comparative method. RESULTS: Forty attributes were identified from 613 statements and classified into 11 categories: sense of professional inadequacy, compassion for patients and their families, desire to support patients and their families, rumination on oneself or one's family, sense of professional mission, dissatisfaction with medical staff, desire to integrate with colleagues, desire to avoid one's duties, conflict between one's belief and reality, reconsideration of the meaning of life, and sense of powerlessness over cancer. CONCLUSIONS: This study identified important components of cognitive reactions of nurses who encounter the traumatic experiences of cancer patients in Japan. This information can contribute to the understanding of the onset of compassion fatigue and provide the foundation for nurses in cancer care to avoid and recover from compassion fatigue.

Effect of guided, structured, writing program on self-harm ideations and emotion regulation.

AIMS: This study investigated the efficacy of structured writing on reducing self-harm ideations and enhancing emotion regulation. METHODS: Japanese university students (N=22) participated in the study. Participants were randomly assigned to the structured writing group (n=10; 70% female), or an assessment only control group (n=12; 67% female). For three consecutive days, participants in the intervention group performed structured writing that included psycho-education and self-reflection about emotions. The Self-Harm Ideation Scale, the Generalized Expectancy for Negative Mood Regulation Scale, and the Acceptance and Action Questionnaire-II were used to assess outcomes. RESULTS: Structured writing had a short-term effect on expectancies for self-regulation of negative moods and acceptance of negative emotions, but had a limited effect on self-harm ideations. CONCLUSION: This study presents preliminary evidence that increasing awareness, learning, and reflection about emotions resulting from using a structured writing program is particularly useful for regulating emotions. J. Med. Invest. 64: 74-78, February, 2017.