Burnout and resilience in critical care nurses: A grounded theory of Managing Exposure.

BACKGROUND: Many critical care nurses experience burnout; however, resilience shows promise as a potential solution to burnout. This study was conducted to better understand nurse burnout and resilience in response to workplace adversity in critical care. DESIGN: A grounded theory investigation, using the Corbin and Strauss methodology. Participants engaged in qualitative, open-ended interviews about burnout and resilience. SETTING: A multi-site, urban, teaching hospital in Canada. PARTICIPANTS: 11 female critical care nurses, with 1-30+ years of critical care experience. FINDINGS: Burnout and resilience can be understood as indicators in a process of responding to workplace adversity. Workplace adversity can take many forms and has a negative impact on nurses. Nurses must be aware of this impact to take action. The process of Managing Exposure is how nurses address workplace adversity, using variety of techniques: protecting, processing, decontaminating, and distancing. The indicators of this process for nurses are thriving, resilience, survival and burnout. Organisational policies can impact on this process. CONCLUSIONS: Resilience and burnout are connected, as indicators of the same process for critical care nurses. Nurse leaders can intervene throughout this process to reduce workplace adversity and support resilience among nurses.

Resisting, reaching out and re-imagining to independence: LPN's transitioning towards BNs and beyond.

Little is known about the process of how nurses transition between vocational training and institutions of higher education. Understanding this process provides educators with the knowledge to support new groups of university students making this transition. Grounded theory (GT) was used to explore and understand this process. Three studies from a 7-year research program were used as data. The analysis led to the generation of a GT illuminating the process of students transitioning from post-LPN to BN. This GT illustrates how students overcome difficulties encountered moving to a more complex nursing role. The students' main concern was a lack of independence. The core variable, which resolves this main concern, and which emerged from the analysis of the data is developing independence. There are three sub-core variables, resisting, reaching out and re-imagining which support this core variable of developing independence.

A tale of two cultures: specialists and generalists sharing the load.

OBJECTIVE: To understand what contributes to good collaborative physician working relationships through identifying the factors that affect working relationships between generalist physicians and specialists. DESIGN: Qualitative study using in-depth interviews. SETTING: University and community hospital inpatient family practice settings in Edmonton, Alta. PARTICIPANTS: Eleven physicians from various specialties who graduated between 1977 and 2001. METHODS: A grounded-theory approach, including constant comparison and creation of memorandums, helped to conceptualize the main concern and generated a framework for how the main concern was being resolved. A semistructured interview guide was developed and individual, in-depth interviews were audiotaped. Purposeful and theoretical sampling techniques were used. Three researchers participated in the analysis. MAIN FINDINGS: The findings suggested that when generalist physicians perceived that work had been imposed on them by specialists without negotiation, they felt overwhelmed by the workload. Differing priorities determined whether physicians were left holding the bag or sharing the load. In a system that valued technology and specialized knowledge and skills, the specialists were better able to control resources, set boundaries, and influence learners. This precipitated a culture of protecting valuable specialty resources, increasing physician isolation, and generalists feeling that they were left holding the bag. In order to reverse this cycle, it was important for physicians to develop good working relationships based on accessibility to needed expertise and tests, with negotiated agreements on how to share resources; mutual empowerment, including negotiation of roles and responsibilities to develop flexible relationships with a clear understanding of roles; and concern for fairness by sharing the load. CONCLUSION: Medical systems that value technology and focused interests might lead to someone being left holding the bag, contributing to generalists feeling overwhelmed and isolated within the system. A comprehensive system that values relationships might help to resolve issues created through perceived inequities in workload, disempowerment, and lack of understanding of roles.

Letting go of preconceptions: a novel approach to creating memorial services.

This article presents a novel application of grounded theory (GT) to the creation of memorial services. Several relevant aspects of GT methodology are presented that have made a positive and significant contribution to the creation of relevant, meaningful, and hopeful memorial services. The relevance of the GT (the story) that emerges as the memorial service lies in the very manner in which the story is created. Here the story itself is the means of responding to the problem, the basic social and psychological process of dealing with loss. "Letting go of preconceptions" is the core variable. It provides the means whereby the energy invested in responding to the problem is best guided in creating meaningful and hopeful stories. Suggested areas of applications and relevance for this methodology, within areas where creating stories of meaning and hope are essential to healing, also are presented.

The Self-Perception and Relationships Tool (S-PRT): a novel approach to the measurement of subjective health-related quality of life.

BACKGROUND: The Self-Perception and Relationships Tool (S-PRT) is intended to be a clinically responsive and holistic assessment of patients' experience of illness and subjective Health Related Quality of Life (HRQL). METHODS: A diversity of patients were involved in two phases of this study. Patient samples included individuals involved with renal, cardiology, psychiatric, cancer, chronic pelvic pain, and sleep services. In Phase I, five patient focus groups generated 128 perceptual rating scales. These scales described important characteristics of illness-related experience within six life domains (i.e., Physical, Mental-Emotional, Interpersonal Receptiveness, Interpersonal Contribution, Transpersonal Receptiveness and Transpersonal Orientation). Item reduction was accomplished using Importance Q-sort and Importance Checklist methodologies with 150 patients across the participating services. In Phase II, a refined item pool (88 items) was administered along with measures of health status (SF-36) and spiritual beliefs (Spiritual Involvements and Beliefs Scale--SIBS) to 160 patients, of these 136 patients returned complete response sets. RESULTS: Factor analysis of S-PRT results produced a surprisingly clean five-factor solution (Eigen values> 2.0 explaining 73.5% of the pooled variance). Items with weaker or split loadings were removed leaving 36 items to form the final S-PRT rating scales; Intrapersonal Well-being (physical, mental & emotional items), Interpersonal Receptivity, Interpersonal Contribution, Transpersonal Receptivity and Transpersonal Orientation (Eigen values> 5.4 explaining 83.5% of the pooled variance). The internal consistency (Cronbach's Alpha) of these scales was very high (0.82-0.97). Good convergent correlations (0.40 to 0.67) were observed between the S-PRT scales and the Mental Health scales of the SF-36. Correlations between the S-PRT Intrapersonal Well-being scale and three of SF-36 Physical Health scales were moderate (0.30 to 0.46). The criterion-related validity of the S-PRT spiritual scales was supported by moderate convergence (0.40-0.49) with three SIBS scales. CONCLUSION: Evidence supports the validity of the S-PRT as a generally applicable measure of perceived health status and HRQL. The test-retest reliability was found to be adequate for most scales, and there is some preliminary evidence that the S-PRT is responsive to patient-reported changes in determinants of their HRQL. Clinical uses and directions for future research are discussed.