Mason Virginia M, Leslie Gail, Clark Kathleen, Lyons Pat, Walke Erica, Butler Christina, Griffin Martha
Virginia M. Mason, PhD, RN, ACNS-BC, CCRN, is a nurse educator for critical care at Boston Medical Center. She has a BSN from Boston College, MSN from Yale University Graduate School of Nursing, and PhD from University of Mass Worcester-Amherst Collaborative Graduate School of Nursing and has completed postdoctoral studies at Yale University Graduate School of Nursing. She has 35 years of experience as a clinical nurse specialist/nurse educator. She is a member of the Advisory Board of the Continuing Nursing Education Provider Unit, Boston University School of Medicine. Gail Leslie, MSN, RN, PMHCNS-BC, is an advanced practice nurse in urgent care psychiatry and a Connell Fellow in Ethics at Massachusetts General Hospital, Boston. She earned a BSN from Boston College School of Nursing and an MSN degree from Yale University School of Nursing. Her additional clinical experiences include 15 years of psychiatric nursing consultation in the surgical intensive care, burn, transplant and dialysis units and the emergency room Acute Psychiatry Service at Massachusetts General Hospital, and 5 years in outpatient psychiatry at the Boston VA Outpatient Clinic. Kathleen Clark, BSN, RN, MMHC, has been a practicing critical care nurse for 30 years. She has extensive experience in emergency and critical care as a staff nurse, educator, and manager. She is currently a doctoral candidate at Sacred Heart University whose research and pedagogical interests include lateral violence and undergraduate nursing students and critical care staff and patient satisfaction. Pat Lyons, MS, RN, CNS-BC, CCRN, CPAN, is a clinical educator for the surgical intensive care unit and postanesthesia care unit at Boston Medical Center. She has an ASN from Massasoit College, a BSN from University of Massachusetts Boston, and an MSN degree and a post-master's degree certificate in nursing education from Regis College. She has over 25 years of critical care nursing experience. Erica Walke, MSN, ACCNS-AG, RN, i
Dimens Crit Care Nurs. 2014 Jul-Aug;33(4):215-25. doi: 10.1097/DCC.0000000000000056.
Preparation for replacing the large proportion of staff nurses reaching retirement age in the next few decades in the United States is essential to continue delivering high-quality nursing care and improving patient outcomes. Retaining experienced critical care nurses is imperative to successfully implementing the orientation of new inexperienced critical care nurses. It is important to understand factors that affect work engagement to develop strategies that enhance nurse retention and improve the quality of patient care. Nurses' experience of moral distress has been measured in medical intensive care units but not in surgical trauma care units, where nurses are exposed to patients and families faced with sudden life-threatening, life-changing patient consequences.This pilot study is a nonexperimental, descriptive, correlational design to examine the effect of compassion satisfaction, compassion fatigue, moral distress, and level of nursing education on critical care nurses' work engagement. This is a partial replication of Lawrence's dissertation. The study also asked nurses to describe sources of moral distress and self-care strategies for coping with stress. This was used to identify qualitative themes about the nurse experiences. Jean Watson's theory of human caring serves as a framework to bring meaning and focus to the nursing-patient caring relationship.A convenience sample of 26 of 34 eligible experienced surgical intensive care unit trauma nurses responded to this survey, indicating a 77% response rate. Twenty-seven percent of the nurses scored high, and 73% scored average on compassion satisfaction. On compassion fatigue, 58% scored average on burnout and 42% scored low. On the secondary traumatic stress subscale, 38% scored average, and 62% scored low. The mean moral distress situations subscale score was 3.4, which is elevated. The mean 9-item Utrecht Work Engagement Scale total score, measuring work engagement, was 3.8, which is considered low.Content analysis was used to identify themes of Role Conflict With Management/Rules, Death and Suffering, Dealing With Violence in the Intensive Care Unit, Dealing With Family, Powerlessness, Physical Distress, and Medical Versus Nursing Values. Additional themes identified were caring, helping families, long-time interdependent relationships of colleagues, and satisfaction in trauma nursing.As work engagement increased, compassion satisfaction significantly increased, and burnout significantly decreased. Results of this study support moral distress as a clinically meaningful issue for surgical intensive care unit nurses. Moral distress scales were elevated, whereas work engagement scales were low. This finding was congruent with Lawrence's study and may reflect ongoing need for greater supports for experienced intensive care unit nurses, from both education and management. Future recommendations for research include examining the interaction of these variables in larger samples to examine additional explanatory factors as well as strategies for self-care, motivation, and behavior change.
为美国未来几十年大量达到退休年龄的注册护士做好更替准备，对于持续提供高质量护理服务和改善患者治疗效果至关重要。留住经验丰富的重症监护护士对于成功指导新入职的缺乏经验的重症监护护士至关重要。了解影响工作投入的因素对于制定提高护士留用率和改善患者护理质量的策略很重要。护士的道德困扰经历已在医疗重症监护病房进行过测量，但在外科创伤护理病房尚未进行过测量，在外科创伤护理病房，护士会接触到面临突然危及生命、改变生活后果的患者及其家属。这项试点研究采用非实验性、描述性、相关性设计，以检验同情满足感、同情疲劳、道德困扰和护理教育水平对重症监护护士工作投入的影响。这是对劳伦斯博士论文的部分复制。该研究还要求护士描述道德困扰的来源以及应对压力的自我护理策略。这用于确定关于护士经历的定性主题。琼·沃森的人文关怀理论作为一个框架，为护理-患者关怀关系赋予意义并提供重点。34名符合条件的经验丰富的外科重症监护病房创伤护士中有26名参与了这项调查，回复率为77%。27%的护士在同情满足感方面得分较高，73%得分中等。在同情疲劳方面，58%的护士在职业倦怠方面得分中等，42%得分较低。在继发性创伤压力子量表上，38%得分中等，62%得分较低。道德困扰情况子量表的平均得分是3.4，处于较高水平。测量工作投入的9项乌得勒支工作投入量表的平均总分是3.8，被认为较低。内容分析用于确定与管理/规则的角色冲突、死亡和痛苦、应对重症监护病房的暴力、应对家属、无力感、身体困扰以及医疗与护理价值观等主题。确定的其他主题包括关怀、帮助家属、同事间长期的相互依赖关系以及创伤护理中的满意度。随着工作投入的增加，同情满足感显著增加，职业倦怠显著降低。本研究结果支持道德困扰是外科重症监护病房护士临床上有意义的问题这一观点。道德困扰量表得分较高，而工作投入量表得分较低。这一发现与劳伦斯的研究一致，可能反映出经验丰富的重症监护病房护士持续需要来自教育和管理方面更多的支持。未来的研究建议包括在更大样本中研究这些变量的相互作用，以检验其他解释因素以及自我护理、动机和行为改变的策略。
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