This paper aims to offer methodological insight into the reflexive use of metaphors that assist in revealing the emotional labour of health care staff to themselves and to the researcher. It focusses ...on the method utilised for these semi-structured interviews, targeting the engrained and emotive experiences of emotional labour using metaphors. Taking metaphors from the ethnographic observation, ‘to’ the interview setting, proved a stimulating tool for lively discussion and narrative sharing. This approach offered an invaluable and enlightening tool for exploring the nurse’s experiences, it gave them a point of reference to discuss their challenging and personal experiences. It can offer other researchers, and particularly those studying ‘invisible’ labour (by subconscious nature or lack of physicality) a novel approach to data collection. The empirical study underpinning this article set out to explore, in particular, the ‘invisible’ emotional labour undertaken by nurses working within the emergency department (ED) setting. This is a clinical and nursing speciality facing sustained pressure in the English National Health Service (NHS) – a challenging and distinctive environment to nurse. Two EDs were used as the case studies for an in-depth ethnography (one District General Hospital and one University Teaching Hospital and Trauma Centre). As part of this, the 18 semi-structured, formal interviews were completed with ED nursing staff (to explore their experiences of emotional labour) and data was collected over a 6 month period.
Through their analysis, the authors identified several tensions between the realities of healthcare delivery that seem incompatible with and affect the psychological ill-health of the workforce. ......they call for an urgent need to restore the balance in four key areas and prioritise multilevel systems approaches that consider the conflicting demands between meeting service delivery requirements, and protecting the workforce: Over the last 30 years, the unwaning pressure on healthcare services in contemporary practice has increased the intensity of emotional work, as staff still strive to ‘balance’ meeting patient expectation, their own professional expectations of what ‘good’ care looks like and operational demands. Certain types of emotional labour (namely ‘deep acting’, where staff try to manipulate true feelings to conform to the ‘expected’ emotional display) are related to burnout, poor well-being and intention to leave.13 This can result in secondary trauma, ‘moral injury’, suppressing guilt, frustration and grief as staff are unable to deliver care which aligns with their professional values.14 In a study undertaken during the COVID-19 pandemic, healthcare workers were twice as likely as the general population to experience post-traumatic stress disorder, and one in five met the threshold for conditions such as anxiety and depression.15 In practice though, strategies to address psychological well-being often focus on strengthening an individual’s resilience and are usually designed to respond to acute trauma (eg, trauma-focused peer support known as ‘TRiM’) rather than considering cumulative stress and moral injury. ...the nurses left behind are twice as likely to be dissatisfied with their jobs, to show high burnout levels, and to report low or deteriorating quality of care in their hospitals,21 continuing the cycle.
ObjectivesTo identify and present the available evidence regarding workforce well-being in the emergency department.DesignScoping review.SettingThe emergency department (ED).Data sourcesCINAHL, ...MEDLINE, APA PsycINFO and Web of Science were searched with no publication time parameters. The reference lists of articles selected for full-text review were also screened for additional papers.Eligibility criteria for study selectionAll peer-reviewed, empirical papers were included if: (1) participants included staff-based full-time in the ED, (2) ED workforce well-being was a key component of the research, (3) English language was available and (4) the main focus was not burnout or other mental illness-related variables.ResultsThe search identified 6109 papers and 34 papers were included in the review. Most papers used a quantitative or mixed methods survey design, with very limited evidence using in-depth qualitative methods to explore ED workforce well-being. Interventions accounted for 41% of reviewed studies. Findings highlighted pressing issues with ED workforce well-being, contributed to by a range of interpersonal, organisational and individual challenges (eg, high workloads, lack of support). However, the limited evidence base, tenuous conceptualisations and links to well-being in existing literature mean that the findings were neither consistent nor conclusive.ConclusionsThis scoping review highlights the need for more high-quality research to be conducted, particularly using qualitative methods and the development of a working definition of ED workforce well-being.
This study describes the psychological effects of an experience of death education (DE) used to explore a case of suicide in an Italian high school. DE activities included philosophical and religious ...perspectives of the relationships between death and the meaning of life, a visit to a local hospice, and psychodrama activities, which culminated in the production of short movies. The intervention involved 268 high school students (138 in the experimental group). Pre-test and post-test measures assessed ontological representations of death, death anxiety, alexithymia, and meaning in life. Results confirmed that, in the experimental group, death anxiety was significantly reduced as much as the representation of death as annihilation and alexithymia, while a sense of spirituality and the meaning of life were more enhanced, compared to the No DE group. These improvements in the positive meaning of life and the reduction of anxiety confirmed that it is possible to manage trauma and grief at school with death education interventions that include religious discussion, psychodrama and movie making activities.
This article describes the ways in which students move from being almost fearful of research to becoming practitioners who undertake research with confidence. The students are part of a top up BSc ...(Hons) Humanistic Integrative Psychotherapy programme; they are skilled, experienced and accredited practitioners who have to undertake a psychotherapy degree due to changes in Irish law. This article focuses on the ways in which action methods are used to guide the students through the research process from question-finding through to writing their proposals and onwards to completing their research projects. Psychodrama principles of warm up, action and sharing are integral to the process. Sharing is an expected and fundamental part of the process and takes the form of disseminating key results to their psychotherapy colleagues locally, nationally and internationally in print and at conference presentations
This article, for the Zeitschrift für Psychodrama und Soziometrie, focuses on a study that used collaborative qualitative research methodology; namely the Co-operative Inquiry Cycle (1988). ...Co-operative Inquiry Cycle (CI) aimed to identify the ways in which psychodramatists worked with people who were survivors of sexual abuse and how they ensured that the protagonist experience was healing rather than harmful and re-traumatising. This study comprised of four senior psychodrama trainers/practitioners, who acted as co-researchers and co-subjects for two cycles. The texts were collected through semi-structured interview, audio-taped and transcribed; once analysed any questions unanswered or issues that were unclear formed the basis of the second cycle of inquiry. Analysing qualitative text presents challenges to new practitioner researchers, so there is an emphasis on how to do this, using material from the study and how to present the results in coherent ways.
Aims and objectives
This research aimed to investigate the use of intentional rounding within in the emergency department setting through exploration of the staff nurse experience. The focus was its ...implementation at a large teaching hospital in England.
Background
Research into the use of intentional rounding in any area of practice is minimal in the UK; however, a broader evidence base comes from America. The majority of this research supports the notion of intentional rounding for improved patient care and outcomes. Research from the UK is generally more contested. There is less literature on using intentional rounding specifically in the emergency department setting.
Design
Qualitative methodological approach.
Methods
Semi‐structured interviews (n = 5) were completed with staff nurses working within an emergency department. A purposive sampling technique was used for recruitment. The data was then analysed using ‘Framework Method of Qualitative Analysis’ (Spencer et al. 2014).
Results
The findings were categorised into four headings: (1) Improved patient experience, (2) Current unmanageability, (3) Adapting for the emergency department, (4) Benefits on achieving quality indicators and targets.
Conclusion
The findings show that although staff felt the introduction of intentional rounding techniques could lead to improvements in patient safety and overall care experience, they also identified a range of difficulties and adaptations needed to ensure its success within this acute care environment.
Relevance to clinical practice
The research offers an insight into the staff's perceptions of using intentional rounding and also explains the practical difficulties faced by the nursing staff with potential suggestions that may help to address these problems. Benefits include more open communication between staff and patients and potentially more timely response to patient need, which positively impacts levels of safety and satisfaction. Barriers include lack of staff engagement, and the environmental factors and pressures, within the ED setting.
This book explores the exciting areas of overlap between psychodrama and other therapeutic schools and presents opportunities for their creative interaction and integration. Psychodramatists, to ...varying degrees, integrate the ideas and philosophies of other forms of psychotherapy into their clinical practice. Similarly, other therapists make use of the action methods of psychodrama. This edited volume contains contributions from a variety of dual-trained therapists qualified in psychodrama and trained in another therapeutic modality, including dramatherapy, occupational therapy, art therapy, family therapy, cognitive behavioural therapy (CBT), and more. Each chapter considers a different model of interaction and integration between therapeutic schools and explains how they can enhance and enrich a therapist's professional practice. In doing so, this book reveals an understanding of the core commonalities of the therapeutic process. With clinical case studies illustrating enhanced practice through creative interaction of the therapeutic schools, this book will be of interest to psychodramatists and all other therapists who integrate action techniques into their clinical practice.
Aims
This study aims to apply Hochschild's theory of emotional labour to emergency care, and uncover the ‘specialty‐specific’ feeling rules driving this labour. Despite the importance of positive ...nurse well‐being, the emotional labour of nursing (a great influencer in wellbeing) remains neglected.
Design and Methods
Ethnography enabled immersion in the ED setting, gathering the lived experiences and narratives of the ED nursing team. We undertook first‐hand observations at one major trauma centre ED and one district general ED including semi‐structured interviews (18). A reflexive and interpretive approach towards thematic analysis was used.
Results
We unearthed and conceptualized four feeling rules born from this context and offer extensive insights into the emotional labour of emergency nurses.
Conclusion
Understanding the emotional labour and feeling rules of various nursing specialties offers critical insight into the challenges facing staff ‐ fundamental for nursing well‐being and associated retention programs.
Impact
What problem did the study address?
What were the main findings?
Where and on whom will the research have impact?
Academically, this research expands our understanding ‐ we know little of nurses’ feeling rules and how specialties influence them. Clinically, (including service managers and policy makers) there are practical implications for nurse well‐being.
摘要
目的
本研究旨在将霍赫希尔德的情绪劳动理论应用于急诊护理中, 并对推动此类劳动的“特殊”情绪规则进行披露。护士幸福感极为重要, 但目前, 护士的情感劳动 (对幸福感有巨大影响) 仍然遭到忽视。
设计和方法
人种学常见于ED, 因此, 应收集ED护理团队的生活经验和叙述性资料。目前, 我们已在主要创伤中心ED和普通ED进行观察, 并开展半结构化访谈(18)。主题分析过程中, 采用了自反和解释性方法。
结果
我们发掘四个由此产生的情感规则, 将其概念化, 并为急诊护士的情绪劳动提供广泛见解。
结论
了解各类护理人员的情感劳动和情感规则, 有助于深入了解职员面临的挑战, 而此也是护理健康和相关保留项目的基础。
影响
该研究解决了什么问题?
主要调查结果是什么?
本研究将在何处产生影响, 主要针对谁?
就学术层面而言, 本研究将扩大人们对护士情感规则和专业影响的理解——目前, 人们对此知之甚少。临床层面而言, (包括服务经理和政策制定者) 本研究对护士健康有实际意义。
Aims
This is the second of two papers conceptualizing emotional labour in the emergency department (ED). This paper aims to understand the environmental ‘moderators’ of ED nurses’ emotional labour.
...Design
Ethnography, through an interpretivist philosophy, enabled immersion in the ED setting, gathering the lived experiences and narratives of the ED nurses.
Methods
Observation and semi‐structured interviews over a 6‐month period. Two hospital sites (one district general and one major trauma centre based in the United Kingdom.
Results
Over 200 h of observation plus 18 formal/semi‐structured interviews were completed. Environmental, institutional and organizational dynamics of the emergency department instrumented the emotional labour undertaken by the nursing team. Time and space were found to be ‘moderators’ of ED nurses' emotional labour. This paper focusses on the relevance of space and in particular, ‘excessive visibility’ with little respite for the nurses from their intense emotional performance.
Conclusion
Emotional labour is critical to staff well‐being and the way in which healthcare spaces are designed has an impact on emotional labour. Understanding how emotional labour is moderated in different clinical settings can inform organizational, environmental and workforce‐related decision‐making.
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