Emotional labour in mental health nursing: An integrative systematic review

Emotional labour is the effort consumed by suppressing one's own emotions to care for others effectively while also caring for oneself. Mental health nurses are required to engage in effective therapeutic interactions in emotionally‐intense situations. The aim of the present integrative systematic review was to investigate the emotional labour of mental health work and how this manifested, the impacts, and the ways to mitigate these impacts. In June 2016, using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses methodology, a systematic search of the bibliographic databases was undertaken to identify relevant literature. Screening, data extraction, and synthesis were performed by three reviewers. The inclusion criteria included any original research that investigated the emotional work of mental health nurses. We identified a total of 20 papers to be included in this review. Thematic synthesis of the findings revealed three emergent themes: emotional labour and caring, emotional exhaustion, and self‐protection (expressed as emotional intelligence). Emotional labour, emotional exhaustion, and emotional intelligence were considered to be intrinsically linked, where they were both the influencing factor for burnout and a contributor to attrition. The results highlighted that emotional labour could inspire the development and personal growth of emotional intelligence in mental health nurses. In light of these findings, recommendations for clinical practice were considered; they included supportive work environments, involving nurses in shared decision‐making, and the provision of ongoing professional development opportunities that facilitate the development of emotional intelligence and resilience.     

Caring as a resilient practice in mental health nursing

This paper will develop a discussion about caring as a modern mental health nurse. We argue that the demands of mental health nursing today extend beyond the more traditional skills of care and caring. We believe that in order to meet mental health needs in the 21st century that caring should be extended to encompass the additional expertise of emotional intelligence and resilience. Emotional intelligence, resilience, and resilient behaviours have the potential to assist individuals to transcend negative experiences and transform these experiences into positive self-enhancing ones. This has implications for improved consumer outcomes through role-modelling and educational processes, but also may hold implications in supporting a strong workforce in mental health.     

Nexus between preventive policy inadequacies,workplace bullying,and mental health: Qualitative findings from the experiences of Australian public sector employees

Public sector organizations have been shown to have high levels of workplace bullying, despite widespread adoption of zero‐tolerance policy. Given the level of harm that stems from bullying, it has been suggested that it might be one of the most serious problems facing modern organizations. The qualitative findings from a large cross sectional study of public servants in Australia are reported in the present study. The results highlight palpable mental distress and illness stemming from exposure to workplace bullying. This distress was exacerbated by failures in prohibitive workplace procedures. Reporting bullying through formal organization processes did not lead to resolution of the problem; it instead highlighted feelings of powerlessness and mistrust. In light of the findings, we suggest that an alternative discourse is required, one that gives attention to enhancing employee resilience and self‐healing behaviours to the emotional trauma of workplaces. Organizations might be better placed investing resources in fostering the resilience and emotional intelligence of their workforce, rather than continuing to invest resources in prohibitive policies that fail to address the problem. Employees should be supported to prioritize responsibility for their own mental health, rather than an overreliance on organizational responses.     

Implementing Strong Teens for Adolescent Girls in Residential Treatment: A Quasi-Experimental Evaluation

Adolescents in residential treatment centers (RTCs) often have a severe mental illness as well as significant deficits in their social competencies. Strong Teens is a social and emotional learning (SEL) curriculum designed to decrease internalizing disorders by promoting emotional resilience and social competence. The curriculum has shown promising effects in educational settings. This study is the second to implement Strong Teens in residential treatment with high-risk adolescents. Using a quasi-experimental wait-list control design, therapists implemented Strong Teens with 36 adolescent girls in an RTC during group therapy. The researchers assessed changes in social and emotional knowledge, internalizing symptoms, and resilience using a split-plot repeated measures ANOVA, paired samples t-tests, and effect sizes. Although results indicated that Strong Teens did not affect the girls’ social and emotional knowledge, the intervention did show evidence of reducing their internalizing symptoms and increasing their resilience. In a social validity survey, most group therapists agreed with the goals and procedures of the curriculum but were less certain regarding the outcomes. We recommend that future studies of this population investigate which SEL topics are most suitable, identify the most favorable lesson times for RTC implementation, and explore student perspectives and experiences with Strong Teens.     

Emotional intelligence as a mechanism to build resilience and non‐technical skills in undergraduate nurses undertaking clinical placement

The environments in which nursing work is undertaken can be highly stressful and complex with resultant harmful outcomes for the health of both nurses and patients reported. Undergraduate nursing students are particularly challenged when on clinical placement through having only partially developed work capabilities, with wide claims that these nurses remain underprepared for work even upon graduation. Over time undergraduate nursing education has arguably not prioritized developing resilience and other non‐technical skills required to respond effectively to these challenges. This paper reports findings from a qualitative study of student nurses who received training and coaching in emotional intelligence, a well‐established correlate of resilience, just prior to undertaking a mental health or medical/surgical clinical placement. Of that cohort, 12 agreed to qualitative semi‐structured interviews that sought to better understand how these students used the knowledge and capabilities from the training within clinical placement contexts. Four themes emerged from the thematic analysis of the interviews: (1) greater experiences of resilience; (2) responding positively to mental health consumers; (3) experiences of greater empathy and compassion; and (4) experiences of improved non‐technical work skills. Implications from these findings suggest that student and patient experiences of nursing placement, and mental health nursing placements in particular, would be enhanced by pre‐placement emotional intelligence training and coaching. Such training will support nursing graduates to be work‐ready upon entering the workforce.     

Workplace resilience and emotional labour of Australian mental health nurses: Results of a national survey

Emotional labour is a form of adversity faced by mental health nurses in the context of their workplace interactions. Frequent exposure to emotional adversity can negatively impact mental health nurses’ biopsychosocial well‐being, workplace relationships, and performance. Workplace resilience is a dynamic interactive process within and between the person and their environment that promotes positive adaptation to adverse events and restores well‐being. Workplace resilience could be a protective process that helps mental health nurses positively adapt to workplace emotional adversity. This study aimed to investigate Australian mental health nurses’ workplace resilience and emotional labour and explore the relationship between them. A national cross‐sectional online survey comprising the Resilience at Work and Emotional Labour scales was completed by registered nurses (n = 482) working in a mental health role or setting across Australia. There was a strong negative relationship between resilience and the emotional labour strategy of surface acting. A positive association between resilience, frequency of emotional labour, and clinical supervision was also found. These findings point to a potential link between mental health nurses’ skills of cognitive reframing, and emotional and behavioural regulation needed to effectively manage their emotions and remain therapeutic in interpersonal interactions. Clinical supervision may be a key strategy in supporting mental health nurses’ resilience. Further investigation of workplace individuals’ internal and external resources, and organizational resources, supports, and strategies that can promote and strengthen mental health nurses’ well‐being is needed.     

Burnout phenomenon: neurophysiological factors,clinical features,and aspects of management

Burnout syndrome is a distinct “occupational phenomenon” rather than a medical condition, comprising emotional exhaustion, physical fatigue, and cognitive weariness. Both exogenous work-related and endogenous personal factors determine the extent and the severity of symptoms in burnout syndrome. Persistent burnout is a cause of reduced quality of life and is associated with increased risk of sleep impairment and with several medical disorders including mild cognitive impairment, diabetes, and cardiovascular disease.Active coping strategies promoting mental resilience and adaptive behavior, stress-reducing activities, improving work conditions, and reducing exposure to work stressors together may alleviate the distress of burnout and should be introduced early in the clinical course of burnout syndrome. The purpose of this review was to explain this complex and puzzling phenomenon and to describe burnout management.     

情绪伪装

情绪伪装是个体情绪体验与情绪表现不一致的行为。它在社会生活中习得并且终身发展,受到社会环境、家庭、教育及同伴关系等因素的影响,并且由于个体的认知、情感和行为不同而采取不同的策略、产生不同的结果,对个体的生理、心理和社会功能均会产生影响。     

Resilience: a concept analysis

TOPIC: Concept analysis of resilience. PURPOSE: To analyze the concept of resilience and provide a definition of resilience that is contextually independent of specific age-related groups or populations. SOURCES: Published literature. CONCLUSIONS: Resilience is being increasingly studied in innovative ways among diverse populations. The broadly accepted definition of the term, however, has evolved through literature related specifically to children and adolescents. This concept analysis can provide a fundamental definition of resilience that is derived from the evolution of the term but broadly supports contemporary applications. Resilience researchers can apply this definition when exploring the possibility of resilience-based interventions.     

社区女性乳腺癌患者与非乳腺疾病者的情绪管理差异分析

目的 调查社区女性乳腺癌患者与非乳腺疾病者情绪调节自我效能感、情绪控制现状,并分析其差异性。方法 以一般资料调查表、情绪调节自我效能感量表和中文版考陶尔德情绪控制量表为工具,采用方便抽样法,对西安市社区卫生服务中心妇女保健科管理的女性乳腺癌患者(268例)、非乳腺疾病者(341例)进行调查,并按照倾向性评分1∶1匹配的原则得出乳腺癌组(209例)和非乳腺疾病组(209例),比较2组间情绪控制和情绪调节自我效能的差异。结果 乳腺癌组患者和非乳腺疾病组受试对象情绪控制总分分别为(54.18±7.51)分、(48.56±9.42)分,独立样本t检验结果显示2组间情绪控制总分及各维度得分比较,差异均有统计学意义(t=5.757,4.504,3.168,2.682;均P<0.05);乳腺癌组患者和非乳腺疾病组受试对象情绪调节自我效能感总分分别为(47.32±5.40)分、(58.72±3.97)分,独立样本t检验结果显示2组间情绪调节自我效能感总分及各维度得分比较,差异均有统计学意义(t=19.248,9.842,8.252,7.755,9.266,5.598;均P<0.001)。结论 社区女性乳腺癌患者情绪控制水平较高,而情绪调节自我效能感水平较低。     

Emotional intelligence in nursing work

BACKGROUND: Emotional labour has been widely accepted in the literature as part of nursing work, however the contribution of emotional intelligence in the nursing context requires further study. AIM: This paper aims to present an analysis of the literature on emotional intelligence and emotional labour, and consider the value of emotional intelligence to nursing. METHOD: A literature search was undertaken using the CINAHL and MEDLINE databases. Search terms used were 'emotions', 'intelligence', 'emotions and intelligence' and 'emotional labour'. A hand-search of relevant journals and significant references added to the data. RESULTS: Emotional intelligence plays an important part in forming successful human relationships. Emotional labour is important in establishing therapeutic nurse-patient relationships but carries the risk of 'burnout' if prolonged or intense. To prevent this, nurses need to adopt strategies to protect their health. The potential value of emotional intelligence in this emotional work is an issue that still needs to be explored. CONCLUSIONS: Analysis of the literature suggests that the modern demands of nursing draw on the skills of emotional intelligence to meet the needs of direct patient care and co-operative negotiations with the multidisciplinary team. The significance of this needs to be recognized in nurse education. The link between emotional intelligence and emotional labour is a fruitful area for further research. The potential benefits of gaining a better understanding of how these concepts interact is largely conjecture until we have more evidence. The prospect that there may be advantages to both nurses and patients is a motivating factor for future researchers.     

心理韧性10年文献回顾及其对心理护理的启示

目的通过回顾国内近十年来的相关文献,对心理韧性的发展现状进行文献计量学分析,提出今后护理实践的努力方向。方法以"心理韧性"、"心理弹性"、"心理复原力"、"韧性"、"弹性"、"复原力"和"Resilience"分别作为主题词和关键词,在中国知网(China National Knowledge Infrastructure,CNKI)中,检索2003-2012年的相关文献,并对文献的数量以及研究的对象、方法和内容进行分析。结果有关心理韧性的文献逐年增多,研究方法以描述性研究和综述类文章较多,研究对象多集中于大学生、青少年这类年轻的群体中,研究内容以综合性研究和相关性研究居多。结论心理韧性的研究越来越引起国内研究者的关注,但是研究方法单一,研究对象分布不均衡,研究内容较局限,在心理护理领域中的应用还需做出进一步的努力。