SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
Mrs. NAIR SRILATHA BHASKARAN
FIRST YEAR M Sc NURSING
PSYCHIATRIC NURSING
2011 – 2013
MANASA COLLEGE OF NURSING,
MALUR
Karnataka.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / Mrs. SRILATHA2 / NAME OF THE INSTITUTION / MANASA COLLEGE OF NURSING, MALLUR, KARNATAKA
3 / COURSE OF STUDY AND SUBJECT / I YEAR M. Sc. NURSING
PSYCHIATRIC NURSING
4 / DATE OF ADMISSION TO COURSE / 17-10-2011
5 / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE EFFECTIVENESS OF INTERVENTIONAL PACKAGE ON LEVEL OF SELF ESTEEM AND BURNOUT AMONG NOVICE NURSES IN SELECTED HOSPITALS BANGALORE”
6.0
/ BRIEF RESUME OF THE INTENDED WORK :
INTRODUCTION
Burnout is a unique type of stress syndrome that is fundamentally characterized by “emotional exhaustion”. Because of the nature of their work, health care professionals are at especially high risk for experiencing the emotional exhaustion component of burnout. This is problematic because, as Lafer observed, “the stress, danger, exhaustion, and frustration that have become built into the normal daily routine of hospital nurses constitute the single biggest factor driving nurses out of the industry.” Others have echoed this link between current work conditions and high rates of turnover. Noting the close connection between feelings of burnout and intentions to leave one’s job. In an international study on hospital care, Aiken and her colleagues have demonstrated that nurses experience burnout at significantly higher rates than expected for medical workers based on national norms In another study, 43% of surgical nurses who reported high levels of burnout said that they intended to leave their jobs within the next 12 months. In comparison, only 11% of nurses who were not burned out stated that they intended to leave their jobs.
Exhausted, discouraged, saddened, powerless, frightened – these are the emotions experienced by nurses on a daily basis. Nurses’ negative feelings about their jobs, including their feelings of burnout, tend to be influenced more by the organizational practices governing the workplace than by the challenges inherent in caring for others. Supporting this view, a report based on the National Sample Survey of Registered Nurses indicated that it was the “structure of the job, rather than the composition of the work” that influenced nurses’ job satisfaction. Despite the prominent role that feeling and emotion play in nurses’ self-reflections about their work, few researchers have systematically examined the emotional components of nurses’ work experiences and their relationship to the experience of burnout.
ANA concerning “how nurses felt as they left their jobs each day.” The ANA reported that the four most frequent responses were: Exhausted and discouraged (50%); discouraged and saddened by what I couldn’t provide for my patients (44%); powerless to affect change necessary for safe, quality patient care (40%); and frightened for patients (26%). Exhausted, discouraged, saddened, powerless, frightened – these are the emotions experienced by nurses on a daily basis. Recognizing that burnout is rooted in such intense emotional experiences is integral to specifying the facets of the work environment that are directly affecting nurses’ well-being and to effectively managing the hospital work environment in ways that can improve nursing outcomes. As others have shown, having a healthy and satisfied workforce is consistently associated with higher rates of patient satisfaction This is especially true in the case of nursing, a profession whose “ethic of care” is central to its claim for professional distinctiveness and in which the ability to effectively manage one’s own and others’ emotions is critical to the provision of excellent patient care
Despite the central place that emotion holds in the conceptualization of burnout studies indicating that the experience and management of emotion are critical to nursing practice scholars know relatively little about how emotional experiences may differ among nurses or whether such experiences correlate directly with job burnout. ...scholars know relatively little about how emotional experiences may differ among nurses or whether such experiences correlate directly with job burnout. As an initial step toward increased understanding, this paper explores the types of emotional experiences reported by direct care hospital nurses and how these are related to burnout. In what follows, we examine the prevalence with which direct care hospital nurses experienced and managed their emotions at work, and the extent to which these occupational experiences were associated with reports of job burnout. Because turnover has been shown to be particularly high among registered nurses who are under the age of 30.
The nursing shortage in the United States has resulted in a need for newly graduated novice nurses to rapidly transition into the nursing workforce. Although some nursing schools provide clinical experience in the intensive care unit (ICU), many novice nurses are not confident about their skills in providing critical-care nursing. To assist novice nurses in rapidly transitioning into the ICU nurse role, an innovative internship program for novice nurses was designed and implemented. A pilot study was conducted to determine if working with experienced nurses in the ICU environment, in addition to formal education and skills training in critical-care nursing, enables novice nurses to effectively transition into the role of ICU nurse. Qualitative and quantitative results of the program after the second year are discussed. This study examined the effects on veteran and novice participants of a life review program designed for nursing home residents with Alzheimer's disease or severe cognitive dysfunction. Using a pre-post test experimental design, veterans, novices and the control group were tested for changes in disorientation, social interaction, and self-esteem. The results confirm the findings of an earlier study [1] that there is an impact of the Life Review Program on level of disorientation, social interaction and life review. There is some evidence to suggest that the improvements may be somehow stored in memory and triggered when the program is repeated.
6.1. NEED FOR THE STUDYIt is crucial for novices to be aware that they need more expertise, without depriving them of their self-confidence. They will have to set goals for achieving expertise as soon as their teaching experience allows them to do so. It is crucial that student NEs is exposed to clinical situations in such a way that they gain the necessary skills before they go into actual teaching. Novices clearly expressed their need for more teaching exposure, and it is recommended that nursing schools participate in the education and training of student NEs, to enable these novices to acquire the necessary skills.The effective implementation of mentoring programmes in the nursing schools may require the expenditure of a great deal of energy and redirection of considerable resources. It requires a realignment of roles, outcomes, competencies and relationships. It also raises new potentially divisive issues of responsibility and control over the accompaniment of novices. It is therefore crucial that the principals of the nursing schools foster a culture of novice support and accompaniment. If a culture of support and accompaniment of novices is fostered in the RSA nursing context, and if novices can be supported competently by their mentors, they may suffer less reality shock once they enter the nursing education fields, and become more competent in LRIM. This necessitates senior NEs who are willing to put in more effort for a few weeks per year, to act as mentors for novices and/or student NEs. Mentors should also foster a climate of trust between themselves and novices, and create self-confidence by providing support, and constructive criticism when justified. Most of the Hospitals there is a planned process to help novice nurses to socialize with the new context, with congruent assignment and evaluation (the percentage varied from 66% in emergency rooms to 100% in Neurosurgery Intensive Care Units). In every hospital, a novice nurse is assigned to expert nurses who help him/her during the first months. The period in which a novice nurse is in excess in the staff and where He/She depends closely to mentor's supervision varies from one to three months. The total planned socialization period varied from three to six months but It is never shorter then tree months. The nurses' turn-over is a criticality since it often causes a decrease in the abovementioned periods. The criteria used to chose experts nurses often include clinical experience and good evaluation of their job. In the examined contexts, expert nurses lacked specific qualifications in educational skills or specific training adult education.
Assertiveness training is important in nursing for two main reasons. One is that nurses are charged with making sure that patients are following the treatment plan. For example, a patient with heart disease will have a restricted diet but if he is not following this, he is putting his life in danger. A nurse must be able to communicate with the patient why it is so important that he follow the doctor's orders. The second reason assertiveness training is important is to prevent burnout. Nurses have a high risk of burnout, particularly novice nurses. Burnout is an experience of exhaustion and lost of interest. Most people who become nurses do so with a desire to help people. If a nurse sees that a patient is not getting better or is not following doctor's orders and feels powerless to help rectify the situation, then she risks burnout.
According to a study done in Japan, as reported by Medical News Today, novice nurses tend to burnout more easily when their assertiveness scores are too low. Assertiveness training helps prevent this because it empowers nurses to communicate effectively to assist in patient recovery.
Because of all these the investigator felt a need to assess the effectiveness of interventional package on level of self esteem and burnout among novice nurses in selected hospitals Bangalore
6.2 REVIEW OF LITERATURE
Review of literature is a systematic search of published work to gain information about a research topic. Review of relevant literature serves as an essential background for any research. Critical examination of previous studies will help researcher to formulate and delimit the problem, to suggest theoretical framework for the study, to learn from the reported experience of others about its feasibility to critically evaluate the various methods used by others and choose the most appropriate design for the investigation.16
Here the review of literature of the present study has been divided under the following areas:-
1. Literature related to self esteem and burnout.
2. Literature related to effectiveness of assertiveness training.
3. Literature related to effectiveness of assertiveness training on self esteem and burnout.
1. Literature related to self esteem and burnout:A study aimed to clarify the factors affecting rapid turnover of novice nurses in a prospective manner. Carried out an investigation in 20 university hospitals whose directors of nursing service departments accepted our request to cooperate with our research program. These hospitals were selected from all of the 102 university hospitals listed in The Hospital Catalog of Japan. The subjects were 1,203 novice hospital nurses who gave their informed consent for participation in our study. The questionnaires, which dealt with burnout, assertiveness, stressful life events, reality shock, ward assignment preference, transfer preference, job satisfaction (workplace, salary, workload, and overtime), social support and coping mechanisms were completed by 923 novice nurses in June 2003. Then, their turnover was investigated in December 2003. Thirty-seven novice nurses (4.0%) quit during this period. Multiple logistic regression analysis showed that the factors affecting rapid turnover were 1) graduation from vocational nursing schools, 2) dissatisfaction with assignment to a ward contrary to their desire, and 3) no peers for support. Assignment of novice nurses towards they choose as far as possible, avoidance of assigning novice nurses towards alone, and establishment of a support system for nurses who graduate from vocational nursing schools seem to be important for preventing rapid turnover of novice nurses.
A survey data collected from 843 direct care hospital nurses, we show that, compared to their older counterparts, nurses under 30 years of age were more likely to experience feelings of agitation and less likely to engage in techniques to manage these feelings. Younger nurses also reported significantly higher rates of burnout and this was particularly true among those experiencing higher levels of agitation at work. We conclude by suggesting the need for increased awareness of the emotional demands facing today’s nursing workforce as well as the need for more experienced nurses to serve as emotional mentors to those just entering the profession.
In an another study Registered nurses employed within two acute care hospitals in an urban midwestern city were provided with a questionnaire at their place of employment. Eighty-one percent of the eligible registered nurses returned completed surveys. Although data were collected from both direct-care nurses and nurse managers, in this paper , limit the sample to the 829 registered nurses who provided direct care to hospital patients and for whom complete data were available. In this study examined the emotional exhaustion dimension of burnout, emotional experiences, and emotional labor both generally and by age. For the purposes of this study, nurses’ age was measured in years and then dichotomized to create a variable identifying those under the age of thirty (Over 30 = 0; Under 30 = 1). The emotional exhaustion dimension of the Maslach Burnout Inventory (MBI) was used to assess job burnout Emotional experiences were assessed using a question that asked nurses how strongly or intensely they felt twelve different emotions while they were at work during the past week. factors analyses indicated that positive emotions and agitated emotions were the most commonly reported and, as a result, they serve as the focus for this paper. The “positive emotions” scale was created by summing the responses for happy, proud, excited, calm, and relaxed). The “agitated emotions” scale summed responses for the feelings of frustration, anger, and irritation
This study among a sample of 207 general practitioners (GPs) uses a five-year longitudinal design to test a process model of burnout. On the basis of social exchange and equity theory, it is hypothesized and found that demanding patient contacts produce a lack of reciprocity in the GP–patient relationship, which, in turn, depletes GPs' emotional resources and initiates the burnout syndrome. More specifically, structural equation analyses confirmed that—both at T1 and T2—lack of reciprocity mediates the impact of patient demands on emotional exhaustion. Emotional exhaustion, in turn, evokes negative attitudes toward patients (depersonalization), and toward oneself in relation to the job (reduced personal accomplishment). Moreover, this process model of burnout was confirmed at T2, even after controlling for T1-scores on each of the model components. Finally, T1 depersonalization predicted the intensity and frequency of T2 patient demands, after controlling for T1 patient demands. This major finding suggests that GPs who attempt to gain emotional distance from their patients as a way of coping with their exhaustion, evoke demanding and threatening patient behaviors themselves.