Contenuto dell'articolo principale
Abstract
INTRODUZIONE. Il lavoro in hospice richiede agli infermieri di saper gestire una relazione empatica ma anche distaccata tanto con i morenti quanto con i loro familiari. Tale esigenza determina un lavoro emozionale impegnativo.
OBIETTIVO. Lo studio presenta i risultati di una ricerca su tale problema, svolta per rilevare le loro difficoltí relazionali.
METODO. Ventisette partecipanti si sono sottoposti a un colloquio, realizzato con l'Interpretative Phenomenological Analysis e finalizzato ad indagare i vissuti conflittuali derivanti da incidenti critici.
RISULTATI. Gli infermieri esercitano uno stressante lavoro emozionale per cercare di sciogliere la dissonanza tra quanto intimamente esperito e le norme implicitamenteassunte con il ruolo professionale, il quale richiede loro un continuo surface acting.
CONCLUSIONI. Il modello delle cure palliative conferisce grande importanza alla gestione della dimensione emozionale nella relazione con il paziente terminale e la sua famiglia. Dall'indagine emerge che questa area è particolarmente critica e richiede una specifica forma di intervento. I nodi cruciali intorno ai quali ruotano gli incidenti critici più significativi riguardano il truth telling, la sedazione terminale e il rapporto con i familiari.
PAROLE CHIAVE: assistenza infermieristica, incidenti critici, lavoro emozionale, modello palliativo, hospice
The nursing hospice care: Critical incidents in managing the relationship with patients and their families
ABSTRACT
INTRODUCTION. The hospice care requires nurses to set an empathic but also uninvolvedrelationship with both the dying and their families. This requirement results ina challenging emotional work. Aims. Detecting relational difficulties in assisting terminal patients, the study presents the results of an analysis focused on the emotional work of nurses in hospice.
METHOD. Twenty-seven nurses voluntarily participated in an interview, realized with the Interpretative Phenomenological Analysis and aimed to investigate the conflicting lived regarded as critical incidents.
RESULTS. All nurses are subject to continual emotional work to dissolve the dissonance between how intimately experienced and the implicit rules of the professional role, which seems to require their continuous surface acting.
CONCLUSIONS. The palliative care model attaches great importance to the management of the emotional dimension in the relationship with the terminally ill patient and his family. Our research shows that this area is particularly critical and requires a constant burden for nurses. We believe that the emotional work is to find specific moments aimed at elaborating the emotional overload, from which compassion fatigue and burnout may depend.
KEY WORDS: nursing, critical incidents, emotional work, palliative care, hospice
Dettagli dell'articolo
Riferimenti
- Alexander, S. C., Pollak, K. I., Morgan, P. A., Strand, J.,
- Abernethy, A. P., Jeffreys, A. S., Arnold, R. M.,
- Olsen, M., Rodriguez, K. L., Garrigues, S. K.,
- Manusov, J. R., & Tulsky, J. A. (2010). How do
- non-physician clinicians respond to advanced
- cancer patients' negative expressions of emotions?
- Support Care Cancer, 19 (1), 155-159.
- Back, A. L., Steinhauser, K. E., Kamal, A. H., &
- Jackson, V.A. (2016). Building resilience for
- palliative care clinicians: An approach to burnout
- prevention based on individual skills and
- workplace factors. Journal of Pain and Symptom
- Management, 52 (2), 284-291.
- Carmack, B. J. (1997). Balancing engagement and
- detachment in caregiving. IMAGE: Journal of
- Nursing Scholarship, 29 (2), 139-143.
- Carpineta, S. (1992). La comunicazione infermierepaziente.
- Roma: Carocci.
- Cavanagh, S. (1992). Job satisfaction of nursing staff
- working in hospitals. Journal of Advanced
- Nursing, 17 (6), 704-711.
- De Jong, J., Le Blanc, P. M., Peeters, M. C. W., &
- Noordam, H. (2008). Emotional job demands and
- the role of matching job resourses: A cross sectional
- study among health care workers. International
- Journal of Nursing Studies, 45 (10), 1460-1469.
- Flick, U. (1998). An introduction to qualitative
- research. London: Sage.
- Grandey, A. A. (2000). Emotion regulation in the
- workplace: A new way to conceptualize emotional
- labor. Journal of Occupational Health Psychology,
- (1), 95-110.
- Grandey, A. A. (2003). When "˜the show must go on':
- Surface acting and deep acting as determinants of
- emotional exhaustion and peer-rated service
- delivery. Academy of Management Journal, 46 (1)
- -96.
- Henderson, A. (2001). Emotional labor and nursing:
- An under-appreciated aspect of caring work.
- Nursing Inquiry, 8 (2), 130-138.
- Hochschild, A. R. (1979). Emotion work, feeling rules,
- and social structure. The American Journal of
- Sociology, 85 (3), 551-575.
- Lauterbach, S., & Becker, P. (1996). Caring for self:
- Becoming a self-reflective nurse. Holistic Nursing
- Practice, 10 (2), 57-68.
- Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001).
- Job burnout. Annual Review of Psychology, 52,
- -422.
- Morris, J. A., & Feldman, D. C. (1996). The
- dimensions, antecedents, and consequences of
- emotional labor. Academy of Management Review,
- (4), 986-1010.
- Pereira, S. M., Fonseca, A. M., & Carvalho, A. S.
- (2011). Burnout in palliative care: A systematic
- review. Nursing Ethics, 18(3), 317-326.
- Pringle, J., Drummond, J., McLafferty. E., & Hendry,
- C. (2011). Interpretative phenomenological
- analysis: A discussion and critique. Nurse
- Researcher, 18 (3), 20-24.
- Slocum-Gori, S., Hemsworth, D., Chan, W. W.,
- Carson, A., & Kazanjian, A. (2011).
- Understanding compassion satisfaction,
- compassion fatigue and burnout: A survey of the
- hospice palliative care workforce. Palliative
- Medicine, 27 (2), 172–178.
- Smith, P. (1991). The nursing process: Raising the
- profile of emotional care in nurse training. Journal
- of Advanced Nursing, 16 (1), 74-81.
- Swanson, K. M. (1993). Nursing as informed caring for
- the well-being of others. IMAGE: Journal of
- Nursing Scholarship, 25 (4), 352-357.
- Swetz, K. M., Harrington, S. E., Matsuyama, R. K.,
- Shanafelt, T. D., & Lyckholm, L. J. (2009).
- Strategies for avoiding burnout in hospice and
- palliative medicine: Peer advice for physicians on
- achieving longevity and fulfillment. Journal of
- Palliative Medicine, 12 (9), 773-777.
- Testoni, I., Falletti, S., Visintin, E. P., Ronconi, L., &
- Zamperini, A. (2016). Il volontariato nelle cure
- palliative: religiosití , rappresentazioni esplicite
- della morte e implicite di Dio tra deumanizzazione
- e burnout. Psicologia della Salute, 2, 27-42.
- Testoni, I., Milo, V., Ronconi, L., Feltrin, A.,
- Zamperini, A., Rodelli, M., Cillo U., Germani, G.
- (2017). Courage and representations of death in
- patients who are waiting for a liver transplantation.
- Cogent Psychology, 4: 1294333.
- Testoni, I., Parise, G., Zamperini, A., Visintin, E. P.,Toniolo, E., Vicentini, S., & De Leo, D. (2016).
- The "sick-lit" question and the death education
- answer. Papageno versus werther effects in
- adolescent suicide prevention, Human Affairs, 26
- (2), 153-166.
- Testoni, I. (2016). Psicologia del lutto e del morire: dal
- lavoro clinico alla death education. Psicoterapia e
- Scienze Umane, 50 (2), 229-252.
- Tripp, D. (1993). Critical incidents in teaching:
- Developing professional judgement. London:
- Routledge.
- Van den Pol-Grevelink, A., Jukema, J. S., & Smits, C. H.
- (2012). Person-centred care and job satisfaction of
- caregivers in nursing homes: A systematic review of
- the impact of different forms of person-centred care
- on various dimensions of job satisfaction.
- International Journal of Geriatric Psychiatry, 27 (3),
- -229.
- Zamperini, A., Paoloni, C., & Testoni, I. (2015). Il
- lavoro emozionale dell'assistenza infermieristica:
- incidenti critici e strategie di coping. Assistenza
- Infermieristica e Ricerca, 34 (3), 142-148.
Riferimenti
Alexander, S. C., Pollak, K. I., Morgan, P. A., Strand, J.,
Abernethy, A. P., Jeffreys, A. S., Arnold, R. M.,
Olsen, M., Rodriguez, K. L., Garrigues, S. K.,
Manusov, J. R., & Tulsky, J. A. (2010). How do
non-physician clinicians respond to advanced
cancer patients' negative expressions of emotions?
Support Care Cancer, 19 (1), 155-159.
Back, A. L., Steinhauser, K. E., Kamal, A. H., &
Jackson, V.A. (2016). Building resilience for
palliative care clinicians: An approach to burnout
prevention based on individual skills and
workplace factors. Journal of Pain and Symptom
Management, 52 (2), 284-291.
Carmack, B. J. (1997). Balancing engagement and
detachment in caregiving. IMAGE: Journal of
Nursing Scholarship, 29 (2), 139-143.
Carpineta, S. (1992). La comunicazione infermierepaziente.
Roma: Carocci.
Cavanagh, S. (1992). Job satisfaction of nursing staff
working in hospitals. Journal of Advanced
Nursing, 17 (6), 704-711.
De Jong, J., Le Blanc, P. M., Peeters, M. C. W., &
Noordam, H. (2008). Emotional job demands and
the role of matching job resourses: A cross sectional
study among health care workers. International
Journal of Nursing Studies, 45 (10), 1460-1469.
Flick, U. (1998). An introduction to qualitative
research. London: Sage.
Grandey, A. A. (2000). Emotion regulation in the
workplace: A new way to conceptualize emotional
labor. Journal of Occupational Health Psychology,
(1), 95-110.
Grandey, A. A. (2003). When "˜the show must go on':
Surface acting and deep acting as determinants of
emotional exhaustion and peer-rated service
delivery. Academy of Management Journal, 46 (1)
-96.
Henderson, A. (2001). Emotional labor and nursing:
An under-appreciated aspect of caring work.
Nursing Inquiry, 8 (2), 130-138.
Hochschild, A. R. (1979). Emotion work, feeling rules,
and social structure. The American Journal of
Sociology, 85 (3), 551-575.
Lauterbach, S., & Becker, P. (1996). Caring for self:
Becoming a self-reflective nurse. Holistic Nursing
Practice, 10 (2), 57-68.
Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001).
Job burnout. Annual Review of Psychology, 52,
-422.
Morris, J. A., & Feldman, D. C. (1996). The
dimensions, antecedents, and consequences of
emotional labor. Academy of Management Review,
(4), 986-1010.
Pereira, S. M., Fonseca, A. M., & Carvalho, A. S.
(2011). Burnout in palliative care: A systematic
review. Nursing Ethics, 18(3), 317-326.
Pringle, J., Drummond, J., McLafferty. E., & Hendry,
C. (2011). Interpretative phenomenological
analysis: A discussion and critique. Nurse
Researcher, 18 (3), 20-24.
Slocum-Gori, S., Hemsworth, D., Chan, W. W.,
Carson, A., & Kazanjian, A. (2011).
Understanding compassion satisfaction,
compassion fatigue and burnout: A survey of the
hospice palliative care workforce. Palliative
Medicine, 27 (2), 172–178.
Smith, P. (1991). The nursing process: Raising the
profile of emotional care in nurse training. Journal
of Advanced Nursing, 16 (1), 74-81.
Swanson, K. M. (1993). Nursing as informed caring for
the well-being of others. IMAGE: Journal of
Nursing Scholarship, 25 (4), 352-357.
Swetz, K. M., Harrington, S. E., Matsuyama, R. K.,
Shanafelt, T. D., & Lyckholm, L. J. (2009).
Strategies for avoiding burnout in hospice and
palliative medicine: Peer advice for physicians on
achieving longevity and fulfillment. Journal of
Palliative Medicine, 12 (9), 773-777.
Testoni, I., Falletti, S., Visintin, E. P., Ronconi, L., &
Zamperini, A. (2016). Il volontariato nelle cure
palliative: religiosití , rappresentazioni esplicite
della morte e implicite di Dio tra deumanizzazione
e burnout. Psicologia della Salute, 2, 27-42.
Testoni, I., Milo, V., Ronconi, L., Feltrin, A.,
Zamperini, A., Rodelli, M., Cillo U., Germani, G.
(2017). Courage and representations of death in
patients who are waiting for a liver transplantation.
Cogent Psychology, 4: 1294333.
Testoni, I., Parise, G., Zamperini, A., Visintin, E. P.,Toniolo, E., Vicentini, S., & De Leo, D. (2016).
The "sick-lit" question and the death education
answer. Papageno versus werther effects in
adolescent suicide prevention, Human Affairs, 26
(2), 153-166.
Testoni, I. (2016). Psicologia del lutto e del morire: dal
lavoro clinico alla death education. Psicoterapia e
Scienze Umane, 50 (2), 229-252.
Tripp, D. (1993). Critical incidents in teaching:
Developing professional judgement. London:
Routledge.
Van den Pol-Grevelink, A., Jukema, J. S., & Smits, C. H.
(2012). Person-centred care and job satisfaction of
caregivers in nursing homes: A systematic review of
the impact of different forms of person-centred care
on various dimensions of job satisfaction.
International Journal of Geriatric Psychiatry, 27 (3),
-229.
Zamperini, A., Paoloni, C., & Testoni, I. (2015). Il
lavoro emozionale dell'assistenza infermieristica:
incidenti critici e strategie di coping. Assistenza
Infermieristica e Ricerca, 34 (3), 142-148.