The emotional cost of nursing

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Nurses cure the sick, heal the wounded, and comfort the dying, but are they doing so at their own cost?

Jenny Watts, researcher and psychology PhD student at the University of Leicester in Leicester, England aims to find out in a new project examining the emotional toll of nursing. The project, which follows a large scale methodical review of published literature Watts conducted last year, will explore how exposure to patient suffering and empathizing with patients influence nurses’ experiences of distress.

“The [previous] review revealed certain nurse characteristics may predict a specific form of distress,” says Watts. “There appear to be many moderating variables, but the literature suggested more empathetic nurses showed greater vulnerability to what had been labeled as burnout and secondary traumatic stress.”

Watts’ findings indicate nurses who empathize and identify with their patients can share patients’ emotional reactions, thus nurses with highly distressed patients can develop similar symptoms. In addition, dealing with patients’ concerns can lead to draining of emotional resources.

Such distress can significantly affect nurses’ personal and professional lives, resulting in flashbacks of traumatic events, sleeping difficulty, emotional detachment, and increased feelings of work-related dissatisfaction.

“There is evidence that caring for others can have negative implications for their career, in terms of physical health and professional functioning. However, we need to determine a more precise understanding of nurse distress to enable suitable interventions,” Watts says.

According to Watts, one of the major findings of her review implicates age is a predictive factor of distress. For instance, younger, less experienced nurses report greater distress.

“This project aims to test these apparent relationships and determine how much variance in distress—in the form of burnout, for example—can be determined by factors, such as empathy and social support,” Watts says.

Pending approval of the NHS Research Ethics Committee in the U.K., Watts will start the first stage of the project with the university’s School of Psychology. A qualitative pilot study will involve nursing staff employed in long-term care facilities and hospital wards for older adults. Watts wants to study the nurses due to the U.K.’s aging population and adults older than 70 being the largest consumers of hospital care. Nurses witnessing death and deterioration in older adults have reported distress and may suffer from anxiety and depression as a result.

The project will include the use of qualitative tools to first gather nurses’ experiences of patient care and then apply quantitative measures, such as questionnaires to assess the variables (i.e., social support or staff characteristics).

“Using the results, we aim to construct predictive models of the nurses’ distress,” Watts says. “These models may reveal sources of vulnerability, enabling education and training to be tailored more effectively.”

She adds, “This strategy may also reveal sources of resilience, such as a negative relationship between social support and burnout, and these more positive findings could also be applied in strengthening occupational policy.”

Fortunately, working in the profession doesn’t and won’t take a large emotional toll on every nurse. “Not all nurses will experience significant distress as a result of exposure to patients’ suffering. However, for those that do, the consequences can be far-reaching.”

It is because of this that more knowledge is needed and more measures be taken to prevent nurses and patients from suffering the effects of distress.

“It is increasingly important to maintain the health and wellbeing of healthcare providers,” says Watts. “In addition, there is evidence within the literature that compassionate care can have a positive impact on patient outcomes.”