Patient-centred nursing, compassion satisfaction and compassion fatigue in Australian intensive care units
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Aim: To develop a conceptual framework outlining processes involved in patient-centred nursing and compassion satisfaction or compassion fatigue in the context of critical care nursing. Background: The aggressive curative setting of intensive care may compromise elements of patient-centred nursing. Critical care nurses are expected to employ bio-medical nursing expertise while delivering compassionate nursing care to critically ill patients; they are at high risk of anxiety and fatigue with no assurance their patients will recover despite their best efforts. Compassion satisfaction and compassion fatigue influence nurses’ intention to leave; workforce turnover is high. Methods: Mixed method research using an explanatory sequential design together with constructivist methodology was adopted. A concept analysis defined patient-centred nursing in context and an integrative literature review examined barriers and facilitators to patient-centred nursing in intensive care. A cross-sectional survey collected data from nurses of two adult Australian intensive care units measuring compassion satisfaction and fatigue. Grounded theory methods were employed to examine critical care nurses’ experience of compassion satisfaction, compassion fatigue and patient-centred nursing. In a novel approach to the discovery of new knowledge, Bowen Family Systems Theory was applied to intensive care nursing. Data were integrated at various points using a constructivist paradigm contributing to conceptual development. Findings: Patient-centred nursing in intensive care is different to other areas of healthcare. The critical care environment and complex challenges faced by critical care nurses were found to compromise their ability to provide effective patient-centred nursing. Overall, critical care nurses had mid-range levels of compassion satisfaction and fatigue. Workplace, education, tenure, age and experience were found to be predictive and contributing factors to compassion satisfaction and fatigue. Early to mid-career critical care nurses were at greatest risk. The experience of compassion satisfaction or fatigue impacts the ability to deliver compassionate patient-centred nursing. Moments of compassion satisfaction and fatigue may occur along a continuum, keeping time with critical care nurses’ expectations being met and their ability to meet perceived expectations. Bowen Family Systems Theory, when applied to intensive care nursing identified possible strategies to assist critical care nurses’ provision of patient-centred nursing. Findings from each subsection of this program of work were brought together, contributing to the development of the conceptual framework comprising five levels: workplace, expectations, differentiation, patient-centred nursing and compassion. Existing knowledge and new knowledge is threaded through the framework. Conclusion: This innovative approach resulted in new insights into processes surrounding patient-centred nursing, compassion satisfaction and compassion fatigue in intensive care nursing. Applying Bowen Family Systems Theory to intensive care nursing resulted in new knowledge and recommendations to develop workplace culture and enhance critical care nurses’ compassion satisfaction.
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