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      The relationship between workload and burnout among nurses: The buffering role of personal, social and organisational resources

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          Abstract

          Workload in the nursing profession is high, which is associated with poor health. Thus, it is important to get a proper understanding of the working situation and to analyse factors which might be able to mitigate the negative effects of such a high workload. In Germany, many people with serious or life-threatening illnesses are treated in non-specialized palliative care settings such as nursing homes, hospitals and outpatient care. The purpose of the present study was to investigate the buffering role of resources on the relationship between workload and burnout among nurses. A nationwide cross-sectional survey was applied. The questionnaire included parts of the Copenhagen Psychosocial Questionnaire (COPSOQ) (scale ‘quantitative demands’ measuring workload, scale ‘burnout’, various scales to resources), the resilience questionnaire RS-13 and single self-developed questions. Bivariate and moderator analyses were performed. Palliative care aspects, such as the ‘extent of palliative care’, were incorporated to the analyses as covariates. 497 nurses participated. Nurses who reported ‘workplace commitment’, a ‘good working team’ and ‘recognition from supervisor’ conveyed a weaker association between ‘quantitative demands’ and ‘burnout’ than those who did not. On average, nurses spend 20% of their working time with palliative care. Spending more time than this was associated with ‘burnout’. The results of our study imply a buffering role of different resources on burnout. Additionally, the study reveals that the ‘extent of palliative care’ may have an impact on nurse burnout, and should be considered in future studies.

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          A Monte Carlo study of the effects of correlated method variance in moderated multiple regression analysis

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            Development and psychometric evaluation of the Resilience Scale.

            This study describes the development and initial psychometric evaluation of the 25-item Resilience Scale (RS) in a sample of 810 community-dwelling older adults. Principal components factor analysis of the RS was conducted followed by oblimin rotation indicating that the factor structure represented two factors (Personal Competence and Acceptance of Self and Life). Positive correlations with adaptational outcomes (physical health, morale, and life satisfaction) and a negative correlation with depression supported concurrent validity of the RS. The results of this study support the internal consistency reliability and concurrent validity of the RS as an instrument to measure resilience.
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              White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care.

              Dementia is a life-limiting disease without curative treatments. Patients and families may need palliative care specific to dementia. To define optimal palliative care in dementia. Five-round Delphi study. Based on literature, a core group of 12 experts from 6 countries drafted a set of core domains with salient recommendations for each domain. We invited 89 experts from 27 countries to evaluate these in a two-round online survey with feedback. Consensus was determined according to predefined criteria. The fourth round involved decisions by the core team, and the fifth involved input from the European Association for Palliative Care. A total of 64 (72%) experts from 23 countries evaluated a set of 11 domains and 57 recommendations. There was immediate and full consensus on the following eight domains, including the recommendations: person-centred care, communication and shared decision-making; optimal treatment of symptoms and providing comfort (these two identified as central to care and research); setting care goals and advance planning; continuity of care; psychosocial and spiritual support; family care and involvement; education of the health care team; and societal and ethical issues. After revision, full consensus was additionally reached for prognostication and timely recognition of dying. Recommendations on nutrition and dehydration (avoiding overly aggressive, burdensome or futile treatment) and on dementia stages in relation to care goals (applicability of palliative care) achieved moderate consensus. We have provided the first definition of palliative care in dementia based on evidence and consensus, a framework to provide guidance for clinical practice, policy and research.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                22 January 2021
                2021
                : 16
                : 1
                : e0245798
                Affiliations
                [1 ] Institute of Occupational, Social and Environmental Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
                [2 ] Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
                [3 ] Department for Occupational Medicine, Hazardous Substances and Health Science, Institution for Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
                [4 ] Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
                Universtiy of Düsseldorf, GERMANY
                Author notes

                Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: The project was funded by the BGW - Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (Institution for Statutory Accident Insurance and Prevention in Health and Welfare Services). The BGW is responsible for the health concerns of the target group investigated in the present study, namely nurses. Prof. Dr. A. Nienhaus is head of the Department for Occupational Medicine, Hazardous Substances and Health Science of the BGW and co-author of this publication. All other authors declare to have no potential conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                ‡ These authors are joint senior authors on this work.

                Author information
                https://orcid.org/0000-0002-8390-0594
                Article
                PONE-D-20-23720
                10.1371/journal.pone.0245798
                7822247
                33481918
                56ad2ba9-e75b-4616-b8e4-fc42c27357c2
                © 2021 Diehl et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 30 July 2020
                : 7 January 2021
                Page count
                Figures: 3, Tables: 5, Pages: 17
                Funding
                Funded by: Institution for Statutory Accident Insurance and Prevention in Health and Welfare Services
                Award Recipient :
                The research was funded by the BGW - Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (Institution for Statutory Accident Insurance and Prevention in Health and Welfare Services). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Health Care
                Palliative Care
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Psychological Stress
                Biology and Life Sciences
                Psychology
                Psychological Stress
                Social Sciences
                Psychology
                Psychological Stress
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Nurses
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Nurses
                People and Places
                Population Groupings
                Professions
                Supervisors
                Biology and Life Sciences
                Psychology
                Psychometrics
                Social Sciences
                Psychology
                Psychometrics
                Medicine and Health Sciences
                Health Care
                Patients
                Outpatients
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Nursing Homes
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Custom metadata
                According to the Ethics Committee of the Medical Association of Rhineland-Palatinate (Study ID: 837.326.16 (10645)), the Institute of Occupational, Social and Environmental Medicine of the University Medical Center of the University Mainz is specified as data holding organization. The institution is not allowed to share the data publically in order to guarantee anonymity to the institutions that participated in the survey because some institution-specific information could be linked to specific institutions. The data set of the present study is stored on the institution server at the University Medical Centre of the University of Mainz and can be requested for scientific purposes via the institution office. This ensures that data will be accessible even if the authors of the present paper change affiliation. Postal address: University Medical Center of the University of Mainz, Institute of Occupational, Social and Environmental Medicine, Obere Zahlbacher Str. 67, D-55131 Mainz. Email address: arbeitsmedizin@ 123456uni-mainz.de .

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