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- Empowering leader behaviours: impact on health professionals’ empowerment and commitmentPublication . Hernández-Marrero, P.; Pereira, S. Martins; Lopes, T.; Flint, D. H.Background: The importance of leaders’ behaviours in empowering staff in the workplace is advocated in healthcare management literature. However, there is a lack of empirical evidence linking empowering leadership behaviours with professionals’ sense of workplace empowerment and commitment. Facilitative leadership styles are considered important to redesigning work in palliative care provided in primary care services. Aims: To test a model linking leader-empowering behaviours to health professionals’ perceptions of workplace empowerment and commitment in primary care. Methods: As part of a larger multicenter survey study, a random sample of 209 professionals (nurses and physicians) providing palliative care in primary care settings in two Spanish regions was drawn. Three pre-validated scales were used to measure leader-empowering behaviours, empowerment and commitment. Multiple regression analyses were conducted to test the mediation model. Results: Overall, perceptions of workplace empowerment were significantly related to all dimensions of leader-empowering behaviours. These dimensions were correlated with empowerment and commitment (rs= .31 to .63). Empowerment at least partially mediated the relationship between leader-empowering behaviours and commitment. Empowerment had a significant impact on commitment (β = .64, p < .05). Conclusions: The results of this study highlight the importance of facilitative leaders in creating empowering work environments. Hence, recommendations can be made to ensure that healthcare managers leading primary care teams facilitate the implementation and delivery of palliative care in these settings by promoting professionals’ empowerment and commitment. This study provides encouraging empirical support and guidance for healthcare leaders interested in creating highly-effective work environments that benefit both patients and professionals who care for them within current turbulent healthcare organisations.
- Ethical decisions in palliative care: a burnout risk factor?: results from a mixed-methods multicentre study in PortugalPublication . Pereira, S. Martins; Hernández-Marrero, P.; Carvalho, A. S.Background: Ethical decision-making in end-of-life care is perceived asstressful. Making ethical decisionsisrelated to higher levels of burnout among health professionals. Aims: To identify the most common ethical decisions made by Portuguese palliative care teams and understand how the making ofsuch decisionsrelatesto burnout. Methods: Mixed methodsstudy in 9 palliative care teams. Data was collected through: questionnaires ofsocio-demographic and profession-related variables, and work-related experiences; Maslach Burnout Inventory; interviews; observations. Quantitative data analysesincluded descriptive, uni and multivariate logistic regressions; qualitative data was analysed inductively with themes/categories emerging from data. Triangulation ensured reliability. A total of 88 professionals(66% response rate) were included, 11 nurses and 9 physicians were interviewed and 240 hours of observations were fulfilled. Results: The most common ethical decisions were caused by communication issues, forgoing treatment and terminalsedation. Although perceived as a burnout risk factor in the speech of the participants, quantitative data showed that making ethical decisions was notsignificantly associated with burnout. These findings were explained through the analysis of the transcripts of interviews and field-notes: The decision-making process using an interdisciplinary team approach and consulting ethical committees were identified as protective factors against burnout. Conclusions: Making ethical decisionsis not associated with burnout among professionals working in Portuguese palliative care teams. Thisis explained by the ethical deliberation and decision-making processfollowed by these teams. Promoting palliative care skills among professionals providing end-of-life care in othersettings might be useful to diminish burnout related to making ethical end-of-life decisions.
- Implementation of an education program in palliative care among nursing students: an action-research project in the outermost region of the AzoresPublication . Lima, T.; Pereira, S. Martins; Hernández-Marrero, P.Background: Most courses leading to a nursing degree do not meet the recommendations of the European Association for Palliative Care in palliative care. This may led to difficulties when caring for patients with palliative care needs. In outermost regions, investing in education is a keystone to ensure palliative care provision for all citizens. Objectives: To study the impact of an optional education program in palliative care among nursing students in their (i) knowledge, (ii) attitudes towards patients and families, and (iii) emotional coping. Methods: Research-action. Data was collected using the following instruments: pre and post-education program questionnaire; field-notes of the participant students and course leaders; written reflections provided by the participant students during the practicum that followed the course completion; focus groups with students after the same practicum. Questionnaires were analysed comparatively; content analyses were done inductively to the transcripts of field-notes, written reflections and focus groups. 24 nursing students participated in this study. Results: After the course completion, the students exhibited a more accurate and broader concept of palliative care. The major impact of the course on the students’ attitudes towards patients and families referred to an improvement in the students’ ability to identify palliative care needs and to better communicate. The course had a major impact on the awareness of students concerning their emotions. Also, the students became more able to cope with difficult situations(e.g., end-of-life care and decisions). Conclusions: The education program in palliative care contributed significantly to students’ clinical practice, namely in terms of an increase of self-confidence while caring for terminally ill patients. By participating in this course, students expanded their knowledge on palliative care, which had an impact also in the development of their competences.