SciELO - Scientific Electronic Library Online

 
vol.22The perceptions of professional nurses on student mentorship in clinical areas: A study in Polokwane municipality hospitals, Limpopo provinceCost-savings accruable to removing value added tax from antiretrovirals in the South African private health sector índice de autoresíndice de assuntospesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados

Artigo

Indicadores

Links relacionados

  • Em processo de indexaçãoCitado por Google
  • Em processo de indexaçãoSimilares em Google

Compartilhar


Health SA Gesondheid (Online)

versão On-line ISSN 2071-9736
versão impressa ISSN 1025-9848

Health SA Gesondheid (Online) vol.22  Cape Town  2017

http://dx.doi.org/10.1016/j.hsag.2017.01.003 

FULL LENGTH ARTICLE

 

Exploring resilience in nurses caring for older persons

 

 

Petronella BenadéI, *; Emmerentia du PlessisII; Magdalena Petronella KoenII, 1

IINSINQ Research Focus Area, North-West University, Potchefstroom Campus, South Africa
IINorth-West University, Mafikeng Campus, South Africa

 

 


ABSTRACT

BACKGROUND: A shortage of nurses caring for older persons is experienced due to adverse working conditions. Resilience might empower nurses to persevere while caring for older persons. Research regarding the resilience of nurses caring for older persons is scarce.
OBJECTIVES: The objectives were to explore and describe the strengths and coping abilities of nurses caring for older persons and to formulate recommendations to strengthen their resilience.
METHODOLOGY: An explorative, descriptive qualitative research design was used. An all-inclusive sample of nurses caring for older persons in an urban setting in the North West Province, South Africa, participated in the study. During phase one, demographic information was obtained, and narratives were written (n = 43). Four focus group interviews were conducted in phase two (n = 17) and recommendations were formulated in phase three. Content analysis was used.
PRINCIPAL RESULTS: Participants experienced adverse working circumstances while caring for older persons and they needed resilience to balance the emotional nature of the work, work ethics, staff shortages, physical demands of the work and the dependency of the older persons. These nurses used personal, professional, contextual and spiritual strengths to handle adverse working conditions.
CONCLUSIONS: By applying their personal, professional, contextual and spiritual strengths, nurses could further enhance these strengths and possibly their resilience. The participants' identified strengths were used to formulate recommendations to strengthen resilience of nurses caring for older persons.

Keywords: Adverse working conditions, Care of older persons, Challenges encountered in caring for older persons, Nurses' strengths, Resilience of nurses


 

 

1. Introduction

The aim of this study was to explore and describe the resilience of nurses caring for older persons. Resilience might enable nurses to better cope with adverse working conditions experienced while caring for older persons. This article reports on qualitative research that explored the resilience of nurses caring for older persons in the North West Province (NWP) of South Africa.

1.1. Background

Populations globally, including South Africa, are rapidly growing older (World Health Organization [WHO], 2011; Statistics South Africa, 2011). It is projected that the number of people aged 65 and older will increase from 524 million in 2010 to almost 1.5 billion in 2050 (WHO, 2011). The number of older persons in sub-Saharan Africa (SSA) is expected to grow faster than in the rest of the world and will increase from 46 million in 2015 to 157 million by 2050 (WHO, 2015).

These growing numbers of older persons require qualified nurses to provide specialised care (Fedele, 2015). However, adverse working conditions experienced by nurses caring for older persons cause international as well as national nursing shortages (Chenoweth, Jeon, Merlyn, & Brodaty, 2010; Christopher, Chiarella, & Waters, 2015; Department of Social Development [DSD], 2010; Fedele, 2015).

Nurses caring for older persons experience a low professional status and their work is physically and emotionally challenging (Chenoweth et al., 2010; Schmidt, Dichter, Palm, & Hasselhorn, 2012). These nurses often experience workplace violence (Isaksson, Graneheim, Richter, Eisemann, & Aström, 2008; Sharipova, Hogh, & Borg, 2010). Older persons with dementia place even more pressure on nurses because they require more time and knowledge and their demands are unpredictable (Josefsson, Sonde, Winblad, & Wahlin, 2007). This challenging behaviour of the older persons is stressful to the nurses and influences their health and work ability and may cause burnout (Schmidt et al., 2012). Lack of leadership and involvement from management in facilities may cause stress to the nurses and may contribute to the low job satisfaction experienced by these nurses (Testad, Mikkelsen, Ballard, & Aarsland, 2010). All these factors could aggravate stress and burnout and might cause nurses to resign, aggravating the nursing shortage (Schmidt et al., 2012).

Despite these adverse working conditions, some nurses manage to cope and persevere and some even flourish (Jackson, Firtko, & Edenborough, 2007; Koen, Van Eeden, & Wissing, 2011a). The resilience of these nurses might enable them to handle the adverse working conditions experienced while caring for older persons and to persevere (Jackson et al., 2007; Koen et al., 2011a).

1.2. Resilience theory

Resilience is the ability to adjust successfully to adversity experienced (Jackson et al., 2007). Resilience is needed to handle everyday difficulties as well as great life-changing events and the positive adjustment must be in accordance with the difficulty experienced (Fletcher & Sarkar, 2013). The quality of "bouncing back" and going forward in life after difficulties is evident in resilience (Earvolino-Ramirez, 2007,p. 76). Resilience refers to the ability to be resourceful and use all the available internal and external resources to handle different contextual and developmental challenges (Pooley & Cohen, 2010). Resilience can be defined as the part played by psychological processes and behaviour in encouraging the use of personal resources and protecting an individual from the potential negative consequences of stressors (Fletcher & Sarkar, 2013). Nurses can be empowered to cope with stress at work and prevent burnout if they demonstrate resilient behaviour (Edward & Hercelinskyj, 2007).

1.3. Trends from research literature

Studies regarding nurses' resilience in caring for older persons seem to be scarce. In one such study, Cameron and Brownie (2010) investigated the resilience of registered nurses who cared for older persons in high-care residential aged care facilities. These nurses enhanced their resilience by using strengths such as clinical knowledge, skills and expertise, support and self-reflection (Cameron & Brownie, 2010). Studies regarding the resilience of professional nurses in public and private healthcare facilities were conducted by Koen et al. (2011a) and Koen, Van Eeden, Wissing, and Du Plessis (2011b). Koen, Van Eeden, Wissing, and Koen (2011c) formulated guidelines to enhance nurses' resilience.

Although valuable guidelines were formulated by Koen et al. (2011c), this research was not conducted in facilities caring for older persons and these guidelines do not focus on the practicalities faced by nurses caring for older persons. Although the research findings of Cameron and Brownie (2010) provided valuable information on how resilience is enhanced by these nurses, this research included only registered nurses and not enrolled nurses nor auxiliary nurses and no recommendations were formulated for strengthening resilience in nurses caring for older persons, indicating the need for this study.

1.4. Research problem

An increasing shortage of nurses caring for older persons became evident from several reports, while there is an increased need for such care brought about by the ageing population (Chenoweth et al., 2010; Christopher et al., 2015; DSD, 2010; Fedele, 2015; WHO, 2011). According to Jackson et al. (2007, p. 1, 7) nurses can be assisted to "survive" and "thrive" in the workplace by building their personal resilience.

However, the strengths and coping abilities nurses use while caring for older persons were unknown and no recommendations to strengthen resilience in nurses caring for older persons could be found in the literature. This situation gave rise to the following research questions:

What strengths and coping abilities do nurses use while caring for older persons?

What recommendations could be formulated to strengthen resilience in nurses caring for older persons?

1.5. Objectives

This study aimed to:

explore and describe the strengths and coping abilities of nurses caring for older persons

formulate recommendations to strengthen resilience in nurses caring for older persons.

1.6. Significance of the study

Recommendations to strengthen their resilience might empower nurses to be more resilient while caring for older persons and to better handle the adverse working conditions experienced. Management would benefit if the nurses are more resilient and do not resign. The older persons would benefit if the nurses would be able to survive and remain in their jobs caring for older persons.

1.7. Definitions of key concepts

1.7.1. Resilience

Resilience is the ability to handle adversity and still be able to bounce back and continue with life (Earvolino-Ramirez, 2007). Internal and external resources enable a person to handle the challenges experienced and protect a person against the negative effects of these stressors (Fletcher & Sarkar, 2013; Pooley & Cohen, 2010). In this study resilience refers to the ability of nurses to handle adverse working conditions experienced while caring for older persons and to continue with their work and even to grow stronger in the process.

1.7.2. Nurse

A nurse is a person registered with the South African Nursing Council (SANC) in a category under section 31(1) of the Nursing Act, No. 33 of 2005 to practise nursing or midwifery (SANC, 2005). Different categories of nurses include: auxiliary nurses; enrolled/staff nurses and professional nurses (SANC, 2005). All these categories of nurses participated in this study.

1.7.3. Older person

In South Africa a man aged 65 years or older and a woman aged 60 years of age or older are regarded as being older persons (Older Persons Act, No. 13 of 2006). In this study all persons older than 60 years of age were regarded as being older persons.

1.7.4. Adverse working conditions/challenges

Adverse means "unfavourable" and adversity refers to "difficulty or misfortune" (Concise Oxford English Dictionary, 2011, p. 19). A challenge refers to "a demanding task or situation" (Concise Oxford English Dictionary, 2011, p. 235). In this study adverse working conditions refer to difficult circumstances (challenges) in the workplace that nurses experience while caring for older persons.

1.7.5. Strength

A strength is "a good or beneficial quality" implying "being strong" and it can be seen as "a source of mental or emotional support" (Concise Oxford English Dictionary, 2011, p. 1427). In this study a strength is a valued attribute that can make nurses strong and enable them to handle adverse working conditions experienced while caring for older persons.

1.7.6. Theoretical framework

The resilience of nurses caring for older persons was explored without a specific theoretical framework guiding the study. After the data had been analysed, a thorough literature control of the emerged themes and subthemes provided a theoretical framework, namely Carr's model "Bringing strengths to bear on opportunities and challenges" (Carr, 2004, p. 304). This model was used to explain, discuss and interpret the qualitative findings and to formulate recommendations. According to this model we use historical, personal and contextual strengths to handle our opportunities and challenges (Carr, 2004). The findings of our study revealed that the participants used personal, professional, contextual and spiritual strengths to handle adverse working conditions/challenges experienced while caring for older persons (Benadé, 2014).

 

2. Research method and design

2.1. Research design

An explorative descriptive qualitative design was used.

2.2. Context of the study

The study was conducted in an urban setting in the NWP of South Africa. Seven facilities, providing care to older persons in the community, participated in the research. These facilities comprised three old age homes, one retirement village, one service centre for the aged, one facility providing care to older and disabled persons and one residential home.

2.3. Population

The population included all the professional nurses, enrolled nurses and auxiliary nurses caring for older persons in facilities or in the community, in an urban setting within the eastern portion of the NWP.

2.4. Sampling method

An all-inclusive, voluntary sample of nurses caring for older persons in the participating facilities participated in the research. The first author contacted all these facilities to obtain permission for conducting the research at their facilities. Seven facilities granted permission. All professional nurses, enrolled nurses and auxiliary nurses, who were willing to participate voluntarily in the study, were included in the study because they all had practical experience in caring for older persons and were able to communicate in Afrikaans or English.

2.5. Sample size

The sample size for the completion of the demographic information form and writing of the narratives was 43 and included nurses from all seven participating facilities. Four focus group interviews were conducted that included a total of 17 nurses from five of the seven facilities. Six nurses participated in focus group one; three in focus group two; five in focus group three; and three in focus group four.

2.6. Data collection

2.6.1. Materials

During phase one, participants were asked to complete the demographic information form and to write a narrative (see Section 2.6.2.2). Focus group interviews were conducted during phase two. Recommendations to strengthen resilience in nurses caring for older persons were formulated during phase three.

2.6.2. Data collection method

2.6.2.1. Demographic information form. The following information to contextualize the findings was obtained by means of the demographic information form: employment status, marital status, age, gender, home language, highest level of education, nursing category and number of years of caring for older persons.

2.6.2.2. Narratives. Participants were requested to write a letter to "Nurse Dawn", an imaginary young nurse who would like to care for older persons. They had to tell her about their personal strengths enabling them to care for older persons, how they managed to cope while caring for older persons, what made it worthwhile caring for older persons and how they managed to be resilient while caring for older persons.

2.6.2.3. Focus group interviews. All the nurses who participated in phase one were invited to participate in phase two, the focus group interviews. They received an interview schedule and the focus group interviews were voice recorded. The purpose of the focus group interviews was to validate the preliminary results obtained from the narratives and to provide the participants with opportunities to add new information. Two new quest