|
|
Bergen Open Research Archive >
Faculty of Psychology >
Department of Education and Health Promotion >
Department of Education and Health Promotion >
Please use this identifier to cite or link to this item:
http://hdl.handle.net/1956/2646
|
| Title: | Thriving despite adversity : job engagement and self-care among community nurses |
| Authors: | Vinje, Hege Forbech |
| Issue Date: | 13-Dec-2007 |
| Publisher: | The University of Bergen |
| Abstract: | Background: Community nursing in Norway has become an increasingly stressful occupation
and many nurses who experience symptoms of burnout leave the profession. Yet others
manage to cope with the adversity of nursing. This study addressed the question ‘how and
why do nurses in community health care experience job engagement and stay healthy – and
what can we learn from those who succeed?’ The assumption underlying this study was that
job engagement is health promoting, and the intention was to study how and why community
nurses can thrive despite the burdens of nursing. The idea was that if we could better
understand nurses’ job engagement, we might be able to suggest ways in which to help all
community nurses to thrive.
Objective: The main objective of this study was to explore, in-depth, the nature of job
engagement among thriving community health nurses and to investigate how job engagement
may be maintained and promoted. Job engagement was understood to consist of three basic
phenomena: “calling”, “zest for work” and “vitality,” all of which required in-depth
exploration. This was done by conducting one empirical in-depth interview study and
qualitative content analysis addressing the questions and aims of the study.
Design: The study used an explorative qualitative design, positioned as phenomenological
research in relation to its philosophical approach of being concerned with the nurses’ lifeworlds,
while methodologically it also drew on hermeneutics. The data were collected
through 15 tape-recorded interviews that took between forty-five minuets to two hours, and
were conducted in the interviewees’ workplaces or homes. A thematic interview guide was
modified from interview to interview, but the opening question was always: “Can you please
tell your work-life story?” Fourteen interviews were transcribed verbatim and the nurses read
and approved the transcriptions. The fifteenth interview was recorded, but could not be
transcribed due to an equipment failure. The data from this interview were recaptured as well
as possible from notes taken after the interview. A qualitative content analysis was conducted
with both descriptive and interpretive approaches. The analytic tool evolved throughout the
project. Five analytical steps were undertaken: 1) Gaining a general impression of the
interview; 2) Dividing the text into fragments of meaning (meaning units); 3) Transforming
the meaning units; 4) Meaning condensation and the creation of codes and categories and; 5)
Searching for themes, understood as the expression of latent content. The analysis consisted of analysing each participant’s story and each issue and theme across participants and was
conducted with a combination of case-focused, cross-case and issue-focused analysis. Further,
the analysis proved to be a spiral-like process where I repeatedly and cyclically moved
between steps and between cases, and between working with the transcribed interviews and
reading literature on topics related to the phenomena being studied.
Findings: In addressing research question 1: ‘How do thriving nurses experience job
engagement?’, I explored job engagement among community nurses who were thriving at the
time they participated in the study, and the processes that promoted job engagement among
these nurses (presented in paper 1). The analysis revealed that the nurses had high level of
ethical standards and that a sense of calling was a core aspect in all the nurses’ lives,
something which they expressed through their nursing practice. The analysis also revealed a
relatively enduring pattern of introspection and reflection, including deep attention to
meaning, meaningfulness, and values connected to challenges at work, their experience of job
engagement and their attempts to promote and maintain it. The concept of ‘meaning’ in and of
life emerged as highly essential in the nurses’ experience of job engagement, and that helped
to crystallise the job engagement construct, in which the search for meaning, the experience
of meaning, and holding on to meaning has the force of a drive. The analysis thus revealed
that job engagement was experienced by these nurses as a process driven by the search for
meaning, the experience of meaning and the holding on to meaning. Job engagements’
motivational factor was a sense of calling and the calling/vocation match. Its fundament was
the talent and habit of introspection and reflection.
The findings indicate that to promote job engagement, acknowledgment of the importance of
values and possible value conflict between the person and the workplace is vital, both before a
choice of profession is made and on a relatively continuing basis during one’s work life. The
data illustrated that it is possible to make introspection and reflection about values and the
meaning of work an integral part of working life. On the basis of the entire analysis and
interpretation, it is concluded that staff development and vocational guidance work should
include explicit recognition of, and attention to, the importance of a nurse’s awareness of
values, ethical issues, and the meaning of work, as vital to the experience of job engagement.
In addressing research question 2: ‘What is the role of job engagement in community nurse
burnout?’ I explored whether job engagement may contribute to exhaustion and burnout and not only health and well-being, and the processes that might inhibit job engagement among
community nurses (presented in paper 2). Nine of the nurses had experienced stress bringing
them close to burnout, and one of them to burnout, yet they had all regained enthusiastic
engagement in nursing at the time of the interviews. Their stories revealed a negative process,
in which job engagement played a perverse role which brought them to the brink of burnout.
Choosing nursing as a profession helped the nurses to respond to an existential issue: finding
meaning in life. The nurses expressed that a sense of calling was an underlying guide to their
choice of profession. The need to experience and hold on to meaning tended to overshadow
the importance of manageability of one’s professional responsibilities. High job engagement,
which followed from the nurses’ sense of calling to the nursing profession and the nurses’
devotion to work, contributed to a strong sense of duty and heavy self-demand regarding own
and other’s levels of performance. This got them into trouble. The study illustrated that moral
distress and overload leading to near burnout may be exacerbated by a high level of job
engagement and frustration about not living up to one’s high ethical standards. Thus, job
engagement appears to play a paradoxical role in nurse burnout. Further, the study also
suggests that job engagement may not only promote thriving on the job, but may also
contribute to a negative process leading to poor functioning. The motivational factor of this
negative process also appeared to be the sense of calling and the calling/vocation match,
where highly diligent dutifulness resulted in experiences of moral distress, overload, fatigue
and even burnout.
In addressing research question 3: ‘How do thriving nurses maintain and enhance their job
engagement?, I explored the role of self-care in maintaining and enhancing job engagement
among thriving community nurses, and I aimed at summarising the salutogenic and
pathogenic processes in which job engagement plays a central role (presented in paper 3). In
nine cases, the perceived failure to live up to one’s own performance demands contributed to
the process of burning out. This triggered introspection, sensibility and reflection, leading to
coping, avoidance of burnout, and the enhancement of job engagement. The nurses showed
alertness, appraisal and the ability to act to preserve job engagement. This pattern brought to
mind the construct ‘sensibility’ which is theorized in paper 3 and argued to be of vital
importance to maintain and enhance job engagement. To enhance job engagement, the nurses
worked to lower the too-rigorous standards they had set for themselves and for others, and/or
they changed jobs or modified their working conditions. This self-care happened on a
philosophical level and on a practical level and often combined actions played out in the following way: the nurses’ abiding existential curiosity about the surrounding world and
about self, stimulated self-monitoring and self-tuning in their search for coherence.
‘Existential curiosity’ and ‘monitoring and self-tuning’ were thus the forerunners to action.
The data revealed six main active coping strategies which provided the direct means to regain
job engagement; ‘striving to be a realistic idealist’; ‘engaging in meaningful activities
alongside nursing’; ‘ensuring a place for silence and withdrawn peace’; ‘solving emotional
problems’; ‘learning from experience’ and;’ ability and willingness to undertake major
change’. The ‘Self-tuning Model of Self-care’ was developed to summarise these processes
graphically. The Model shows three parallel processes, one of which is characterised as
salutogenic and another as pathogenic, both driven by the same motivational factor—a sense
of calling and the calling/vocation match. These two processes are mediated by a third process
involving introspection, sensibility, reflection and active coping. This is a sensing/reacting
process that is adaptive in that it can result in changes leading to regaining job engagement.
Thus, the promotion and maintaining of job engagement appears to be dependent on the
nurses’ self-care.
Conclusion: Job engagement plays a seemingly paradoxical role in nurse work-life. A nurse’s
sense of calling and his/her experience of calling/vocation match stimulate two processes
leading simultaneously to high job engagement and to highly diligent dutifulness. The
salutogenic process, in which job engagement plays a central role, can be stimulated, and
meaning, zest for work and vitality can be protected if the nurse engages in an ongoing
mediating self-care process described in this study as ‘self-tuning’. This self-care process is
teachable and has as its fundament the talent and habits of introspection, sensibility, reflection
and active coping. Self-tuning also depends on the willingness to learn from experience and
on being able to take action to improve one’s situation. The findings of this study, informed
by the experience of nurses, may have relevance to persons in stressful professions who wish
to stimulate their job engagement or who find themselves on the path to burnout. |
| URI: | http://hdl.handle.net/1956/2646 |
| ISBN: | 978-82-308-0480-3 (print version) |
| Appears in Collections: | Department of Education and Health Promotion
|
Items in BORA are protected by copyright, with all rights reserved, unless otherwise indicated.
|
