surviving and thriving in the face of workplace adversity

370 Pages·2013·5.31 MB·English

SURVIVING AND THRIVING IN THE FACE OF
WORKPLACE ADVERSITY: AN INTERVENTION TO
IMPROVE PERSONAL RESILIENCE IN
NURSES AND MIDWIVES

A thesis submitted in fulfilment of the requirements for
the degree of
Doctor of Philosophy
University of Western Sydney

© Glenda Elizabeth McDonald

June 2010
Dedicated to the participants of this study, whose generosity of
spirit, commitment and support for this work inspired me to
follow my instincts and undertake research that would
ultimately mean something to them

“The Lord said…Leave your country, your people and your father’s household and
go to the land I will show you…Lift up your eyes from where you are and look north
and south, east and west. All the land that you see I will give to you…”
- Genesis 12, 13

The familiar life horizon has been outgrown:
The old concepts, ideals, and emotional
patterns no longer fit; the time for the
passing of a threshold is at hand.
- Joseph Campbell

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Acknowledgements

I wish to particularly thank my supervisors Professor Debra Jackson, Professor Lesley
Wilkes, Professor Margaret Vickers and Dr Shantala Mohan for their continuing
guidance and support during the years of my candidature, and especially during the
writing of this thesis. You have each contributed to my personal and professional
development and education in ways I will not forget.

I wish to thank the Australian Research Council for awarding me a scholarship for
this research, which made its completion possible. I am also grateful for all the
collegial support I received from the FaCH Research Group students and others at the
University of Western Sydney.

I would also like to thank Anna McManus, Marion Cornish, Robbie Lloyd and Lucy
Andrew-Jarius, who contributed to my facilitation of the study intervention with your
time, experience, skills, wisdom, encouragement and insight.

Heartfelt thanks go to my wonderful mother and children for all your support and for
helping me laugh when I really needed to.

A special thank you to Lisa Desmond and Tina Shinn, I would not have made it
through without your belief in me, and to all the women in my cell group, you are a
blessing and I thank you for your prayers and encouragement.

I am deeply grateful to my study participants for entrusting me with your stories, and
for your whole-hearted participation in the study. I hope this work honours your
contribution.

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Statement of Authentication

The work presented in this thesis is, to the best of my knowledge and
belief, original except as acknowledged in the text. I hereby declare that
I have not previously submitted this material, either in full or in part, for
a degree at this or any other institution.

_____________________

Glenda McDonald

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Outcomes of this thesis

Publications

McDonald, G., Mohan, S., Jackson, D., Vickers, M. & Wilkes, L. (2010).
Continuing connections: the experiences of retired and senior working nurse mentors.
Journal of Clinical Nursing, (in press)

McDonald, G., Jackson, D., Vickers, M. & Wilkes, L. (2010). Workplace
conversations: Building and maintaining collaborative capital. Contemporary Nurse,
(in press)

Conferences/ Research dissemination

11th – 14th April 2010: Attendance and presentation at the 3rd International Nurse
Education Conference, Sydney

Podium presentation: An educational intervention to promote personal
resilience in nurses and midwives.

2nd-4th June 2009: Attendance and presentation at the University of Western
Sydney’s College of Health and Science Research Futures Postgraduate Forum

Podium presentation: A Collective Case Study of Nurses and Midwives:
factors associated with workplace adversity and maintaining personal resilience

25th-27th September 2008: Attendance and presentation at the Royal College of
Nursing Australia National Conference, Celebrating Professional Excellence in
Nursing, Perth

Podium presentation: Continuing connections: fostering mentoring
relationships between retired and working nurses and midwives.

3rd – 5th June 2008: Attendance and presentation at the University of Western
Sydney’s College of Health and Science Research Futures Postgraduate Forum

Podium presentation: Surviving and thriving in the face of workplace
adversity: an intervention to develop personal resilience in nurses & midwives

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TABLE OF CONTENTS

Dedication……………………………………………………………………….…. i
Acknowledgements………………………………...………………...…………….. ii
Statement of Authentication..……………..……………………………………….. iii
Outcomes of the thesis ………….………………………………………...……...... iv
Table of Contents…………………………………………………………………... v
List of Tables….…………………………………………………………………… x
List of Figures…….………………...…………….................................................... x
Thesis Abstract...…………………………………………………………………… xi
CHAPTER 1: INTRODUCTION
Abstract…….……..………………………………………………………………... 1
Introduction.…….…….…………………………………………………………..… 2
1.2 Study Background………………………………...…………………………… 3
1.3 Purpose of the Study...…………………………………………...……………. 5
1.4 Research Questions……………………………………………...…………….. 5
1.5 Significance of the Study….……………………………………………...…… 6
1.6 Definitions of terms used in this thesis…….………………………………….. 7
1.7 Thesis structure…..…….………...……………………………………………. 8
1.8 Summary..……..……………….……………………………………………… 9
CHAPTER 2: LITERATURE REVIEW
Abstract………………………………………………………………..…………… 10
2.1 Introduction…………………….……………………………………………… 11
2.2 Workplace Adversity in the Contemporary Nursing Context………….……… 12
2.3 Causes of Workplace Adversity……………………….………………………. 12
2.4 Working Conditions……..…………………………………………………….. 12
2.4.1 Extended Hours………….…………………………………………... 13
2.4.2 Casualisation of Nursing and Midwifery workforce………………… 14
2.4.3 Workplace Autonomy………….…………….……………………… 15
2.4.4 Staff Support………...…………………….………………………… 16
2.5 Work Environment…………………………………………………….. 18
2.5.1 Heavy workload……….…………………………………………….. 18
2.5.2 High physical demands…….………………………………………... 19
2.5.2.1 Shift work………………………………………………….. 20
2.5.3 Low personal satisfaction……….…………….……………………... 20
2.5.4 Autonomy……………………………………………………………. 21
2.5.5 Working relations……………………………………………………. 23
2.5.6 Workplace bullying and aggression..…………………………………. 24
2.6 Daily challenges faced at work……………….……………………………….. 26
2.6.1 Quality of patient care……………………………………………..… 27
2.6.2 Role overload………………………………………………………... 28
2.6.3 Adverse events and medical errors…..……………………………… 29
2.6.4 Work injuries………………………………………………………… 29
2.6.4.1 Use of pain medication……………………………………. 30
2.7 The Effects of Workplace Adversity on the Wellbeing of Nurses and
Midwives…………………………………………………………………… 30
2.7.1 Work stress…………………………………………………………... 31
2.7.2 Respect and recognition……………………………………………... 32
2.7.3 Physical health of nurses and midwives…………………………….. 33
2.8 Personal Resilience……………………………………………………………. 34
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2.8.1 Introduction…………..……………………………………………… 34
2.8.2 Personal Resilience in the Contemporary Nursing Context…………. 35
2.8.3 Hardiness……………..……………………………………………… 36
2.8.4 Nurturing Positive Networks and Relationships.……………………. 37
2.8.4.1 The Role of Mentoring…………………………………….. 39
2.8.5 Maintaining a Positive Outlook……………………………………... 41
2.8.6 Intellectual Flexibility……………..………………..……………….. 44
2.8.7 Emotional Intelligence….....………………………………………… 45
2.8.8 Work Life Balance………………..…………………………………. 47
2.8.9 Spirituality…………………………………………………………… 48
2.8.10 Reflective and Critical Thinking…..……………………………….. 50
2.9 Work-based learning programs………..………………………………………. 51
2.10 Justification of this study……………………………………..……………… 52
2.11 Summary……………………..………………………………………………. 54
CHAPTER 3: METHODOLOGY AND METHODS
Abstract……………….…………………………………………………………….. 55
3.1 Introduction…………………………………………………………………….. 56
3.2 Methodology………………………………………………………………........ 56
3.2.1 Case Study Design………..………………………………………….. 57
3.2.2 Case studies in research literature………..…………………………... 59
3.3 Collective Case Study……….…………………………………………………. 60
3.3.1 The current study…………………………………..………………… 62
3.4 Research Study Design………………..……………………………………….. 65
3.4.1 Phase 1: Pre-Intervention………..………….……………………….. 67
3.4.1.1 Recruitment of nurse/midwife cases….…………………….. 67
3.4.1.2 Qualitative Interviews............................................................ 67
3.4.2 Phase 2: Intervention……….………………………………………... 68
3.4.3 Phases 3 and 4: Post-Intervention….………………………………... 68
3.4.3.1 Phase 3: Immediate Post –Intervention…………………… 68
3.4.3.2 Phase 4: Six Months Post-Intervention……..…………...... 68
3.5 The Setting……………………………………………………………………... 69
3.5.1 Ante-natal Ward….……...…………………………………………… 70
3.5.2 Delivery Suite………………………………………………………... 70
3.5.3 Post-natal Ward………………………………………………………. 70
3.6 Entering the Field………………………………………………………………. 71
3.7 Participants….………………………………………………………………….. 71
3.7.1 Recruitment…………………………………………………………... 71
3.7.2 Participants for each cycle.…………………………………………... 73
3.7.2.1 Cycle 1……….……………………………………………... 73
3.7.2.2 Cycle 2…………………………………………………….... 74
3.8 Data Collection………………...………………………………………………. 74
3.8.1 Pre-Intervention Phase: Qualitative Interviews……………………... 74
3.8.1.1 Field notes……………….…………………………………. 75
3.8.2 Post-Intervention Phases: Qualitative Interviews…………………… 76
3.9 Management and Analysis of Data………………….……………………......... 76
3.10 Ethical Process and Practice……………...…………………………………... 78
3.10.1 Consent……………………………………………………………… 79
3.10.2 Confidentiality………………..……………………..………………. 79
3.10.3 Respectful treatment of Participants………………………………... 81
3.11 Limitations to the Method…………………………………………………….. 81
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3.12 Summary…………………………………………….………………………... 82
CHAPTER 4: SETTING THE SCENE: PARTICIPANTS’ EXPERIENCES
OF WORKPLACE ADVERSITY
Abstract……………………………………………………………………………... 83
4.1 Introduction…………………………………………………………………….. 84
4.2 Participants……………………………………………………………………... 84
4.3 Difficult interactions with colleagues, management and clients……………….. 87
4.3.1 Difficult interactions with colleagues…………..……………………. 87
4.3.1.1 Lack of teamwork…………….….……...………………….. 88
4.3.1.2 Bullying…………………………………………………….. 89
4.3.1.3 Nursing hierarchy………………………………………….. 91
4.3.1.4 Difficult interactions with physicians……………………… 98
4.3.1.5 Lack of interpersonal communication skills……………….. 98
4.3.1.6 Ineffective conflict resolution………………………………. 99
4.3.2 Difficult interactions with management……………………………… 100
4.3.2.1 Difficult interactions with the NUM………………………... 101
4.3.2.2 Interactions from management decisions………..………… 101
4.3.3 Difficult interactions with clients…..………………………………… 103
4.4 Lack of support and recognition…………………………………….................. 105
4.4.1 Lack of support/recognition from colleagues………………………... 106
4.4.2 Management’s lack of support for nurses and midwives as
clinicians and workers………………………………………………... 108
4.4.3 Lack of support/recognition from ‘outside influences’….…………… 112
4.5 Workload and work pressure…………………………………………………... 112
4.5.1 Aspects of workload………………………………………………….. 114
4.5.2 Aspects of work pressure………..………..………………………….. 116
4.5.2.1 Dissatisfaction with quality of care………………………... 120
4.6 Work/life imbalance……………………………………………………………. 121
4.7 Summary ………………………………………………………………………. 126
CHAPTER 5: WORKPLACE ADVERSITY: ITS IMPACT AND
RESOLUTION PRE-INTERVENTION
Abstract……………………………………………………………………………... 127
5.1 Introduction…….……………………………………………………………… 128
5.2 The Impact of Workplace Adversity Pre-intervention…………………………. 129
5.2.1 The impact of exhaustion and shift work…….………………………. 129
5.2.1.1 Coping with shift work……………………………………... 133
5.2.2 The impact of emotional labour on relationships………..…………… 136
5.2.3 The impact of stress…..……………………………………………… 139
5.2.3.1 Coping with stress………………………………………….. 141
5.2.4 The impact on general health, diet and excercise……………………. 143
5.2.5 The impact on fulfilment and commitment to stay…………………... 145
5.3 The Resolution of Workplace Adversity Pre-intervention……………………... 150
5.3.1 Organisational initiatives for resilience……………………………… 151
5.3.1.1 Autonomy…………………………………………………... 151
5.3.1.2 Nature of work……………………………………………... 152
5.3.2 Collegial support and resilience……………………………………… 153
5.3.3 Personal initiatives for resilience………….…………………………. 154
5.3.3.1 Support from significant others…………….………………. 155
5.3.3.2 Self-care……………………………………………………. 155
5.4 Summary of the pre-intervention phase………………………………………... 159
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CHAPTER 6: THE INTERVENTION: DEVELOPMENT AND
IMPLEMENTATION
Abstract ……………………………………………………………………………. 162
6.1 Introduction …….……...………….……………………………….................... 163
6.2 Development of the Workshops…………………………………...…………… 163
6.3 Learning goals and outcomes…….…………………………………………….. 164
6.4 Adult Education Philosophies…………………………………………………. 170
6.4.1 Andragogical approach…..…………………………………………... 170
6.5 Learning Materials……………………………………………………………... 171
6.6 Learning Activities………………….......…...………………………………… 172
6.6.1 Collaborative Learning Activities……………………………………. 172
6.6.2 Self-reflective Learning Activities…………………………………… 173
6.6.3 Creative Learning Activities…….…………………………………… 173
6.6.4 Therapeutic Learning Activities……………………………………… 174
6.7 Implementation of the Workshops………...…………………………………… 180
6.7.1 Participation Rate…………………………………………………….. 181
6.7.2 Format and Content of the Workshops……………………………..... 181
6.8 Forming the group…………….………………………………………………... 182
6.9 Participant Reflections on the Intervention …….……………………………… 186
6.10 Development of the Mentoring Program……………………………………... 188
6.11 Mentors…………………………...…………………………………………... 188
6.11.1 Recruitment of Mentors…………………………………………….. 190
6.11.2 Cycle 1 Mentors…………………………………………………….. 191
6.11.3 Cycle 2 Mentors…………………………………………………….. 192
6.12 Mentors Information Day…………………………………...………………… 193
6.13 Matching Mentoring Partners…………...……………………………………. 194
6.14 Ongoing Support of Mentors………...……………………………………….. 195
6.15 Mentor Reflections………………..…………………………………………... 196
6.16 Challenges of the Intervention……………………………….……………….. 197
6.17 Recommendations…………………………...………………………………... 200
6.18 Summary……………………………………………………………………… 201
CHAPTER 7: POST-INTERVENTION FINDINGS
Abstract…...………………………………………………………………………… 202
7.1 Introduction……………….……………………………………………………. 203
7.2 Building, strengthening and maintaining resilience……………….…………… 205
7.3 The Mentoring Program.…….…………………………………………………. 205
7.4 Personal gains from the mentoring program………..………………………….. 206
7.4.1 Confidence in solving problems……………..………………………. 206
7.4.2 Receiving support and friendship………………………………......... 207
7.4.3 Gaining a role model and confidential advisor…….………………… 208
7.4.4 Withstanding workplace adversity………………………..………….. 209
7.4.5 Benefits for vulnerable nurses and midwives….…………………….. 210
7.5 Professional gains from the mentoring program……..………………………… 211
7.5.1 Increased assertiveness…………..…………………………………... 211
7.5.2 Greater professional networks……...………………………………... 212
7.5.3 Raised self-esteem and sense of value……………………………….. 213
7.5.4 Career development/progression……………………………………... 213
7.5.5 Taking on new challenges in the workplace…….………………….... 215
7.5.6 Renewed passion for nursing/midwifery………………….…………. 216
7.6 The Workshop Program…………….………………………………………….. 217
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7.7 Personal gains from the workshop program…………………………………… 217
7.7.1 An experiential learning opportunity……………………….………... 217
7.7.2 Creative self-expression……………………………….……………... 218
7.7.3 Exposure to new ideas and strategies………………………..……….. 219
7.8 Professional gains from the workshop program…..........……………………… 220
7.8.1 Increased assertiveness at work…………….......……………………. 221
7.8.2 Improved workplace relationships and communication……………... 222
7.8.3 Increased collaborative capital………………………………………. 223
7.8.4 Understanding self-care……………………..………………………. 224
7.9 Personal resilience initiatives………………………………………………….. 225
7.9.1 Letting harmful emotions go………..…………………..…………… 225
7.9.2 Nurturing supportive relationships……….………………………….. 226
7.9.3 Contributing to the resilience of colleagues………..……………….... 227
7.9.4 Re-defining resilience and setting new standards.…..……………….. 228
7.9.5 Awareness of self and resilience……………………………………... 230
7.10 Impact of resilience on health and wellbeing, fulfilment and
Commitment to stay…………………………………………………………… 230
7.11 Resilience and health and wellbeing …….……….................………………... 231
7.12 Resilience and fulfilment……………….…………………………………….. 233
7.13 Resilience and commitment to stay………………………………..…………. 234
7.14 Meanings of resilience………….……….……………………………………. 236
7.15 Defining resilience…………….………………….………………………....... 236
7.16 Making meanings of resilience through creative expression….……………… 237
7.17 Summary………………………………...……………………………………. 240
CHAPTER 8: DISCUSSION
Abstract……………………………………………………………………………... 241
8.1 Introduction…………………………………………………………………….. 242
8.2 Building resilient nurses and midwives………………………………………... 243
8.2.1 Knowing about the personal attributes of resilience…………………. 243
8.2.2 Regaining hope and a positive outlook………………………………. 244
8.2.3 Developing self-care and improving health and wellbeing………….. 246
8.2.4 Improving individual practice with personal resilience……………… 246
8.2.5 Creating authenticity…….…………………………………………… 249
8.3 Nurses and midwives who thrive and their personal resilience………………... 250
8.4 Nurses’ and midwives’ perceptions of resilience……………………………… 254
8.5 Building a better workplace with personal resilience………………………….. 258
8.5.1 Building effective communication in the workplace………………… 258
8.5.2 Building support networks in the workplace………………………… 261
8.5.3 Building collaborative capital with improved personal resilience…… 263
8.5.4 Building personal fulfilment with work through personal resilience... 264
8.6 Building personal resilience through a work-based intervention………………. 267
8.7 Conclusion……………………………………………………………………... 270
8.8 Summary……………………………………………………………………….. 271
CHAPTER 9: CONCLUSION
Abstract……………………………………………………………………………... 272
9.1 Recapping the findings………………...………………..……………………… 273
9.2 Implications for nurses and midwives……………….………………………… 275
9.3 Implications for nursing managers and health care organisations….………….. 277
9.4 Recommendations for future research….……………………………………… 280
9.5 Limitations of this study………….……………………………………………. 281
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