Download PDF
  • Fabio Mozzarelli
  • Original Article

Who helps the rescuer? Survey on the nurses of the Emergency Department and Emergency medical system of Piacenza through the Professional quality of Life scale (ProQOL)

  • 2/2019-giugno
  • ISSN 2532-1285
  • https://doi.org/10.23832/ITJEM.2019.024

Ilenia Treno nurse
Gabriella Di Girolamo nurse manager
Fabio Mozzarelli chief nurse

General hospital Guglielmo Da Saliceto Piacenza, Italy

Abstract

Introduction

It is known that the staff assigned to the emergency health services, is almost routinely called to emergency situations.
In order to measure the level of work stress to which the emergency area nurses of the Piacenza Local Health Authority are subjected, an assessment scale called professional quality of Life scale (ProQOL) was identified and used.

Materials and methods

The survey involved the nurses emergency medical system (EMS) and emergency rooms (ER) of the central hospital of Piacenza and peripheral Hospitals in Piacenza and its interland.
A total of 85 ProQOL questionnaires were administered, obtaining 100%  adhesion.

Results 

The frequencies detected through the survey with the “ Compassion Satisfaction Scale” subscale are placed  in the intermediate range. The highest frequency of high professional satisfaction is recorded in the operators exclusively employed in the ER.
Compared to the second “Burnout Scale” subscale, no nurse has a high score and therefore this level remains empty in all Operating Units. Considering the third subscale “Secondary Traumatic Stress Scale”, emerges a higher frequency (77%) of the low level for nurses exclusively employed at EMS.

Discussion

The survey conducted on nurses in the ER in Piacenza Hospital and its interland, shows average values ​​of stress that do not have alarming  characteristics.

Conclusions 

It appears that the professional figures protect themselves by acquiring and maintaining high professional skills with the support of specific training and training projects as well as partly envisaged by the health accreditation systems.

Keywords

emergency, rescuers, ProQOL, stress, nurses

Background

Personnel assigned to EMS and ER or operating in emergency departments, is often exposed to situations with a high emotional impact and in most cases, they develop, through field experience, a high threshold of tolerance to emergency situations. However they are not always able to govern reactions of distress and psychological suffering 1,2,3.
In the United Kingdom some recent surveys have shown that emergency nurses showed a higher incidence of psychophysical disorders compared to colleagues in other clinical branches4. In the last years, there has been a growing attention to the discomfort of personnel operating in emergency situations, also due to the rising diffusion of studies on post-traumatic disorders of professionals in the emergency department5,6.
However, in the collective imagination, the belief remains that rescuers are always able to manage any psychological trauma situation without having negative consequences and this attitude leads professionals to deny and / or hide any disorders resulting from exposure to painful events7.
The aim of this study is to investigate the quality of life inherent to the work environment of emergency professionals called daily to manage traumatic situations in order to verify critical issues and possible training needs.

Methods

The survey involved 85 nurses from the EMS and ER of Piacenza and its interland, of whom 47 in Piacenza (31 in ER and 16 in EMS), 8 in Bobbio, 13 in Castel San Giovanni, 17 in Fiorenzuola, obtaining 100% adhesion.

All nurses were asked to complete the ProQOL Scale, with a guarantee of anonymity, in order to participate in a survey on the quality of professional life. Each participant delivered, in due time, the form in a sealed envelope, inserting it in a container dedicated to this research.
The anonymous administration of the ProQOL assessment scale took place in the period between the 17thof August 2015 and the 3thof October 2015. The research was carried out after having requested and obtained authorization from the Piacenza Local Health system and after obtaining the consent of the partecipants.
Anonymity has also been ensured through the guarantee of not including the identification data. At the time of compilation, each questionnaire was given a random code communicated only afterwards to the interested party in order to know , if requested, the results of the evaluation. To facilitate data collection, the time of shift change was chosen between morning and afternoon, in order to find as many partecipants as possible.
With the aim of ensuring a correct filling of the questionnaire by the nurses, working priorities where respected. The research project with its consent to be signed was delivered first and subsequentely evaluation scale associated with the random code.
We also investigated the professional setting of belonging, seniority and work experience.
The evaluation scale called Professional Quality of Life Scale (ProQOL), is a validated tool even in the italian version8.
It consists of 30 questions, divided into three subscales, which correspond to 10 items, each of them can have a minimum score of zero (never) and a maximum of 5 (always), the instructions indicate that the answers required must refer to the previous month.
The three subscales consider the following constructs: the Compassion Satisfaction Scale, a component that investigates job satisfaction, the Burnout Scale which measures the eventual condition in which the professional shows signs and symptoms of work sickness and the Secondary Traumatic Stress Scale designed to analyze the effect that particularly traumatic events can have had on the operator.
The statistical analysis was performed with the SPSS Statistical Software Version 14.0, using the frequency distributions and the percentages for the discrete variables and the comparison between the groups was carried out with the Chi Square test.
The central trend measurements used were the mean and the standard deviation whereas for the comparison between the average scores of the various groups was carried out using the ANOVA statistic for the analysis of variance.
The differences are considered statistically significant with p values ​​<0.05.

Results

 

Table 1 shows the professional belonging of the participants, which demonstrates a higher frequency of operators belonging to the ER service with 43 nurses (51%).
The lowest frequency is represented by the nurses operating exclusively in EMS, who are 17 (20%) of the overall sample, and finally 29% refers instead to 25 nurses who work simultaneously in both environments. If we consider the representation of the participants  through their working place, it is possible to have a detailed picture of the situation: the nurses operating in the ER of Piacenza are 31 (66%) compared to the total 47, while at EMS 16 (34%) compared to the total 47.
In Bobbio only one nurse among 8 (12%), works exclusively in the ER; the remaining 88% refers to ER and EMS. In this case, no professional is exclusively assigned to the EMS. Also in Castel San Giovanni we see the highest frequency of use in the intra and extra-hospital environment (ER and EMS) with 10 (77%) represented by 13 nurses; only 3 (23%) of the total thirteen, remain exclusive in the ER. In Bobbio, Castel S. Giovanni and Fiorenzuola, the nursing staff carries out their working activity simultaneously both in EMS and in ER.
In the district of Val D’Arda to Fiorenzuola, there is a frequency with 8 nurses (47% of the total 17) both in ER and EMS, while in this last seat exclusively one nurse is placed ( 6% of 17).
 

CASEMIX

  
 

SETTING 

EMERGENCY ROOM

OPERATION CENTER 

ER and EMS

  

 FREQUENCY

51%

20%

29%

  

43

17

25

  

Table 1. 

        
 
With regard to seniority, there is a clear prevalence of personnel who has been working for less then ten years (51 nurses 60%) as shown in Table 2. Only 15 professional (18%), the lowest percentage, has been working for more than twenty years. 
 

SENIORITY OF WORK

  
 
 

Frequency

%

  

<10 years

51

60%

  

10-20 years

19

22%

  

>20 years

15

18%

  

Total

85

100%

  
 
Table 2. 
 
The Compassion Satisfaction Scale identifies the incidence of high, medium or low professional satisfaction of the operators considered. No significant differences emerged in the Compassion Satisfaction Scale between the various areas examined (as shown in table 3).
 

COMPASSION  SATISFACTION  SCALE

  
 
 

ER

OPERATION CENTER

ER and EMS

  

LOW

5%

0%

0%

  

MEDIUM

65%

59%

64%

  

HIGH

30%

41%

36%

  

TOTAL

100%

100%

100%

  

CHI QUADRO

3,26

  

P VALUE

0,515 No statistical differences 

  
 
Table 3. 
 
From a qualitative point of view, it is interesting to note that the highest percentage of nurses who work  either in the ER or in the EMS, or in both the ER and the EMS, are in the middle range; the highest frequency (64%), however, is attributable to nurses who work both in an ER and the EMS. Conversely, the highest frequency of high professional satisfaction is registered in the operators employed exclusively in the ER. In any case, the data does not appear to be statistically significant.
The Burnout Scale identifies the presence of high, medium or low level of burnout. Table 4 shows the incidence in the Burnout Scale, where no significant differences appear between the various areas examined.
From a qualitative point of view it is possible to find that no nurse has a high score in any of the EMS Operation center and that the highest frequency of low Burnout is found in the professionals exclusively employed in EMS Operation center (63%) (table n.4).
 

BURNOUT  SCALE

  
 
 

ER

OPERATION CENTER

ER and EMS

  

LOW

46%

62%

44%

  

MEDIUM

54%

38%

56%

  

HIGH

0%

0%

0%

  

TOTAL

100%

100%

100%

  

CHI QUADRO

1,542

  

P VALUE

0,462 No statistical differences

  
 
Table 4. 
 
The Secondary Traumatic Stress Scale identifies the presence of high, medium or low incidence of traumatic events reported.
Table 5 shows the incidence in Secondary Traumatic Stress Scalewhere no statistically significant differences appears between the different areas analyzed.
Compared to the subscale that investigates burnout, one can observe a higher frequency (77%) of the low level for nurses exclusively employed at EMS and there are no high levels of stress in any of the three professional settings.
 

SECONDARY  TRAUMATIC  STRESS  SCALE

  
 
 

ER

OPERATION CENTER

ER and EMS

  

LOW

65%

77%

72%

  

MEDIUM

35%

23%

28%

  

HIGH

0%

0%

0%

  

TOTAL

100%

100%

100%

  

CHI QUADRO

0,857

  

P VALUE

0,652 No statistical differences

  
 
Table 5.
 
Finally, in Table 6, the analysis of Variance (ANOVA) is reported, carried out on the average scores obtained at the three subscales of the ProQOL subdivided by workplaces from which a statistically significant difference emerges in the average scores of the Secondary Traumatic Scale (p = 0.005 ) to indicate higher scores present among the nurses of Bobbio (23.6) and Fiorenzuola (22.7) compared to those of Piacenza and Castel San Giovanni (17.6). It is important to consider that this significance may be affected by the different numbers of the examined groups (N = 8 Bobbio, N = 12 Castelsangiovanni, N = 16 Fiorenzuola, N = 46 Piacenza) and the results must be interpreted with extreme caution. 
 
DISTRIBUTION  IN  THE  THREE  UNDER  SCALE  IN  ProQOL
  

UNDER SCALE 

COMPASSION SATISFACTION  SCALE

BURNOUT SCALE

SECONDARY  TRAUMATIC STRESS  SCALE 

  
 

PLACE

N

Average and Standard Deviation 

N

Average and Standard Deviation

N

Average and Standard Deviation

  

PIACENZA

47

38 ± 6

44

23,5 ± 5

46

19 ± 4

  

BOBBIO

8

39,3 ± 6

8

23,1 ± 3

8

23,6 ± 7

  

CASTEL S. GIOVANNI

13

39,7 ± 6

13

20,8 ± 3

12

17,6 ± 7

  

FIORENZUOLA

17

39,3 ± 7

17

23,8 ± 5 

16

22,7 ± 5

  

TOTAL

85

38,7 ± 6

82

23,1 ± 5

82

20 ± 5

  

F

0,349

1,333

4,657

  

P VALUE

0,79

0,27

0,005 

  
 
Table 6. 

Discussion

During the administration of the test no particular management problems were encountered; nurses have shown interest in completing every single item requested.

There were no cases of non-comprehension of the questions.
With regard to the distribution of the nurses, it is worth remembering that in Piacenza the professionals carry out exclusive activities in the ER or EMS, while in the peripheral hospital these functions can add up.
Regarding the results, a significance appears that, with respect to the average scores of the Secondary Traumatic Stress Scale which could indicate that in the more decentralized centers there are no structures that could give greater security or support for more severe cases, where in some cases, the operating room, intensive care unit, surgical wards were needed.
This lack of support could increase the perceived stress of nurses, who must decide quickly whether to undertake centralization towards the reference hub structure.
 
Limitations of the study
 
The result of this study should be used to improve the quality of work in a brief period of time because it affects a very complex environment strongly affected by the human factor in which over time conditions, environment, personnel and contextual variables would surely change rapidly. Since this is a research on the quality of life in the professional field, a very partial and limited relapse derives from the context in which it was studied, with results that cannot be generalized to other ER or  EMS, although similar in type and organization.
 
Strengths
 
It seems very interesting to notice how the personal beliefs of the partecipants differs from the results acquired from the questionaires. Specifically, before carrying out this research, many operators reported being stressed by their work, but this condition does not appear from the data collected in this survey.
This fact implies that validated assessment scales could give a better assessment of the environment in which the rescuer work rather their personal beliefs.
 
Implications in clinical practice
 
The survey carried out could favor the use of ad hoc paths, such as training, auditing, discussion of clinical cases, training, coaching, defusing, debriefing9 to improve the health of the professionnel. The need for psychotherapeutic courses with evidence based criteria for prevention and Treatment of Post Traumatic Stress Disorder such as Eye Movement Desensitization and Reprocessing(EMDR) could also be evaluated.

Conclusions

The survey conducted on nurses in the EMS and ER in Piacenza and its interland, shows average values ​​of stress.It appears that job satisfaction is high in all three areas of work.

The EMS and ER nurses can always better “protect themself” by acquiring and periodically refreshing their skills with the help of training projects.

References

  1. Storti M, Visonà M. Il disturbo post traumatico da stress nel personale di emergenza: una revisione della letteratura. Scenario, 2010; 27(01):19-24 
  2. SkogstadM. Work-related post-traumatic stress. Disorder Occup Med., 2013; 63(3):175-182
  3. Ricciardi M. L’importanza del supporto psicologico per i soccorritori. Psicologia dell’emergenza: emergenza ambientale. Found to: http://www.formazioneinemergenzasanitaria.net/Scritti_e_articoli/Psicotrauma69.pdf [consulted in 20/06/2015]
  4. Rodgers LM. A five year study comparing early retirements on medical grounds in ambulance personnel with those in other groups of health service staff. Part II: causes of retirements. Occup Med., 1998; 48: 119-32.
  5. Bennett P, Williams Y, Page N, et al. Levels of mental health problems among UK emergency ambulance workers. Emerg Med J., 2004; 21:235-6.
  6. Regehr C, Hill J, Golberg G, Hughes J. Postmortem inquiries and trauma responses in paramedics and firefighters. J Interpers Violence. 2003; 18: 607-22.
  7. ShepherdL. Cognitive appraisals, objectivity and coping in ambulance workers: a pilot study. Emerg Med., 2014; 31(1):41–44
  8. Stamm B H. ProQOL. Found to: http://www.proqol.org/. [Consulted in 04/03/2015].
  9. Troiano M, Lardo T. (2004) Tecniche di gestione dello stress da evento critico: il defusing e il debriefing. Found to: http://www.counselling-care.it/pdf/pdf_psico/Psicotrauma16.pdf. [Consulted in 03/05/2015].