Engagement of nurses in their profession. Qualitative study on engagement

array:24 ["pii" => "S2445147917300462" "issn" => "24451479" "doi" => "10.1016/j.enfcle.2017.03.006" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "660" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Clin. 2017;27:153-62" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "HTML" => 2 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1130862117300372" "issn" => "11308621" "doi" => "10.1016/j.enfcli.2017.03.006" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "660" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Clin. 2017;27:153-62" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 28 "formatos" => array:2 [ "HTML" => 23 "PDF" => 5 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "ORIGINAL" "titulo" => "Implicación de las enfermeras en su profesión. Un estudio cualitativo sobre el engagement" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "153" "paginaFinal" => "162" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Engagement of nurses in their profession. Qualitative study on engagement" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rosa García-Sierra, Jordi Fernández-Castro, Fermín Martínez-Zaragoza" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Rosa" "apellidos" => "García-Sierra" ] 1 => array:2 [ "nombre" => "Jordi" "apellidos" => "Fernández-Castro" ] 2 => array:2 [ "nombre" => "Fermín" "apellidos" => "Martínez-Zaragoza" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2445147917300462" "doi" => "10.1016/j.enfcle.2017.03.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445147917300462?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862117300372?idApp=UINPBA00004N" "url" => "/11308621/0000002700000003/v1_201705190128/S1130862117300372/v1_201705190128/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2445147917300383" "issn" => "24451479" "doi" => "10.1016/j.enfcle.2017.03.004" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "659" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Clin. 2017;27:163-71" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3 "HTML" => 3 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Crisis in the health sector: Impact on nurses’ working conditions" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "163" "paginaFinal" => "171" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Crisis en el sector sanitario: impacto percibido en las condiciones de trabajo de las enfermeras" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2371 "Ancho" => 2259 "Tamanyo" => 362495 ] ] "descripcion" => array:1 [ "en" => "Impact of the containment measures on nurses’ working conditions." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alberto Granero-Lázaro, Josep M. Blanch-Ribas, Juan Francisco Roldán-Merino, Jordi Torralbas-Ortega, Ana María Escayola-Maranges" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Alberto" "apellidos" => "Granero-Lázaro" ] 1 => array:2 [ "nombre" => "Josep M." "apellidos" => "Blanch-Ribas" ] 2 => array:2 [ "nombre" => "Juan Francisco" "apellidos" => "Roldán-Merino" ] 3 => array:2 [ "nombre" => "Jordi" "apellidos" => "Torralbas-Ortega" ] 4 => array:2 [ "nombre" => "Ana María" "apellidos" => "Escayola-Maranges" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1130862117300360" "doi" => "10.1016/j.enfcli.2017.03.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862117300360?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445147917300383?idApp=UINPBA00004N" "url" => "/24451479/0000002700000003/v2_201706121007/S2445147917300383/v2_201706121007/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2445147917300474" "issn" => "24451479" "doi" => "10.1016/j.enfcle.2017.03.007" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "662" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Clin. 2017;27:144-52" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Rising to the Challenge of promoting research in primary care and nursing: Research productivity and professional view" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "144" "paginaFinal" => "152" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El reto de potenciar la investigación en Atención Primaria y Enfermería: productividad científica y opinión del profesional" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2546 "Ancho" => 2333 "Tamanyo" => 301384 ] ] "descripcion" => array:1 [ "en" => "Professionals in charge of the scientific production of Mútua Terrassa. And participation of primary care professionals in the survey on perception." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nuria Giménez, Conxi Caro, Ester Ponsa, Ángel Mauricio Perez Ortiz, Inma Navazo, Montse Gavagnach" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Nuria" "apellidos" => "Giménez" ] 1 => array:2 [ "nombre" => "Conxi" "apellidos" => "Caro" ] 2 => array:2 [ "nombre" => "Ester" "apellidos" => "Ponsa" ] 3 => array:2 [ "nombre" => "Ángel Mauricio" "apellidos" => "Perez Ortiz" ] 4 => array:2 [ "nombre" => "Inma" "apellidos" => "Navazo" ] 5 => array:2 [ "nombre" => "Montse" "apellidos" => "Gavagnach" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1130862117300396" "doi" => "10.1016/j.enfcli.2017.03.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862117300396?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445147917300474?idApp=UINPBA00004N" "url" => "/24451479/0000002700000003/v2_201706121007/S2445147917300474/v2_201706121007/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Engagement of nurses in their profession. Qualitative study on engagement" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "153" "paginaFinal" => "162" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rosa García-Sierra, Jordi Fernández-Castro, Fermín Martínez-Zaragoza" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Rosa" "apellidos" => "García-Sierra" "email" => array:1 [ 0 => "rgarcias@cst.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Jordi" "apellidos" => "Fernández-Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Fermín" "apellidos" => "Martínez-Zaragoza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universitat Autònoma de Barcelona, Campus Bellaterra, Cerdanyola (Barcelona), Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Stress and Health Research Group, Departamento de Psicología Básica, Universitat Autònoma de Barcelona, Campus Bellaterra, Cerdanyola (Barcelona), Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departamento de Psicología de la Salud, Universidad Miguel Hernández, Elche (Alicante), Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Implicación de las enfermeras en su profesión. Un estudio cualitativo sobre el engagement" ] ] "textoCompleto" => "<elsevierMultimedia ident="tb0005"></elsevierMultimedia>IntroductionNurses are the largest group of health professionals. Demographic changes due to an ageing population and the increased incidence of chronic disease require nurses to play a crucial role in building efficient health systems that can take on new challenges. Facing these changes requires highly committed practitioners who provide excellent healthcare and this is what we term engagement. The scientific literature on nurses’ engagement shows it to have a positive influence on their professional performance through increased efficacy<a class="elsevierStyleCrossRef" href="#bib0160">1</a> and extra-role<a class="elsevierStyleCrossRef" href="#bib0165">2</a> performance, with a beneficial effect on care outcomes.<a class="elsevierStyleCrossRefs" href="#bib0170">3,4</a>Engagement is a construct arising from positive psychology focussing on people's strengths and is defined as “a positive mental attitude to work, characterised by vigour, dedication and absorption”. Vigour translates as a great willingness to devote effort to work and persistence in the face of difficulty. Devotion refers to being strongly committed to working activities and to feel enthusiasm, inspiration, pride, a sense of challenge and meaning. Absorption translates as being fully focussed and happily immersed in one's work, in such a way that time passes rapidly and a sense of not wishing to leave the workplace.<a class="elsevierStyleCrossRef" href="#bib0180">5</a>Engagement was initially considered in the study as the polar opposite to burnout.<a class="elsevierStyleCrossRef" href="#bib0185">6</a> The syndrome of burnout is defined as “…a state of exhaustion where the person feels cynical about their professional role and doubts their ability to perform” and comprises 3 factors: emotional exhaustion, depersonalisation and reduced self-efficacy.<a class="elsevierStyleCrossRefs" href="#bib0185">6–8</a> Emotional exhaustion is described as a feeling of being unable to offer more of oneself emotionally. Depersonalisation is an attitude of remoteness towards work, towards the people being offered the human service and towards work colleagues. And finally, a lack of self-efficacy is a feeling of not completing tasks properly and of incompetence at work.<a class="elsevierStyleCrossRefs" href="#bib0200">9,10</a> Later the Job-Demands Resources Model (JD-R)<a class="elsevierStyleCrossRefs" href="#bib0210">11–13</a> offered a joint explanation of burnout and engagement, in which the positive and negative aspects of work could be analysed together on establishing 2 distinct psychological processes for burnout and engagement. The JD-R states that employee experience wellbeing through the interaction of work demands and work resources by means of 2 inter-related psychological processes, one leading to burnout through the demanding aspects of the work and the other leading to engagement through work resources.<a class="elsevierStyleCrossRefs" href="#bib0220">13–16</a> These 2 process establish crossed relationships with each other, such as the negative influence of social support in the burnout process<a class="elsevierStyleCrossRef" href="#bib0240">17</a> or the moderating effect of engagement in the relationship between demands of work and burnout,<a class="elsevierStyleCrossRef" href="#bib0245">18</a> as well as other correlations between the model's different components.<a class="elsevierStyleCrossRef" href="#bib0250">19</a> The JD-R was the predominant theoretical framework for our study of nurses’ engagement and, building on it, we examined many aspects that might act as antecedent variables of engagement. We concluded that engagement, in nurses, is a result of the interaction of dispositional factors, career-long learning and working environments.<a class="elsevierStyleCrossRef" href="#bib0255">20</a> Distinctive features of nursing practice such as the strict organisation of tasks and position within health teams suggest that there may be aspects specific to the profession not reflected in the current literature and aspects in the conceptualisation of engagement that differ from the other professions.The main aim of this research study was to identify common aspects in the professional experiences of highly engaged nurses to enable us to develop in depth the construct of engagement within the nursing profession, in order to then apply it in light of all its distinctive features.A specific aim was to determine the features of jobs, organisations and the people involved in the experience of engagement in the nursing profession. With these objectives, we attempt to remedy the lack of research studies on the distinguishing features of nursing in terms of engagement.MethodologyIn order to achieve greater variability of data, provide more chance of new information appearing and to obtain deeper knowledge of the construct under study,<a class="elsevierStyleCrossRef" href="#bib0260">21</a> we explored the experience (of engagement) in nurses from different care areas. For this we used a qualitative research design with a phenomenological approach.We undertook a qualitative analysis of the content, as an inductive approach, examining the experience of engagement in nurses and the meaning it has for them, adapting to the subjectivity of the individuals.<a class="elsevierStyleCrossRef" href="#bib0260">21</a> Our analysis centred on the manifest, not the latent content, in other words, we analysed what the text says is analysed and describe the visible and obvious components (the manifest content).<a class="elsevierStyleCrossRef" href="#bib0265">22</a>We chose a qualitative approach since it was possible that unexpected knowledge might have been generated about the specific work areas, knowledge that would be difficult to obtain taking a quantitative approach with closed questions.The inclusion criteria for participants were nurses with high levels of engagement, working in direct care in hospitals as well as primary care, there were no established exclusion criteria. Sampling by intensity was used for selecting participants, examining the people who most represented the concept of engagement, since we were looking for the maximum information on the construct.The recruitment process took place through all the nursing coordinators of the Consorcio Sanitario of Terrassa, who recommended people with high engagement in their departments, and these people were invited to participate. The coordinators were informed in a meeting of the meaning of engagement, and the objectives and methodology of the research. They were also given written information on the definition of engagement and the research project.The sample size was not predetermined but arose from data saturation. Of the 16 people invited to participate, only one declined the invitation (rejection rate of 6%) in the end, therefore there were 15 participants. The participants were 14 females and one male, aged between 28 and 50 years, with a mean age of 41 years. The people interviewed had worked in nursing between one and 27 years, with a mean number of years worked of 17. At the time of selection the nurses were working in the operating theatre, oncology, palliative care, emergency care, gynaecology, primary care and psychiatry, although they had experience in other departments.The data were collected between February and March 2016, using semi-structured interviews with guidelines for the areas to be covered (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), although these guidelines were flexible according to the progress of the interviews, and whether change or different questions were required during the process.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The place that the interviews were to take place was decided by the participants. They established that they should be held in each participant's work centre, in areas usually used for rest or training, where there were no interruptions. All the interviews (n=15) were held with the same interviewer, they were between 14 and 20min in duration and recorded with the consent of the participants. The recordings were transcribed in writing.Data collection and analysis took place simultaneously. Data collection ended when the subject areas were saturated in 2 consecutive interviews.The constant comparison method was used to interpret the research material until the theoretical saturation point was reached. An inductive approach was used, from the specific to the general, in which the categories derived from the data in the analysis.<a class="elsevierStyleCrossRefs" href="#bib0265">22,23</a>The analysis comprised 5 phases. Each completed by the principal researcher and the other 2 collaborators, who reviewed the result, then the differences in criteria were discussed and finally the end results for each of the phases were agreed by consensus. The first stage of the analysis was to repeatedly read the transcribed material to become familiar with the text and extract relevant verbatims to answer the research questions. In phase 2, the interview verbatims were coded into units of meaning by 2 different investigators and were compared in order to reach a consensus. Expressions with similar meanings were grouped into subcategories and were given names. In phase 3, the subcategories were grouped based on their content and categories were created and then labelled to describe the content. In phase 4, points in common between the categories were identified and the subjects extracted. And finally, in phase 5, the phenomenon of engagement was interpreted, synthesised and reconceptualised specifically to nursing.Various aspects were monitored during the research study. Firstly, epistemological adequacy,<a class="elsevierStyleCrossRef" href="#bib0275">24</a> referring to the adequacy of the qualitative approach, secondly, relevance, given that the research study would have a direct impact on improved knowledge of the engagement phenomenon. Verbatims (identified with a number in brackets for each respondent) are included in the results, as well as the exhaustive description of the analysis, in order to increase the study's reliability, and a table showing the units of meaning, subcategories, categories and themes.<a class="elsevierStyleCrossRef" href="#bib0270">23</a> The credibility criterion, analogous with internal validity in quantitative research, was ensured by the thorough data collection and independent developing of the code scheme undertaken by 3 investigators, as well as by discussion of the codification grid and categorisations of the research team. In order to facilitate transferability, a clear description was given of the context, selection of participants, data collection and analysis process.<a class="elsevierStyleCrossRef" href="#bib0265">22</a> Finally, recognition of reflexivity<a class="elsevierStyleCrossRef" href="#bib0275">24</a> from conception of the project, and the effect that the principal investigator's original training (care nurse) might have had on the study aim, were the reasons for triangulation with investigators from different disciplines and organisations, in order to achieve more effective compression of engagement.The project was approved by the Clinical Research Ethics Committee of the Consorcio Sanitario of Terrassa. The interviews were anonymous and voluntary and the participants were able to interrupt their participation when they wanted. The participants were informed about the research study verbally and in writing, and of the chronogram and dissemination of the study results. Everybody who was interviewed signed their informed consent and was assured of the confidentiality and anonymous nature of the data collected.ResultsThree large themes emerged through analysis of the content described, and these were grouped into 7 categories. In turn, these categories combined 11 subcategories combining 62 different units of meaning. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the 62 codes combined and classified by category and theme.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Job characteristicsThe theme combining the most codes and to which the participants devoted the most time was that of job characteristics. This theme encompasses all the aspects referring to care nurse work in the different positions of the profession and that the respondents found relevant to their professional experience. This theme covers the categories of vigour, dedication and reward.VigourWith regard to vigour, the nurses found that their main sources of energy in their work related to how their work appealed to them, and they showed enthusiasm and pleasure in the tasks that they undertook.I’m full of energy when I arrive in the morning, this is true, and I really want to look after the patient, their family, and sometimes I think, when I get to work, during the day at home I don’t, but it is true that when I get to work I think about the patient, what I can do for them, how I can help them and their family…and I think, let's see if this will help him, I think about what they were talking to me about at the last visit, you know, and I arrive with a lot of enthusiasm. (12)All of the respondents expressed an overall feeling of energy at work, however, there were numerous elements that had a negative effect on their energy and that occasionally had an effect on them, although they did not consider that they had developed burnout syndrome through their trajectory. The difficulties that arose in undertaking their work that they identified as burnout triggers related to workload, which occasionally undermined their ability to perform and made them feel responsible for shortcomings in performance and gave rise to feelings of powerlessness.I’ve had times when there was a lot of work in the hospital and both my colleagues and I have ended up crying, you’re just overwhelmed…If you have 2 patients with complications at the same time, you have no help and you end up crying, and you leave the hospital in tears, this has happened. But I think it is the sense of responsibility that we have really…you ask for help and they can’t give you any, so you become a bit overwhelmed. Not burnout,…I don’t know, but not burnout, because I’ve always tried to turn situations around. (11)There is one aspect that arose frequently during the interviews with regard to the daily difficulties the nurses encountered in undertaking nursing tasks:I think what makes me exhausted, looking at the situations, is that the same negative situations happen again and again, I cannot change them and I meet them in daily practice. I mean, the patients themselves, no, but the limitations in doing my work, I know that these will reoccur because they won’t be resolved, and this is what makes me exhausted. (2)DedicationDedication refers to everything in relation to being engaged with the work and the feelings of pride and meaning it involves. In general most of the units of meaning in this category established a very close link between professional and personal development. This category arose from 2 subcategories, the first was termed “meaning of the work”, where all the nurses interviewed attributed a meaning to their work beyond a simple source of income.…then I did nursing, and it was like a journey, I learned a lot, I had no idea that my work could give me so much, give me so much in return, I could not have imagined it, I studied it, tried it and well, over the years the profession has given me a lot, a lot. (10)I would not change nursing for a different profession, because I feel very, very lucky to be in this profession and it fulfils me as a person as well. (15)In general, being a nurse is somewhat more than having a profession, and appears as a source of personal growth. The second subcategory, termed “challenges and pride”, where the respondents agreed that new challenges arise every day meaning that they had to keep training up-to-date and develop new skills to continue to develop and be proud of their professional performance.Changes are good, making changes is good, although frightening at first, I think everybody needs change. Being on one shift for 20 years performing the same function, I think in the end, I don’t know maybe you become passive and not very motivated from doing the same thing all the time. I think that change is good, because you keep up-to-date, you are motivated, you learn different things, different environments with different people and this offers you much more as a professional, this is what I think. (8)And of course, there are patients who put up a lot of barriers, and then as you start to break through them, you sometimes say “Great! Well done”” you finish your care visit to the patient and you say “That was satisfying, I feel good!”. (12)RewardAlthough none of the questions referred to reward, 8 of the 15 spontaneously highlighted how important it was for them to see the impact of their care on people's lives, and the gratitude that patients showed for their care. They valued this most in terms of reward for their efforts.…and I feel rewarded, why? Well because of the way things turn out, they way they are grateful, well, I think that this is an excellent relationship for me, I couldn’t want for more. Sometimes the extent that my care affects people and what I can give them surprises me, and how it affects the lives of these people. (1)Under the dedication category we have already mentioned how work can act as a source of personal growth. This category stresses reward as an incentive for effort. In all the cases that mentioned the word reward, it was seen as an added value to nursing work.…all this, not much of what you do receives much thanks…which happens in the emergency department as well, not much of what you do has much impact, and well, I like this, this makes me really want to work in this. (5)Contact with families, contact with patients, the relationship fulfils me, fulfils me,…above all being able to please the patient and be with the family in an end-of-life situation and you can help them with their wishes and what they would like to do and you can help them to do this, this fulfils you because you think Gosh! Look, they were able to do that and we were able to achieve it, and the patient feels good, and their family, and you think that's great they were able to see it through! It's not always like that and that's true as well, if only it were always like that. (12)Characteristics of the organisationsThis category includes all the themes that the participants felt were relevant with regard to the organisations in which they worked. The units of meaning that arose in the interviews created 3 categories termed autonomy, social support and conciliation, and are described below.AutonomyThe interview guide (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) shows that autonomy does not appear as a question or theme. However, in 11 interviews, autonomy appears as an invaluable characteristic of the work, or as a desired characteristic for the work to be more satisfactory.And often when I arrive, depending on what I have to do I think, today is going to be a great day, and it is, because you have a lot open to you, because we work differently here to hospital, we are not as programmed. Here nurses are very autonomous, we establish a very different relationship with the patient, and you can develop yourself and do a lot of things, and then you get this in return, and then it is very gratifying to feel like this and I often leave thinking today has been a fantastic day. (10)Social supportSocial support refers to the absence or presence of psychological and instrumental support from members of the working environment. This category arises from superior subcategories and teams. In the superiors section, all the codes refer to immediate superiors, who are intermediate managers between workers and management. In all cases, the role of the coordinators is relevant, either because they are identified as of major support – in terms of flexibility, for example – or in other cases, the exact opposite is perceived, i.e., little effort is made towards improving the organisation of jobs. In some cases, the superiors are seen as responsible for shortfalls in research and teaching, or for not offering sufficient room for dialogue or the possibility to express daily difficulties.I often think we should feel more supported and we should be listened to more. There is often little communication with your supervisors, you often feel…you finish an entire morning of care visits, difficult care visits and there is no time to share, this could improve because you often need to express these things you feel that you need to express, but you have nobody to talk to, so at these times, perhaps because of the people who supervise us, the coordinators, we should maybe have more space, or more interviews or more time to be able to discuss things. Nothing is talked about, nothing is talked about. (8)…at organisational level no, because everybody helps out, and when you’re asked a favour, because somebody is off sick or something, then you ask for something and they help you too, so there is goodwill. (15)In the team subcategory, 8 participants highlighted the importance that the relationship between work colleagues should be strictly professional, so that conflicts do not arise, conflicts that are identified as having a negative impact on overall team performance.…I start the day badly confronting the person in question and then my day is changed. It's not an overall change, generally, with the patients, but it does affect things, yes. It does affect the quality of care, yes, yes. I don’t like it, even when I distance myself, or analyse the situation or if I’ve had a bad day I think, but if this person is not you, you can change, yes, and so much, yes, how you deal with other people, of course. (1)The disregard that some doctors hold for nurses was mentioned in 4 interviews, and the difficulty they have in accepting changes and acknowledging nurses as an essential part of multidisciplinary teams and, in some cases as leaders of projects undertaken in healthcare centres. These difficulties are a source of unrest and require an active attitude on the part of nurses to resolve them.I think a nurse-lead project was started here,…a new thing, not very well defined, and people can’t change their mindset to include this new model and all change is difficult to accept. There are people who adapt to change better and there are people who find it difficult and there are those who never adapt and this sometimes creates conflict in the workplace and can make you feel discouraged, but, well, despite all the difficulties, I think the project went ahead. I’m content. (3)I do occasionally have brushes here because there are people, from my point of view, who are fine with what there is, it's fine, they’ve always been like that, it's always been done like that and always this and that. I like it, well, well scientific evidence says that this should never be done, ever, because it's a mistake and was already proven in 1992…, well, well, well it has always been done like this, and you know, and I think if you spend your time on this… (5)ConciliationThis category covers all the aspects relating to work rotas and the relevance of work shifts, which the interviewees directly associated with family conciliation.In relation to work rotas in general, being able to change shifts to adapt them to children's needs as they grow up was very highly valued. In some cases the work shift was seen as a source of burnout if not possible to adapt. Discontent at having to work on holidays and weekends was also a recurrent theme, the importance of this is shown in the claims of some of the interviewees that their jobs were determined by the work hours and not the work itself and the implications involved.They made it easy for me in the hospital, at first it was impossible really, I have 2 very small babies aged 16 months, 2 twins, and well I was talking here with our bosses and I asked them if I could come in 2hours later and leave 2hours later, move my shift forward really, because I’m not interfering with anybody else, they said “well, look there's no problem with that”. (5).No, it's really difficult, with the hours that we have to work in healthcare, it's really difficult. I’m sure there's no perfect work rota, but these are really awful…weekends, holidays, of course, the 25 December, Christmas evening when it's your turn to work… (9)Individual characteristicsThis theme includes all the individual characteristics that the interviewees identified as relating to their work performance. All the codes that include the categories making up this theme relate to the attitudes they feel necessary for nursing work and the vocational aspects of the job.The word empathy and being close to patients came up constantly in the interviews, identified as vital skills for performance at work. They occasionally outlined the importance of not confusing these skills with friendliness or relationships that are not strictly professional with patients that might have a negative impact on nursing interventions.The relationship with patients is not always the same, of course. There are patients and patients, but I think that we should keep qualities or attitudes as professionals very much in mind and integrated, there are days that you manage this better than others, but well, being empathetic, respectful and humane, I think that you’ll always do well with patients. (3)The value attached to personal maturity is also highlighted and how this affects improved professional work.A lot, my own maturity and personal experience, of course, the more experience you have the better. As long as you have a positive attitude, because you can be on the point of retirement and be really bitter and hardly look at the patients, “they’re fasting, they have allergies…and so on, OK” they might not even tell them, no we’re going to the operating theatre, it depends on your personal engagement, how you engage professionally and personally, you know? In order to empathise with patients and feel like a person who is close to them, not somebody. I’m not going to go up to a patient with my mask on, I would take the mask off, so that they can see that I’m a person like them… (6)Vocation is mentioned as the daily driver and the nurses valued it highly. A vocation to help other arises in a lot of the interviews and in some cases a vocation for caring is specified.…I’m very caring, I need to feel that I’m doing something for others and I notice this at work, I feel like this, I feel needed, I feel loved and I feel that it is easy for me to build a relationship of empathy and trust with people and I feel rewarded… (1)and I decided on nursing because I thought that it was good to help others and the other day I remembered this thought. (2)DiscussionDuring the interviews all the respondents stated they felt vigour in their work, vigour arising from their enthusiasm and pleasure in their work. They also confirmed their dedication when they talked about the meaning of the work, since, for them, being a nurse went beyond being just a source of income, and had become one of personal growth. No unit of meaning came up in the interviews associated with absorption. This result coincides with a research study carried out with focus groups of nurses in Ireland,<a class="elsevierStyleCrossRef" href="#bib0280">25</a> which concluded that the element of absorption did not apply to nursing, since some nurses mentioned that the difficulties in leaving work at the end of the day lead to a desire to leave the profession. Absorption did not appear as a finding in a study that included interviews with Norwegian nurses either.<a class="elsevierStyleCrossRef" href="#bib0285">26</a>It is worth highlighting that claiming to have high engagement is not incompatible with the presence of multiple aspects that lessen energy, since there are several aspects they recognise as reducing their vigour. The most repeated aspects related to the difficulties in developing the nursing profession and the obligation to perform non-nursing tasks, and feelings of powerlessness in problematic situations where nurses cannot intervene to find a solution. Being undervalued by other members of the team and a workload on occasion exceeding their ability to act were other aspects with a negative effect on engagement. Some of these sources of energy depletion coincide with the causes the nurses identified of burnout and which, in studies on the Spanish population, are always due to excessive workload, followed in some cases by contact with suffering and insufficient preparation,<a class="elsevierStyleCrossRef" href="#bib0290">27</a> and in other cases by a lack of social support and interpersonal conflicts.<a class="elsevierStyleCrossRef" href="#bib0295">28</a>An aspect that emerged very strongly in this research study is reward, which appears spontaneously in the interviews as a differential element of nursing work. All the nurses referred to reward as being able to see how care affects people's lives, how they value the gratitude shown by patients and their families as a reward, and they found that very fulfilling. Along these same lines, but in reverse, they stated that some patients do not recognise the importance of nursing work and this leads to depleted engagement. Freeney and Tiernan's study<a class="elsevierStyleCrossRef" href="#bib0280">25</a> already mentioned the significance of contributing to other people's lives and proposed that the capacity for internal reward might be important in nurses’ engagement.In relation to the characteristics of the organisations that the nurses interviewed perceived as motivating, the most frequently mentioned category was autonomy, in both a negative and a positive sense. It should be remembered that the interviews were performed with professionals from different care areas, and the reality is that there are substantial differences with regard to autonomy depending on the area where care is given. The nurses that claimed to have more autonomy in their own tasks were those that worked in hospitals, which makes not being able to complete tasks for which they have been trained and are skilled significant compared with the autonomy legitimately enjoyed by all professionals. In the interviews with nurses working outside hospital, autonomy was highlighted as the great qualitative leap that occurs in their professional careers when they leave hospital care for primary care. Nurses working in hospitals, both in acute and outpatient care, feel that they have to struggle to fulfil their functions with autonomy within work teams. This finding is in line with the discussion held by García-Sierra et al.,<a class="elsevierStyleCrossRef" href="#bib0245">18</a> a research study that was undertaken exclusively in hospitals and in which, unlike the initial hypotheses, autonomy did not arise as a predisposing factor for engagement. In Bragagliotti's<a class="elsevierStyleCrossRef" href="#bib0300">29</a> conceptualisation in 2012, it was demonstrated that autonomy is an antecedent to engagement and the International Council of Nurses describes autonomy as an intrinsic motivator for nurses.<a class="elsevierStyleCrossRef" href="#bib0305">30</a>With regard to social support, coinciding with the previous literature,<a class="elsevierStyleCrossRefs" href="#bib0165">2,3,31</a> the role of nurse supervisors appears relevant, and both positive and negative factors were highlighted. However, relations with colleagues were often perceived as a negative influence, they stressed the importance of relationships being kept strictly professional and that emotional ties should be avoided as a mechanism to avoid conflicts.On an individual level, vocation for the profession was a theme that was repeated throughout the interviews, and the need to develop attitudes such as empathy.The fact that absorption did not arise as relevant in this research study or in other previous studies, suggests the need for reconceptualising engagement in nurses. The role of this element in the construct needs to be re-examined.Furthermore, the possibility results from this research study of incorporating a new element in engagement, which has been categorised as reward here, and which, as the thoughts of the interviewees suggest, appears to bear significant weight on the process of maintaining engagement. With this research study we open a new line of research in relation to re-examining the concept of engagement in nursing. The data indicate that there might be a definition that better adjusts to nursing. Given this new challenge we suggest the following proposal, that engagement in nursing should be defined as “a positive, satisfied mental state relating to the profession, characterised by vigour, dedication and intrinsic reward”.This research study might be limited by the fact that people with high engagement were selected by their immediate superiors, in that there might be the risk that selection by nursing coordinators might have had a degree of bias. We attempted to eliminate this risk by giving a complete definition of the engagement construct so that they knew exactly which characteristics the candidates they proposed should meet. We also found a limitation in the fact that all the participants belonged to the same integral healthcare organisation, which limits variability in the organisational aspects.Nurses with high engagement have energy and dedication for their work; however, absorption does not appear to be a relevant aspect of nursing. Having high engagement does not mean ignoring the negative aspects of the job and the organisations, very much the opposite, a great many aspects arose that were recognised as barriers to maintaining engagement and the nurses were affected by all of them. However, appreciation of positive aspects such as enjoying the job, the meaning of being a nurse, reward and autonomy enable the process of depletion of engagement to be overcome.Practical implicationsThe aim of this research study was to adopt a health promotion perspective and identify factors that help to encourage engagement and to protect against the process leading to burnout in nurses. The results set out here should encourage nursing managers in particular, and care managers in general, to reflect on the importance of a highly engaged nursing workforce. They should consider all the competitive advantages this entails for organisations and promote nurse autonomy in human resource planning and nurse manager leadership at unit level and increase efforts to enable family conciliation.A new definition of the construct is proposed as an emerging line of research.Conflict of interestsThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres852129" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec846702" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres852128" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec846703" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Methodology" ] 6 => array:3 [ "identificador" => "sec0025" "titulo" => "Results" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Job characteristics" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Vigour" ] 2 => array:3 [ "identificador" => "sec0040" "titulo" => "Dedication" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Reward" ] ] ] 3 => array:3 [ "identificador" => "sec0050" "titulo" => "Characteristics of the organisations" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Autonomy" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Social support" ] ] ] 4 => array:2 [ "identificador" => "sec0065" "titulo" => "Conciliation" ] 5 => array:2 [ "identificador" => "sec0070" "titulo" => "Individual characteristics" ] ] ] 7 => array:2 [ "identificador" => "sec0075" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0080" "titulo" => "Practical implications" ] 9 => array:2 [ "identificador" => "sec0085" "titulo" => "Conflict of interests" ] 10 => array:2 [ "identificador" => "xack285796" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-05-06" "fechaAceptado" => "2017-03-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec846702" "palabras" => array:4 [ 0 => "Work engagement" 1 => "Professional burnout" 2 => "Nurses" 3 => "Qualitative research" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec846703" "palabras" => array:4 [ 0 => "Engagement en el trabajo" 1 => "Síndrome de estar quemado" 2 => "Enfermeras" 3 => "Investigación cualitativa" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo identify common issues of nurses with high engagement to enable us to develop the construct as it applies to nursing in more depth. MethodBased on the constructivist paradigm and with a phenomenological approach, a qualitative content analysis was conducted using an inductive approach. Participants were nurses working in direct care in different healthcare areas. The sample size was determined by data saturation and 15 participants were interviewed. ResultsThe units of meaning were grouped into 11 subcategories, and then into 7 categories termed vigour, dedication, reward, autonomy, social support, conciliation and attributes of nurses. Then these categories were grouped into 3 major themes: job characteristics, characteristics of organisations, and individual characteristics. ConclusionsHaving high engagement does not mean ignoring the negative aspects of work and organisations. Nurses who maintain high engagement are also affected by the negative aspects, however the assessment of positive aspects such as enjoying the work, the meaning of being a nurse, reward and autonomy enable the process of depletion of engagement to be overcome.In view of the findings, we propose reconceptualising the construct, taking the features of nursing into account." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoIdentificar aspectos comunes de las enfermeras con elevado engagement, que nos permitan desarrollar con más profundidad el constructo aplicado a enfermería. MétodoA partir del paradigma constructivista y con un enfoque fenomenológico, se llevó a cabo un análisis cualitativo del contenido, utilizando una aproximación inductiva. Las participantes fueron enfermeras que trabajaban en atención directa de diferentes ámbitos asistenciales. El tamaño de la muestra vino dado por la saturación de los datos y fue de 15 participantes a los que se les realizaron entrevistas semiestructuradas grabadas. ResultadosLas unidades de significado se agruparon en 11 subcategorías, estas a su vez en 7 categorías, que se han llamado vigor, dedicación, recompensa, autonomía, apoyo social, conciliación y cualidades de las enfermeras. Posteriormente estas categorías se agruparon en 3 grandes temas: características de los puestos de trabajo, características de las organizaciones y características individuales. ConclusionesEl hecho de tener un engagement elevado no significa ignorar los aspectos negativos del trabajo y de las organizaciones. Las enfermeras que mantienen el engagement elevado también se ven afectadas por los aspectos negativos, sin embargo, la apreciación de aspectos positivos como disfrutar con el trabajo, el significado de ser enfermera, la recompensa y la autonomía permiten superar el proceso de desgaste del engagement.A la vista de los resultados se propone una reconceptualización del constructo que contemple las particularidades de la enfermería." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: García-Sierra R, Fernández-Castro J, Martínez-Zaragoza F. Implicación de las enfermeras en su profesión. Un estudio cualitativo sobre el engagement. Enferm Clin. 2017;27:153–162." ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Themes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Initial questions \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sociodemographic data \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">How old are you? How many years have you been nursing? Can you give a summary of your working history? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Energy at work \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Do you feel you have energy at work? What do you think gives you this energy? Do you know what experiencing burnout is? Have you ever felt that way? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dedication to the job \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">How do you feel when you’re working? What does the job mean to you? How would you describe your relationship with your patients? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Working environment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">How would you describe your relationship with your colleagues? What would be your ideal job? Do think this is possible to achieve? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Conciliation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">What can you tell me about reconciling your work with your (family) life? What could you explain to me about reconciling work and working life? \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1438537.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Guide for the semi structured interview." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Features of nursing work</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Features of the organisations</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Individual features</th></tr><tr title="table-row"><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Vigour</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Dedication</th><th class="td" title="table-head " align="left" valign="top" scope="col">Reward \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Autonomy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Social support</th><th class="td" title="table-head " align="left" valign="top" scope="col">Conciliation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Features of the nurses</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sources of energy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Negative elements \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Meaning of the job \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pride challenge \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reward \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Superiors \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Teams \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Shifts \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Attitudes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vocation \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Feeling happy about going to work \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Emotional exhaustion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The job is an important part of life \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Need to up-date, learn, train \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Great influence of care on people's lives \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Need for more autonomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Need for support from superiors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative influence of colleagues \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adapting rotas to children's schedules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Empathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vocation for caring \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Enthusiasm for the job \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Feeling of powerlessness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">It's more than a profession \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Developing skills, other than technical skills \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">User satisfaction as reward \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Difficulties in performing tasks specific to nursing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Shortfalls in teaching \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Difficulty for colleagues to adapt to change \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The importance of being able to change shifts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Showing closeness to patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vocation for helping \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Enjoying working \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tasks not specific to nursing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">You’re a nurse outside work \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Challenges as a source of satisfaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Work as a source of fulfilment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Feeling responsible for the functioning of the department \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Shortfalls in research \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Professional relationship \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Difficulty in family conciliation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Active behaviour to combat burnout. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anger because of not being able to develop the profession \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The job is a source of growth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pride in a job well done \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A feeling of having much more to offer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Flexibility on the part of superiors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Colleagues’ apathy as a source of discouragement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Work rota as a source of burnout \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Influence of personal situations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Working in places you don’t like \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Source of income \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Autonomy at work brings satisfaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disregard from other professionals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Working rotas, nights and holidays \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Value of maturity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Society undervaluing the profession \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nurses as team leaders \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Importance of trust from the team \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The patient as the single objective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tense working environment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Variety of activities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The word death is always present \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Contradictions with your training \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Budget cuts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Workload \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1438538.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Hierarchical scheme of codes, subcategories, categories and themes arising from the analysis." ] ] 2 => array:5 [ "identificador" => "tb0005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "What is known?The psychological process that leads to engagement is related to resources and is a different process to that leading to burnout, which is linked to demand, these 2 processes are inter-related.Engagement is the result of interaction between dispositional factors, personal learning and working environments and therefore liable to change and affects nurses’ professional activity and has an impact on care outcomes.What do we contribute?This research study was designed to discover aspects of nursing practice that are relevant in maintaining engagement and that quantitative research has failed to make relevant because they are left out of standardised questionnaires. The research study has enabled us to establish that nurses who are engaged also suffer the effect of work demands, and that the resources that relate most to engagement in nursing are meaning of the profession, intrinsic reward and autonomy.Based on the study results, we propose a new definition of engagement for nurses." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0160" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Empowerment, engagement and perceived effectiveness in nursing work environments: does experience matter?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Laschinger" 1 => "P. Wilk" 2 => "J. Cho" 3 => "P. Greco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2834.2008.00907.x" "Revista" => array:6 [ "tituloSerie" => "J Nurs Manag" "fecha" => "2009" "volumen" => "17" "paginaInicial" => "636" "paginaFinal" => "646" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19575722" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0165" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Linking transformational leadership to nurses’ extra-role performance: the mediating role of self-efficacy and work engagement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Salanova" 1 => "L. Lorente" 2 => "M. Chambel" 3 => "I. Martínez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2648.2011.05652.x" "Revista" => array:6 [ "tituloSerie" => "J Adv Nurs" "fecha" => "2011" "volumen" => "67" "paginaInicial" => "2256" "paginaFinal" => "2266" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21535088" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0170" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Staff engagement as a target for managing work environments in psychiatric hospitals: implications for workforce stability and quality of care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Van Bogaert" 1 => "S. Clarke" 2 => "R. Willems" 3 => "M. Mondelaers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2702.2012.04341.x" "Revista" => array:6 [ "tituloSerie" => "J Clin Nurs" "fecha" => "2013" "volumen" => "22" "paginaInicial" => "1717" "paginaFinal" => "1728" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23216757" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0175" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A causal relationship model work engagement affecting organizational citizenship behavior and job performance of professional nursing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Matula" 1 => "V. Uon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "MEJSR" "fecha" => "2016" "volumen" => "24" "paginaInicial" => "1600" "paginaFinal" => "1605" "itemHostRev" => array:3 [ "pii" => "S1474442210700570" "estado" => "S300" "issn" => "14744422" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0180" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The measurement of engagement and burnout: a two sample confirmatory factor analytic approach" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W.B. Schaufeli" 1 => "M. Salanova" 2 => "V.A. González-Román" 3 => "A.B. Bakker" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Happiness Stud" "fecha" => "2002" "volumen" => "3" "paginaInicial" => "71" "paginaFinal" => "92" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0185" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The truth about burnout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Maslach" 1 => "M.P. Leiter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1997" "editorial" => "Jossey-Bass" "editorialLocalizacion" => "San Francisco, CA" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0190" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maslach burnout inventory manual" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Maslach" 1 => "S.E. Jackson" 2 => "M. Leiter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "3rd ed." "fecha" => "1996" "editorial" => "Consulting Psychologists Press" "editorialLocalizacion" => "Palo Alto, CA" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0195" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Areas of worklife: a structured approach to organizational predictors of job burnout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.P. Leiter" 1 => "C. Maslach" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Research in occupational stress and well-being" "paginaInicial" => "91" "paginaFinal" => "134" "serieFecha" => "2004" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0200" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Job burnout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Maslach" 1 => "W.B. Schaufeli" 2 => "M.P. Leiter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1146/annurev.psych.52.1.397" "Revista" => array:6 [ "tituloSerie" => "Annu Rev Psychol" "fecha" => "2001" "volumen" => "52" "paginaInicial" => "397" "paginaFinal" => "422" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11148311" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0205" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Burnout: 35 years of research and practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W.B. Schaufeli" 1 => "M.P. Leiter" 2 => "C. Maslach" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Career Dev Int" "fecha" => "2009" "volumen" => "14" "paginaInicial" => "204" "paginaFinal" => "220" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0210" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The job demands-resources model of burnout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Demerouti" 1 => "A.B. Bakker" 2 => "F. Nachreiner" 3 => "W. Schaufeli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Appl Psychol" "fecha" => "2001" "volumen" => "86" "paginaInicial" => "499" "paginaFinal" => "512" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11419809" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S073510971633426X" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0215" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Internet] Available from: http://doi.wiley.com/10.1002/job.248 [accessed 12.11.16]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Job demands, job resources, and their relationship with burnout and engagement: a multi-sample study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.B. Schaufeli" 1 => "A.B. Bakker" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Organ Behav" "fecha" => "2004" "volumen" => "25" "paginaInicial" => "293" "paginaFinal" => "315" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0220" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Internet] Available from: http://www.emeraldinsight.com/doi/abs/10.1108/02683940710733115 [accessed 12.11.16]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The job demands-resources model: state of the art" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.B. Bakker" 1 => "E. Demerouti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Manag Psychol" "fecha" => "2007" "volumen" => "22" "paginaInicial" => "309" "paginaFinal" => "328" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0225" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Burnout and work engagement among teachers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.J. Hakanen" 1 => "A.B. Bakker" 2 => "W.B. Schaufeli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Sch Psychol" "fecha" => "2006" "volumen" => "43" "paginaInicial" => "495" "paginaFinal" => "513" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0230" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Towards a model of work engagement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.B. Bakker" 1 => "E. Demerouti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Career Dev Int" "fecha" => "2008" "volumen" => "13" "paginaInicial" => "209" "paginaFinal" => "223" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0235" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The future of optimism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Peterson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Psychol" "fecha" => "2000" "volumen" => "55" "paginaInicial" => "44" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11392864" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0240" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The relationship between job stressors, hardy personality, coping resources and burnout in a sample of nurses: a correlational study at two time points" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Garrosa" 1 => "C. Rainho" 2 => "B. Moreno-Jiménez" 3 => "M.J. Monteiro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijnurstu.2009.05.014" "Revista" => array:6 [ "tituloSerie" => "Int J Nurs Stud" "fecha" => "2010" "volumen" => "47" "paginaInicial" => "205" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19596324" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0245" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship between job demand and burnout in nurses: does it depend on work engagement?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. García-Sierra" 1 => "J. Fernández-Castro" 2 => "F. Martínez-Zaragoza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jonm.12382" "Revista" => array:6 [ "tituloSerie" => "J Nurs Manag" "fecha" => "2016" "volumen" => "24" "paginaInicial" => "780" "paginaFinal" => "788" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27111251" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0250" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A study on work engagement among nurses in Japan: the relationship to job-demands, job-resources, and nursing competence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. Hontake" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Nurs Educ Pract" "fecha" => "2016" "volumen" => "6" "paginaInicial" => "1" "paginaFinal" => "7" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0255" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Work engagement in nursing: an integrative review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. García-Sierra" 1 => "J. Fernández-Castro" 2 => "F. Martínez-Zaragoza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jonm.12312" "Revista" => array:6 [ "tituloSerie" => "J Nurs Manag" "fecha" => "2016" "volumen" => "24" "paginaInicial" => "E101" "paginaFinal" => "E111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26032875" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0260" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nursing research. Principles and methods" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.F. Polit" 1 => "C. Beck" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2004" "editorial" => "Lippincott Williams & Wilkins" "editorialLocalizacion" => "Philadelphia, PA" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0265" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "U.H. Graneheim" 1 => "B. Lundman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nedt.2003.10.001" "Revista" => array:6 [ "tituloSerie" => "Nurse Educ Today" "fecha" => "2004" "volumen" => "24" "paginaInicial" => "105" "paginaFinal" => "112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14769454" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0270" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The qualitative content analysis process" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Elo" 1 => "H. Kyngäs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2648.2007.04569.x" "Revista" => array:6 [ "tituloSerie" => "J Adv Nurs" "fecha" => "2008" "volumen" => "62" "paginaInicial" => "107" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18352969" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0275" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Criterios de calidad en la investigación cualitativa en salud (ICS): apuntes para un debate necesario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Calderon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Salud Pública" "fecha" => "2002" "volumen" => "76" "paginaInicial" => "473" "paginaFinal" => "482" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12422422" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0280" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exploration of the facilitators of and barriers to work engagement in nursing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y.M. Freeney" 1 => "J. Tiernan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijnurstu.2009.05.003" "Revista" => array:7 [ "tituloSerie" => "Int J Nurs Stud" "fecha" => "2009" "volumen" => "46" "paginaInicial" => "1557" "paginaFinal" => "1565" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19523629" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S000291491631373X" "estado" => "S300" "issn" => "00029149" ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0285" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community nurses who thrive. The critical role of job engagement in the face of adversity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.F. Vinje" 1 => "M.B. Mittelmark" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.NND.0000320695.16511.08" "Revista" => array:6 [ "tituloSerie" => "J Nurses Staff Dev" "fecha" => "2008" "volumen" => "24" "paginaInicial" => "195" "paginaFinal" => "202" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18838896" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0290" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The relationship between emotional intelligence, occupational stress and health in nurses: a questionnaire survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.M. Augusto Landa" 1 => "E. López-Zafra" 2 => "M.P. Berrios Martos" 3 => "M.del.C. Aguilar-Luzón" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijnurstu.2007.03.005" "Revista" => array:6 [ "tituloSerie" => "Int J Nurs Stud" "fecha" => "2008" "volumen" => "45" "paginaInicial" => "888" "paginaFinal" => "901" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17509597" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0295" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The relationship between psychosocial job stress and burnout in emergency departments: an exploratory study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. García-Izquierdo" 1 => "M.I. Ríos-Rísquez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.outlook.2012.02.002" "Revista" => array:6 [ "tituloSerie" => "Nurs Outlook" "fecha" => "2012" "volumen" => "60" "paginaInicial" => "322" "paginaFinal" => "329" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22464694" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0300" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Work engagement in nursing: a concept analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Bargagliotti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2648.2011.05859.x" "Revista" => array:6 [ "tituloSerie" => "J Adv Nurs" "fecha" => "2012" "volumen" => "68" "paginaInicial" => "1414" "paginaFinal" => "1428" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22044047" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0305" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: http://memberfiles.freewebs.com/67/27/85462767/documents/managing_nursing_workforce-2.pdf [accessed 12.11.16]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Managing the multi-generational nursing workforce: managerial and policy implications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Manion" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2009" "editorial" => "International Centre for Human Resources in Nursing" "editorialLocalizacion" => "Ginebra, Suiza" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0310" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Social support and work engagement: a study of Malaysian nurses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Othman" 1 => "A.M. Nasurdin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2834.2012.01448.x" "Revista" => array:6 [ "tituloSerie" => "J Nurs Manag" "fecha" => "2013" "volumen" => "21" "paginaInicial" => "1083" "paginaFinal" => "1090" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23409702" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack285796" "titulo" => "Acknowledgements" "texto" => "To the nurses who were voluntarily interviewed. Without them this study would not have been possible. To the nursing management and coordinators of the Consorcio Sanitario of Terrassa for their collaboration in contacting the participants." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/24451479/0000002700000003/v2_201706121007/S2445147917300462/v2_201706121007/en/main.assets" "Apartado" => array:4 [ "identificador" => "63169" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24451479/0000002700000003/v2_201706121007/S2445147917300462/v2_201706121007/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445147917300462?idApp=UINPBA00004N"]

Statistics

Original Article

Engagement of nurses in their profession. Qualitative study on engagement

Implicación de las enfermeras en su profesión. Un estudio cualitativo sobre el engagement

Rosa García-Sierraa,b,

Corresponding author

rgarcias@cst.cat

Corresponding author.

, Jordi Fernández-Castroc, Fermín Martínez-Zaragozad

a Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain

b Universitat Autònoma de Barcelona, Campus Bellaterra, Cerdanyola (Barcelona), Spain

c Stress and Health Research Group, Departamento de Psicología Básica, Universitat Autònoma de Barcelona, Campus Bellaterra, Cerdanyola (Barcelona), Spain

d Departamento de Psicología de la Salud, Universidad Miguel Hernández, Elche (Alicante), Spain

Read

Times
was read the article

Total PDF

Total HTML

Share statistics

 array:24 [
  "pii" => "S2445147917300462"
  "issn" => "24451479"
  "doi" => "10.1016/j.enfcle.2017.03.006"
  "estado" => "S300"
  "fechaPublicacion" => "2017-05-01"
  "aid" => "660"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;. All rights reserved"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Enferm Clin. 2017;27:153-62"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 2
    "HTML" => 2
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1130862117300372"
      "issn" => "11308621"
      "doi" => "10.1016/j.enfcli.2017.03.006"
      "estado" => "S300"
      "fechaPublicacion" => "2017-05-01"
      "aid" => "660"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Enferm Clin. 2017;27:153-62"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 28
        "formatos" => array:2 [
          "HTML" => 23
          "PDF" => 5
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
        "titulo" => "Implicaci&#243;n de las enfermeras en su profesi&#243;n&#46; Un estudio cualitativo sobre el <span class="elsevierStyleItalic">engagement</span>"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "153"
            "paginaFinal" => "162"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Engagement of nurses in their profession&#46; Qualitative study on engagement"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Rosa Garc&#237;a-Sierra, Jordi Fern&#225;ndez-Castro, Ferm&#237;n Mart&#237;nez-Zaragoza"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Rosa"
                "apellidos" => "Garc&#237;a-Sierra"
              ]
              1 => array:2 [
                "nombre" => "Jordi"
                "apellidos" => "Fern&#225;ndez-Castro"
              ]
              2 => array:2 [
                "nombre" => "Ferm&#237;n"
                "apellidos" => "Mart&#237;nez-Zaragoza"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2445147917300462"
          "doi" => "10.1016/j.enfcle.2017.03.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445147917300462?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862117300372?idApp=UINPBA00004N"
      "url" => "/11308621/0000002700000003/v1_201705190128/S1130862117300372/v1_201705190128/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2445147917300383"
    "issn" => "24451479"
    "doi" => "10.1016/j.enfcle.2017.03.004"
    "estado" => "S300"
    "fechaPublicacion" => "2017-05-01"
    "aid" => "659"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Enferm Clin. 2017;27:163-71"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 3
      "HTML" => 3
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Crisis in the health sector&#58; Impact on nurses&#8217; working conditions"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "163"
          "paginaFinal" => "171"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Crisis en el sector sanitario&#58; impacto percibido en las condiciones de trabajo de las enfermeras"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 2371
              "Ancho" => 2259
              "Tamanyo" => 362495
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Impact of the containment measures on nurses&#8217; working conditions&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Alberto Granero-L&#225;zaro, Josep M&#46; Blanch-Ribas, Juan Francisco Rold&#225;n-Merino, Jordi Torralbas-Ortega, Ana Mar&#237;a Escayola-Maranges"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "Granero-L&#225;zaro"
            ]
            1 => array:2 [
              "nombre" => "Josep M&#46;"
              "apellidos" => "Blanch-Ribas"
            ]
            2 => array:2 [
              "nombre" => "Juan Francisco"
              "apellidos" => "Rold&#225;n-Merino"
            ]
            3 => array:2 [
              "nombre" => "Jordi"
              "apellidos" => "Torralbas-Ortega"
            ]
            4 => array:2 [
              "nombre" => "Ana Mar&#237;a"
              "apellidos" => "Escayola-Maranges"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1130862117300360"
        "doi" => "10.1016/j.enfcli.2017.03.005"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862117300360?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445147917300383?idApp=UINPBA00004N"
    "url" => "/24451479/0000002700000003/v2_201706121007/S2445147917300383/v2_201706121007/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2445147917300474"
    "issn" => "24451479"
    "doi" => "10.1016/j.enfcle.2017.03.007"
    "estado" => "S300"
    "fechaPublicacion" => "2017-05-01"
    "aid" => "662"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Enferm Clin. 2017;27:144-52"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Rising to the Challenge of promoting research in primary care and nursing&#58; Research productivity and professional view"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "144"
          "paginaFinal" => "152"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "El reto de potenciar la investigaci&#243;n en Atenci&#243;n Primaria y Enfermer&#237;a&#58; productividad cient&#237;fica y opini&#243;n del profesional"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 2546
              "Ancho" => 2333
              "Tamanyo" => 301384
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Professionals in charge of the scientific production of M&#250;tua Terrassa&#46; And participation of primary care professionals in the survey on perception&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Nuria Gim&#233;nez, Conxi Caro, Ester Ponsa, &#193;ngel Mauricio Perez Ortiz, Inma Navazo, Montse Gavagnach"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Nuria"
              "apellidos" => "Gim&#233;nez"
            ]
            1 => array:2 [
              "nombre" => "Conxi"
              "apellidos" => "Caro"
            ]
            2 => array:2 [
              "nombre" => "Ester"
              "apellidos" => "Ponsa"
            ]
            3 => array:2 [
              "nombre" => "&#193;ngel Mauricio"
              "apellidos" => "Perez Ortiz"
            ]
            4 => array:2 [
              "nombre" => "Inma"
              "apellidos" => "Navazo"
            ]
            5 => array:2 [
              "nombre" => "Montse"
              "apellidos" => "Gavagnach"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1130862117300396"
        "doi" => "10.1016/j.enfcli.2017.03.008"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862117300396?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445147917300474?idApp=UINPBA00004N"
    "url" => "/24451479/0000002700000003/v2_201706121007/S2445147917300474/v2_201706121007/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Engagement of nurses in their profession&#46; Qualitative study on engagement"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "153"
        "paginaFinal" => "162"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Rosa Garc&#237;a-Sierra, Jordi Fern&#225;ndez-Castro, Ferm&#237;n Mart&#237;nez-Zaragoza"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Rosa"
            "apellidos" => "Garc&#237;a-Sierra"
            "email" => array:1 [
              0 => "rgarcias&#64;cst&#46;cat"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Jordi"
            "apellidos" => "Fern&#225;ndez-Castro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Ferm&#237;n"
            "apellidos" => "Mart&#237;nez-Zaragoza"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Consorci Sanitari de Terrassa&#44; Terrassa &#40;Barcelona&#41;&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Universitat Aut&#242;noma de Barcelona&#44; Campus Bellaterra&#44; Cerdanyola &#40;Barcelona&#41;&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Stress and Health Research Group&#44; Departamento de Psicolog&#237;a B&#225;sica&#44; Universitat Aut&#242;noma de Barcelona&#44; Campus Bellaterra&#44; Cerdanyola &#40;Barcelona&#41;&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Departamento de Psicolog&#237;a de la Salud&#44; Universidad Miguel Hern&#225;ndez&#44; Elche &#40;Alicante&#41;&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Implicaci&#243;n de las enfermeras en su profesi&#243;n&#46; Un estudio cualitativo sobre el <span class="elsevierStyleItalic">engagement</span>"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0030" class="elsevierStylePara elsevierViewall">Nurses are the largest group of health professionals&#46; Demographic changes due to an ageing population and the increased incidence of chronic disease require nurses to play a crucial role in building efficient health systems that can take on new challenges&#46; Facing these changes requires highly committed practitioners who provide excellent healthcare and this is what we term engagement&#46; The scientific literature on nurses&#8217; engagement shows it to have a positive influence on their professional performance through increased efficacy<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a> and extra-role<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">2</span></a> performance&#44; with a beneficial effect on care outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Engagement is a construct arising from positive psychology focussing on people&#39;s strengths and is defined as &#8220;a positive mental attitude to work&#44; characterised by vigour&#44; dedication and absorption&#8221;&#46; Vigour translates as a great willingness to devote effort to work and persistence in the face of difficulty&#46; Devotion refers to being strongly committed to working activities and to feel enthusiasm&#44; inspiration&#44; pride&#44; a sense of challenge and meaning&#46; Absorption translates as being fully focussed and happily immersed in one&#39;s work&#44; in such a way that time passes rapidly and a sense of not wishing to leave the workplace&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Engagement was initially considered in the study as the polar opposite to burnout&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a> The syndrome of burnout is defined as &#8220;&#8230;a state of exhaustion where the person feels cynical about their professional role and doubts their ability to perform&#8221; and comprises 3 factors&#58; emotional exhaustion&#44; depersonalisation and reduced self-efficacy&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#8211;8</span></a> Emotional exhaustion is described as a feeling of being unable to offer more of oneself emotionally&#46; Depersonalisation is an attitude of remoteness towards work&#44; towards the people being offered the human service and towards work colleagues&#46; And finally&#44; a lack of self-efficacy is a feeling of not completing tasks properly and of incompetence at work&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">9&#44;10</span></a> Later the Job-Demands Resources Model &#40;JD-R&#41;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">11&#8211;13</span></a> offered a joint explanation of burnout and engagement&#44; in which the positive and negative aspects of work could be analysed together on establishing 2 distinct psychological processes for burnout and engagement&#46; The JD-R states that employee experience wellbeing through the interaction of work demands and work resources by means of 2 inter-related psychological processes&#44; one leading to burnout through the demanding aspects of the work and the other leading to engagement through work resources&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">13&#8211;16</span></a> These 2 process establish crossed relationships with each other&#44; such as the negative influence of social support in the burnout process<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a> or the moderating effect of engagement in the relationship between demands of work and burnout&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> as well as other correlations between the model&#39;s different components&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a> The JD-R was the predominant theoretical framework for our study of nurses&#8217; engagement and&#44; building on it&#44; we examined many aspects that might act as antecedent variables of engagement&#46; We concluded that engagement&#44; in nurses&#44; is a result of the interaction of dispositional factors&#44; career-long learning and working environments&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a> Distinctive features of nursing practice such as the strict organisation of tasks and position within health teams suggest that there may be aspects specific to the profession not reflected in the current literature and aspects in the conceptualisation of engagement that differ from the other professions&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The main aim of this research study was to identify common aspects in the professional experiences of highly engaged nurses to enable us to develop in depth the construct of engagement within the nursing profession&#44; in order to then apply it in light of all its distinctive features&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A specific aim was to determine the features of jobs&#44; organisations and the people involved in the experience of engagement in the nursing profession&#46; With these objectives&#44; we attempt to remedy the lack of research studies on the distinguishing features of nursing in terms of engagement&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methodology</span><p id="par0055" class="elsevierStylePara elsevierViewall">In order to achieve greater variability of data&#44; provide more chance of new information appearing and to obtain deeper knowledge of the construct under study&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a> we explored the experience &#40;of engagement&#41; in nurses from different care areas&#46; For this we used a qualitative research design with a phenomenological approach&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">We undertook a qualitative analysis of the content&#44; as an inductive approach&#44; examining the experience of engagement in nurses and the meaning it has for them&#44; adapting to the subjectivity of the individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a> Our analysis centred on the manifest&#44; not the latent content&#44; in other words&#44; we analysed what the text says is analysed and describe the visible and obvious components &#40;the manifest content&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">We chose a qualitative approach since it was possible that unexpected knowledge might have been generated about the specific work areas&#44; knowledge that would be difficult to obtain taking a quantitative approach with closed questions&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The inclusion criteria for participants were nurses with high levels of engagement&#44; working in direct care in hospitals as well as primary care&#44; there were no established exclusion criteria&#46; Sampling by intensity was used for selecting participants&#44; examining the people who most represented the concept of engagement&#44; since we were looking for the maximum information on the construct&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The recruitment process took place through all the nursing coordinators of the <span class="elsevierStyleItalic">Consorcio Sanitario</span> of Terrassa&#44; who recommended people with high engagement in their departments&#44; and these people were invited to participate&#46; The coordinators were informed in a meeting of the meaning of engagement&#44; and the objectives and methodology of the research&#46; They were also given written information on the definition of engagement and the research project&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The sample size was not predetermined but arose from data saturation&#46; Of the 16 people invited to participate&#44; only one declined the invitation &#40;rejection rate of 6&#37;&#41; in the end&#44; therefore there were 15 participants&#46; The participants were 14 females and one male&#44; aged between 28 and 50 years&#44; with a mean age of 41 years&#46; The people interviewed had worked in nursing between one and 27 years&#44; with a mean number of years worked of 17&#46; At the time of selection the nurses were working in the operating theatre&#44; oncology&#44; palliative care&#44; emergency care&#44; gynaecology&#44; primary care and psychiatry&#44; although they had experience in other departments&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The data were collected between February and March 2016&#44; using semi-structured interviews with guidelines for the areas to be covered &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; although these guidelines were flexible according to the progress of the interviews&#44; and whether change or different questions were required during the process&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The place that the interviews were to take place was decided by the participants&#46; They established that they should be held in each participant&#39;s work centre&#44; in areas usually used for rest or training&#44; where there were no interruptions&#46; All the interviews &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; were held with the same interviewer&#44; they were between 14 and 20<span class="elsevierStyleHsp" style=""></span>min in duration and recorded with the consent of the participants&#46; The recordings were transcribed in writing&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Data collection and analysis took place simultaneously&#46; Data collection ended when the subject areas were saturated in 2 consecutive interviews&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The constant comparison method was used to interpret the research material until the theoretical saturation point was reached&#46; An inductive approach was used&#44; from the specific to the general&#44; in which the categories derived from the data in the analysis&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">22&#44;23</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The analysis comprised 5 phases&#46; Each completed by the principal researcher and the other 2 collaborators&#44; who reviewed the result&#44; then the differences in criteria were discussed and finally the end results for each of the phases were agreed by consensus&#46; The first stage of the analysis was to repeatedly read the transcribed material to become familiar with the text and extract relevant verbatims to answer the research questions&#46; In phase 2&#44; the interview verbatims were coded into units of meaning by 2 different investigators and were compared in order to reach a consensus&#46; Expressions with similar meanings were grouped into subcategories and were given names&#46; In phase 3&#44; the subcategories were grouped based on their content and categories were created and then labelled to describe the content&#46; In phase 4&#44; points in common between the categories were identified and the subjects extracted&#46; And finally&#44; in phase 5&#44; the phenomenon of engagement was interpreted&#44; synthesised and reconceptualised specifically to nursing&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Various aspects were monitored during the research study&#46; Firstly&#44; epistemological adequacy&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a> referring to the adequacy of the qualitative approach&#44; secondly&#44; relevance&#44; given that the research study would have a direct impact on improved knowledge of the engagement phenomenon&#46; Verbatims &#40;identified with a number in brackets for each respondent&#41; are included in the results&#44; as well as the exhaustive description of the analysis&#44; in order to increase the study&#39;s reliability&#44; and a table showing the units of meaning&#44; subcategories&#44; categories and themes&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a> The credibility criterion&#44; analogous with internal validity in quantitative research&#44; was ensured by the thorough data collection and independent developing of the code scheme undertaken by 3 investigators&#44; as well as by discussion of the codification grid and categorisations of the research team&#46; In order to facilitate transferability&#44; a clear description was given of the context&#44; selection of participants&#44; data collection and analysis process&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a> Finally&#44; recognition of reflexivity<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a> from conception of the project&#44; and the effect that the principal investigator&#39;s original training &#40;care nurse&#41; might have had on the study aim&#44; were the reasons for triangulation with investigators from different disciplines and organisations&#44; in order to achieve more effective compression of engagement&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The project was approved by the Clinical Research Ethics Committee of the <span class="elsevierStyleItalic">Consorcio Sanitario</span> of Terrassa&#46; The interviews were anonymous and voluntary and the participants were able to interrupt their participation when they wanted&#46; The participants were informed about the research study verbally and in writing&#44; and of the chronogram and dissemination of the study results&#46; Everybody who was interviewed signed their informed consent and was assured of the confidentiality and anonymous nature of the data collected&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0120" class="elsevierStylePara elsevierViewall">Three large themes emerged through analysis of the content described&#44; and these were grouped into 7 categories&#46; In turn&#44; these categories combined 11 subcategories combining 62 different units of meaning&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the 62 codes combined and classified by category and theme&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Job characteristics</span><p id="par0125" class="elsevierStylePara elsevierViewall">The theme combining the most codes and to which the participants devoted the most time was that of job characteristics&#46; This theme encompasses all the aspects referring to care nurse work in the different positions of the profession and that the respondents found relevant to their professional experience&#46; This theme covers the categories of vigour&#44; dedication and reward&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Vigour</span><p id="par0130" class="elsevierStylePara elsevierViewall">With regard to vigour&#44; the nurses found that their main sources of energy in their work related to how their work appealed to them&#44; and they showed enthusiasm and pleasure in the tasks that they undertook&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0105"><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">I&#8217;m full of energy when I arrive in the morning&#44; this is true&#44; and I really want to look after the patient&#44; their family&#44; and sometimes I think&#44; when I get to work&#44; during the day at home I don&#8217;t&#44; but it is true that when I get to work I think about the patient&#44; what I can do for them&#44; how I can help them and their family&#8230;and I think&#44; let&#39;s see if this will help him&#44; I think about what they were talking to me about at the last visit&#44; you know&#44; and I arrive with a lot of enthusiasm&#46; &#40;12&#41;</span></p></span></p><p id="par0135" class="elsevierStylePara elsevierViewall">All of the respondents expressed an overall feeling of energy at work&#44; however&#44; there were numerous elements that had a negative effect on their energy and that occasionally had an effect on them&#44; although they did not consider that they had developed burnout syndrome through their trajectory&#46; The difficulties that arose in undertaking their work that they identified as burnout triggers related to workload&#44; which occasionally undermined their ability to perform and made them feel responsible for shortcomings in performance and gave rise to feelings of powerlessness&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">I&#8217;ve had times when there was a lot of work in the hospital and both my colleagues and I have ended up crying&#44; you&#8217;re just overwhelmed&#8230;If you have 2 patients with complications at the same time&#44; you have no help and you end up crying&#44; and you leave the hospital in tears&#44; this has happened&#46; But I think it is the sense of responsibility that we have really&#8230;you ask for help and they can&#8217;t give you any&#44; so you become a bit overwhelmed&#46; Not burnout&#44;&#8230;I don&#8217;t know&#44; but not burnout&#44; because I&#8217;ve always tried to turn situations around&#46; &#40;11&#41;</span></p></span></p><p id="par0140" class="elsevierStylePara elsevierViewall">There is one aspect that arose frequently during the interviews with regard to the daily difficulties the nurses encountered in undertaking nursing tasks&#58;<span class="elsevierStyleDisplayedQuote" id="dsq0010"><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">I think what makes me exhausted&#44; looking at the situations&#44; is that the same negative situations happen again and again&#44; I cannot change them and I meet them in daily practice&#46; I mean&#44; the patients themselves&#44; no&#44; but the limitations in doing my work&#44; I know that these will reoccur because they won&#8217;t be resolved&#44; and this is what makes me exhausted&#46; &#40;2&#41;</span></p></span></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Dedication</span><p id="par0145" class="elsevierStylePara elsevierViewall">Dedication refers to everything in relation to being engaged with the work and the feelings of pride and meaning it involves&#46; In general most of the units of meaning in this category established a very close link between professional and personal development&#46; This category arose from 2 subcategories&#44; the first was termed &#8220;meaning of the work&#8221;&#44; where all the nurses interviewed attributed a meaning to their work beyond a simple source of income&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0110"><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8230;then I did nursing&#44; and it was like a journey&#44; I learned a lot&#44; I had no idea that my work could give me so much&#44; give me so much in return&#44; I could not have imagined it&#44; I studied it&#44; tried it and well&#44; over the years the profession has given me a lot&#44; a lot&#46; &#40;10&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0015"><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">I would not change nursing for a different profession&#44; because I feel very&#44; very lucky to be in this profession and it fulfils me as a person as well&#46; &#40;15&#41;</span></p></span></p><p id="par0150" class="elsevierStylePara elsevierViewall">In general&#44; being a nurse is somewhat more than having a profession&#44; and appears as a source of personal growth&#46; The second subcategory&#44; termed &#8220;challenges and pride&#8221;&#44; where the respondents agreed that new challenges arise every day meaning that they had to keep training up-to-date and develop new skills to continue to develop and be proud of their professional performance&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0020"><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Changes are good&#44; making changes is good&#44; although frightening at first&#44; I think everybody needs change&#46; Being on one shift for 20 years performing the same function&#44; I think in the end&#44; I don&#8217;t know maybe you become passive and not very motivated from doing the same thing all the time&#46; I think that change is good&#44; because you keep up-to-date&#44; you are motivated&#44; you learn different things&#44; different environments with different people and this offers you much more as a professional&#44; this is what I think&#46; &#40;8&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0025"><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">And of course&#44; there are patients who put up a lot of barriers&#44; and then as you start to break through them&#44; you sometimes say &#8220;Great&#33; Well done&#8221;&#8221; you finish your care visit to the patient and you say &#8220;That was satisfying&#44; I feel good&#33;&#8221;&#46; &#40;12&#41;</span></p></span></p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Reward</span><p id="par0155" class="elsevierStylePara elsevierViewall">Although none of the questions referred to reward&#44; 8 of the 15 spontaneously highlighted how important it was for them to see the impact of their care on people&#39;s lives&#44; and the gratitude that patients showed for their care&#46; They valued this most in terms of reward for their efforts&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0030"><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8230;and I feel rewarded&#44; why&#63; Well because of the way things turn out&#44; they way they are grateful&#44; well&#44; I think that this is an excellent relationship for me&#44; I couldn&#8217;t want for more&#46; Sometimes the extent that my care affects people and what I can give them surprises me&#44; and how it affects the lives of these people&#46; &#40;1&#41;</span></p></span></p><p id="par0160" class="elsevierStylePara elsevierViewall">Under the dedication category we have already mentioned how work can act as a source of personal growth&#46; This category stresses reward as an incentive for effort&#46; In all the cases that mentioned the word reward&#44; it was seen as an added value to nursing work&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0035"><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8230;all this&#44; not much of what you do receives much thanks&#8230;which happens in the emergency department as well&#44; not much of what you do has much impact&#44; and well&#44; I like this&#44; this makes me really want to work in this&#46; &#40;5&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0040"><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Contact with families&#44; contact with patients&#44; the relationship fulfils me&#44; fulfils me&#44;&#8230;above all being able to please the patient and be with the family in an end-of-life situation and you can help them with their wishes and what they would like to do and you can help them to do this&#44; this fulfils you because you think Gosh&#33; Look&#44; they were able to do that and we were able to achieve it&#44; and the patient feels good&#44; and their family&#44; and you think that&#39;s great they were able to see it through&#33; It&#39;s not always like that and that&#39;s true as well&#44; if only it were always like that&#46; &#40;12&#41;</span></p></span></p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Characteristics of the organisations</span><p id="par0165" class="elsevierStylePara elsevierViewall">This category includes all the themes that the participants felt were relevant with regard to the organisations in which they worked&#46; The units of meaning that arose in the interviews created 3 categories termed autonomy&#44; social support and conciliation&#44; and are described below&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Autonomy</span><p id="par0170" class="elsevierStylePara elsevierViewall">The interview guide &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; shows that autonomy does not appear as a question or theme&#46; However&#44; in 11 interviews&#44; autonomy appears as an invaluable characteristic of the work&#44; or as a desired characteristic for the work to be more satisfactory&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0045"><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">And often when I arrive&#44; depending on what I have to do I think&#44; today is going to be a great day&#44; and it is&#44; because you have a lot open to you&#44; because we work differently here to hospital&#44; we are not as programmed&#46; Here nurses are very autonomous&#44; we establish a very different relationship with the patient&#44; and you can develop yourself and do a lot of things&#44; and then you get this in return&#44; and then it is very gratifying to feel like this and I often leave thinking today has been a fantastic day&#46; &#40;10&#41;</span></p></span></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Social support</span><p id="par0175" class="elsevierStylePara elsevierViewall">Social support refers to the absence or presence of psychological and instrumental support from members of the working environment&#46; This category arises from superior subcategories and teams&#46; In the superiors section&#44; all the codes refer to immediate superiors&#44; who are intermediate managers between workers and management&#46; In all cases&#44; the role of the coordinators is relevant&#44; either because they are identified as of major support &#8211; in terms of flexibility&#44; for example &#8211; or in other cases&#44; the exact opposite is perceived&#44; i&#46;e&#46;&#44; little effort is made towards improving the organisation of jobs&#46; In some cases&#44; the superiors are seen as responsible for shortfalls in research and teaching&#44; or for not offering sufficient room for dialogue or the possibility to express daily difficulties&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0050"><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">I often think we should feel more supported and we should be listened to more&#46; There is often little communication with your supervisors&#44; you often feel&#8230;you finish an entire morning of care visits&#44; difficult care visits and there is no time to share&#44; this could improve because you often need to express these things you feel that you need to express&#44; but you have nobody to talk to&#44; so at these times&#44; perhaps because of the people who supervise us&#44; the coordinators&#44; we should maybe have more space&#44; or more interviews or more time to be able to discuss things&#46; Nothing is talked about&#44; nothing is talked about&#46; &#40;8&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0055"><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8230;at organisational level no&#44; because everybody helps out&#44; and when you&#8217;re asked a favour&#44; because somebody is off sick or something&#44; then you ask for something and they help you too&#44; so there is goodwill&#46; &#40;15&#41;</span></p></span></p><p id="par0180" class="elsevierStylePara elsevierViewall">In the team subcategory&#44; 8 participants highlighted the importance that the relationship between work colleagues should be strictly professional&#44; so that conflicts do not arise&#44; conflicts that are identified as having a negative impact on overall team performance&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0060"><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8230;I start the day badly confronting the person in question and then my day is changed&#46; It&#39;s not an overall change&#44; generally&#44; with the patients&#44; but it does affect things&#44; yes&#46; It does affect the quality of care&#44; yes&#44; yes&#46; I don&#8217;t like it&#44; even when I distance myself&#44; or analyse the situation or if I&#8217;ve had a bad day I think&#44; but if this person is not you&#44; you can change&#44; yes&#44; and so much&#44; yes&#44; how you deal with other people&#44; of course&#46; &#40;1&#41;</span></p></span></p><p id="par0185" class="elsevierStylePara elsevierViewall">The disregard that some doctors hold for nurses was mentioned in 4 interviews&#44; and the difficulty they have in accepting changes and acknowledging nurses as an essential part of multidisciplinary teams and&#44; in some cases as leaders of projects undertaken in healthcare centres&#46; These difficulties are a source of unrest and require an active attitude on the part of nurses to resolve them&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0065"><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">I think a nurse-lead project was started here&#44;&#8230;a new thing&#44; not very well defined&#44; and people can&#8217;t change their mindset to include this new model and all change is difficult to accept&#46; There are people who adapt to change better and there are people who find it difficult and there are those who never adapt and this sometimes creates conflict in the workplace and can make you feel discouraged&#44; but&#44; well&#44; despite all the difficulties&#44; I think the project went ahead&#46; I&#8217;m content&#46; &#40;3&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0070"><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">I do occasionally have brushes here because there are people&#44; from my point of view&#44; who are fine with what there is&#44; it&#39;s fine&#44; they&#8217;ve always been like that&#44; it&#39;s always been done like that and always this and that&#46; I like it&#44; well&#44; well scientific evidence says that this should never be done&#44; ever&#44; because it&#39;s a mistake and was already proven in 1992&#8230;&#44; well&#44; well&#44; well it has always been done like this&#44; and you know&#44; and I think if you spend your time on this&#8230; &#40;5&#41;</span></p></span></p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conciliation</span><p id="par0190" class="elsevierStylePara elsevierViewall">This category covers all the aspects relating to work rotas and the relevance of work shifts&#44; which the interviewees directly associated with family conciliation&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">In relation to work rotas in general&#44; being able to change shifts to adapt them to children&#39;s needs as they grow up was very highly valued&#46; In some cases the work shift was seen as a source of burnout if not possible to adapt&#46; Discontent at having to work on holidays and weekends was also a recurrent theme&#44; the importance of this is shown in the claims of some of the interviewees that their jobs were determined by the work hours and not the work itself and the implications involved&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0075"><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">They made it easy for me in the hospital&#44; at first it was impossible really&#44; I have 2 very small babies aged 16 months&#44; 2 twins&#44; and well I was talking here with our bosses and I asked them if I could come in 2<span class="elsevierStyleHsp" style=""></span>hours later and leave 2<span class="elsevierStyleHsp" style=""></span>hours later&#44; move my shift forward really&#44; because I&#8217;m not interfering with anybody else&#44; they said &#8220;well&#44; look there&#39;s no problem with that&#8221;&#46; &#40;5&#41;&#46;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0080"><p id="spar0140" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">No&#44; it&#39;s really difficult&#44; with the hours that we have to work in healthcare&#44; it&#39;s really difficult&#46; I&#8217;m sure there&#39;s no perfect work rota&#44; but these are really awful&#8230;weekends&#44; holidays&#44; of course&#44; the 25 December&#44; Christmas evening when it&#39;s your turn to work&#8230; &#40;9&#41;</span></p></span></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Individual characteristics</span><p id="par0200" class="elsevierStylePara elsevierViewall">This theme includes all the individual characteristics that the interviewees identified as relating to their work performance&#46; All the codes that include the categories making up this theme relate to the attitudes they feel necessary for nursing work and the vocational aspects of the job&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">The word empathy and being close to patients came up constantly in the interviews&#44; identified as vital skills for performance at work&#46; They occasionally outlined the importance of not confusing these skills with friendliness or relationships that are not strictly professional with patients that might have a negative impact on nursing interventions&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0085"><p id="spar0145" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">The relationship with patients is not always the same&#44; of course&#46; There are patients and patients&#44; but I think that we should keep qualities or attitudes as professionals very much in mind and integrated&#44; there are days that you manage this better than others&#44; but well&#44; being empathetic&#44; respectful and humane&#44; I think that you&#8217;ll always do well with patients&#46; &#40;3&#41;</span></p></span></p><p id="par0210" class="elsevierStylePara elsevierViewall">The value attached to personal maturity is also highlighted and how this affects improved professional work&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0090"><p id="spar0150" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">A lot&#44; my own maturity and personal experience&#44; of course&#44; the more experience you have the better&#46; As long as you have a positive attitude&#44; because you can be on the point of retirement and be really bitter and hardly look at the patients&#44; &#8220;they&#8217;re fasting&#44; they have allergies&#8230;and so on&#44; OK&#8221; they might not even tell them&#44; no we&#8217;re going to the operating theatre&#44; it depends on your personal engagement&#44; how you engage professionally and personally&#44; you know&#63; In order to empathise with patients and feel like a person who is close to them&#44; not somebody&#46; I&#8217;m not going to go up to a patient with my mask on&#44; I would take the mask off&#44; so that they can see that I&#8217;m a person like them&#8230; &#40;6&#41;</span></p></span></p><p id="par0215" class="elsevierStylePara elsevierViewall">Vocation is mentioned as the daily driver and the nurses valued it highly&#46; A vocation to help other arises in a lot of the interviews and in some cases a vocation for caring is specified&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0095"><p id="spar0155" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8230;I&#8217;m very caring&#44; I need to feel that I&#8217;m doing something for others and I notice this at work&#44; I feel like this&#44; I feel needed&#44; I feel loved and I feel that it is easy for me to build a relationship of empathy and trust with people and I feel rewarded&#8230; &#40;1&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0100"><p id="spar0160" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">and I decided on nursing because I thought that it was good to help others and the other day I remembered this thought&#46; &#40;2&#41;</span></p></span></p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0220" class="elsevierStylePara elsevierViewall">During the interviews all the respondents stated they felt vigour in their work&#44; vigour arising from their enthusiasm and pleasure in their work&#46; They also confirmed their dedication when they talked about the meaning of the work&#44; since&#44; for them&#44; being a nurse went beyond being just a source of income&#44; and had become one of personal growth&#46; No unit of meaning came up in the interviews associated with absorption&#46; This result coincides with a research study carried out with focus groups of nurses in Ireland&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a> which concluded that the element of absorption did not apply to nursing&#44; since some nurses mentioned that the difficulties in leaving work at the end of the day lead to a desire to leave the profession&#46; Absorption did not appear as a finding in a study that included interviews with Norwegian nurses either&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">It is worth highlighting that claiming to have high engagement is not incompatible with the presence of multiple aspects that lessen energy&#44; since there are several aspects they recognise as reducing their vigour&#46; The most repeated aspects related to the difficulties in developing the nursing profession and the obligation to perform non-nursing tasks&#44; and feelings of powerlessness in problematic situations where nurses cannot intervene to find a solution&#46; Being undervalued by other members of the team and a workload on occasion exceeding their ability to act were other aspects with a negative effect on engagement&#46; Some of these sources of energy depletion coincide with the causes the nurses identified of burnout and which&#44; in studies on the Spanish population&#44; are always due to excessive workload&#44; followed in some cases by contact with suffering and insufficient preparation&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">27</span></a> and in other cases by a lack of social support and interpersonal conflicts&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">An aspect that emerged very strongly in this research study is reward&#44; which appears spontaneously in the interviews as a differential element of nursing work&#46; All the nurses referred to reward as being able to see how care affects people&#39;s lives&#44; how they value the gratitude shown by patients and their families as a reward&#44; and they found that very fulfilling&#46; Along these same lines&#44; but in reverse&#44; they stated that some patients do not recognise the importance of nursing work and this leads to depleted engagement&#46; Freeney and Tiernan&#39;s study<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a> already mentioned the significance of contributing to other people&#39;s lives and proposed that the capacity for internal reward might be important in nurses&#8217; engagement&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">In relation to the characteristics of the organisations that the nurses interviewed perceived as motivating&#44; the most frequently mentioned category was autonomy&#44; in both a negative and a positive sense&#46; It should be remembered that the interviews were performed with professionals from different care areas&#44; and the reality is that there are substantial differences with regard to autonomy depending on the area where care is given&#46; The nurses that claimed to have more autonomy in their own tasks were those that worked in hospitals&#44; which makes not being able to complete tasks for which they have been trained and are skilled significant compared with the autonomy legitimately enjoyed by all professionals&#46; In the interviews with nurses working outside hospital&#44; autonomy was highlighted as the great qualitative leap that occurs in their professional careers when they leave hospital care for primary care&#46; Nurses working in hospitals&#44; both in acute and outpatient care&#44; feel that they have to struggle to fulfil their functions with autonomy within work teams&#46; This finding is in line with the discussion held by Garc&#237;a-Sierra et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> a research study that was undertaken exclusively in hospitals and in which&#44; unlike the initial hypotheses&#44; autonomy did not arise as a predisposing factor for engagement&#46; In Bragagliotti&#39;s<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a> conceptualisation in 2012&#44; it was demonstrated that autonomy is an antecedent to engagement and the International Council of Nurses describes autonomy as an intrinsic motivator for nurses&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">With regard to social support&#44; coinciding with the previous literature&#44;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;3&#44;31</span></a> the role of nurse supervisors appears relevant&#44; and both positive and negative factors were highlighted&#46; However&#44; relations with colleagues were often perceived as a negative influence&#44; they stressed the importance of relationships being kept strictly professional and that emotional ties should be avoided as a mechanism to avoid conflicts&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">On an individual level&#44; vocation for the profession was a theme that was repeated throughout the interviews&#44; and the need to develop attitudes such as empathy&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">The fact that absorption did not arise as relevant in this research study or in other previous studies&#44; suggests the need for reconceptualising engagement in nurses&#46; The role of this element in the construct needs to be re-examined&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Furthermore&#44; the possibility results from this research study of incorporating a new element in engagement&#44; which has been categorised as reward here&#44; and which&#44; as the thoughts of the interviewees suggest&#44; appears to bear significant weight on the process of maintaining engagement&#46; With this research study we open a new line of research in relation to re-examining the concept of engagement in nursing&#46; The data indicate that there might be a definition that better adjusts to nursing&#46; Given this new challenge we suggest the following proposal&#44; that engagement in nursing should be defined as &#8220;a positive&#44; satisfied mental state relating to the profession&#44; characterised by vigour&#44; dedication and intrinsic reward&#8221;&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">This research study might be limited by the fact that people with high engagement were selected by their immediate superiors&#44; in that there might be the risk that selection by nursing coordinators might have had a degree of bias&#46; We attempted to eliminate this risk by giving a complete definition of the engagement construct so that they knew exactly which characteristics the candidates they proposed should meet&#46; We also found a limitation in the fact that all the participants belonged to the same integral healthcare organisation&#44; which limits variability in the organisational aspects&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Nurses with high engagement have energy and dedication for their work&#59; however&#44; absorption does not appear to be a relevant aspect of nursing&#46; Having high engagement does not mean ignoring the negative aspects of the job and the organisations&#44; very much the opposite&#44; a great many aspects arose that were recognised as barriers to maintaining engagement and the nurses were affected by all of them&#46; However&#44; appreciation of positive aspects such as enjoying the job&#44; the meaning of being a nurse&#44; reward and autonomy enable the process of depletion of engagement to be overcome&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Practical implications</span><p id="par0270" class="elsevierStylePara elsevierViewall">The aim of this research study was to adopt a health promotion perspective and identify factors that help to encourage engagement and to protect against the process leading to burnout in nurses&#46; The results set out here should encourage nursing managers in particular&#44; and care managers in general&#44; to reflect on the importance of a highly engaged nursing workforce&#46; They should consider all the competitive advantages this entails for organisations and promote nurse autonomy in human resource planning and nurse manager leadership at unit level and increase efforts to enable family conciliation&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">A new definition of the construct is proposed as an emerging line of research&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflict of interests</span><p id="par0280" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres852129"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Method"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec846702"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres852128"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todo"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec846703"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Methodology"
        ]
        6 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Results"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Job characteristics"
            ]
            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Vigour"
            ]
            2 => array:3 [
              "identificador" => "sec0040"
              "titulo" => "Dedication"
              "secciones" => array:1 [
                0 => array:2 [
                  "identificador" => "sec0045"
                  "titulo" => "Reward"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "sec0050"
              "titulo" => "Characteristics of the organisations"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0055"
                  "titulo" => "Autonomy"
                ]
                1 => array:2 [
                  "identificador" => "sec0060"
                  "titulo" => "Social support"
                ]
              ]
            ]
            4 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Conciliation"
            ]
            5 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Individual characteristics"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Practical implications"
        ]
        9 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Conflict of interests"
        ]
        10 => array:2 [
          "identificador" => "xack285796"
          "titulo" => "Acknowledgements"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-05-06"
    "fechaAceptado" => "2017-03-13"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec846702"
          "palabras" => array:4 [
            0 => "Work engagement"
            1 => "Professional burnout"
            2 => "Nurses"
            3 => "Qualitative research"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec846703"
          "palabras" => array:4 [
            0 => "<span class="elsevierStyleItalic">Engagement</span> en el trabajo"
            1 => "S&#237;ndrome de estar quemado"
            2 => "Enfermeras"
            3 => "Investigaci&#243;n cualitativa"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To identify common issues of nurses with high engagement to enable us to develop the construct as it applies to nursing in more depth&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Based on the constructivist paradigm and with a phenomenological approach&#44; a qualitative content analysis was conducted using an inductive approach&#46; Participants were nurses working in direct care in different healthcare areas&#46; The sample size was determined by data saturation and 15 participants were interviewed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The units of meaning were grouped into 11 subcategories&#44; and then into 7 categories termed vigour&#44; dedication&#44; reward&#44; autonomy&#44; social support&#44; conciliation and attributes of nurses&#46; Then these categories were grouped into 3 major themes&#58; job characteristics&#44; characteristics of organisations&#44; and individual characteristics&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Having high engagement does not mean ignoring the negative aspects of work and organisations&#46; Nurses who maintain high engagement are also affected by the negative aspects&#44; however the assessment of positive aspects such as enjoying the work&#44; the meaning of being a nurse&#44; reward and autonomy enable the process of depletion of engagement to be overcome&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In view of the findings&#44; we propose reconceptualising the construct&#44; taking the features of nursing into account&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Identificar aspectos comunes de las enfermeras con elevado <span class="elsevierStyleItalic">engagement</span>&#44; que nos permitan desarrollar con m&#225;s profundidad el constructo aplicado a enfermer&#237;a&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A partir del paradigma constructivista&#160;y con un enfoque fenomenol&#243;gico&#44; se llev&#243; a cabo un an&#225;lisis cualitativo del contenido&#44; utilizando una aproximaci&#243;n inductiva&#46; Las participantes fueron enfermeras que trabajaban en atenci&#243;n directa de diferentes &#225;mbitos asistenciales&#46; El tama&#241;o de la muestra vino dado por la saturaci&#243;n de los datos y fue de 15 participantes a los que se les realizaron entrevistas semiestructuradas grabadas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las unidades de significado se agruparon en 11 subcategor&#237;as&#44; estas a su vez en 7 categor&#237;as&#44; que se han llamado vigor&#44; dedicaci&#243;n&#44; recompensa&#44; autonom&#237;a&#44; apoyo social&#44; conciliaci&#243;n y cualidades de las enfermeras&#46; Posteriormente estas categor&#237;as se agruparon en 3 grandes temas&#58; caracter&#237;sticas de los puestos de trabajo&#44; caracter&#237;sticas de las organizaciones y caracter&#237;sticas individuales&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El hecho de tener un <span class="elsevierStyleItalic">engagement</span> elevado no significa ignorar los aspectos negativos del trabajo y de las organizaciones&#46; Las enfermeras que mantienen el <span class="elsevierStyleItalic">engagement</span> elevado tambi&#233;n se ven afectadas por los aspectos negativos&#44; sin embargo&#44; la apreciaci&#243;n de aspectos positivos como disfrutar con el trabajo&#44; el significado de ser enfermera&#44; la recompensa y la autonom&#237;a permiten superar el proceso de desgaste del <span class="elsevierStyleItalic">engagement&#46;</span></p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A la vista de los resultados se propone una reconceptualizaci&#243;n del constructo que contemple las particularidades de la enfermer&#237;a&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Garc&#237;a-Sierra R&#44; Fern&#225;ndez-Castro J&#44; Mart&#237;nez-Zaragoza F&#46; Implicaci&#243;n de las enfermeras en su profesi&#243;n&#46; Un estudio cualitativo sobre el <span class="elsevierStyleItalic">engagement</span>&#46; Enferm Clin&#46; 2017&#59;27&#58;153&#8211;162&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Themes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Initial questions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sociodemographic data&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">How old are you&#63;<br>How many years have you been nursing&#63;<br>Can you give a summary of your working history&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Energy at work&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Do you feel you have energy at work&#63;<br>What do you think gives you this energy&#63;<br>Do you know what experiencing burnout is&#63;<br>Have you ever felt that way&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dedication to the job&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">How do you feel when you&#8217;re working&#63;<br>What does the job mean to you&#63;<br>How would you describe your relationship with your patients&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Working environment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">How would you describe your relationship with your colleagues&#63;<br>What would be your ideal job&#63;<br>Do think this is possible to achieve&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Conciliation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">What can you tell me about reconciling your work with your &#40;family&#41; life&#63;<br>What could you explain to me about reconciling work and working life&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1438537.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0165" class="elsevierStyleSimplePara elsevierViewall">Guide for the semi structured interview&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Features of nursing work</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Features of the organisations</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Individual features</th></tr><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Vigour</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Dedication</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Reward&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Autonomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Social support</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Conciliation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Features of the nurses</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sources of energy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Negative elements&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Meaning of the job&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pride challenge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reward&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Superiors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Teams&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Shifts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Attitudes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vocation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Feeling happy about going to work&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Emotional exhaustion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The job is an important part of life&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Need to up-date&#44; learn&#44; train&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Great influence of care on people&#39;s lives&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Need for more autonomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Need for support from superiors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative influence of colleagues&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Adapting rotas to children&#39;s schedules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Empathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vocation for caring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Enthusiasm for the job&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Feeling of powerlessness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">It&#39;s more than a profession&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Developing skills&#44; other than technical skills&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">User satisfaction as reward&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Difficulties in performing tasks specific to nursing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shortfalls in teaching&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Difficulty for colleagues to adapt to change&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The importance of being able to change shifts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Showing closeness to patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vocation for helping&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Enjoying working&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tasks not specific to nursing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">You&#8217;re a nurse outside work&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Challenges as a source of satisfaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Work as a source of fulfilment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Feeling responsible for the functioning of the department&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shortfalls in research&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Professional relationship&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Difficulty in family conciliation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Active behaviour to combat burnout&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Anger because of not being able to develop the profession&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The job is a source of growth&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pride in a job well done&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A feeling of having much more to offer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Flexibility on the part of superiors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Colleagues&#8217; apathy as a source of discouragement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Work rota as a source of burnout&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Influence of personal situations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Working in places you don&#8217;t like&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Source of income&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Autonomy at work brings satisfaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Disregard from other professionals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Working rotas&#44; nights and holidays&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Value of maturity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Society undervaluing the profession&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nurses as team leaders&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Importance of trust from the team&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The patient as the single objective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tense working environment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Variety of activities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The word death is always present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Contradictions with your training&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Budget cuts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Workload&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1438538.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0170" class="elsevierStyleSimplePara elsevierViewall">Hierarchical scheme of codes&#44; subcategories&#44; categories and themes arising from the analysis&#46;</p>"
        ]
      ]
      2 => array:5 [
        "identificador" => "tb0005"
        "tipo" => "MULTIMEDIATEXTO"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "texto" => array:1 [
          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">What is known&#63;</span><p id="par0010" class="elsevierStylePara elsevierViewall">The psychological process that leads to engagement is related to resources and is a different process to that leading to burnout&#44; which is linked to demand&#44; these 2 processes are inter-related&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Engagement is the result of interaction between dispositional factors&#44; personal learning and working environments and therefore liable to change and affects nurses&#8217; professional activity and has an impact on care outcomes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">What do we contribute&#63;</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research study was designed to discover aspects of nursing practice that are relevant in maintaining engagement and that quantitative research has failed to make relevant because they are left out of standardised questionnaires&#46; The research study has enabled us to establish that nurses who are engaged also suffer the effect of work demands&#44; and that the resources that relate most to engagement in nursing are meaning of the profession&#44; intrinsic reward and autonomy&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Based on the study results&#44; we propose a new definition of engagement for nurses&#46;</p></span></span>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Empowerment&#44; engagement and perceived effectiveness in nursing work environments&#58; does experience matter&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Laschinger"
                            1 => "P&#46; Wilk"
                            2 => "J&#46; Cho"
                            3 => "P&#46; Greco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2834.2008.00907.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Nurs Manag"
                        "fecha" => "2009"
                        "volumen" => "17"
                        "paginaInicial" => "636"
                        "paginaFinal" => "646"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19575722"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Linking transformational leadership to nurses&#8217; extra-role performance&#58; the mediating role of self-efficacy and work engagement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Salanova"
                            1 => "L&#46; Lorente"
                            2 => "M&#46; Chambel"
                            3 => "I&#46; Mart&#237;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2648.2011.05652.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Adv Nurs"
                        "fecha" => "2011"
                        "volumen" => "67"
                        "paginaInicial" => "2256"
                        "paginaFinal" => "2266"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21535088"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Staff engagement as a target for managing work environments in psychiatric hospitals&#58; implications for workforce stability and quality of care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Van Bogaert"
                            1 => "S&#46; Clarke"
                            2 => "R&#46; Willems"
                            3 => "M&#46; Mondelaers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2702.2012.04341.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Nurs"
                        "fecha" => "2013"
                        "volumen" => "22"
                        "paginaInicial" => "1717"
                        "paginaFinal" => "1728"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23216757"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A causal relationship model work engagement affecting organizational citizenship behavior and job performance of professional nursing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46; Matula"
                            1 => "V&#46; Uon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "MEJSR"
                        "fecha" => "2016"
                        "volumen" => "24"
                        "paginaInicial" => "1600"
                        "paginaFinal" => "1605"
                        "itemHostRev" => array:3 [
                          "pii" => "S1474442210700570"
                          "estado" => "S300"
                          "issn" => "14744422"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The measurement of engagement and burnout&#58; a two sample confirmatory factor analytic approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46;B&#46; Schaufeli"
                            1 => "M&#46; Salanova"
                            2 => "V&#46;A&#46; Gonz&#225;lez-Rom&#225;n"
                            3 => "A&#46;B&#46; Bakker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Happiness Stud"
                        "fecha" => "2002"
                        "volumen" => "3"
                        "paginaInicial" => "71"
                        "paginaFinal" => "92"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The truth about burnout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Maslach"
                            1 => "M&#46;P&#46; Leiter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1997"
                        "editorial" => "Jossey-Bass"
                        "editorialLocalizacion" => "San Francisco&#44; CA"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maslach burnout inventory manual"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Maslach"
                            1 => "S&#46;E&#46; Jackson"
                            2 => "M&#46; Leiter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "3rd ed&#46;"
                        "fecha" => "1996"
                        "editorial" => "Consulting Psychologists Press"
                        "editorialLocalizacion" => "Palo Alto&#44; CA"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Areas of worklife&#58; a structured approach to organizational predictors of job burnout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;P&#46; Leiter"
                            1 => "C&#46; Maslach"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Research in occupational stress and well-being"
                        "paginaInicial" => "91"
                        "paginaFinal" => "134"
                        "serieFecha" => "2004"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Job burnout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Maslach"
                            1 => "W&#46;B&#46; Schaufeli"
                            2 => "M&#46;P&#46; Leiter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1146/annurev.psych.52.1.397"
                      "Revista" => array:6 [
                        "tituloSerie" => "Annu Rev Psychol"
                        "fecha" => "2001"
                        "volumen" => "52"
                        "paginaInicial" => "397"
                        "paginaFinal" => "422"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11148311"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Burnout&#58; 35 years of research and practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46;B&#46; Schaufeli"
                            1 => "M&#46;P&#46; Leiter"
                            2 => "C&#46; Maslach"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Career Dev Int"
                        "fecha" => "2009"
                        "volumen" => "14"
                        "paginaInicial" => "204"
                        "paginaFinal" => "220"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The job demands-resources model of burnout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Demerouti"
                            1 => "A&#46;B&#46; Bakker"
                            2 => "F&#46; Nachreiner"
                            3 => "W&#46; Schaufeli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Appl Psychol"
                        "fecha" => "2001"
                        "volumen" => "86"
                        "paginaInicial" => "499"
                        "paginaFinal" => "512"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11419809"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S073510971633426X"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;Internet&#93; Available from&#58; <span class="elsevierStyleInterRef" id="intr0010" href="http://doi.wiley.com/10.1002/job.248">http&#58;&#47;&#47;doi&#46;wiley&#46;com&#47;10&#46;1002&#47;job&#46;248</span> &#91;accessed 12&#46;11&#46;16&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Job demands&#44; job resources&#44; and their relationship with burnout and engagement&#58; a multi-sample study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46;B&#46; Schaufeli"
                            1 => "A&#46;B&#46; Bakker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Organ Behav"
                        "fecha" => "2004"
                        "volumen" => "25"
                        "paginaInicial" => "293"
                        "paginaFinal" => "315"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;Internet&#93; Available from&#58; <span class="elsevierStyleInterRef" id="intr0015" href="http://www.emeraldinsight.com/doi/abs/10.1108/02683940710733115">http&#58;&#47;&#47;www&#46;emeraldinsight&#46;com&#47;doi&#47;abs&#47;10&#46;1108&#47;02683940710733115</span> &#91;accessed 12&#46;11&#46;16&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The job demands-resources model&#58; state of the art"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;B&#46; Bakker"
                            1 => "E&#46; Demerouti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Manag Psychol"
                        "fecha" => "2007"
                        "volumen" => "22"
                        "paginaInicial" => "309"
                        "paginaFinal" => "328"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Burnout and work engagement among teachers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;J&#46; Hakanen"
                            1 => "A&#46;B&#46; Bakker"
                            2 => "W&#46;B&#46; Schaufeli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Sch Psychol"
                        "fecha" => "2006"
                        "volumen" => "43"
                        "paginaInicial" => "495"
                        "paginaFinal" => "513"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Towards a model of work engagement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;B&#46; Bakker"
                            1 => "E&#46; Demerouti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Career Dev Int"
                        "fecha" => "2008"
                        "volumen" => "13"
                        "paginaInicial" => "209"
                        "paginaFinal" => "223"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The future of optimism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Peterson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Psychol"
                        "fecha" => "2000"
                        "volumen" => "55"
                        "paginaInicial" => "44"
                        "paginaFinal" => "55"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11392864"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The relationship between job stressors&#44; hardy personality&#44; coping resources and burnout in a sample of nurses&#58; a correlational study at two time points"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Garrosa"
                            1 => "C&#46; Rainho"
                            2 => "B&#46; Moreno-Jim&#233;nez"
                            3 => "M&#46;J&#46; Monteiro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijnurstu.2009.05.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Nurs Stud"
                        "fecha" => "2010"
                        "volumen" => "47"
                        "paginaInicial" => "205"
                        "paginaFinal" => "215"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19596324"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship between job demand and burnout in nurses&#58; does it depend on work engagement&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Garc&#237;a-Sierra"
                            1 => "J&#46; Fern&#225;ndez-Castro"
                            2 => "F&#46; Mart&#237;nez-Zaragoza"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jonm.12382"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Nurs Manag"
                        "fecha" => "2016"
                        "volumen" => "24"
                        "paginaInicial" => "780"
                        "paginaFinal" => "788"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27111251"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A study on work engagement among nurses in Japan&#58; the relationship to job-demands&#44; job-resources&#44; and nursing competence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46; Hontake"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Nurs Educ Pract"
                        "fecha" => "2016"
                        "volumen" => "6"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Work engagement in nursing&#58; an integrative review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Garc&#237;a-Sierra"
                            1 => "J&#46; Fern&#225;ndez-Castro"
                            2 => "F&#46; Mart&#237;nez-Zaragoza"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jonm.12312"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Nurs Manag"
                        "fecha" => "2016"
                        "volumen" => "24"
                        "paginaInicial" => "E101"
                        "paginaFinal" => "E111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26032875"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nursing research&#46; Principles and methods"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;F&#46; Polit"
                            1 => "C&#46; Beck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2004"
                        "editorial" => "Lippincott Williams &#38; Wilkins"
                        "editorialLocalizacion" => "Philadelphia&#44; PA"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Qualitative content analysis in nursing research&#58; concepts&#44; procedures and measures to achieve trustworthiness"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "U&#46;H&#46; Graneheim"
                            1 => "B&#46; Lundman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.nedt.2003.10.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nurse Educ Today"
                        "fecha" => "2004"
                        "volumen" => "24"
                        "paginaInicial" => "105"
                        "paginaFinal" => "112"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14769454"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The qualitative content analysis process"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Elo"
                            1 => "H&#46; Kyng&#228;s"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2648.2007.04569.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Adv Nurs"
                        "fecha" => "2008"
                        "volumen" => "62"
                        "paginaInicial" => "107"
                        "paginaFinal" => "115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18352969"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Criterios de calidad en la investigaci&#243;n cualitativa en salud &#40;ICS&#41;&#58; apuntes para un debate necesario"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Calderon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Salud P&#250;blica"
                        "fecha" => "2002"
                        "volumen" => "76"
                        "paginaInicial" => "473"
                        "paginaFinal" => "482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12422422"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exploration of the facilitators of and barriers to work engagement in nursing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Y&#46;M&#46; Freeney"
                            1 => "J&#46; Tiernan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijnurstu.2009.05.003"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int J Nurs Stud"
                        "fecha" => "2009"
                        "volumen" => "46"
                        "paginaInicial" => "1557"
                        "paginaFinal" => "1565"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19523629"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S000291491631373X"
                          "estado" => "S300"
                          "issn" => "00029149"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Community nurses who thrive&#46; The critical role of job engagement in the face of adversity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46;F&#46; Vinje"
                            1 => "M&#46;B&#46; Mittelmark"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.NND.0000320695.16511.08"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Nurses Staff Dev"
                        "fecha" => "2008"
                        "volumen" => "24"
                        "paginaInicial" => "195"
                        "paginaFinal" => "202"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18838896"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The relationship between emotional intelligence&#44; occupational stress and health in nurses&#58; a questionnaire survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;M&#46; Augusto Landa"
                            1 => "E&#46; L&#243;pez-Zafra"
                            2 => "M&#46;P&#46; Berrios Martos"
                            3 => "M&#46;del&#46;C&#46; Aguilar-Luz&#243;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijnurstu.2007.03.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Nurs Stud"
                        "fecha" => "2008"
                        "volumen" => "45"
                        "paginaInicial" => "888"
                        "paginaFinal" => "901"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17509597"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The relationship between psychosocial job stress and burnout in emergency departments&#58; an exploratory study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Garc&#237;a-Izquierdo"
                            1 => "M&#46;I&#46; R&#237;os-R&#237;squez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.outlook.2012.02.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nurs Outlook"
                        "fecha" => "2012"
                        "volumen" => "60"
                        "paginaInicial" => "322"
                        "paginaFinal" => "329"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22464694"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Work engagement in nursing&#58; a concept analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Bargagliotti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2648.2011.05859.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Adv Nurs"
                        "fecha" => "2012"
                        "volumen" => "68"
                        "paginaInicial" => "1414"
                        "paginaFinal" => "1428"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22044047"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available from&#58; <span class="elsevierStyleInterRef" id="intr0020" href="http://memberfiles.freewebs.com/67/27/85462767/documents/managing_nursing_workforce-2.pdf">http&#58;&#47;&#47;memberfiles&#46;freewebs&#46;com&#47;67&#47;27&#47;85462767&#47;documents&#47;managing&#95;nursing&#95;workforce-2&#46;pdf</span> &#91;accessed 12&#46;11&#46;16&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Managing the multi-generational nursing workforce&#58; managerial and policy implications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Manion"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2009"
                        "editorial" => "International Centre for Human Resources in Nursing"
                        "editorialLocalizacion" => "Ginebra&#44; Suiza"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Social support and work engagement&#58; a study of Malaysian nurses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46; Othman"
                            1 => "A&#46;M&#46; Nasurdin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2834.2012.01448.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Nurs Manag"
                        "fecha" => "2013"
                        "volumen" => "21"
                        "paginaInicial" => "1083"
                        "paginaFinal" => "1090"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23409702"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack285796"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0285" class="elsevierStylePara elsevierViewall">To the nurses who were voluntarily interviewed&#46; Without them this study would not have been possible&#46;</p> <p id="par0290" class="elsevierStylePara elsevierViewall">To the nursing management and coordinators of the <span class="elsevierStyleItalic">Consorcio Sanitario</span> of Terrassa for their collaboration in contacting the participants&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/24451479/0000002700000003/v2_201706121007/S2445147917300462/v2_201706121007/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "63169"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/24451479/0000002700000003/v2_201706121007/S2445147917300462/v2_201706121007/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445147917300462?idApp=UINPBA00004N"
]