• <tr id="yyy80"></tr>
  • <sup id="yyy80"></sup>
  • <tfoot id="yyy80"><noscript id="yyy80"></noscript></tfoot>
  • 99热精品在线国产_美女午夜性视频免费_国产精品国产高清国产av_av欧美777_自拍偷自拍亚洲精品老妇_亚洲熟女精品中文字幕_www日本黄色视频网_国产精品野战在线观看 ?

    Self-endangering: A qualitative study on psychological mechanisms underlying nurses’ burnout in long-term care

    2022-02-08 03:23:56LaraLuisaEderBertoltMeyer

    Lara Luisa Eder , Bertolt Meyer

    Department of Psychology, Wilhelm-Raabe-Str.43, Chemnitz University of Technology, Chemnitz, Germany

    Keywords:Altruism Caregivers Health personnel Mental health Nursing homes Professional burnout Social identification Workload

    ABSTRACT Objectives: To develop a more specific understanding of psychological mechanisms in the development of burnout in long-term care as a basis for potential new intervention strategies aiming at improving nurses’ mental health.Methods: Two qualitative studies with thematic analysis were conducted.In Study 1,we conducted eight group interviews with 110 nurses from May-July 2019 in the context of workshops at eight nursing homes in Germany.In Study 2, we supplemented these with semi-structured interviews with 14 executives at German nursing homes in December 2019.Results: The thematic analysis in Study 1 identified three main themes:causes of challenges,employees’opportunities for change, and organisational opportunities for change.Thematic analysis in Study 2 identified three main themes: job motives, reasons for filling in for others, and employee self-care.Further, our results show that the need to stand in for colleagues, in particular, is one of the greatest challenges for geriatric caregivers.In dealing with these challenges we found that self-endangering behaviour-a diminished ability to say no when asked to fill in or to do work overtime-was an important antecedent of nurses’ burnout.Further, high levels of altruistic motivation and identification with the team or organisation were associated with self-endangering behaviour in the presence of adverse working conditions.Low levels of self-worth are a further risk factor for self-endangering.Conclusions: Our findings are at odds with some core tenets of classic models of job demands and burnout that construe motivation and identification as resources.Our results show the need of a holistic intervention program in nursing including individual coaching, team-based interventions and organisational development processes.Employees themselves should be sensitized to this issue and supported in the long term, and politicians should create structures that do not encourage this behaviour any further.

    What is known?

    · Nurses are highly stressed and consequently show high burnout rates - these trends are increasing due to demographic change and emigration in the nursing professions.

    · Theoretical models of demands and stresses highlight the importance of resources, e.g., self-efficacy or coping strategies.

    · Little is known about specific psychological mechanism behind the resources that are crucial for improving the nurses’ mental health, e.g., team-based behaviour.

    · Most of the recent studies used a quantitative approach and may not be holistic enough to be able to develop new intervention strategies.

    What is new?

    · A qualitative analysis of psychological mechanisms in the development of burnout in long-term care was conducted under a specific perspective.

    · The construct of self-endangering in nursing is considered as a mediating variable in the context of demands and the emergence of burnout.

    1.Introduction

    As in most countries, the elderly care system in Germany is facing major challenges due to the on-going demographic changes:As of 2019, the number of individuals requiring long-term care in Germany had doubled in the last 15 years to 3.8 million [1]and is predicted to rise to over 5 million individuals by 2050 [2].

    As a result, the demand for caregivers will increase in the coming decades.At the same time, demographic changes will continue to increase the average age of caregivers.In addition,there is already an extreme shortage of skilled workers in nursing [3,4],resulting in a high density of work and resulting burdens for caregivers and nurses.

    Given these issues, nurses are an important societal resource and are therefore particularly worth protecting.However,burnout is rampant among nurses [5].Work overload, work-related stress,aggression at work, the intention to abandon the profession, and turnover intentions contribute to nurses’ burnout [6].In addition,being single is associated with higher levels of nurses’exhaustion,such that a lack of support complicates dealing with stress-related emotions in high demanding working situations [7].Therefore,work design strategies and interventions for promoting nurses’psychological well-being and protecting them against burnout are central for the sustainability of elderly care systems.

    On the basis of central theoretical models of the antecedents of burnout-the job demands-resources (JD-R) model [8]and the conservation of resources theory (COR) [9], we already know that resources and demands interact with each other in their effect on employee mental health.According to the JD-R approach, job characteristics can be divided into job resources and job demands[10].Job demands are defined as social, psychological, physical, or organisational aspects that require sustained physical or cognitive,or emotional effort or ability, and as a result, are associated with costs, e.g.emotionally demanding interactions [10].Job resources refer to the physical,psychological,social,or organisational aspects of the job that are functional in achieving work goals and reducing job demands and the associated physiological and psychological costs or that stimulate personal growth,learning,and development[10].Workplace commitment, a good working team, recognition from supervisor[11],stress management techniques,e.g.,effective coping strategies [12]and work ethic feasibility [13]are helpful resources in dealing with stress.Even though we already know about important resources for dealing with stress from various studies, we still know little about their exact psychological impact mechanisms in nurses and their interaction with each other.However, from our point of view, this is indispensable for the development of targeted measures,such that nurses learn to reflect about and deal with their own resources, especially as long as politics does not create better care conditions.

    For gaining more insights into the relation between nurses’ resources and burnout, we interviewed leaders and employees at eight nursing homes in Germany and analysed the transcripts using reflexive thematic analysis [14].Reflexive thematic analysis is “a fully qualitative approach - with data collection and analysis techniques underpinned by a qualitative philosophy or paradigm approach” [14, p.6].Given that we aim to develop theory rather than test it, this qualitative approach appears most suitable.It enables an active researcher role in the research process and allows a dynamic evaluation process such that new themes can emerge throughout the process[14],which for us is the decisive advantage over a quantitative approach when it comes to understanding(new)psychological phenomena in depth.

    If we succeed in identifying psychological mechanisms behind important resources in dealing with stressful working situations in long-term care, we can, first, make an important contribution to empirical research on stress and strain in this target group and,second, develop new practical interventions.We hope that our results can also serve as starting points for holistic interventions in occupational health management in nursing homes.

    1.1.Background

    1.1.1.Workload in nursing care

    Shiftworking [15], heavy workloads [16], organisational problems such as time pressure [16,17], work overload due to understaffing [18], little control over work circumstances [19], and high levels of responsibility[20]characterize the working conditions in nursing homes.Further, we already know that nurses’ lower job satisfaction,lack of support,and feeling of poor leadership relate to higher levels of burnout and stress [21].Nurses working in longterm care face additional challenges, as they provide more intensive care, and their clients often suffer from dementia [22]and challenge nurses with their behaviour [23].Therefore, in sum,nurses are particularly vulnerable to burnout [24].See the supplemental online file for more information on the special challenges in the residential elderly care system in Germany(Appendix A).

    1.1.2.Development of stress and burnout

    For explaining the psychological processes underlying nurses’exhaustion and burnout,two theories appear especially relevant,as they consider the interactions of demands and resources in the context of working: the JD-R model [8], and the conservation of resources theory [9].

    According to specific resources, examples are social support[25], autonomy [26], and competence [27].Further, clinical expertise, a good work-life balance, positive attitudes, managerial leadership, social support, and self-efficacy can prevent stress[13,28,29].Moreover, personality patterns influence coping strategies[30],and active coping strategies mitigate the negative effect of high job demands [29].Those resources can buffer several demands in the context of exhaustion [25,31,32]and therefore have great relevance for stress management in high-demand workings settings.

    Moreover, COR theory proposes that demands diminish resources and that the(temporal)processes associated with resource losses cause emotional exhaustion [33].According to COR theory,personal resources(e.g.self-efficacy)and social resources(e.g.close relationships) are central to individual’s identity, and individuals maintain psychological health by preserving these resources.The threat of resources, or an insufficient gain of resources after an investment or resource losses are the core antecedents of stress,burnout and exhaustion[9,34,35].If we now assume,based on the difficult working conditions in long-term care that have persisted for years and the high burnout rates, that a loss of resources has already been ongoing for many years, it seems all the more important to understand how and why resources were lost and what it takes for rebuilding them.

    Many interventions for health promotion have already been derived based on the JD-R and COR models.However, we can see from the increasing burdens reported in care [5,36,37]that the interventions are not sufficient.We posit that more knowledge is needed about psychological mechanisms and their interactions surrounding nurses’ psychological resources.Different levels of resources among team members may also affect individual team members’ health behaviour such that resource imbalances in the team can increase increases nurses’ exhaustion.

    For example, COR theory posits that individuals with fewer resources are more likely to experience a further resource loss.However, the question arises as to which specific individual and team-based resources are needed in long-term care to compensate for the previous loss and to rebuild resources.Our efforts seek to answer this question.

    1.2.The study

    Previous research, especially today’s stress research, raises the question as to what other environmental or personal factors might protect nurses against job stressors [29].We would go further to say that it is not only the question of further resources, but much more the specific psychological mechanism that is crucial for improving the nurses’ mental health.Although psychological factors are particularly important in dealing with stress,they are only examined in a few quantitative studies [38-42]and have not yet been integrated in terms of influences on individual’s and teambased behaviour.See Fig.1 for a detailed description of the approach used in this study.

    2.Methods of Study 1: employee workshops

    2.1.Aims

    The purpose of Study 1 was to 1)examine the causes of nurses’burnout from the perspective of the employees themselves,and 2)elaborate what possible changes would help.We aimed to focus on specific people- and organisation-related causes and possible changes.

    2.2.Design

    We applied a qualitative study design using a reflexive thematic analysis approach.Thematic analysis is a data-driven method that identifies reoccurring themes or topics and relations among them in texts through inductively coding statements into sub-categories and categories[43].In this way,the identified themes and patterns are strongly linked to the data themselves [44].

    2.3.Sample/participants

    Fig.1. The present study’s procedure.

    We surveyed data from eight nursing homes located in North Rhine Westphalia in Germany that were participating in a large research project on health care.To represent the mixed cultures of nursing homes in Germany, they differed in the number of residents,sponsorship(private or state),and geographical area.We invited all the different professional groups in the nursing homes to participate through their area supervisors.The organisation leaders chose the participants of the workshops themselves, with a maximum of 25 people for one workshop.The sampling was influenced by low staff levels and the complexity of taking personnel out of their schedule.Therefore, a random or unbiased sampling was not possible, such that workshop participants consisted of nurses with a more constructive or critical approach towards their working conditions.We collected data in the summer of 2019.

    The participants in the eight workshops conducted in the nursing homes were 110 of the nursing home employees in different functional areas (nurse specialists, nursing assistants,caregivers, social services employees, home economics, cook).Since the workshops were part of a wider research project,we were not allowed to define any study-specific inclusion or exclusion criteria.The only default we made was that employees’ participation was voluntary and that groups consisted of a mix of different functional and living areas.For reasons of anonymity and global project guidelines, we did not survey any demographic data.See supplemental online file for information about the health care project (Appendix B).

    2.4.Data collection

    Following the results of an employee survey(see Appendix B for detailed information about the covered scales), which was conducted in a previous analysis step in the health care project,the first author of this paper and another project partner selected two main topics individually for each nursing home, e.g.burnout, emotional labour, to be dealt with in the workshops at the beginning.Workshop participants could choose three further topics among the constructs collected in the survey, e.g.presenteeism, burnout,general health, work-privacy conflict.Participants then rated the importance of the potential topics by assigning points to each.The five topics that received the most points were then selected for the workshop.See supplemental online file for more information about the workshops and the detailed schedule (Appendix C).

    2.5.Ethical considerations

    Approval was obtained from the research ethics board of the university.At the beginning of the entire research project, all nursing home leaders were informed comprehensively about the project, its contents, methods and objectives in one-on-one meetings and steering committees.In addition, employees were informed through staff meetings and written notices.All participations provided informed consent.The employees all participated in the workshops voluntarily and during their working hours.The objectives and content of the questions were made clear several times at each stage.The workshops were anonymous, so no personal data was collected.Furthermore, no managers took part in the workshops, in order to create a confidential and protected atmosphere for the employees.

    2.6.Data analysis

    The employees’ individual answers to the questions on the causes and the respective change possibilities in the workshops were recorded in keywords in columns on flipcharts.We subsequently transferred these keywords into MAXQDA for analysing the data using thematic analysis [43].We did not return transcripts to participants.The existing cooperation with the organisation helped us interpret the data,as Braun et al.(2018)[14]also mentioned that the aim of thematic analysis is not to exactly summarize the data and minimize the researcher’s subjectivity.The aim is much more to provide a coherent interpretation grounding in the data by the researcher playing an active role [14].

    Given the aim of the study, we analysed the results of the questions “What are the causes of [topic](for example, high burnout symptoms, high rates of presentism), what must happen for the condition to improve,what can I contribute to that,and what can the institution contribute to that,”because we wanted to focus on causes and possible changes.We followed the six phases of thematic analysis [43]for the evaluation.After transcribing the data, we reread the issues referred to the workshops.As thematic analysis is a data-driven method [43], we inductively coded the participants’statements,which consisted of a few words or short sentences,and initial discursive themes.That means that the identified themes and patterns are strongly linked to the data themselves[44].The themes were grouped and then reviewed for overarching major themes,variability,and consistency.These themes were interpreted through a process of reading and rereading, as well as reference to relevant literature and consultation with colleagues.We then formed main codes and subcodes.Our implicit knowledge on the organisation and structures helped us to move beyond the surface or obvious content[14].During the coding process, we grouped themes or separated them if a thematic differentiation appeared necessary,so we always paid attention to identifying new codes.

    The whole category system evolved dynamically throughout the coding process, and all eight workshops were coded.We stopped coding when all transcripts were assigned to an appropriate category and the description of the coding system was complete.When the coding process was completed,we checked and rechecked the themes and discussed them with two colleagues who work in the psychological sector.If a statement was not appropriate to a theme,we discussed that and, if applicable, built a new theme.We then discussed the themes’areas of overlap and the identified relations in-between, which we summarized for visualizing in MAXMAPS.

    After that,based on the frequency distribution of the topics,we identified the most frequent topics from the employees’perspective.

    2.7.Rigour

    To improve the rigour of thematic analysis, we used the MAXQDA computer software[45].Further,we tried to support the validity of data using verbatim quotes [46].We ensured trustworthiness by following the Lincoln and Guba (1985) [47]criteria during our research process.Specifically, we ensured credibility through the familiarity between the main researcher and the nurses:By interacting with the nursing homes and their employees during the health care project, participants were already familiar with the first author for eight months when the workshops started,and a baseline level of trust had emerged.To ensure confirmability and dependability,we conducted several peer debriefings and four expert exchanges about the code assignments and theme building during the coding process.All experts had a psychological background,such that three had at least a master’s degree in psychology and one was in advanced master’s studies with additional practical work experience in the field of training.Two of the other three were researchers in organizational psychology and one had a clinical psychology background working in a hospital.All experts were familiar with the nurses'working situations but were not part of the practical project activities in the nursing homes.Additionally,we implemented the peer debriefings with our health care project partners from occupational health management.In sum, we were able to bring together a good mix of scientific and practical experience.To increase transferability, we have prepared a detailed description of the contextual factors of the health care project,the nursing homes and the samples.See the supplemental online file(Appendix B).

    3.Results of Study 1

    The thematic analysis identified three main themes: causes of challenges, employees’ opportunities for change, and organisational opportunities for change.Table 1 gives the central themes and subthemes, definitions, examples, and frequencies.

    3.1.Theme 1: causes of challenges

    This category contained the antecedents and causes of jobrelated challenges that the nurses identified.These included especially structural working conditions (e.g.working hours,personnel structures)and employee’s psychological characteristics such as missing self-care or attitudes.With 98 mentions, participants referred to the structural working conditions the most frequently, followed by employee characteristics such as missing self-care and employees’ attitudes and values with 38 mentions,team culture and climate with 35 mentions, and leadership behaviour with 19 mentions (see Table 1).

    Employee’s psychological characteristics, team culture and climate,and leadership behaviour were the vaguest themes,so we present some examples.Employees’ characteristics as a cause of challenges included missing self-care, missing self-efficacy, and employees’attitudes and values.Missing self-care means not being able to switch off after work, being too tired to do something in your free time,the thought to still be able to do more,meaning that one does not think of oneself and that employees’ would rather save the other persons weekend than their own.

    “I could do more.” (NH 1)

    “You put other people before yourself.”(NH 8)

    Employees’attitudes and values mean especially a strong sense of responsibility and duty and having a bad conscience towards colleagues and residents.

    “I would rather save the other person’s weekend than my own.”(NH 6)

    “I have feelings of guilt towards colleagues and residents.”(NH 5)

    The team culture and climate included aspects such as remaining silent for fear of consequences, lack of confidence, hierarchical differences between the professional groups, lack of cohesion among staff, ignoring each other, or talking about someone behind their back:

    “Colleagues relying too much on others.” (NH 3)

    “You don’t want to stab others in the back.” (NH 6)

    The leaderships aspect included a lack of praise and appreciation, pressure, and a lack of acceptance for employees who do not fill in for others.

    3.2.Theme 2: employees’ opportunities for change

    This category contained opportunities for change that the nurses identified.The most frequent topics were self-care (see Table 1, mentioned 61 times) and behaviour in the team (see Table 1, named 31 times).

    Table 1Study 1: Themes and subthemes.

    “I could openly say to the team,‘it’s all too much for me’.” (NH 3)

    Self-care was in turn divided into five further sub-categories:self-efficacy, self-reflection, consideration of the state of health,separation of work and personal life,and the most important topic from the employees’ view: distancing oneself from something.Distancing oneself from something means,on the one hand,being able to set physical and especially mental limits regarding residents,the leader,or colleagues and,on the other hand,being able to say no when the leader or colleagues ask you to step in for another employee in the event of absenteeism.

    “I could learn to say‘no’and think of myself.” (NH 5)

    “I could put‘the brakes on myself’more often.” (NH 1)

    “Your own awareness of being able to do something and wanting to do something.” (NH 7)

    3.3.Theme 3: organisational opportunities for change

    This category contained the organisational opportunities for change that the nurses identified.The most frequently mentioned topics were work organisation (named 99 times, see Table 1) and leadership (named 40 times, see Table 1).Within work organisation, the most important themes from the employees’ view were personnel management, times for exchange, and organisation in case of illness.Within the theme leadership,the employees pointed out that they want an understanding attitude and recognition from the management.

    “They could accept a‘No’without making me feel guilty.” (NH 3)

    “They could give me the feeling that it is allowed to say‘No’(e.g.when they ask me tofill in for others).” (NH 1)

    4.Methods of Study 2: semi-structured interviews with leaders

    4.1.Aims & design

    The aims of Study 2 were to 1) examine the causes of nurses’burnout from the leadership and employee perspective, and 2)elaborate potential changes or interventions that might help to mitigate burnout.We aimed to focus on specific people- and organisation-related causes and possible changes.We used the same approach as mentioned in Study 1.

    4.2.Sample and participants

    At each of the participating nursing homes,we asked for two or three executives to participate in the interviews during the health care project process.None of them knew about the aim of this study, and this research project was independent from the health care project process or aims.We collected data in December 2019.

    Fourteen executives in different units at six of the eight nursing homes took part in the interviews: 12 women and two men aged 36-58 years (Mean= 45.86,SD= 7.36).The mean years of affiliation with their organisation ranged from 1 year to 3 months to 33 years (Mean= 11.23,SD= 10.68).

    The participants were divided into their functional areas at the nursing homes: four directors of the facilities, two living area managers, two home economics managers, two nursing service managers, and two social service managers.

    4.3.Data collection

    We used semi-structured interviews to ensure that the executives were guided but not limited in their answers.We gave them no restrictions in their explanations, and we added exploratory questions to gain a deeper perspective on what was being said.

    Before the interviews, we sent the information and declaration of consent form via email to the voluntary participants.Three of the 14 interviews were conducted via face-to-face conversations and 11 via telephone.Before starting, we asked for consent for the interview to be audio recorded.Interviews lasted between 8 and 33 min,with an average interview time of 16 min 40 s.

    A guideline for the interviews was prepared in advance that included all topics relevant to the survey and their possible interrelationships.Conducting semi-structured interviews allows the interviewer, for example, to adjust the order of questions and to respond to the answers of the individual interview participants[48].

    Although we analysed the results of the workshops in study one in a standardized way in MAXQDA after carrying out the interviews,we already knew a lot about the employees’most important topics and correlations from the workshops.The identification of the topics for the semi-standardized interviews with the executives was therefore based on the answers of the employees in the workshops.For the interview questions, see the supplemental online file (Appendix D).

    4.4.Ethical considerations

    Approval was obtained from the research ethics board of the university.In addition,the consent of all facility managers and the corresponding works councils on site was obtained throughout the research project.All interviewees were informed in advance in writing about the procedure and the contents and asked for written consent to participate.In addition,another verbal explanation was given on the day of the interview, and only after the participants had given their consent were the interviews recorded by telephone for later evaluation.Demographic data were requested prior to recording,so that they were fully anonymised.We have no further ethical concerns regarding the study, as we did not deceive or manipulate the target group in the course of the research.

    4.5.Data analysis

    We fully transcribed the interviews into MAXQDA according to Dresing, Pehl and Schmieder’s (2018) [49]semantic transcription rules for analysing the data using thematic analysis[43].We did not return transcripts to participants.Due to the fact that the first author conducted the interviews and afterward the transcription herself, all uncertainties and supposed misunderstandings were clarified directly in the interviews.Nevertheless, we contacted the leaders via telephone in case of uncertainties or questions.After transcribing the interviews,the first author of this paper reread the contents several times.The first author carried out the interviews with the leaders,so she was already familiar with the content.We coded the interview statements in an inductive-deductive way.Based on the interview questions we built the upper categories in a deductive way and then following the sub-categories in an inductive way directly on the interview material.During the evaluation phase, the category system grew from interview to interview.The coding process was the same as described in Study 1 above.

    As described in Study 1,we grouped themes or separated them if a thematic differentiation appeared necessary, so we always paid attention to identifying new codes.We stopped coding when all interviews were coded and all aspects were assigned to an appropriate category.

    The whole category system evolved dynamically throughout the coding process, and all relevant text passages from the 14 interviews were coded.When the coding process was completed,we checked and rechecked the themes and discussed the patterns and relations with two colleagues who work in the psychological sector.If a statement was not appropriate to a theme, we discussed that and,if applicable,built a new theme or renamed themes.After we put the themes in relation to each other,we summarized the results for visualizing in MAXMAPS.

    Based on the frequency distribution of the topics, we then identified the most frequent topics from the leaders’ perspective.

    5.Results of Study 2

    Thematic analysis identified three main themes: job motives,reasons for filling in for others, and employee self-care (Table 2).

    5.1.Theme 1: job motives

    This category contained the different job motives that had motivated nurses to choose their job.These included social motivation and general conditions that the profession entails.

    The general conditions in nursing,such as earning money,being able to make a career,or to have a secure job were a less common reason for working in a nursing home(named 8 times,see Table 2).The most common motive for people working in nursing homes in the view of leaders was social motivation (named 29 times, see Table 2).We differentiated the social motivation into three sub codes and found that helping and having relationships with others were the strongest motivators for employees working in the context of nursing.Having relationships meant relationships with the residents and developing relationships with your colleagues.

    Table 2Study 2: Themes and subthemes.

    Table 2 (continued)

    “Employees go into a deep level with them.” (P7)

    “Have a feeling of being needed.” (P4)

    “Feel that the residents, they just love you.” (P4)

    “Well,it is such a(…)good network that you build up,besides the family structure or acquaintances and friendships that you cultivate.You must have colleagues there as well.I think you profit from it very, very, very much.Teamwork, teamwork is needed.” (P13)

    In the context of helping, some of the respondents also mentioned what is so called the helping syndrome, meaning that employees in nursing homes are often over-motivated to help others and that this can sometimes be pathological.

    “It’s more like that helper syndrome that’s going on,which may not be so obvious to you either.And says yes, I’m totally interested in helping people somehow from the nursing point of view, because they are so limited.(…) It may be pathological or not, it doesn’t matter.(…)Yes,if no peace comes in there.If you feel like you are always driven by love for people and you want to help other people all the time and are NEVER free of that,then I think it’s pathological,so it goes along with it to such an extent that I think it’s really pathological.” (P2)

    5.2.Theme 2: reasons for filling in for others

    This category contained employees’ approach in the event of necessary coverage for absent employees, the general conditions for coverage, differences between employees who fill in for others and those who do not,employee substitution behaviour, and duty of managers to provide for the welfare of their staff.

    5.2.1.Employees’approach to covering for absent employees

    In the event of necessary coverage for absent employees, the leaders reported that they pursue two approaches.They can call in employees in their free time to cover for the absenteeism, or they can try to cover for absent employees by implementing an on-call standby service system (this was implemented in only one of the participating nursing homes and only for care assistants), by covering via the existing staff on site,by sharing the working time for the present staff, or by leaders stepping in themselves.

    When none of these alternatives are possible, the leaders usually must make use of employees who are on leave (named 19 times, see Table 2).When we asked which employees the leaders call first, they mentioned three things that they do.First, they call part-time employees.

    “There are people who oftenfill in, these are our part-time employees.Because you call themfirst because they are more often out in the open.” (P5)

    Second,they call employees that they know will agree to come in.

    “You call actually,you call those who you know they will come in,you call themfirst.” (P10)

    Third,they take overtime and replacement rhythm into account when deciding who to ask first:

    “Then it was actually fairness, because I always think fairness is above everything.The one who has the least overtime, he is askedfirst,if he can’t,the next one is asked.So,we looked at the numbers or the rhythm,how often did one person step in and how often did the other.So that everyone feels treated equally,and then you just go through,he was already there,has the least overtime,so the next one comes in.” (P2)

    5.2.2.Employee substitution behaviour

    From the leaders’ point of view, all reported that they have employees who always stand in for their colleagues when coverage was needed and agree when they are asked,and all have employees who never fill in for their colleagues and everybody knows that they will not agree when they are asked.

    “There are people who would alwaysfill in, even if they have worked-I would say-maybe even too much.They wouldfill in anyway.And others always have other appointments.” (P11)

    5.2.3.Differences between employees whofill in for each other and those who do not

    The differences between employees who fill in and those who do not could be divided into five subthemes:identification with the residents,intrinsic motivation,team spirit,personal characteristics,and structural conditions.

    One of the two most frequently mentioned differences between employees was in team spirit.Team spirit means that employees who fill in for each other do not let their colleagues down,they stick together and they do not want to abandon their team.

    “They want to be a good colleague.” (P8)

    “The attitude could be, I won't let the team down so that could be an attitude.And some people don’t care, so if you don't step up then.Maybe they don’t have such a strong bond to the team or the institution, so maybe the identification is different,I could at least imagine.” (P11)

    The second most frequently mentioned difference between employees was in personal characteristics, which means personality traits and attitudes.It was mentioned that employees who often or always fill in for others feel extremely responsible,are particularly selfless and helpful,put their private lives on hold,and have a pronounced helper syndrome.

    5.3.Theme 3: employees’ self-care

    This category contained the management’s responsibility for employees’ health care and self-care, the general attitude to selfcare, the meaningfulness of self-care, break culture, self-care capabilities, and the ability to distance oneself from something(Table 2).

    5.3.1.Self-care capabilities

    All the participating leaders agreed that the majority of the employees have only limited abilities to look after themselves(named 18 times, see Table 2).

    “Yes, exactly, so how should I say, those who are especially connected to the work or the wearer,I think they don’t really take care of themselves, including me (laughs).” (P10)

    They described was a lack of awareness of self-care on the part of employees and stated that many do not know what they can do.It was also argued that one reason for the low self-care capabilities is the helping syndrome and that people who work in the care context often tend to be selfless.

    “There are especially among the skilled workers’employees who sometimes tend to go beyond their limits and do not say to themselves,now it’s time to go home,now I need my time off.”(P6)

    Further, some executives saw an age effect.They reported that older employees often react selflessly and should do more self-care than they actually do.

    “I believe I would also like to make this clear to the older employees,who have gone through the old school, I say it now times through the old school, still have such old pictures in their heads.Without me,it does not work and I must somehow go on until(…)until it is no longer possible,so they really react very selflessly.And so,with the younger employees who come, who, for example, want to combine family and career,but who then also set a few conditions,this sometimes meets with irritation between the generations.You have to do justice to both.For those who are still socialized differently and have gone through the old school of nursing care for the elderly and for those younger employees who,I believe,have a completely different approach to the work-life balance.So, I think you have to create a good understanding of each other.The younger ones I think they already have a different one,so I hope they have a different view of the working conditions and (…) yes, I think they are always the older employees,by older I mean also those who are my age,we are the ones who are perhaps still a bit of the old breed or I would say we got to know them differently.So, the older employees really have to,I think sometimes they have to do a bit more for themselves.” (P13)

    5.3.2.Ability to distance oneself from something

    5.3.2.1.Ability to say no.The employees’ ability to say no when they are asked to fill in for their colleagues or do some extra work was one of the main themes in the interviews.All leaders mentioned that saying no is accepted and necessary for a good selfcare in the nursing homes.Conversely, this ability is only very slightly developed among the employees.

    “(…)and all those who have this background working with people in this way often have a problem saying no, because they tend to put others in the foreground rather than their own needs.” (P7)

    5.3.2.2.Depending on occupational group or individual characteristics.Executives reported that employees’ability to say no depends on the professional activities and thereby on the occupational group in the nursing homes.Especially for the nursing stuff, it is usually difficult to say no, whereas for example for the social services,it is often easier because more flexible in terms of timing.To put it more generally, some processes in the nursing home encourage the employees’ ability to distance themselves from something because they can be rescheduled or cancelled.Further,it was mentioned that the social services staff sometimes know more about themselves or self-care strategies because they learned this during their education and training.

    “My experience is that sometimes nursing staff can not do that.Because they really do have the attitude that they have to help people and on the other hand they have to have this attitude, so that they can work well or are good and what we want for our residents,and that really is a greater challenge in the nursingfield than in some other occupational groups in the home.” (P9)

    In contrast to the executives’ view concerning factors influencing the capability to distance oneself from something as described above, some leaders also mentioned that this capability depends on individual aspects.

    “I would sayfirst of all that it also strongly depends on the employee’s personality.” (P13)

    5.4.Self-endangering in nursing

    Our results show a vicious circle of high stress and little self-care causing health problems and absenteeism.This absenteeism in turn requires flexibility and coverage by others, which leads to more stress for the nursing staff.With regard to the boundary conditions,our study participants see the greatest potential for change in their own self-care and in the behaviour within the team.

    In our two qualitative studies, we investigated nurses’ challenges and associated boundary conditions in long-term care in order to examine the psychological mechanisms behind individuals’ resources or even lack of resources.

    Overall,the thematic analyses led to the main topic of accepting extra tasks or filling in for colleagues in cases of illness or absence,which usually results in overtime,long and frequent work shifts in a row,presenteeism,and lack of recovery.Our results indicate that employees'interpersonal differences in team identification as well as in the personal characteristics determine the way that nurses in long-term care deal with and react to these special demands.One of the most important themes for employees and executives seems to be the ability to say no and the associated general ability to set oneself apart from colleagues and long-term care residents.Participants mentioned that they“find it important for self-care to say no and to say no, but unfortunately, I can’t now.” A lot of participants believed that“there are many who have a particular problem saying no.” Overall, a large number of statements reflected selfsacrificing behaviour among nursing staff.In summary, on the basis of our qualitative results, we construe self-endangering as a central mediator between nursing-specific characteristics and burnout.Basically, based on our findings, we assume that two facets of self-endangering at work can be classified:behaviour and behavioural tendencies and cognitions.We define self-endangering behaviour as a diminished ability to say no when asked to fill in or to do overtime.We define self-endangering cognitions as the nurses’own inner beliefs with regard to having a moral obligation to fill in for colleagues at the expense of their own health.

    As we see the introduction of the construct of self-endangering in the context of nursing as a central contribution,we will focus on this aspect and its connections to the mentioned individuals’ resources and characteristics of nurses in the discussion.

    6.Discussion

    6.1.Self-endangering in nursing

    To our knowledge, there has been only little research on selfsacrificing behaviour in the professional context, but we propose that the concept of self-endangering work behaviour is close to what we found in the context of self-sacrificing behaviour in nursing.Self-endangering behaviour is defined as“actions that aim to deal with work-related demands but simultaneously increase the likelihood of health problems and impede necessary recovery from work-related stress” [50, p.28].These are, for example, behaviours that are internalized but have a potential health risk,such as extending work time,reducing recovery time,intensifying work,and presenteeism [51].Self-endangering also includes goalreaching behaviours that involve taking risks, such as skipping security regulations [50].These behaviours are positively associated with dealing with stressful work situations and achieving goals.They thereby support self-esteem and satisfaction, but they are also associated with deteriorating employee health [50].

    In the long term, self-endangering coping behaviour leads to heavy workloads and reduced performance,well-being,and health[52].Therefore, self-endangering coping behaviour is a vicious circle, as mentioned above.Even if such problems are recognized,employees do not manage to change anything and even behavioural prevention approaches,such as stress management seminars and self-discipline, appear to be insufficient [53].

    Whereas Krause et al.(2010) [53]posit that employees exhibit self-endangering coping because of career aspiration, we propose that for nurses,it is based on an altruistic attitude,the desire to gain a boost in self-esteem by helping others,and on team identification.

    6.2.Altruistic values

    Several participants mentioned for example that“you put other people before yourself”and“you do not think of yourself”at work.In addition, when we asked the executives about the nurses’ job motives, all leaders mentioned that it is “l(fā)ove for fellow human beings,” “the desire to help others,” the possibilities to enter into deep relationships, and a “feeling of being loved and needed” that motivates nurses in their job.

    In line with these results, previous studies found out that altruism is the most important work value for nurses [54-56].Whereas Saito et al.(2018) [57]found that altruistic work values have the potential to buffer against nurses’burnout symptoms,our results indicate that being altruistically motivated in the context of nursing often implies filling in for colleagues more often, working overtime (excessively), or presenteeism.“Yeah, that’s a bit of the helper syndrome.I do think that it is more pronounced in nursing than average.I go into the profession to help,I see the necessity and yes,I know exactly,if I do not step in then my colleague has to do it,or in the end,the residents are perhaps not well cared for and there is already extreme responsibility.”Adjacent to this,recent research has found that, as described above, work intensification can deteriorate employees’ health[50,58].Based on the observed altruistic attitude,it is likely that the desire to help others is not limited to the process of patient care but also has an impact on the team,such as on team identification.

    6.3.Team identification

    At our workshops, nurses often reported that they sometimes miss appreciation and open communication culture in their team and that colleagues badmouth others behind their backs.Participants also said that “better to save your colleague's weekend than your own”or that they do not want to leave colleagues in the lurch.We therefore conclude that team culture in the elderly care is typically characterized by strong identification with colleagues;however,this can be associated with the expectation that everyone always stands in for colleagues:“Yeah,I would just say they identify with the team, the people who fill in.”

    It seems that when nurses fill in for others,they feel responsible for the well-being of the other team members, such that they would rather take on the extra workload themselves than burden their colleagues with it.According to Krause et al.(2010) [53],especially when goals are set at a team level, employees develop the expectation that colleagues will contribute strongly or perform at the same level, and as a result, weaker or sick people are excluded.Additionally,peer pressure increases when no coverage is provided by the company, and therefore one's own limits are increasingly ignored[53].

    Although a recent meta-analysis found that organisational and work group identification is positively associated with employees’health[59],we assume a negative relation based on our results.We suspect that nurses in long-term care who identify with their colleagues are more likely to show self-endangering behaviour,which means filling in for others and coming to work even when ill,which leads to poor mental health in the long term.

    6.4.Self-worth

    Kupcewicz and J′ozwik(2020)[60]already found out that global self-esteem is a predictor of burnout in nurses in Poland.They conclude that nurses with low self-esteem often experience symptoms of burnout and were more likely to experience personal burnout than work-related burnout [60].

    Because many of the nurses in this study reported that they are often not able to delimit themselves from work or special demands or say no to extra work or filling in for colleagues, we further assume that the more nurses have less self-worth the more they define their self-worth through their work; they therefore show more self-endangering behaviour so they can boost their selfesteem.

    6.5.Theoretical implications of self-endangering in nursing

    In summary,recent research shows positive impacts of altruism[57]and team identification [59]on psychological well-being,whereas based on our findings, we suggest negative impacts.However,for less self-care[61,62]and low self-worth[60],previous research found negative influences on mental health, but a more detailed examination in the context of self-endangering has not yet been investigated.Due to these partly contradictory or not yet considered relations, we see great potential in investigating possible mediator effects, which is why we attach particular importance to self-endangering on the basis of our findings.

    We therefore assume that the antecedents altruism and team identification play an important key role in the emergence of selfendangering in nursing, such that high levels of these variables promote self-sacrificing cognitions and behaviour.Low levels of self-worth are a further risk factor for self-endangering, such that low levels of self-worth promote self-sacrificing cognitions and behaviour.In sum, we assume that nurses who often show selfendangering behaviour and cognitions tend to develop burnout symptoms,in the way that nurses self-sacrifice themselves for their work and go beyond their boundaries (see Fig.2).

    Previous research already shows the importance of other constructs that are related to self-endangering behaviour for nurses’burnout such as work engagement [63], organizational citizenship behaviour[64]and workaholism[65].By introducing the construct of self-endangering in nursing, we believe that we can broaden the perspective of the previous operationalisations to include the fill-in situation in the event of absenteeism, which is very important for nursing care.Future research can now examine whether the constructs mentioned above predict self-endangering behaviour.Regarding COR theory, self-endangering cognitions might be an importantmechanismbehindthedownwardspiralofresourcelosses,such that it might be particularly difficult to develop a healthy selfcare concept for nurses who cannot say no in cases of the need to fill in and feel guilty towards residents and colleagues.Especially with regard to the altruistic personality tendencies and perceived lower self-worth,more quantitative longitudinal research is required.

    For future leadership research, self-endangering in nursing implies that the leader’s role in the development of selfendangering behaviour and cognitions has to be examined; protecting vulnerable staff through leadership behaviour seems crucial.

    6.6.Consequences for further interventions in nursing care

    With a view to the important role of self-endangering and the possible antecedents,further interventions in the context of health promotion programmes should focus on nurses’ special job motivation and attitudes to reduce self-sacrificing within their work.It therefore seems extremely important to train nurses in selfreflection and self-empathy, such as the training in the empCARE programme [66], but even more in reflecting upon their desire to help others and their understanding of team work and team identification.

    In sum,this means that we need holistic training programmes in nursing care that include: 1) individual training, e.g.coaching,where motivation and personal attitudes toward the job and the definition of one’s own self-esteem are discussed and reflected upon,with the aim that nurses are sensitized and develop personal strategies, 2) team-based interventions, where the team reflects upon their own team values, rules, and culture, with the aim to develop behavioural rules for a healthy cooperation especially in the case of failures, and 3) organisational development processes that reflect upon the organisational structures and culture,with the aim that wards in hospitals and living areas in long-term care facilities are well organised [67].

    Fig.2. The mediating effect of self-endangering between individuals' ressources and the development of burnout.

    Finally,we need to stress that identifying self-endangering as a potential individual risk factor for nurses’ burnout doesnotentail that a problematic quality on the side of the nurses is partially responsible for their psychological health issues.Self-endangering only surfaces in the presence of adverse working conditions such as too few staff and too many residents.If working conditions in nursing were not as problematic as they are,nurses would not face the difficult choice between endangering themselves for the sake of their colleagues and residents and taking care of their own health needs.

    6.7.Limitations

    To our knowledge, this study is the first to examine selfendangering behaviour in nursing in long-term care.Of course,our study is not without limitations,especially because we focused on only German nurses in elderly care.Therefore, the first limitation is that our results are not generalizable for nurses in other working contexts or from other cultures.Second,our sample is not representative, so further research is needed in the context of nurses in elderly care to further examine our findings.Nevertheless,we believe that our study offers new knowledge and approaches in the context of the health of elderly care workers.

    7.Conclusions

    This qualitative study dealt with the question of the challenges faced by employees in elderly care and the opportunities for change that arise from their perspective.Our results show that especially the need for filling in for colleagues is one of the greatest challenges for nurses in elderly care.We found different conditioning factors for nurses’self-endangering at work,such as the value of altruism,strong identification with the team,and low occupational self-care abilities.Future research needs to investigate whether quantitative verification confirms these assumptions.

    Adjacent to this, new interventions and programmes can be developed for and implemented in nursing homes to prevent nurses’ burnout and other mental and physical problems.In the long term, this could break the vicious circle of filling in, presenteeism, and illness and enable employees to work more healthily in their everyday work.Of course,it must not be forgotten that these preventive approaches can only be effective in particular or under certain circumstances if working conditions in the nursing sector are also changed.

    Funding

    The publication of this article was funded by Chemnitz University of Technology.This research was partially supported by funds from an association of several German public long term-care organisations under the joint project Healthy Ageing in Long-Term Geriatric Care(gesaPflege).

    CRediT authorship contribution statement

    Lara Luisa Eder:Conceptualization, Methodology, Formal analysis, Investigation, Writing - original draft, Visualization,Project administration.Bertolt Meyer:Formal analysis, Resources,Writing - review&editing, Supervision, Funding acquisition.

    Declaration of competing interest

    We have no known conflict of interest to disclose.

    Appendices.Supplementary data

    Supplementary data to this article can be found online at https://doi.org/10.1016/j.ijnss.2021.12.001.

    亚洲国产精品专区欧美| 久久综合国产亚洲精品| 亚洲真实伦在线观看| 亚洲成色77777| 亚洲欧美成人精品一区二区| 国产色爽女视频免费观看| 成年av动漫网址| 少妇 在线观看| 好男人视频免费观看在线| 精品少妇久久久久久888优播| 日韩强制内射视频| 日本猛色少妇xxxxx猛交久久| 在线观看三级黄色| 国产成年人精品一区二区| 最近最新中文字幕免费大全7| 国产一区亚洲一区在线观看| 国产精品秋霞免费鲁丝片| 亚洲激情五月婷婷啪啪| 久久久久久久久久人人人人人人| 日本熟妇午夜| 午夜视频国产福利| 赤兔流量卡办理| 天堂网av新在线| 国产 一区 欧美 日韩| 尤物成人国产欧美一区二区三区| 女的被弄到高潮叫床怎么办| 韩国高清视频一区二区三区| 51国产日韩欧美| 国产精品久久久久久精品电影小说 | 欧美性猛交╳xxx乱大交人| 精品久久久久久久久av| 欧美国产精品一级二级三级 | 婷婷色av中文字幕| 性插视频无遮挡在线免费观看| 搡老乐熟女国产| 看非洲黑人一级黄片| 国产精品一区二区性色av| 国产淫语在线视频| 97在线人人人人妻| 亚洲精品一区蜜桃| 亚洲av不卡在线观看| 男人狂女人下面高潮的视频| 婷婷色av中文字幕| 欧美 日韩 精品 国产| 美女视频免费永久观看网站| 久久99热6这里只有精品| 在线 av 中文字幕| 丝袜美腿在线中文| 女人十人毛片免费观看3o分钟| 天美传媒精品一区二区| 亚洲欧美日韩卡通动漫| 免费观看性生交大片5| 搡老乐熟女国产| 欧美精品国产亚洲| 国产成人精品婷婷| 在线观看国产h片| 男女边吃奶边做爰视频| 国产亚洲午夜精品一区二区久久 | 高清毛片免费看| 免费黄频网站在线观看国产| 最近2019中文字幕mv第一页| 99久久精品国产国产毛片| 男男h啪啪无遮挡| av卡一久久| 精品久久久精品久久久| 精品久久久精品久久久| 婷婷色综合www| 美女cb高潮喷水在线观看| 性色avwww在线观看| 好男人在线观看高清免费视频| 在现免费观看毛片| 99久久精品国产国产毛片| 久久韩国三级中文字幕| 国产成人a∨麻豆精品| 69av精品久久久久久| 王馨瑶露胸无遮挡在线观看| 国产精品久久久久久av不卡| av国产久精品久网站免费入址| 国产精品久久久久久av不卡| 最近中文字幕高清免费大全6| 综合色丁香网| 91在线精品国自产拍蜜月| 国产精品女同一区二区软件| 听说在线观看完整版免费高清| 亚洲av电影在线观看一区二区三区 | 午夜免费鲁丝| 天美传媒精品一区二区| 91久久精品国产一区二区成人| av卡一久久| 毛片女人毛片| 在线 av 中文字幕| 老司机影院成人| 成人一区二区视频在线观看| 亚洲在线观看片| 日本一本二区三区精品| 成人综合一区亚洲| 国产在线男女| 欧美变态另类bdsm刘玥| 亚洲丝袜综合中文字幕| 日韩视频在线欧美| 看黄色毛片网站| 99re6热这里在线精品视频| 久久久欧美国产精品| 97超碰精品成人国产| 国产午夜精品一二区理论片| 人人妻人人看人人澡| 特级一级黄色大片| 五月开心婷婷网| 国产精品一区二区三区四区免费观看| 亚洲性久久影院| 久久鲁丝午夜福利片| 成年版毛片免费区| 午夜福利在线观看免费完整高清在| 一级毛片黄色毛片免费观看视频| 亚洲欧美一区二区三区黑人 | 国产高清不卡午夜福利| 亚洲av二区三区四区| 精品国产露脸久久av麻豆| 亚洲av日韩在线播放| 三级国产精品欧美在线观看| 午夜福利网站1000一区二区三区| 免费看a级黄色片| 日产精品乱码卡一卡2卡三| 亚洲精品日韩av片在线观看| 精华霜和精华液先用哪个| 免费播放大片免费观看视频在线观看| www.色视频.com| 一级a做视频免费观看| 成人特级av手机在线观看| 中国国产av一级| 欧美一区二区亚洲| 午夜福利视频精品| 2021少妇久久久久久久久久久| 韩国高清视频一区二区三区| 日本三级黄在线观看| 九九爱精品视频在线观看| 欧美潮喷喷水| av在线亚洲专区| 在线a可以看的网站| 国产爱豆传媒在线观看| 亚洲精品日韩av片在线观看| 日本wwww免费看| av又黄又爽大尺度在线免费看| 亚洲av电影在线观看一区二区三区 | 亚洲四区av| 麻豆精品久久久久久蜜桃| av在线app专区| 亚洲欧美成人精品一区二区| 免费av不卡在线播放| 麻豆久久精品国产亚洲av| 国产午夜精品久久久久久一区二区三区| 国产伦精品一区二区三区视频9| 一级a做视频免费观看| 午夜亚洲福利在线播放| 欧美成人a在线观看| 一级黄片播放器| 熟妇人妻不卡中文字幕| 男女无遮挡免费网站观看| 岛国毛片在线播放| 亚洲欧美精品专区久久| 日韩不卡一区二区三区视频在线| 各种免费的搞黄视频| 在线观看美女被高潮喷水网站| 性插视频无遮挡在线免费观看| 在线免费观看不下载黄p国产| 国产欧美日韩一区二区三区在线 | 男人添女人高潮全过程视频| 内射极品少妇av片p| 在线天堂最新版资源| 国产黄频视频在线观看| 99热网站在线观看| 国产综合精华液| 亚洲av免费高清在线观看| 美女高潮的动态| 老女人水多毛片| 国产成人一区二区在线| 成年女人看的毛片在线观看| 黄片无遮挡物在线观看| 各种免费的搞黄视频| 国产av国产精品国产| 日韩 亚洲 欧美在线| 高清毛片免费看| 国产一区二区三区综合在线观看 | 麻豆成人午夜福利视频| 丝袜脚勾引网站| 嘟嘟电影网在线观看| 欧美97在线视频| 日日啪夜夜爽| 小蜜桃在线观看免费完整版高清| 成人亚洲精品一区在线观看 | 亚洲精品日本国产第一区| 蜜桃亚洲精品一区二区三区| 亚洲人成网站高清观看| 日日摸夜夜添夜夜添av毛片| 国产男女超爽视频在线观看| 午夜日本视频在线| 色吧在线观看| 国产免费视频播放在线视频| 亚洲成人久久爱视频| 丝瓜视频免费看黄片| 成人午夜精彩视频在线观看| 国产毛片a区久久久久| 国产乱人视频| 亚洲国产精品专区欧美| 国产视频首页在线观看| 婷婷色综合www| 亚洲人成网站在线播| 国产成人午夜福利电影在线观看| 日本-黄色视频高清免费观看| 国产真实伦视频高清在线观看| 少妇人妻久久综合中文| 男女国产视频网站| 亚洲欧美清纯卡通| 欧美丝袜亚洲另类| av线在线观看网站| 欧美高清成人免费视频www| 色网站视频免费| 婷婷色麻豆天堂久久| 99热网站在线观看| 日韩成人av中文字幕在线观看| 国产老妇伦熟女老妇高清| 中文字幕制服av| av在线亚洲专区| 91午夜精品亚洲一区二区三区| 一级毛片 在线播放| 嫩草影院精品99| 2021少妇久久久久久久久久久| 国产v大片淫在线免费观看| 联通29元200g的流量卡| 网址你懂的国产日韩在线| 婷婷色综合大香蕉| 一级a做视频免费观看| 丰满少妇做爰视频| 久久久久久久大尺度免费视频| 亚洲三级黄色毛片| 内射极品少妇av片p| 1000部很黄的大片| 久久久成人免费电影| 嫩草影院精品99| 美女cb高潮喷水在线观看| 别揉我奶头 嗯啊视频| 中国美白少妇内射xxxbb| 国产熟女欧美一区二区| 亚洲av二区三区四区| 夫妻性生交免费视频一级片| 亚洲图色成人| 中文天堂在线官网| 在线观看三级黄色| 欧美xxxx性猛交bbbb| 久久久久国产网址| 看黄色毛片网站| 国产午夜福利久久久久久| 亚洲欧美成人综合另类久久久| 在线观看国产h片| 久久精品夜色国产| 亚洲丝袜综合中文字幕| 永久网站在线| av免费在线看不卡| 一区二区三区四区激情视频| a级毛色黄片| av黄色大香蕉| 天天一区二区日本电影三级| 亚洲天堂av无毛| 超碰av人人做人人爽久久| 久久99热6这里只有精品| 麻豆成人av视频| 成人毛片a级毛片在线播放| 18禁裸乳无遮挡动漫免费视频 | 国产一区二区三区综合在线观看 | 别揉我奶头 嗯啊视频| 国产精品99久久久久久久久| 国产黄频视频在线观看| 狂野欧美激情性xxxx在线观看| 少妇 在线观看| 小蜜桃在线观看免费完整版高清| 亚洲欧美精品自产自拍| av又黄又爽大尺度在线免费看| 欧美xxxx性猛交bbbb| 日日摸夜夜添夜夜添av毛片| 免费播放大片免费观看视频在线观看| 午夜老司机福利剧场| 免费少妇av软件| 精品熟女少妇av免费看| 亚州av有码| 一级毛片我不卡| 久久精品国产亚洲av天美| 色综合色国产| 欧美日韩精品成人综合77777| 性插视频无遮挡在线免费观看| 在线免费观看不下载黄p国产| 真实男女啪啪啪动态图| 欧美日韩一区二区视频在线观看视频在线 | 天堂中文最新版在线下载 | 97热精品久久久久久| 亚洲美女搞黄在线观看| 看免费成人av毛片| 久久99热这里只有精品18| 一个人观看的视频www高清免费观看| 18禁动态无遮挡网站| 免费看光身美女| 看非洲黑人一级黄片| 大片免费播放器 马上看| 亚洲人成网站在线观看播放| 亚洲精品久久久久久婷婷小说| 一级a做视频免费观看| 免费黄色在线免费观看| 人妻 亚洲 视频| 纵有疾风起免费观看全集完整版| 大片电影免费在线观看免费| 五月天丁香电影| 国产在线男女| 亚洲精品视频女| 久久久精品欧美日韩精品| 建设人人有责人人尽责人人享有的 | 有码 亚洲区| 51国产日韩欧美| 欧美变态另类bdsm刘玥| 亚洲精品日韩在线中文字幕| 国产男女内射视频| 亚洲欧美一区二区三区国产| 日韩欧美一区视频在线观看 | 99热全是精品| 人妻一区二区av| 免费观看a级毛片全部| 久久6这里有精品| 特大巨黑吊av在线直播| 国产成人精品福利久久| 日韩制服骚丝袜av| 国内精品宾馆在线| 精品久久久噜噜| 亚洲av欧美aⅴ国产| 国产国拍精品亚洲av在线观看| 国产老妇伦熟女老妇高清| 一级毛片aaaaaa免费看小| 永久免费av网站大全| 久久久精品94久久精品| 黄色视频在线播放观看不卡| 人人妻人人看人人澡| 日日啪夜夜撸| 久久人人爽av亚洲精品天堂 | 一级av片app| 尾随美女入室| 免费观看a级毛片全部| 久久精品综合一区二区三区| 日本av手机在线免费观看| 国产在线一区二区三区精| 欧美日韩综合久久久久久| 国产一区亚洲一区在线观看| 国产老妇伦熟女老妇高清| 少妇的逼水好多| 亚洲一区二区三区欧美精品 | 国产精品国产av在线观看| av播播在线观看一区| 91精品伊人久久大香线蕉| 免费黄网站久久成人精品| 三级经典国产精品| 国产精品人妻久久久影院| 亚洲欧美中文字幕日韩二区| 搞女人的毛片| xxx大片免费视频| 亚洲成人一二三区av| 欧美日韩一区二区视频在线观看视频在线 | 国产极品天堂在线| 午夜亚洲福利在线播放| 老师上课跳d突然被开到最大视频| 两个人的视频大全免费| 成人漫画全彩无遮挡| 亚洲久久久久久中文字幕| 国产午夜福利久久久久久| 国产一区二区亚洲精品在线观看| 免费看日本二区| 久久久久久久久久久免费av| 免费不卡的大黄色大毛片视频在线观看| 成年人午夜在线观看视频| 欧美高清成人免费视频www| 亚洲欧洲国产日韩| 亚洲国产色片| 天天一区二区日本电影三级| 九九久久精品国产亚洲av麻豆| 99久久精品国产国产毛片| 夜夜爽夜夜爽视频| 日韩av在线免费看完整版不卡| 超碰av人人做人人爽久久| 成年av动漫网址| 精品熟女少妇av免费看| 国产精品国产三级国产av玫瑰| 国产成人aa在线观看| 亚洲精华国产精华液的使用体验| 亚洲欧洲国产日韩| 日韩亚洲欧美综合| 国产伦理片在线播放av一区| 日本午夜av视频| 少妇猛男粗大的猛烈进出视频 | 欧美日韩视频精品一区| 深爱激情五月婷婷| 亚洲av不卡在线观看| 欧美最新免费一区二区三区| xxx大片免费视频| 熟女人妻精品中文字幕| 日本熟妇午夜| 国产精品一及| 99热6这里只有精品| 岛国毛片在线播放| 视频区图区小说| 亚洲欧美中文字幕日韩二区| 久久亚洲国产成人精品v| 成人黄色视频免费在线看| 免费观看无遮挡的男女| 少妇的逼水好多| www.色视频.com| 国产精品久久久久久久久免| 日韩欧美 国产精品| 日韩成人av中文字幕在线观看| 乱码一卡2卡4卡精品| 精品人妻偷拍中文字幕| 国产精品女同一区二区软件| 老师上课跳d突然被开到最大视频| 免费观看av网站的网址| 丰满乱子伦码专区| 极品教师在线视频| 日本-黄色视频高清免费观看| a级毛片免费高清观看在线播放| 亚洲精品中文字幕在线视频 | 2021天堂中文幕一二区在线观| 69av精品久久久久久| 国产成人精品一,二区| 哪个播放器可以免费观看大片| 日韩欧美精品免费久久| 波多野结衣巨乳人妻| 3wmmmm亚洲av在线观看| 丝袜脚勾引网站| 久久鲁丝午夜福利片| 日韩三级伦理在线观看| 51国产日韩欧美| 日韩,欧美,国产一区二区三区| 午夜福利视频精品| 亚洲三级黄色毛片| 日本午夜av视频| 下体分泌物呈黄色| 成人高潮视频无遮挡免费网站| 五月玫瑰六月丁香| 18禁动态无遮挡网站| 人体艺术视频欧美日本| 国产亚洲最大av| 涩涩av久久男人的天堂| freevideosex欧美| 一个人观看的视频www高清免费观看| 免费少妇av软件| 日本色播在线视频| 好男人在线观看高清免费视频| 不卡视频在线观看欧美| 亚洲精品日韩av片在线观看| 午夜激情久久久久久久| 亚洲国产成人一精品久久久| 日韩欧美 国产精品| 欧美xxxx黑人xx丫x性爽| 九草在线视频观看| 一边亲一边摸免费视频| 新久久久久国产一级毛片| 91aial.com中文字幕在线观看| 简卡轻食公司| 国产高清不卡午夜福利| 听说在线观看完整版免费高清| 97在线人人人人妻| 亚洲熟女精品中文字幕| 丝袜脚勾引网站| 国产老妇女一区| 99九九线精品视频在线观看视频| 亚洲人成网站高清观看| 又大又黄又爽视频免费| 成年免费大片在线观看| 国产精品一区二区性色av| 亚洲,一卡二卡三卡| 国产又色又爽无遮挡免| 亚洲精品乱久久久久久| 特大巨黑吊av在线直播| 免费看a级黄色片| 国产亚洲av嫩草精品影院| 看免费成人av毛片| 欧美日韩视频高清一区二区三区二| 精品久久久久久久人妻蜜臀av| 欧美精品国产亚洲| 日韩视频在线欧美| 草草在线视频免费看| 秋霞在线观看毛片| 国内精品美女久久久久久| 女人十人毛片免费观看3o分钟| 亚洲精品一二三| 大片电影免费在线观看免费| 新久久久久国产一级毛片| 久久国产乱子免费精品| 国产成人aa在线观看| 午夜福利在线观看免费完整高清在| 丝袜美腿在线中文| 国产伦在线观看视频一区| 亚洲国产欧美人成| 久久久a久久爽久久v久久| 草草在线视频免费看| 热re99久久精品国产66热6| 91久久精品电影网| 国模一区二区三区四区视频| 黄色一级大片看看| 听说在线观看完整版免费高清| 日韩电影二区| 爱豆传媒免费全集在线观看| 久久久久久久久久久丰满| 深夜a级毛片| 久久人人爽人人片av| av网站免费在线观看视频| 久久久色成人| 老司机影院毛片| 卡戴珊不雅视频在线播放| 熟女av电影| av一本久久久久| 亚洲丝袜综合中文字幕| 国产一区亚洲一区在线观看| av在线app专区| 国产伦精品一区二区三区视频9| 特大巨黑吊av在线直播| 免费看a级黄色片| 三级国产精品片| 中文天堂在线官网| 免费观看的影片在线观看| 大香蕉久久网| 久久久精品欧美日韩精品| kizo精华| 中文精品一卡2卡3卡4更新| 国产在线一区二区三区精| 日本午夜av视频| 超碰97精品在线观看| 午夜福利在线在线| 久久久久国产精品人妻一区二区| 国产精品一区二区性色av| 亚洲最大成人手机在线| 高清午夜精品一区二区三区| 18禁在线无遮挡免费观看视频| 看免费成人av毛片| 久久久久久久精品精品| 精品少妇黑人巨大在线播放| 美女xxoo啪啪120秒动态图| 午夜免费男女啪啪视频观看| 精品久久久久久久久av| 80岁老熟妇乱子伦牲交| 国产亚洲午夜精品一区二区久久 | 免费观看a级毛片全部| 欧美3d第一页| 男人舔奶头视频| 97精品久久久久久久久久精品| 天天躁夜夜躁狠狠久久av| 熟女人妻精品中文字幕| 亚洲精品aⅴ在线观看| 水蜜桃什么品种好| 午夜日本视频在线| 免费在线观看成人毛片| 日韩av在线免费看完整版不卡| 亚洲成人久久爱视频| 国产永久视频网站| 国产成人aa在线观看| 亚洲精品aⅴ在线观看| 男人爽女人下面视频在线观看| 纵有疾风起免费观看全集完整版| 亚洲av免费高清在线观看| 免费观看在线日韩| 国产淫片久久久久久久久| 久久精品人妻少妇| 狂野欧美白嫩少妇大欣赏| 国产乱人视频| 最近的中文字幕免费完整| 神马国产精品三级电影在线观看| 人妻系列 视频| 中文欧美无线码| 国产v大片淫在线免费观看| 3wmmmm亚洲av在线观看| 国产v大片淫在线免费观看| 精华霜和精华液先用哪个| 中文字幕免费在线视频6| 国产精品秋霞免费鲁丝片| 国产亚洲av片在线观看秒播厂| xxx大片免费视频| 亚洲丝袜综合中文字幕| 亚洲国产欧美人成| 成年女人在线观看亚洲视频 | 天堂网av新在线| 国产一区二区亚洲精品在线观看| 久热这里只有精品99| 国国产精品蜜臀av免费| 亚洲人成网站在线观看播放| 一级二级三级毛片免费看| 久久鲁丝午夜福利片| 欧美xxxx性猛交bbbb| 免费av不卡在线播放| 97热精品久久久久久| 九九在线视频观看精品| 乱系列少妇在线播放| 2021天堂中文幕一二区在线观| 成人亚洲精品av一区二区| 七月丁香在线播放| 美女被艹到高潮喷水动态| 青春草亚洲视频在线观看| 国产伦在线观看视频一区| 一区二区三区四区激情视频| 波野结衣二区三区在线| 亚洲最大成人手机在线| 天天躁夜夜躁狠狠久久av| 建设人人有责人人尽责人人享有的 | 男人爽女人下面视频在线观看| 亚洲激情五月婷婷啪啪| 国产精品一二三区在线看| 亚洲成人中文字幕在线播放| 亚洲久久久久久中文字幕| 中国三级夫妇交换| 大又大粗又爽又黄少妇毛片口| 色哟哟·www| 在线精品无人区一区二区三 | 久久韩国三级中文字幕|